bluuebunny/crossref_metadata_2025_split huggingface dataset:
Therapeutic work with clients living in poverty
Authors: Ballo Elvera , Tribe Rachel 
Published: January 2023

Background: Financial inequalities appear to be increasing and poverty is becoming ubiquitous. Poverty affects mental health but its impact on mental health and wellbeing is rarely highlighted within health research. Aims: The Covid-19 pandemic, the Ukrainian invasion and other international and national events have led to a cost-of-living crisis for many people. This is likely to lead to an increase in related referrals and therefore active consideration of the relevant issues relating to poverty appears vital. This paper reports a study which sought to understand how therapists experienced their work with clients who self-refer due to living in poverty. Method: Eight therapists participated in semi-structured interviews analysed using Interpretative Phenomenological Analysis (IPA). Results: Three superordinate themes were elicited: firstly ‘Resilience in the struggle to engage with therapeutic work’, secondly ‘Struggling to promote social activism’ and thirdly, ‘Navigating multiple challenges and barriers’. Each superordinate theme contains two or three sub themes. Conclusions: Issues of structural inequality (including but not limited to poverty) impact significantly on people’s lives but are often ignored or minimised in therapeutic work. It is important that therapists are aware of poverty and take this into account when working with clients.
Comparison of the Effects of Surgical Smoke on the Air Quality and on the Physical Symptoms of Operating Room Staff
Authors: Soysal Ganime Esra , Ilce Arzu , Lakestani Sanaz , Sit Mustafa , Avcioglu Fatma 
Published: January 2023

Background Surgical smoke can be a hazard because e it contains toxic gases with carcinogenic effects that may threaten health. This study aims to determine the effect of surgical smoke containing toxic chemicals on indoor air quality and examine employees’ physical symptoms in the operating room. Method The study was conducted in the operating room between June 2020 and July 2020. In the study, 45 air samples were taken before, during, and after surgery using the active sampling method. Nineteen employees working in the operating room were asked about their physical complaints and their throat cultures were taken before and after surgery. These results were compared with those of the employees working in internal units. Results The Total Volatile Organic Compounds value at the time of surgery was significantly higher ( p ≤ 0.05). Benzene concentrations remained constantly high ( p ≤ 0.05) throughout the surgery, exceeding the limit values. Other VOCs (Volatile Organic Compounds) were significantly higher during surgery and remained below the limit values ( p ≤ 0.05). When compared in terms of open and laparoscopic surgery, no difference between VOC concentrations was observed ( p ≤ 0.05). The physical symptoms of the surgical team increased during the operation, and they experienced more complaints of tearing, burning in the eyes, hair odor, nausea, and cough than those working in the internal units (e.g., internal medicine, dermatology; ( p ≤ 0.05). Conclusions Surgical smoke was an important contaminant for indoor air quality in the operating room.
Pharmacokinetics of zanamivir in critically ill patients undergoing continuous venovenous hemofiltration
Authors: Wieringa André , ter Horst Peter GJ , Wagenvoort GertJan HJ , Koch Birgit CP , Haringman Jasper J 
Published: January 2023

Background Limited data exist for dosing of zanamivir in the setting of CVVH in the intensive care unit (ICU). Our objective is to report the pharmacokinetics and sieving coefficient (Sv) of zanamivir in patients receiving continuous venovenous hemofiltration (CVVH). Methods In this prospective observational study, patients of ≥18 years admitted to the ICU with a life-threatening Influenza A or B infection, treated with zanamivir i.v. undergoing CVVH were included. Patients received a zanamivir loading dose of 600 mg i.v., 12 h later followed by maintenance dosages two times daily according to the treating physician. Per patient, nine CFT plasma and nine ultrafiltrate samples were drawn on day 2 of treatment and analysed with a validated HPLC-MS/MS method. Results Four patients were included in the study. The zanamivir elimination half-life was prolonged with 5.6–9.9 h, compared to patients with normal renal function. A Sv of approximately 1.0 was identified, with unrestricted transport of zanamivir to the ultrafiltrate. Conclusions Zanamivir is well cleared by CVVH. In absence of the possibility for therapeutic drug monitoring, the ultrafiltration rate seems as a good surrogate parameter to estimate the CLCVVH and may help guide the dosing of zanamivir.
Enlarging Paravisceral Aortic Aneurysm Treated With In Situ Laser Fenestration of Physician-Modified Stent Graft for Preservation of Accessory Renal Arteries
Authors: Brown Adam , Wooster Mathew 
Published: January 2023

