bluuebunny/crossref_metadata_2025 huggingface dataset:
Detection of benign granular cell tumor of the breast via 18F-PSMA-PET/CT in a patient with very high-risk prostate cancer: A case report
Authors: Ghabili Kamyar , Rajyaguru Rushi , De La Plante Alexandra , Widders Kristine L. , Chetlen Alison L. , Choe Angela I. , Kasales Claudia J.
Published: August 2024

Incidental extra-prostatic prostate-specific membrane antigen (PSMA) uptake on initial staging positron emission tomography/computed tomography (PET/CT) scans poses diagnostic challenges, as it can be associated with various benign and malignant lesions. We present the case of a 68-year-old man with very high-risk prostate cancer who was incidentally discovered to have a benign granular cell tumor in the breast initially detected on PSMA-PET/CT. Imaging studies and biopsy were pivotal in the diagnosis, as the tumor’s appearance was concerning for breast carcinoma. Recognizing extra-prostatic PSMA uptake in the breast, particularly in patients with prostate cancer, is crucial for guiding appropriate management, accurately interpreting subsequent imaging findings, and assessing radiologic-pathologic correlation.
Phospholipase A2 receptor-negative membranous nephropathy presenting as a rare renal manifestation of IgG4-related disease
Authors: Sama Srikar , Weickhardt Alexander , Subramanian Preethi , Reddy Pooja
Published: August 2024

IgG4-related disease is a fibroinflammatory condition characterized by dense lymphoplasmacytic infiltrates rich in IgG4-positive plasma cells affecting multiple organs. Though the most common renal manifestation of IgG4-related disease is tubulointerstitial nephritis, it can rarely present as secondary membranous nephropathy. We present a case of a 75-year-old male with phospholipase A2 receptor-negative membranous nephropathy as an atypical manifestation of IgG4-related disease. The patient presented with nephrotic syndrome and was found to have elevated serum IgG4 levels and IgG4-positive plasma cells in the kidney biopsy. He was successfully treated with corticosteroids and rituximab, resulting in significant improvement in proteinuria and normalization of IgG4 levels. This case highlights the importance of considering IgG4-related disease in patients with phospholipase A2 receptor-negative membranous nephropathy, especially in those with a history of other organ involvement. Early recognition and treatment of IgG4-related disease are crucial to prevent progressive kidney damage and improve patient outcomes.
Profile of men and women sentenced to community services: Risk factors and social vulnerability
Authors: Pérez-Ramírez Meritxell , Grané Aurea
Published: August 2024

This study explores profiles of individuals in community service, focussing on gender differences and women’s social vulnerability. Surveys from 503 participants undergoing community service via the Spanish Red Cross unveiled significant gender-related distinctions. Women faced more family responsibilities and lower incomes than men, with heightened economic challenges and engagement in informal work. Property ownership was less frequent among women, who also grappled with more outstanding mortgage payments and single parenthood. A larger share of women relied on institutional support and joined the Extreme Vulnerability Programme. These findings resonate with global research advocating holistic intervention for women offenders. However, this demands a broader array of community service tailored to women’s needs, especially concerning dependent children. Addressing core necessities such as housing, healthcare, and employment, along with enhancing self-worth and recognition, proves pivotal in deterring women from criminal behaviour. A gender-oriented approach to alternative sentencing can enhance effectiveness and compliance.
Internationalization as Intermingling? A Qualitative Study of Chinese International Students’ Motivations and Experiences in an Australian University
Authors: Qu Mingxin , Forsey Martin
Published: August 2024

Internationalization and the concomitant flow of cultural diversity often associated with it are highly prized by universities; many tertiary institutions claim internationalization of the campus, the curriculum, research, and the student body as a major goal, a key performance indicator. However, in the current climate of global international education, overseas student integration and their adjustment difficulties into the life of the host country are often posited as personal failures, and international education scholarship focuses heavily on the failure of international students to integrate into host societies. We question the assumptions underpinning the tendency of universities to link internationalization to the development of interculturality across the campus through bringing together students from different national backgrounds. The belief is that students seek such interactions; internationalization could be achieved through such simplistic practices; this assumption needs empirical scrutiny. In this focused study, we report the motivations and experiences of 24 Chinese international students in an Australian university. A significant majority of the participants reported little interest in intercultural interactions with both host national students and other international students outside their own cultural groups. For those who have hopes of becoming some form of “global citizen,” the experiences of these Chinese students suggest that cross-cultural communication is not as successful as hoped in the spaces of encounters, including classrooms, university student accommodation, and social activities out of the classrooms. The voices of these students suggest the need for intervention in the realization of the internationalization vision held by most universities and a reframing of goals and practices to narrow the breach between lofty rhetoric and the practice of international education.
Online Mindfulness-Based Interventions for Healthcare Professionals: A Scoping Review
Authors: Baek Gumhee , Cha Chiyoung , Lee Miran , Cho Aram
Published: August 2024

Background:

Healthcare professionals work in challenging environments with extended working hours and excessive workloads to provide high-quality care. However, they hardly get the time to care for themselves. Online mindfulness-based interventions—which are not restricted by time or location—can be a powerful strategy to help healthcare professionals.

Objectives:

This scoping review aims to explore the current evidence about online mindfulness-based interventions for healthcare professionals.

