bluuebunny/crossref_metadata_2025_split huggingface dataset:
Understanding online dual practice of public hospital doctors in China: a mixed-methods study
Authors: Xu Duo , Zhan Jiajia , Cheng Terence , Fu Hongqiao , Yip Winnie 
Published: February 2022

Abstract
Telemedicine and telehealth hold promise for reducing access barriers, improving quality and containing medical costs. As Internet companies enter the healthcare market, a rising number of online healthcare platforms have emerged worldwide. In some countries like China, public hospital doctors are providing direct-to-consumer telemedicine services on these commercial platforms as independent providers. Such online service provision creates a new form of dual practice, which we refer to as ‘online dual practice’ in this study. Using a mixed-methods design, this study aims to investigate the prevalence of online dual practice, doctors’ time allocation and motivations for engaging in it and its potential impacts on the health system in China. We use the web-crawled data from four leading online health platforms to examine the prevalence of online dual practice in China. Then we conduct in-depth interviews with 38 active doctors on these platforms to investigate their time allocation, motivations and perception regarding online service provision. We find that the nationwide prevalence of online dual practice in China reaches at least 16.5% in 2020 and that it is more common among senior public hospital doctors. Public hospital doctors mainly use small pockets of time during working hours and after-hours to render services on the platforms The five most commonly cited motivations for their engagement in online dual practice are efficiency improvement, personal control, career development, financial rewards and serving the patients. Interviewed doctors believe that their online service provision is conducive to increasing healthcare access and improving efficiency, but some also express their concerns about the quality of care. Further analysis shows that the impact of online dual practice on health system performance remains an open question and regulatory policies on it should be health-system specific.
An evaluation of training using singing as a tool for community building in changing societies
Authors: Garry Fran , Phelan Helen 
Published: February 2022

Summary
This article investigates lived experiences of participation in a training programme entitled ‘Singing as a Tool for Community Building in Changing Societies’, facilitated by Musicians Without Borders (MWB) and coordinated in partnership with the Health Research Institute PART-IM (Participatory and Arts-Based Methods for Involving Migrants in Health Research) research cluster at the University of Limerick. The aim of this qualitative study is to enhance understanding of participant experience regarding programme delivery, skill acquisition and community building. The research methodology uses an ethnographic framework. Data collection approaches included participant observation, author fieldnotes, individual semi-structured interviews, and an anonymous, post-training, feedback questionnaire. Thematic analysis of the data resulted in three key themes: the importance of expert facilitation; culturally aware contextualizing and conceptualizing of singing; and professional, whole-person support. These themes were cross-referenced against the research categories of delivery, skill and community building. The findings propose the importance of experienced, expert facilitators, contextualized understandings of diverse artistic traditions delivered by a culturally diverse team, and attention to the whole-person needs of both facilitators and participants. This research enhances understanding of participant experiences of arts-based training programmes in singing and the potential application of this learning for using singing as an arts-based research (ABR) method in migrant health research.
High S100B Levels Predict Antidepressant Response in Patients With Major Depression Even When Considering Inflammatory and Metabolic Markers
Authors: Navinés Ricard , Oriolo Giovanni , Horrillo Igor , Cavero Myriam , Aouizerate Bruno , Schaefer Martin , Capuron Lucile , Meana J Javier , Martin-Santos Rocio 
Published: February 2022

Abstract

Background
The relationship between antidepressant response and glial, inflammatory, and metabolic markers is poorly understood in depression. This study assessed the ability of biological markers to predict antidepressant response in major depressive disorder (MDD).

Methods
We included 31 MDD outpatients treated with escitalopram or sertraline for 8 consecutive weeks. The Montgomery-Åsberg Depression Rating Scale (MADRS) was administered at baseline and at week 4 and 8 of treatment. Concomitantly, blood samples were collected for the determination of serum S100B, C-reactive protein (CRP), and high-density lipoprotein cholesterol (HDL)-C levels. Treatment response was defined as ≥50% improvement in the MADRS score from baseline to either week 4 or 8. Variables associated with treatment response were included in a linear regression model as predictors of treatment response.