Purpose: In situ laser fenestration (LISF) was performed as a bailout procedure to ensure renal perfusion during complex aortic aneurysm repair. Case Report: A 69 year-old male patient with previous repair of abdominal aortic aneurysm who presented with increasing lower back pain and an enlarging, 6-cm, perivisceral aortic aneurysm that required urgent repair. Given potential complications and risks of redo open repair, we performed endovascular repair via deployment of a 5-vessel fenestrated physician modified stent graft (PMEG) with stent placement to the celiac, superior mesenteric, right renal, and 2 of the larger 3 left renal arteries. The renal artery planned for sacrifice was found intraoperatively to be perfusing a large portion of the kidney. Subsequently, LISF was used to cannulate and salvage perfusion to the third renal artery. Completion aortogram demonstrated patency of all renal visceral vessels with no vessel leak. Follow-up CT angiogram 1 year later demonstrated aortic graft with all visceral stents patent, no endoleak, and a reduction in residual aneurysm sac. Conclusion: Even with careful planning and design of a physician modified stent graft, in situ laser fenestration provides an option to successfully create additional stents intraoperatively in order to preserve perfusion to critical visceral organs. Clinical Impact In situ laser fenestration will provide surgeons with a valuable intra-operative method to create additional stents when organ perfusion would otherwise be lost. As more surgeons develop this technical ability and more long-term outcomes are studied, this method has the possibility to not only be used for urgent and emergent cases but may one day be an acceptable variation to standard practice.
Esophagojejunostomy or Fistulojejunostomy Are Safe Salvage Operations for Bariatric Surgery Leaks
Authors: Leeds Steven G. , Kerlee Kacie R. , Fair Lucas , Tran Daniel , Davis Daniel G. , Ogola Gerald O. , Ward Marc A. 
Published: January 2023

Background: Sleeve gastrectomy is the most commonly performed bariatric surgery, and staple line leaks occur in 1% or less of patients. Gastric bypass is still a common weight loss surgery with a leak rate of 2%. Definitive surgical management of the leak is mainly accomplished with esophagojejunostomy or fistulojejunostomy. Proceeding with surgical management of these leaks is poorly understood given the rare need and high risk. We reviewed our outcomes of definitive surgical management for leaks following weight loss surgery. Methods: An institutional review board approved database identified patients undergoing definitive surgical management for bariatric surgery leaks with either an esophagojejunostomy or fistulojejunostomy. Initial data that led to the leak, intraoperative factors, and postoperative outcomes were collected. Primary endpoint was leak after definitive surgical procedure. Results: A database of 87 patients was queried to find 22 patients undergoing surgery. Twelve patients underwent esophagojejunostomy and 10 patients underwent fistulojejunostomy. There was a mean of 90 days to leak recognition. There was a mean of 228 days from first endoscopic procedure to definitive surgery in the 18 patients undergoing initial endoscopic management. The mean time from the sentinel surgery to definitive surgery was 296 days. There were 6 patients (27%) that had subsequent leaks after definitive surgery. All subsequent leaks healed with endoscopic therapy. No deaths occurred. Conclusion: Bariatric surgery leaks are difficult to manage. When endoscopic management fails, esophagojejunostomy, and fistulojejunostomy are safe and feasible salvage options. Additional leaks following these salvage operations can occur in up to 27% of patients.
Racial Disparities in Technology Use in Children With Type 1 Diabetes: A Qualitative Content Analysis of Parents’ Perspectives
Authors: Howe Carol J. , Morone Jennifer , Hawkes Colin P. , Lipman Terri H. 
Published: January 2023