Design:

A scoping review was conducted.

Methods:

A literature search was conducted to retrieve articles published between October 2016 and March 2023 in seven databases, including backward and forward citation tracking from the included articles. Among 1,278 articles retrieved, 33 met the criteria for review.

Results:

Two-thirds of the studies utilized commercialized mindfulness programs ( n = 22). Duration of the mindfulness interventions varied from 1 week to 4 months, and half of the studies used audio-guided programs. Online mindfulness-based intervention studies were targeted to reduce burnout ( n = 26), and the majority reported reduction in burnout ( n = 18).

Conclusion:

Most studies used individual audio-guided programs that warrant the use of diverse delivery methods such as video media, simulation, and virtual reality for interactions in the future. Although the literature has accumulated evidence for commercialized online mindfulness-based interventions, further studies are needed to develop and test tailored interventions for healthcare professionals.
Cervical Vertebra Bone Quality Score Predicts Zero-Profile Anchored Spacer Interbody Fusion Cage Subsidence after Anterior Cervical Diskectomy and Fusion: A Retrospective Study
Authors: Feng Ningning , Li Wenhao , Yu Xing , Zhao He , Qiu Ziye , Guan Jianbin , Jiang Guozheng , Yang Kaitan
Published: August 2024

Study Design

Retrospective study.

Objective

This retrospective study primary focus is to investigate the relationship between the C-VBQ score and the occurrence of postoperative zero-profile anchored spacer (ROI-C) interbody fusion cage subsidence. Additionally, we aim to evaluate the predictive efficacy of the C-VBQ scoring system for subsidence in the context of ACDF with the ROI-C.

Methods

Patients who underwent ACDF with the ROI-C cage at our hospital between January 2016 and December 2022 were included in this study. Univariate analysis and multivariate logistic regression were employed to identify independent risk factors associated with ROI-C cage subsidence after ACDF. Pearson correlation analysis was utilized to assess the correlation between the C-VBQ score and the height of ROI-C cage subsidence.

Results

A total of 102 patients underwent ACDF with ROI-C in our hospital were included in this study. Univariate analysis showed that age ( P = 0.021) and C-VBQ score ( P < 0.001) were the influencing factors of cage subsidence. Pearson correlation analysis showed that there was a significant positive correlation between the subsidence height of ROI-C cage and C-VBQ (r = 0.55, P < 0.01). Multivariate binary logistic regression analysis showed that C-VBQ score was the only variable that could significantly predict the subsidence of ROI-C cage after ACDF. Higher C-VBQ score was significantly associated with cage subsidence ( P < 0.001).The AUC was 0.89, and the cutoff value for C-VBQ was 2.70.

Conclusion

The findings indicate a significant correlation between a higher C-VBQ score before surgery and ROI-C cage subsidence after ACDF. The preoperative assessment of C-VBQ proves valuable for clinicians, enabling them to identify patients with low bone mineral density and predict the risk of zero-profile anchored spacer interbody fusion cage subsidence following ACDF.
Reconstructive Microsurgery and the Flow State
Authors: Dowling Kevin W. , Landis Christopher G. , Landis George H.
Published: August 2024

Introduction: “Flow states”, characterized by intense focus during complex tasks, are proposed as common to the practice of reconstructive microsurgery. Existing literature establishes close relationships between the experience of flow and key aspects of mental health. Taking a holistic approach, the paper defines flow and establishes its relevance to both microsurgical practice and to the life and well-being of microsurgeons. Means of cultivating and enhancing flow are offered with important acknowledgement of the benefits and potential pitfalls involved. Methods: The paper is based on an extensive literature review. Numerous sources are critically evaluated for research design, methodology, and consistency of results with existing literature before being synthesized for relevance to microsurgical practice. Results: Existing literature defines flow with precision by way of environmental preconditions and experiential characteristics. The relationship of flow to more general psychological health is also well-established. The effects of flow on performance and how to optimally utilize and balance flow are burgeoning topics of study. Conclusion: Microsurgeons may benefit from the explicit recognition of flow states and the application of strategies that foster and balance flow within microsurgery. Techniques such as mental visualization, mindfulness practices, and attention training are tools that may potentially enhance flow experiences, reduce stress, improve performance, and mitigate burnout. Overemphasizing flow within surgery at the expense of finding flow in life more broadly, however, can lead to negative consequences. The paper highlights the potential benefits of integrating flow states into reconstructive microsurgery, offers suggestions for finding flow effectively, and underscores the importance of harnessing flow not only within surgery but also across different life spheres to ensure a well-rounded, sustainable, and fulfilling professional and personal existence.
Effects of Monaural Temporal Electrode Asynchrony and Channel Interactions in Bilateral and Unilateral Cochlear-Implant Stimulation
Authors: Lindenbeck Martin J. , Majdak Piotr , Laback Bernhard
Published: August 2024