Results
Twenty-seven patients (87%) completed 8 weeks of treatment; 74% and 63% were responders at week 4 and 8, respectively. High S100B and low HDL-C levels at baseline were associated with better treatment response at both time points. Low CRP levels were correlated with better response at week 4. Multivariate analysis showed that high baseline S100B levels and low baseline HDL-C levels were good predictors of treatment response at week 4 (R2 = 0.457, P = .001), while S100B was at week 8 (R2 = 0.239, P = .011). Importantly, baseline S100B and HDL-C levels were not associated with depression severity and did not change over time with clinical improvement.

Conclusions
Serum S100B levels appear to be a useful biomarker of antidepressant response in MDD even when considering inflammatory and metabolic markers.
Population pharmacokinetics of piperacillin/tazobactam in critically ill Korean patients and the effects of extracorporeal membrane oxygenation
Authors: Kim Yong Kyun , Kim Hyoung Soo , Park Sunghoon , Kim Hwan-il , Lee Sun Hee , Lee Dong-Hwan 
Published: February 2022

Abstract

Objectives
To explore extracorporeal membrane oxygenation (ECMO)-related alterations of the pharmacokinetics (PK) of piperacillin/tazobactam and determine an optimal dosage regimen for critically ill adult patients.

Methods
Population PK models for piperacillin/tazobactam were developed using a non-linear mixed effect modelling approach. The percentage of time within 24 h for which the free concentration exceeded the MIC at a steady-state (50%fT&gt;MIC, 100%fT&gt;MIC, and 100%fT&gt;4×MIC) for various combinations of dosage regimens and renal function were explored using Monte-Carlo simulation.

Results
A total of 226 plasma samples from 38 patients were used to develop a population PK model. Piperacillin/tazobactam PK was best described by two-compartment models, in which estimated glomerular filtration rate (eGFR), calculated using CKD-EPI equation based on cystatin C level, was a significant covariate for total clearance of each piperacillin and tazobactam. ECMO use decreased the central volume of distribution of both piperacillin and tazobactam in critically ill patients. Patients with Escherichia coli or Klebsiella pneumoniae infection, but not those with Pseudomonas aeruginosa infection, exhibited a PK/pharmacodynamic target attainment &gt;90% when the target is 50%fT&gt;MIC, as a result of applying the currently recommended dosage regimen. Prolonged or continuous infusion of 16 g/day was required when the treatment goal was 100%fT&gt;MIC or 100%fT&gt;4×MIC, and patients had an eGFR of 130–170 mL/min/1.73 m2.

Conclusions
ECMO use decreases piperacillin/tazobactam exposure. Prolonged or continuous infusion can achieve the treatment target in critically ill patients, particularly when MIC is above 8 mg/L or when patients have an eGFR of 130–170 mL/min/1.73 m2.
Challenges and strategies for promoting health equity in virtual care: findings and policy directions from a scoping review of reviews
Authors: Budhwani Suman , Fujioka Jamie , Thomas-Jacques Tyla , De Vera Kristina , Challa Priyanka , De Silva Ryan , Fuller Kaitlin , Shahid Simone , Hogeveen Sophie , Chandra Shivani , Bhatia R Sacha , Seto Emily , Shaw James 
Published: February 2022

Abstract

Objective
We sought to understand and synthesize review-level evidence on the challenges associated with accessibility of virtual care among underserved population groups and to identify strategies that can improve access to, uptake of, and engagement with virtual care for these populations.

Materials and Methods
A scoping review of reviews was conducted (protocol available at doi: 10.2196/22847). A total of 14 028 records were retrieved from MEDLINE, EMBASE, CINAHL, Scopus, and Epistemonikos databases. Data were abstracted, and challenges and strategies were identified and summarized for each underserved population group and across population groups.