Purpose: The purpose of the study was to describe differences in non-Hispanic Black (NHB) and non-Hispanic White (NHW) parents’ perceptions of factors that influence the use of diabetes technology. Methods: Focus groups were conducted with parents of NHB and NHW children at a pediatric diabetes center in the Northeast United States. Kilbourne’s health disparities framework informed the focus group guide and a priori coding for directed content analysis. Further analysis allowed subcategories to emerge inductively. Results: Twenty-one parents participated. Five subcategories emerged, describing differences in NHB and NHW parent decisions regarding diabetes technology: (1) child’s choice, (2) shame versus pride, (3) pros and cons of technology, (4) time frame, and (5) blood glucose indications of readiness. NHB parents feared technology malfunction, worried that visible devices could worsen experienced stigma of diabetes diagnosis, and described the diabetes team as gatekeepers, who changed eligibility criteria for diabetes technology use for their research purposes. In contrast, NHW parents reported diabetes team expectation of diabetes technology use and did not report provider-related barriers. Conclusion: This study adds to existing literature advancing our understanding of the patient and provider mechanisms underlying racial disparities in diabetes technology use. This understanding may guide development of interventions focused on patients, providers, and structural factors to improve equity in use of diabetes technology by youth with type 1 diabetes.
Aspergillus Niger thermostable Cytosine deaminase-dextran conjugates with enhanced structure stability, proteolytic resistance, and Antiproliferative activity
Authors: El-Sayed Ashraf S. A. , Rady Amgad M. , Mohamed Hossam Taha , Zein Nabila , Yassin Marwa A. , Mohamed Nabil Z. , Hassan Abdallah , Amer Mahmoud M. , El-Sharakawy Reyad , El-Sharkawy Aya Ali , El-Sayed Nesma , Ali Mostafa G. 
Published: January 2023

AbstractCytosine deaminase (CDA) is a prodrug mediating enzyme converting 5-flurocytosine into 5-flurouracil with profound broad-range anticancer activity towards various cell lines. Availability, molecular stability, and catalytic efficiency are the main limiting factors halting the clinical applications of this enzyme on prodrug and gene therapies, thus, screening for CDA with unique biochemical and catalytic properties was the objective. Thermotolerant/ thermophilic fungi could be a distinctive repertoire for enzymes with affordable stability and catalytic efficiency. Among the recovered thermotolerant isolates, Aspergillus niger with optimal growth at 45 °C had the highest CDA productivity. The enzyme was purified, with purification 15.4 folds, molecular mass 48 kDa and 98 kDa, under denaturing and native PAGE, respectively. The purified CDA was covalently conjugated with dextran with the highest immobilization yield of 75%. The free and CDA-dextran conjugates have the same optimum pH 7.4, reaction temperature 37 °C, and pI 4.5, and similar response to the inhibitors and amino acids suicide analogues, ensuring the lack of effect of dextran conjugation on the CDA conformational structure. CDA-Dextran conjugates had more resistance to proteolysis in response to proteinase K and trypsin by 2.9 and 1.5 folds, respectively. CDA-Dextran conjugates displayed a dramatic structural and thermal stability than the free enzyme, authenticating the acquired structural and catalytic stability upon dextran conjugation. The thermal stability of CDA was increased by about 1.5 folds, upon dextran conjugation, as revealed from the half-life time (T1/2). The affinity of CDA-conjugates (Km 0.15 mM) and free CDA (Km 0.22 mM) to deaminate 5-fluorocytosine was increased by 1.5 folds. Upon dextran conjugation, the antiproliferative activity of the CDA towards the different cell lines “MDA-MB, HepG-2, and PC-3” was significantly increased by mediating the prodrug 5-FC. The CDA-dextran conjugates strongly reduce the tumor size and weight of the Ehrlich cells (EAC), dramatically increase the titers of Caspase-independent apoptotic markers PARP-1 and AIF, with no cellular cytotoxic activity, as revealed from the hematological and biochemical parameters.
Brain relaxation using desflurane anesthesia and total intravenous anesthesia in patients undergoing craniotomy for supratentorial tumors: a randomized controlled study
Authors: Jiang Ze , Wu Youxuan , Liang Fa , Jian Minyu , Liu Haiyang , Mei Hongxun , Han Ruquan 
Published: January 2023

Abstract
Background
Satisfactory brain relaxation is essential in neurosurgery. Desflurane anesthesia and propofol-based total intravenous anesthesia (TIVA) have different effects on cerebral hemodynamics, potentially contributing to discrepant brain relaxation. The purpose of this study was to compare the effects of desflurane and TIVA on brain relaxation in patients undergoing craniotomy for supratentorial tumors.