Timing cues such as interaural time differences (ITDs) and temporal pitch are pivotal for sound localization and source segregation, but their perception is degraded in cochlear-implant (CI) listeners as compared to normal-hearing listeners. In multi-electrode stimulation, intra-aural channel interactions between electrodes are assumed to be an important factor limiting access to those cues. The monaural asynchrony of stimulation timing across electrodes is assumed to mediate the amount of these interactions. This study investigated the effect of the monaural temporal electrode asynchrony (mTEA) between two electrodes, applied similarly in both ears, on ITD-based left/right discrimination sensitivity in five CI listeners, using pulse trains with 100 pulses per second and per electrode. Forward-masked spatial tuning curves were measured at both ears to find electrode separations evoking controlled degrees of across-electrode masking. For electrode separations smaller than 3 mm, results showed an effect of mTEA. Patterns were u/v-shaped, consistent with an explanation in terms of the effective pulse rate that appears to be subject to the well-known rate limitation in electric hearing. For separations larger than 7 mm, no mTEA effects were observed. A comparison to monaural rate-pitch discrimination in a separate set of listeners and in a matched setup showed no systematic differences between percepts. Overall, an important role of the mTEA in both binaural and monaural dual-electrode stimulation is consistent with a monaural pulse-rate limitation whose effect is mediated by channel interactions. Future CI stimulation strategies aiming at improved timing-cue encoding should minimize the stimulation delay between nearby electrodes that need to be stimulated successively.
Universal Ultrasound Screening for Developmental Dysplasia of the Hip Among Infants in Community Settings in Japan: A Scoping Review
Authors: Inagaki-Asano Asa , Honda Chikako , Matsumoto Hiroshige , Yoshioka-Maeda Kyoko
Published: August 2024

Introduction

Early identification of developmental dysplasia of the hip (DDH) is necessary to minimize its negative effects. Ultrasound screening is useful for detecting DDH in hospitals. Awareness about community-based screening systems is low in Japan. Despite established nationwide home visiting services and child health checkups in the country, more than 10% of DDH patients are diagnosed at the age of ≥1 year. This review aimed to clarify the status of universal ultrasound screening for DDH among infants in community settings in Japan.

Methods

The electronic databases of Igaku Chuo Zasshi, MEDLINE, CHINAL, ERIC, and APA PsycInfo were searched for articles published between 2002 and 2022. Articles were evaluated with the reach, effectiveness, adoption, implementation, and maintenance framework.

Results

In total, 148 articles were identified. Two articles were manually added, and 67 articles were excluded through abstract reviews, of which 20 were duplicates. Finally, 18 articles were included in the analysis. There are two types of universal ultrasound screening in community settings: municipality-led and hospital-led. Since 1992, municipality-led screening has been conducted during public infant health checkups in five municipalities. Six hospitals implemented ultrasound screening. The participation rate was around 90%. The Graf method is typically used for this purpose. The prevalence of abnormal hips was 3.6%–16.6%. Owing to limited human resources and skills in ultrasound, all studies mentioned the necessity of a universal screening system for the early detection of DDH.

Conclusion

Embedding universal ultrasound screening in community health checkup systems enables collaboration between healthcare professionals and caregivers to improve health inequities and ensure early detection of DDH cases.
Buongiorno’s radiative Prandtl-Eyring nanofluid flow through porous medium over a stretching surface with cross-diffusion effects
Authors: Nandeppanavar Mahantesh M , Basha Hussain , Udgiri Sheetal
Published: August 2024

The main focus of the current analysis is to describe the thermo-magnetic flow, heat and mass transport features of two-dimensional dissipative Prandtl-Eyring nanofluid (PE-NF) flow over a stretching sheet under the influence of porous medium and magnetic Ohmic dissipation numerically. An innovative Buongiorno’s nanofluid model in terms of Brownian motion and thermophoresis is deployed to accurately simulate the nano behavior in Prandtl-Eyring within the boundary layer regime. The thermal radiation and heat source/sink effects are also included to describe the thermal transport process. In addition to this, the thermo-diffusion and diffusion-thermo effect are included to demonstrate the temperature and concentration diffusion mechanism under the presence of chemical reaction process. The emerged coupled nonlinear two-dimensional time-independent partial differential equations are rendered to their dimensionless form through appropriate similarity transformations and solved by deploying Matlab-based BVP4C technique. The graphical visualization showed that, the increasing magnetic number diminished the flow field and enhanced the temperature and concentration profiles in the flow regime. Rising porous parameter decayed the Prandtl-Eyring nanofluid velocity. Increasing radiation and Eckert numbers enhance the temperature field in the flow regime. Magnifying Prandtl-Eyring parameter suppressed the velocity diffusion. Increasing Brownian motion and thermophoresis parameters increases the temperature profile. Amplifying Soret parameter upsurges the concentration profile. Skin-friction coefficient amplified with enhanced magnetic and porous numbers. Heat transfer rate acts as increasing function of thermophoresis and Brownian motion parameters. The main objective of this study is the addition of magnetic Ohmic dissipation, radiation, porous medium, thermal source/sink, Soret and Dufour effects and Buongiorno nanofluid model and this consideration generalizes former studies and gives a new re-defined mathematical formulation of heat and mass transport features of Prandtl-Eyring nanofluid flow over a stretching sheet. Finally, the numerical accuracy of the current similarity results is validated with available solutions and noticed a good agreement.
“Macular Sinkhole” With Secondary Choroidal Neovascularization
Authors: Patel Dillan , Carroll Robert M.
Published: August 2024