Results
A total of 37 reviews were included. Commonly occurring challenges and strategies were grouped into 6 key thematic areas based on similarities across communities: (1) the person’s orientation toward health-related needs, (2) the person’s orientation toward health-related technology, (3) the person’s digital literacy, (4) technology design, (5) health system structure and organization, and (6) social and structural determinants of access to technology-enabled care. We suggest 4 important directions for policy development: (1) investment in digital health literacy education and training, (2) inclusive digital health technology design, (3) incentivizing inclusive digital health care, and (4) investment in affordable and accessible infrastructure.

Discussion and Conclusion
Challenges associated with accessibility of virtual care among underserved population groups can occur at the individual, technological, health system, and social/structural determinant levels. Although the policy approaches suggested by our review are likely to be difficult to achieve in a given policy context, they are essential to a more equitable future for virtual care.
Pre-Existing Autoimmune Disease and Mortality in Patients Treated with Anti-PD-1 and Anti-PD-L1 Therapy
Authors: Tang Kimberly , Tiu Bruce C , Wan Guihong , Zhang Shijia , Nguyen Nga , Leung Bonnie , Gusev Alexander , Reynolds Kerry L , Kwatra Shawn G , Semenov Yevgeniy R 
Published: February 2022

Abstract
Although indications for immune checkpoint inhibitors (ICIs) have dramatically increased in the past decade, ICIs have been associated with autoinflammatory immune-related adverse events, which can resemble autoimmune diseases (ADs). Little is known about the impact of baseline AD on mortality in cancer patients treated with ICIs. Here, we identified 17 497 patients with preexisting autoimmune diagnoses prior to treatment with antiprogrammed cell death receptor-1 or antiprogrammed cell death ligand-1 therapy and 17 497 matched controls through the TriNetX Diamond network of more than 200 million patients across the United States and Europe. Using a Cox proportional hazards model, we found that patients with history of AD were not at higher risk of mortality than non-AD patients (hazard ratio [HR] = 1.03, 95% confidence interval [CI] = 1 to 1.07; P = .05). Additionally, history of Hashimoto disease (HR = 0.75, 95% CI = 0.62 to 0.90; P = .002) and vitiligo (HR = 0.52, 95% CI = 0.34 to 0.81; P = .003) were statistically significantly associated with decreased mortality. This suggests that underlying AD need not be a contraindication to inclusion in clinical trials and administration of ICI for treatment of cancer.
The Agency of Music in Industrial Society: A Comparative Study of the Royal Manchester Institution, Manchester Athenaeum and Manchester Mechanics’ Institution, 1834-1860
Authors: Johnson Rachel 
Published: February 2022

Abstract
Three institutions dedicated to education, rational recreation and moral improvement existed concurrently in early Victorian Manchester: the Royal Manchester Institution, the Manchester Mechanics’ Institution and the Manchester Athenaeum. Their archives reveal the prominent place of music within each institution’s programmes, in the form of lectures, classes and concerts, yet so far the significance of such music has been overlooked. Alarmed by civil unrest and radical activism, the industrial elite of Manchester – frequently described as the world’s first industrial city – hoped to shape the ‘lower orders’ to align with existing societal ideals. Music, through the institutions, was frequently employed as an agent of ideology and social control. But the intent behind the institutions’ musical programming did not always reflect how the music was used or received in practice. This article asks what the institutions aimed to achieve and how music acted in ways not always envisaged by the organizing committees. It critiques existing literature that views these institutions as primarily a means of social control, arguing that such an approach risks diminishing the experiences of those involved and obscuring more nuanced reasons for the promotion of and engagement with music. Exploring the activities and musical participation of protagonists within these institutions and in their wider lives affords new understanding of the agency of music in industrial society.
The cooling of massive white dwarfs from Gaia EDR3
Authors: Fleury Leesa , Caiazzo Ilaria , Heyl Jeremy 
Published: February 2022