Methods
In this randomized, controlled study, we enrolled patients aged 18–60 years, with ASA I–III, who were scheduled to undergo elective craniotomy for supratentorial tumors. Patients were randomly assigned in a 1:1 ratio to receive desflurane anesthesia or TIVA. The primary outcome was the proportion of satisfactory brain relaxation. Secondary outcomes included emergence and extubation times, recovery of cognitive function and postoperative complications.

Results
Of 369 patients who were assessed for eligibility, 111 were randomized and 110 were included in the modified intention-to-treat analysis (55 in the desflurane group and 55 in the TIVA group). The proportion of satisfactory brain relaxation was similar between the two groups: 69% in the desflurane group and 73% in the TIVA group (RR: 0.950, 95% CI: 0.748–1.207; P = 0.675). Patients assigned to the desflurane group had shorter emergence (10 [8–13] min vs. 13 [10–20] min, P < 0.001) and extubation times (13 [10–18] min vs. 17 [13–23] min, P < 0.001), and better recovery of cognitive function at 15 min after extubation (16 [0–24] vs. 0 [0–20], P = 0.003), but experienced increased postoperative nausea and vomiting (PONV) (16 [29%] vs. 6 [11%] P = 0.017) and tachycardia (22 [40%] vs. 9 [16%], P = 0.006) during recovery.

Conclusions
Desflurane anesthesia and TIVA provide similar brain relaxation in patients without intracranial hypertension undergoing elective craniotomy. Desflurane accelerates the recovery from anesthesia but is associated with increased PONV and tachycardia during the recovery period.

Trial registration
Clinicaltrial.gov (NCT04691128). Date of registration: December 31, 2020.
Comparison of postoperative IL-6 and IL-10 levels following Erector Spinae Plane Block (ESPB) and classical Thoracolumbar Interfascial Plane (TLIP) block in a posterior lumbar decompression and stabilization procedure: a randomized controlled trial
Authors: Tantri Aida Rosita , Rahmi Rahmi , Marsaban Arif Hari Martono , Satoto Darto , Rahyussalim Ahmad Jabir , Sukmono Raden Besthadi 
Published: January 2023

AbstractBackground and objectivesThe erector spinae plane block (ESPB) and classical thoracolumbar interfascial plane (TLIP) block can reduce postoperative pain in lumbar surgery. In this study, we compared the efficacy of ESPB and classical TLIP block in providing perioperative analgesia in patients undergoing lumbar posterior decompression and stabilization by comparing postoperative pain, opioid consumption, and IL-6 and IL-10 serum concentrations between ESPB and classical TLIP block.MethodThis was a prospective, double-blinded, randomized controlled trial in tertiary referral hospitals. Forty patients were randomized into two equal groups, each receiving either ESPB or classical TLIP block. The primary outcome was the difference in IL-6 and IL-10 serum concentrations at baseline and 6 h after lumbar posterior decompression and stabilization. The secondary outcome was total opioid consumption and pain score 24 h post-operatively.ResultThere were no significant differences between the ESPB and classical TLIP block groups in pain score, IL-6 and IL-10 concentration change, and total opioid consumption post-operatively. There was a significant difference in the time until the first dose of morphine was needed between the ESPB and classical TLIP block groups (300 min vs. 547.5 min;p = 0.002).ConclusionESPB and classical TLIP block performance during lumbar surgery have comparable pain scores, IL-6 and IL-10 concentration differences pre- and post-operation, and total opioid consumption post-operatively. However, classical TLIP block provides a prolonged duration of analgesia.Trial registrationClinicalTrials.gov NCT04951024.
Chronic Headache Education and Self-Management Study (CHESS): a process evaluation
Authors: Ellard David R. , Nichols Vivien P. , Griffiths Frances E. , Underwood Martin , Taylor Stephanie J. C. ,   On behalf of the CHESS team (Consortium), Ellard David R. , Nichols Vivien P. , Griffiths Frances E. , Underwood Martin , Taylor Stephanie J. C. , Achana Felix , Carnes Dawn , Eldridge Sandra , Haywood Kirstie , Hee Siew Wan , Higgins Helen , Mistry Dipesh , Mistry Hema , Newton Sian , Norman Chloe , Padfield Ms Emma , Patel Shilpa , Petrou Stavros , Pincus Tamar , Potter Rachel , Sandhu Harbinder , Stewart Kimberley , Matharu Manjit 
Published: January 2023

Abstract
Background
The Chronic Headache Education and Self-Management Study (CHESS) multicentre randomised trial evaluated the impact a group education and self-management support intervention with a best usual care plus relaxation control for people living with chronic headache disorders (tension type headaches or chronic migraine, with or without medication overuse headache). Here we report the process evaluation exploring potential explanations for the lack of positive effects from the CHESS intervention.