Purpose: To describe a case of an eccentric macular hole (MH) overlying a choroidal cavitation in a nonmyopic eye with secondary choroidal neovascularization (CNV). Methods: A case report is presented. Results: A 101-year-old man was referred for an asymptomatic retinal pigmentary abnormality in the right eye. A fundus examination showed a yellow–orange circular lesion with a white center and mild associated hemorrhage. Optical coherence tomography showed an eccentric full-thickness MH (FTMH) overlying a choroidal cavitation with intraretinal cystic change and subretinal hyperreflective material suggestive of CNV. The patient was treated with intravitreal antivascular endothelial growth factor and had a good response. Conclusions: Typically described as being adjacent to the optic disc and in myopic fundi, eccentric macular choroidal cavitations may be seen in nonmyopic eyes and associated with FTMHs (“macular sinkholes”) and CNV. This case report expands the spectrum of potentially visually significant findings associated with choroidal cavitary disease.
Association Between Tobacco Smoking and the Development of Diabetic Macular Edema
Authors: Thomson Kyle B. , Khalid Syed I. , Sabherwal Naryan , Heiferman Michael J.
Published: August 2024

Introduction: To explore the effect of cigarette smoking on the risk for developing diabetic macular edema (DME) among patients with diabetes. Methods: This retrospective exactly-matched cohort study used claims data for patients from all 50 states in the United States from 2010 through 2020. Patients with an initial diagnosis of diabetes were stratified into 3 cohorts as follows: active smokers, never smokers, and former smokers. After exact matching based on demographics and comorbidities, Kaplan-Meier survival functions for the 3 cohorts were compared using pairwise log-rank tests. Results: After matching, there were 42 298 patients in each cohort. Over 6 years of follow-up, the cumulative risk for DME was significantly higher among never smokers (1.18%) than among active smokers (0.88%) and former smokers (0.90%) (both P < .001). Conclusions: Among patients with diabetes, smoking may decrease the risk for developing DME. Although the harms of smoking far outweigh any potential protective benefits, further investigation into the mechanisms behind these findings has potential to uncover new therapeutic targets.
Visual and Anatomic Responses in Patients With Neovascular Age-Related Macular Degeneration and a Suboptimal Response to Anti-VEGF Therapy Switched to Faricimab
Authors: Khodor Ali , Choi Stephanie , Nanda Tavish , Caranfa Jonathan T. , Ruiz-Lozano Raul E. , Desai Shilpa H. , Liang Michelle , Baumal Caroline R. , Reed David C. , Cleary Tina S. , Heier Jeffrey S. , Shah Chirag P. , Witkin Andre J.
Published: August 2024

Purpose: To determine the efficacy of switching to intravitreal (IVT) faricimab in patients with treatment-resistant neovascular age-related macular degeneration (nAMD) and determine the rates of reversion to the original antivascular endothelial growth factor (anti-VEGF) therapy. Methods: A retrospective chart review was performed of patients with nAMD and persistent fluid on optical coherence tomography previously treated with anti-VEGF injections who received at least 1 IVT faricimab injection between March 1, 2022, and January 31, 2023. Results: The study comprised 135 eyes of 119 patients. Before switching to IVT faricimab, the mean number of anti-VEGF injections in the previous 12 months was 10.7 ± 2.6 (SD) with a mean interval of 4.8 ± 1.3 weeks (range, 2-8). The mean follow-up was 11.6 ± 2 months. Thirty eyes (22.2%) switched to IVT faricimab returned to the original therapy. Of the 105 eyes remaining on IVT faricimab, 66 (62.9%) had no fluid at the last follow-up. Compared with the original treatment, there was a significant improvement in logMAR visual acuity at the last follow-up in eyes on IVT faricimab (0.42 vs 0.38; P < .01) and in central subfield thickness (286 µm vs 246 µm; P < .0001). There was also a significant increase in the dosing interval after the third injection vs before IVT faricimab was prescribed (4.8 weeks vs 5.5 weeks; P < .001). Conclusions: Faricimab has a potent drying effect and potential for increasing the injection interval in many eyes with nAMD and persistent fluid on other anti-VEGF agents. Although nearly 25% of eyes reverted to the original therapy because of an insufficient response or adverse events, the majority did not achieve fluid resolution after reversion.
Mapping the ripple effects of a compassionate university for serious illness, death, and bereavement
Authors: Bakelants Hanne , Dury Sarah , Chambaere Kenneth , De Donder Liesbeth , Deliens Luc , Vanderstichelen Steven , Marynissen Silke , Cohen Joachim , Van Droogenbroeck Filip
Published: August 2024

Background:

Compassionate communities have been put forward as a promising model for community-based support for people facing serious illness, caregiving, dying, and loss. In particular, educational institutions are increasingly acknowledged as potential settings to function as compassionate schools and compassionate workplaces, cultivating acceptance and validation of these experiences beyond the university setting.

Objectives:

This paper investigates the activities and outcomes of a compassionate community initiative—the Compassionate University program at the Vrije Universiteit Brussel in Belgium.

Design:

Ripple Effects Mapping was used to guide the focus group and individual interviews conducted with core team members responsible for the development and implementation of the Compassionate University program.

Methods:

During the focus group and individual interviews, the core team members reflected on the program contributions, with their narratives visually depicted via a hand-drawn mind map. Qualitative data derived from this mind map were entered into XMIND mapping software and fine-tuned based on the focus group and individual interview transcripts and additional project records.