ABSTRACT
We determine the distribution of cooling ages of massive Gaia EDR3 white dwarfs identified with over 90 per cent probability within 200 pc and with mass in the range 0.95–1.25 M⊙. Using three sets of publicly available models, we consider sub-samples of these white dwarfs sorted into three equally spaced mass bins. Under the assumption of a constant white dwarf formation rate, we find an excess of white dwarfs, both along the Q branch and below it, corresponding respectively to stars that are in the process of freezing and those that are completely frozen. We compare the cooling age distributions for each of these bins to the recently determined time-varying star formation rate of Gaia DR2 main sequence stars. For white dwarfs in the two lightest mass bins, spanning the mass range 0.95–1.15 M⊙, we find that the cumulative cooling age distribution is statistically consistent with the expectation from the star formation rate. For white dwarfs in the heaviest mass bin, 1.15–1.25 M⊙, we find that their cumulative distribution is inconsistent with the star formation rate for all of the models considered; instead, we find that their cooling age distribution is well fitted by a linear combination of the distribution expected for single stellar evolution products and the distribution expected for double white dwarf merger products when approximately 40–50 per cent of the 1.15–1.25 M⊙ white dwarfs that formed over the past 4 Gyr are produced through double white dwarf mergers.
A three-component model for cosmic ray spectrum and dipole anisotropy
Authors: Zhang Yiran , Liu Siming , Zeng Houdun 
Published: February 2022

ABSTRACT
Using a three-component, multiscale diffusion model, we show that the cosmic ray (CR) proton and helium spectra and the dipole anisotropy can be explained with reasonable parameters. The model includes a nearby source associated with the supernova remnant (SNR) that gave rise to the Geminga pulsar, a source at the Galactic Centre, and a component associated with the Galactic disc. The CR flux below TeV is dominated by the disc component. The centre source with a continuous injection of CRs starting about 18 Myr ago is needed to explain the anisotropy above 100 TeV. With the assumption of universal CR spectra injected by all SNRs, the nearby source can produce a TeV spectral bump observed at Earth via slow diffusion across the interstellar magnetic field, which needs to have an angle θ ≈ 5° between the field line and the line of sight towards the source, and have weak magnetic turbulence with the Alfvén Mach number MA ≈ 0.1. Considering the modulation of the Galactic-scale anisotropy by this magnetic field, in a quasi-local approach the field may be directed at a right ascension about −90° and a declination about −7.4° in the equatorial coordinate system.
Vaping in a Time of Pandemics: Risk Perception and Motivations for Electronic Cigarette Use
Authors: Yang Xiaozhao Yousef , Kelly Brian C , Pawson Mark , Vuolo Michael 
Published: February 2022

Abstract

Introduction
Prior studies on the association between the intensity of and motives for vaping e-cigarettes have highlighted the psychological dynamics of motivational changes, but less about how vaping motives may shift as a function of risk perceptions exacerbated by unanticipated events. This study frames the COVID-19 pandemic as an exacerbating threat to pulmonary health, and tests how e-cigarette users’ risk perceptions of COVID-19 are related to different motives for vaping and ultimately the intensity of e-cigarette use.

Aims and Methods
An online survey of e-cigarette users in the United States (n = 562) was conducted during April 2020 when much of the United States was under “lockdown” conditions. We distinguished three types of vaping motives (health, socialization, and dependence) and established the classification with confirmatory factor analysis. Structural equation modeling was conducted for path analyses and mediation tests.

Results
All three vaping motives were significantly associated with greater use intensity. A heightened risk perception of e-cigarette users’ vulnerability to COVID-19 was inversely associated with use intensity (−.18, p &lt; .01) and health motives for vaping (−.27, p &lt; .001), but not associated with socialization and dependence motivations. Health motives for vaping mediated 35% of the association between COVID-19 risk perceptions and use intensity.

Conclusions
Our findings indicate that risk perceptions of exacerbated threats may reduce e-cigarette use directly, and also indirectly through shifting certain types of motivations for vaping. Beyond elucidating the relational dynamics between vaping psychology and health risks, these results also indicate health professionals may leverage the pandemic to promote nicotine cessation or reduced use.