Methods
The CHESS trial included 736 (380 intervention: 356 control) people across the Midlands and London UK. We used a mixed methods approach. Our extensive process evaluation looked at context, reach, recruitment, dose delivered, dose received, fidelity and experiences of participating in the trial, and included participants and trial staff. We also looked for evidence in our qualitative data to investigate whether the original causal assumptions underpinning the intervention were realised.

Results
The CHESS trial reached out to a large diverse population and recruited a representative sample. Few people with chronic tension type headaches without migraine were identified and recruited. The expected ‘dose‘of the intervention was delivered to participants and intervention fidelity was high. Attendance (“dose received”) fell below expectation, although 261/380 (69%) received at least at least the pre-identified minimum dose. Intervention participants generally enjoyed being in the groups but there was little evidence to support the causal assumptions underpinning the intervention were realised.

Conclusions
From a process evaluation perspective despite our extensive data collection and analysis, we do not have a clear understanding of why the trial outcome was negative as the intervention was delivered as planned. However, the lack of evidence that the intervention causal assumptions brought about the planned behaviour change may provide some insight. Our data suggests only modest changes in managing headache behaviours and some disparity in how participants engaged with components of the intervention within the timeframe of the study. Moving forwards, we need a better understanding of how those who live with chronic headache can be helped to manage this disabling condition more effectively over time.

Trial registration
ISRCTN79708100.
Piloting a complex intervention to promote a tobacco and alcohol-free pregnancy: the Smoke and Alcohol Free with EHealth and Rewards (SAFER) pregnancy study
Authors: Breunis Leonieke J. , de Kroon Marlou L. A. , de Jong-Potjer Lieke C. , Steegers Eric A. P. , Been Jasper V. 
Published: January 2023

AbstractBackgroundTobacco smoking and alcohol consumption before and during pregnancy increase the risk of adverse health outcomes for mother and child. Interventions to address smoking and drinking before and during pregnancy have the potential to reduce early-life health inequalities. In the Smoke and Alcohol Free with EHealth and Rewards (SAFER) pilot study we aimed to evaluate the acceptability, feasibility and effectiveness of a complex intervention supporting women in smoking and alcohol cessation before and during pregnancy.MethodsFrom February 2019 till March 2021, we piloted the SAFER pregnancy intervention among pregnant women and women planning pregnancy in South-West Netherlands in an uncontrolled before-after study. Participants were supported in smoking and alcohol cessation via up to six group sessions and an online platform. In addition, biochemically validated cessation was rewarded with incentives (i.e. shopping vouchers) amounting up to 185 euros. We aimed to include 66 women. The primary outcome was smoking and/or alcohol cessation at 34–38 weeks of gestation (if pregnant) or after six group sessions (if not pregnant). Quantitative data were analysed using descriptive statistics. Focus group interviews among those involved in the study were conducted at the end of the study to explore their experiences. Qualitative data was analysed using thematic analysis.ResultsThirty-nine women who smoked were included; no women who consumed alcohol were referred to the study. Unemployment (51%), financial problems (36%) and a smoking partner (72%) were common. Thirteen women (33%) dropped out, often due to other problems impeding smoking cessation or ‘being too busy’ to participate in the group sessions. Eleven women (28%) had quit smoking at the study’s endpoint. The personal and positive approach was highly valued and biochemical validation was felt to be helpful.ConclusionThe SAFER pregnancy intervention seems appropriate for women in need of extra support for smoking cessation before and during pregnancy. Its impact on alcohol cessation could not be studied due to recruitment issues. Recruitment and prevention of early dropout need attention in further development of this intervention.Trial registrationNetherlands Trial Register: NL7493. Date registered: 04/02/2019.