Results:

Thematic analysis identified four outcome areas that encapsulate the key contributions of the Compassionate University program: (i) increased acceptance and integration of topics such as serious illness, death, and bereavement into existing practices; (ii) broader support for and formalization of compassionate procedures and policies; (iii) emergence of informal networks and internal collaboration on the topics; and (iv) diffusion of compassionate ideas beyond the university.

Conclusion:

The Compassionate University program facilitates a cultural shift within the university environment, fostering greater acceptance of integrating topics such as serious illness, death, and bereavement into existing practices. Additionally, compassionate procedures and policies for students and staff have been formalized, and core team members are increasingly called upon to provide support on these matters. Notably, Compassionate University stands out as one of the pioneering initiatives in Europe, attracting different educational institutions seeking guidance on cultivating a more compassionate environment.
AST-120 alleviates renal ischemia-reperfusion injury by inhibiting HK2-mediated glycolysis
Authors: Zhou Jinmeng , Zhang Jinbao , Xu Feng , Gao Haijin , Wang Lei , Zhao Yutong , Li Ke
Published: August 2024

Objective

Renal ischemia/reperfusion injury (IRI) is a major cause of acute kidney injury (AKI), which is associated with high incidence and mortality. AST-120 is an oral carbonaceous adsorbent that can alleviate kidney damage. This study aimed to explore the effects of AST-120 on renal IRI and the molecular mechanism.

Methods

A renal IRI mouse model was established and administrated AST-120, and differentially expressed genes were screened using RNA sequencing. Renal function and pathology were analyzed in mice. Hypoxia/reoxygenation (H/R) cell model was generated, and glycolysis was evaluated by detecting lactate levels and Seahorse analysis. Histone lactylation was analyzed by western blotting, and its relationship with hexokinase 2 (HK2) was assessed using chromatin immunoprecipitation.

Results

The results showed that HK2 expression was increased after IRI, and AST-120 decreased HK2 expression. Knockout of HK2 attenuated renal IRI and inhibits glycolysis. AST-120 inhibited renal IRI in the presence of HK2 rather than HK2 absence. In proximal tubular cells, knockdown of HK2 suppressed glycolysis and H3K18 lactylation caused by H/R. H3K18 lactylation was enriched in HK2 promoter and upregulated HK2 levels. Rescue experiments revealed that lactate reversed IRI that suppressed by HK2 knockdown.

Conclusions

In conclusion, AST-120 alleviates renal IRI via suppressing HK2-mediated glycolysis, which suppresses H3K18 lactylation and further reduces HK2 levels. This study proposes a novel mechanism by which AST-120 alleviates IRI.
Modified thoracoabdominal nerve block via perichondral approach: an alternative for perioperative pain management in laparoscopic cholecystectomy in a middle-income country
Authors: Castillo-Dávila Luisa Fernanda , Torres-Anaya Carlos Jesús , Vazquez-Apodaca Raquel , Borboa-Olivares Hector , Espino-y-Sosa Salvador , Torres-Torres Johnatan
Published: August 2024

Background

Laparoscopic cholecystectomy is known for its minimally invasive nature, but postoperative pain management remains challenging. Despite the enhanced recovery after surgery (ERAS) protocol, regional analgesic techniques like modified perichondral approach to thoracoabdominal nerve block (M-TAPA) show promise. Our retrospective study evaluates M-TAPA’s efficacy in postoperative pain control for laparoscopic cholecystectomy in a middle-income country.

Methods

This was a retrospective case-control study of laparoscopic cholecystectomy patients at Hospital General de Mexico in which patients were allocated to the M-TAPA or control group. The data included demographic information, intraoperative variables, and postoperative pain scores. M-TAPA blocks were administered presurgery. Outcomes: opioid consumption, pain intensity, adverse effects, and time to rescue analgesia. Analysis of variance (ANOVA) compared total opioid consumption between groups, while Student’s t test compared pain intensity and time until the first request for rescue analgesia.

Results

Among the 56 patients, those in the M-TAPA group had longer surgical and anesthetic times (p < 0.001), higher ASA 3 scores (25% vs. 3.12%, p = 0.010), and reduced opioid consumption (p < 0.001). The M-TAPA group exhibited lower postoperative pain scores (p < 0.001), a lower need for rescue analgesia (p = 0.010), and a lower incidence of nausea/vomiting (p = 0.010).

Conclusion

Bilateral M-TAPA offers effective postoperative pain control after laparoscopic cholecystectomy, especially in middle-income countries, by reducing opioid use and enhancing recovery.
Pelvic floor muscle training for female urinary incontinence: development of a programme theory from a longitudinal qualitative case study
Authors: Bugge Carol , Hay-Smith Jean , Hagen Suzanne , Grant Aileen , Taylor Anne , Dean Sarah
Published: August 2024

Background

Urinary incontinence (UI) negatively affects the well-being of women globally. Pelvic Floor Muscle Training (PFMT) is a complex intervention that aims to decrease UI symptoms. Information about how the multiple complex components involved in PFMT achieve and maintain the desired effect are rarely studied as a whole. The evidence base lacks data about how women experience PFMT over time and in the longer-term. This study explored women’s experiences of biofeedback-assisted PFMT and PFMT alone, to identify and understand what influenced self-reported adherence to PFMT, and UI outcomes over time.