Implication
Little is known about how vaping motives shift after unanticipated events such as pandemics. This study contributes to knowledge of how the use of e-cigarettes is motivated by different dimensions of rationales and exogenous risks. Exploiting the emergence of the COVID-19 pandemic, we found risk perceptions are associated with the intensity of e-cigarette use indirectly specifically through health motivations. Risk perceptions are not associated with socialization and dependence motives for vaping.
Factors That Influence the Clinical Implementation of Aerobic Exercise in Stroke Rehabilitation: A Theory-Informed Qualitative Study
Authors: Inness Elizabeth L , Jagroop David , Andreoli Angie , Bayley Mark , Biasin Louis , Danells Cynthia , Hall Jayne , Mansfield Avril , McDonald Alison , Nishri Diane , Salbach Nancy M , Taylor Denise , Wong Karl , Tang Ada 
Published: February 2022

Abstract

Objective
Best practice guidelines recommend that aerobic exercise (AEx) be implemented as early as possible poststroke, yet the prescription of AEx remains limited in stroke rehabilitation settings. This study used theoretical frameworks to obtain an in-depth understanding of barriers and enablers to AEx implementation in the stroke rehabilitation setting.

Methods
A qualitative, descriptive study was conducted. Participants were recruited from 4 stroke rehabilitation settings in Ontario, Canada, that have participated in an implementation study to provide structured AEx programming as part of standard care. Six clinician focus groups (with 19 physical therapists and 5 rehabilitation assistants) and one-to-one interviews with 7 managers and 1 physician were conducted to explore barriers and enablers to AEx implementation. The Theoretical Domains Framework and Consolidated Framework for Implementation Research informed content analysis for clinician and manager perspectives, respectively.

Results
Barriers specific to resource constraints and health care system pressures, combined with patient goals, led to interventions to improve function being prioritized over AEx. Successful implementation was enabled through an interprofessional approach and team engagement in the planning and implementation process. Health care providers described concerns about patient safety, but confidence and capability for implementing AEx were enabled by education, skill development, use of exercise tests, and consultation with individuals with content expertise. Participants described the development of supportive processes that enabled AEx implementation within team workflows and shared resources.

Conclusion
Strategies to support implementation of AEx in stroke rehabilitation should incorporate knowledge and skills, the provision of clinical decision-making tools, access to expert consultation, the roles and social influence of the interprofessional team and formal and informal leaders, and supportive processes adapted to the local context.

Impact
Results from this study will inform the development of a clinical implementation toolkit to support clinical uptake of AEx in the stroke rehabilitation setting.
Hurdles to the Adoption of Gene Therapy as a Curative Option for Transfusion-Dependent Thalassemia
Authors: Thuret Isabelle , Ruggeri Annalisa , Angelucci Emanuele , Chabannon Christian 
Published: February 2022

Abstract
Beta-thalassemia is one of the most common monogenic disorders. Standard treatment of the most severe forms, i.e., transfusion-dependent thalassemia (TDT) with long-term transfusion and iron chelation, represents a considerable medical, psychological, and economic burden. Allogeneic hematopoietic stem cell transplantation from an HLA-identical donor is a curative treatment with excellent results in children. Recently, several gene therapy approaches were evaluated in academia or industry-sponsored clinical trials as alternative curative options for children and young adults without an HLA-identical donor. Gene therapy by addition of a functional beta-globin gene using self-inactivating lentiviral vectors in autologous stem cells resulted in transfusion independence for a majority of TDT patients across different age groups and genotypes, with a current follow-up of multiple years. More recently, promising results were reported in TDT patients treated with autologous hematopoietic stem cells edited with the clustered regularly interspaced short palindromic repeats-Cas9 technology targeting erythroid BCL11A expression, a key regulator of the normal switch from fetal to adult globin production. Patients achieved high levels of fetal hemoglobin allowing for discontinuation of transfusions. Despite remarkable clinical efficacy, 2 major hurdles to gene therapy access for TDT patients materialized in 2021: (1) a risk of secondary hematological malignancies that is complex and multifactorial in origin and not limited to the risk of insertional mutagenesis, (2) the cost—even in high-income countries—is leading to the arrest of commercialization in Europe of the first gene therapy medicinal product indicated for TDT despite conditional approval by the European Medicines Agency.