Methods

This rigorous longitudinal qualitative case study, nested within a randomised controlled trial, recruited forty cases (women with stress or mixed UI; 20 in biofeedback-assisted and 20 in PFMT alone group). A case included up to four semi-structured interviews with each woman (prior to starting PFMT, end of treatment [6 months], 12 months, 24 months). Analysis followed case study analytic traditions, resulting in a Programme Theory about PFMT from the perspectives of women with UI.

Findings

The theory demonstrates factors that motivated women to seek UI treatment, and how these influenced long-term adherence. Therapists who delivered PFMT played a crucial role in supporting women to know how to undertake PFMT (to have capability). Some, but not all, women developed self-efficacy for PFMT. Where women did not have PFMT self-efficacy, adherence tended to be poor. When women had PFMT self-efficacy, the conditions to support adherence were present, but contextual factors could still intercede to inhibit adherence. The intercession of contextual factors was individual to a woman and her life, meaning any particular contextual factor had inconsistent influences on PFMT adherence over time for individual women and exerted varying influences across different women.

Conclusion

Long term adherence to PFMT is a complex interaction between many different factors. Enquiring about an individual woman’s motivation to seek treatment and understanding the contextual factors that affect an individual woman will enable a practitioner to support longer-term adherence.
Opportunities and challenges of a dynamic consent-based application: personalized options for personal health data sharing and utilization
Authors: Lee Ah Ra , Koo Dongjun , Kim Il Kon , Lee Eunjoo , Yoo Sooyoung , Lee Ho-Young
Published: August 2024

Background

The principles of dynamic consent are based on the idea of safeguarding the autonomy of individuals by providing them with personalized options to choose from regarding the sharing and utilization of personal health data. To facilitate the widespread introduction of dynamic consent concepts in practice, individuals must perceive these procedures as useful and easy to use. This study examines the user experience of a dynamic consent-based application, in particular focusing on personalized options, and explores whether this approach may be useful in terms of ensuring the autonomy of data subjects in personal health data usage.

Methods

This study investigated the user experience of MyHealthHub, a dynamic consent-based application, among adults aged 18 years or older living in South Korea. Eight tasks exploring the primary aspects of dynamic consent principles–including providing consent, monitoring consent history, and managing personalized options were provided to participants. Feedback on the experiences of testing MyHealthHub was gathered via multiple-choice and open-ended questionnaire items.

Results

A total of 30 participants provided dynamic consent through the MyHealthHub application. Most participants successfully completed all the provided tasks without assistance and regarded the personalized options favourably. Concerns about the security and reliability of the digital-based consent system were raised, in contrast to positive responses elicited in other aspects, such as perceived usefulness and ease of use.

Conclusions

Dynamic consent is an ethically advantageous approach for the sharing and utilization of personal health data. Personalized options have the potential to serve as pragmatic safeguards for the autonomy of individuals in the sharing and utilization of personal health data. Incorporating the principles of dynamic consent into real-world scenarios requires remaining issues, such as the need for powerful authentication mechanisms that bolster privacy and security, to be addressed. This would enhance the trustworthiness of dynamic consent-based applications while preserving their ethical advantages.
Suggested solutions to barriers in accessing healthcare by persons with disability in Uganda: a qualitative study
Authors: Ssemata Andrew Sentoogo , Smythe Tracey , Sande Slivesteri , Menya Abdmagidu , Hameed Shaffa , Waiswa Peter , Mbazzi Femke Bannink , Kuper Hannah
Published: August 2024

Background

There are 1.3 billion people with disabilities globally, and they frequently face barriers to accessing healthcare, contributing to their worse health and higher mortality. However, little research has explored patient-reported approaches to improve healthcare for persons with disabilities. Consequently, this study aimed to explore possible solutions and recommendations to address the existing barriers to access to healthcare for persons with disabilities in rural Uganda.

Methods

We conducted 27 semi-structured interviews with individuals with various disabilities in rural Luuka district, Eastern Uganda, between September and November 2022. The participants included individuals with visual impairment (n = 5), physical impairment (n = 5), hearing impairment (n = 6), multiple impairments (n = 5), intellectual/cognitive impairment (n = 5), and albinism (n = 1). Interviews were recorded, transcribed verbatim, and thematically analysed. We categorized the solutions using the Missing Billion disability-inclusive health systems framework.

Results

Our findings, framed within the health systems framework, revealed several critical themes. On the demand side, suggested solutions emphasized advocacy and sensitization for persons with disabilities, their communities, and caregivers about healthcare needs. Socio-economic empowerment and community-based health services were also highlighted as essential. On the supply side, participants stressed the importance of training healthcare workers on disability, facilitating dialogue and experience-sharing sessions, and employing health workers with disabilities. Additional recommendations included improving accessibility and reasonable accommodation, organizing inclusive services like special clinic days and outreaches, ensuring representation in health facility management, and establishing comprehensive rehabilitation services with affordable assistive devices.

Conclusion

The multifaceted solutions proposed by persons with disabilities highlight the complex challenges they face in accessing healthcare services and highlight the necessity for comprehensive, sustainable interventions. The call to action for policymakers and healthcare providers is to prioritise the incorporation of disability-inclusive practices and explore multi-dimensional approaches that foster a more inclusive healthcare environment that adequately meets the needs of persons with disabilities.
Comparing mapped park and greenspace boundaries in Philadelphia: implications for exposure assessment in health studies
Authors: Fry Dustin , Roman Lara A. , Kondo Michelle C.
Published: August 2024

An important consideration in studies of the relationship between greenspace exposure and health is the use of mapped data to assign geographic exposures to participants. Previous studies have used validated data from municipal park departments to describe the boundaries of public greenspaces. However, this approach assumes that these data accurately describe park boundaries, that formal parks fully capture the park and greenspace exposure of residents, and (for studies that use personal GPS traces to assign participant exposures) that time spent within these boundaries represents time spent in greenspace. These assumptions are tested using a comparison and ground-truthing of four sources of mapped park and greenspace data in Philadelphia, Pennsylvania: PAD-US-AR, Philadelphia Parks and Recreation, the Delaware Valley Regional Planning Commission, and Open Street Maps. We find several important differences and tradeoffs in these data: the incorporation of highways and building lots within park boundaries, the inclusion or exclusion of formal park spaces (federal, state, and nonprofit), the exclusion of informal parks and greenspaces, and inconsistent boundaries for a linear park. Health researchers may wish to consider these issues when conducting studies using boundary data to assign park exposure.
Scrolling through adolescence: unveiling the relationship of the use of social networks and its addictive behavior with psychosocial health
Authors: Brand Caroline , Fochesatto Camila Felin , Gaya Anelise Reis , Schuch Felipe Barreto , López-Gil José Francisco
Published: August 2024

Background

Understanding the relationship of social network use and addictive behaviors with adolescent psychosocial health is crucial in today’s digital age.

Aim

To verify the associations between social network use, messaging applications, and the addictive behaviors to social network with psychosocial health in Spanish adolescents.

Methods

A cross-sectional study was developed with 632 adolescents, aged 12 to 17 years from the Region of Murcia, Spain. The assessment of social network use (Facebook, Twitter, Instagram, Snapchat, and TikTok) involved evaluating the frequency of use of each social network individually using a single-item scale with five response options. WhatsApp use (i.e., a messaging application) was evaluated in the same manner. The Short Social Networks Addiction Scale-6 Symptoms was employed to assess potential addictive behaviors to social network use. The psychosocial health was assessed using the Strengths and Difficulties Questionnaire. Generalized linear regression models were conducted, and predictive probabilities of having psychosocial health problems were calculated.

Results

The predicted probability of presenting psychosocial health problems in the medium users and high users of social networks was 19.3% (95% confidence interval [CI] 13.0 to 27.7), and 16.2% (95% CI 10.2 to 24.6) higher compared to low users, respectively. High usage of Instagram, TikTok, Snapchat, and Facebook was associated with increased probabilities of psychosocial health problems, with Facebook showing the highest probabilities, at 31.3% (95% CI 14.8 to 54.2) for medium users and 51.9% (95% CI 26.5 to 76.3) for high users. Additionally, adolescents with addictive behaviors to social network use had from 19.0 to 25.2% probabilities of experiencing psychosocial health problems. Finally, the highest probabilities of having psychosocial health problems were identified in adolescents with high addictive behaviors when using social networks (28.9%; 95% CI 19.3 to 40.8%) and the lowest in those with low addictive behaviors (6.8%; 95% CI 3.3 to 13.6%).

Conclusion

Adolescents who use social networks more frequently and exhibit more addictive behaviors related to their use are more likely to experience psychosocial health problems compared to those who do not. Facebook showed the strongest association, followed by Snapchat, Instagram, and TikTok. Our data also revealed that adolescents exhibit various signs of addictive behaviors to social network use.
Variability in forgoing life-sustaining treatment practices in critically Ill patients with hospital-acquired bloodstream infections: a secondary analysis of the EUROBACT-2 international cohort
Authors: Wozniak Hannah , Tabah Alexis , De Waele Jan J. , Timsit Jean-François , Buetti Niccolò ,   EUROBACT-2 Study Group,   the European Society of Intensive Care Medicine (ESICM),   the European Society of Clinical Microbiology,   the Infectious Diseases (ESCMID) Study Group for Infections in Critically Ill Patients (ESGCIP),   the OUTCOMEREA Network
Published: August 2024

Background

The decision to forgo life-sustaining treatment in intensive care units (ICUs) is influenced by ethical, cultural, and medical factors. This study focuses on a population of patients with hospital-acquired bloodstream infections (HABSI) to investigate the association between patient, pathogen, center and country-level factors and these decisions.

Methods

We analyzed data from the EUROBACT-2 study (June 2019–January 2021) from 265 centers worldwide, focusing on non-COVID-19 patients who died in the hospital or within 28 days after HABSI. We assessed whether death was preceded by a decision to forgo life-sustaining treatment, examining country, center, patient, and pathogen variables. To assess the association of each potentially important variable with the decision to forgo life-sustaining treatment, univariable mixed logistic regression models with a random center effect were performed.

Results

Among 1589 non-COVID-19 patients, 519 (32.7%) died, with 191 (36.8%) following a decision to forgo life-sustaining treatment. Significant geographical differences were observed, with no reported decisions to forgo life-sustaining treatment in African countries and fewer in the Middle East compared to Western Europe, Australia, and Asia. Once a center effect was considered, only health expenditure (Odds ratio 1.79, 95%CI: 1.45–2.21, p < 0.01) and age (Odds ratio 1.02, 95%CI: 1.002–1.05, p = 0.03) were significantly associated with decisions to forgo life-sustaining treatment, while other patient and pathogen factors were not.

Conclusion

Economic and regional disparities significantly impact end-of-life decision-making in ICUs. Global policies should consider these disparities to ensure equitable end-of-life care practices.
Antimicrobial metabolites from Probiotics, Pleurotus ostreatus and their co-cultures against foodborne pathogens isolated from ready-to-eat foods
Authors: Bamisi Oluwaferanmi Esther , Ogidi Clement Olusola , Akinyele Bamidele Juliet
Published: August 2024

Background

The incidence of foodborne pathogens in ready- to-eat (RTE) can be attributed to various foodborne diseases. Most of the isolated microorganisms from RTE foods are resistant to common antibiotics and thus, resulted to treatment failure when commercially available antibiotics are administered. However, the secondary metabolites secreted by microorganisms can serve as alternative therapy that are reliable and safe. Secondary metabolites obtained from mono- and co-culture microorganisms can inhibit the growth of antibiotic-resistant microorganisms. Bioactive compounds in the secreted metabolites can be identified and utilized as sources of new antibiotics. In this study, antimicrobial activity of secondary metabolites from Lactobacillus fermentum, Saccharomyces cerevisiae, Pleurotus ostreatus, and their co-cultures were tested against foodborne pathogens isolated from RTE foods using agar well diffusion. The bioactive compounds in the metabolites were identified using gas chromatography-mass spectrometry.

Results

From a total of 100 RTE foods examined, Salmonella enterica, Shigella dysenteriae, Escherichia coli, Klebsiella pneumoniae (subsp ozaenae), Pseudomonas fluorescens, Clostridium perfringes, Bacillus cereus, Listeria monocytogens, and Staphylococcus aureus, Penicillium chrysogenum, Aspergillus flavus, and Aspergillus niger were isolated and displayed multiple antibiotic resistance. The secondary metabolites secreted by co-culture of L. fermentum + P. ostreatus + S. cerevisiae, and co-culture of P. ostreatus + S. cerevisiae have the highest (P ≤ 0.05) zones of inhibition (23.70 mm) and (21.10 mm) against E. coli, respectively. Metabolites from mono-cultured L. fermentum, P. ostreatus, and S. cerevisiae showed zones of inhibition against indicator microorganisms with values ranging from 8.80 to 11.70 mm, 9.00 to 14.30 mm, and 9.30 to 13.00 mm, respectively. Some of the bioactive compounds found in the metabolites of co-cultured microorganisms were alpha-linolenic acid (25.71%), acetic acid 3-methylbutyl ester (13.83%), trans-squalene (12.39%), pentadecylic acid (11.68%), 3- phenyllactic acid (30.13%), linolelaidic acid methyl ester (15.63%), and 4-O-methylmannose (53.74%).

Conclusion

RTE foods contain multiple antibiotics resistance pathogens. The pronounced antimicrobial activity of the secondary metabolites against microorganisms from RTE foods could be attributed to the presence of bioactive compounds in the metabolites. These metabolites can be exploited as alternative food preservatives, biopharmaceuticals and can be used towards better health delivering systems.
Bone marrow toxicity in patients with locally advanced cervical cancer undergoing multimodal treatment with VMAT/IMRT: are there dosimetric predictors for toxicity?
Authors: Hallqvist D. , Kormann C. , Pigorsch S. , Kiechle M. , Combs S. E. , Habermehl D.
Published: August 2024

Purpose

For women with locoregionally advanced cervical cancer, the standard of care treatment is the curatively intended chemoradiation therapy (CRT). A relationship between bone marrow (BM) dose–volume histograms (DVHs) and acute hematological toxicity (HT) has been debated recently. Aim of this study was the evaluation of BM dose constraints and HT in a contemporary patient cohort.

Methods

Radiation treatment plans of 31 patients with cervical cancer (FIGO stage IIB–IVB) treated with intensity-modulated radiotherapy and simultaneous chemotherapy were explored retrospective. Pelvic bones (PB) and femoral heads (FH) were contoured and DVHs were correlated with white blood cells (WBC), hemoglobin levels and platelets.

Results

Comparing the absolute blood levels with the dose volumes of both FH and PB the data showed a significant correlation between WBC and the median dose of the FH and the median dose, V30Gy, V40Gy and V50Gy of the PB. A correlation between the toxicity grade of anemia and mean dose, maximum dose and V5Gy of the PB was found. Counting the highest grade of HT of all three blood levels of each patient, significant correlations were found for the mean and median dose, V30Gy, V40Gy and V50Gy of the PB.

Conclusion

The results show that blood levels may correlate with distinct dosimetric subvolumes of critical bone marrow compartments with a potential impact on therapeutic outcome and treatment-related toxicity. The data presented are in line with the previous findings on the relevance of dosimetric exposure of pelvic bony subvolumes.