bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between the quality of primary care, insurance coverage, and diabetes-related health outcomes in a cohort of older adults in China: results from the China Health and Retirement Longitudinal Study
Authors: Zhang Adary , Quan Jianchao , Eggleston Karen 
Published: September 2022

ObjectiveThis study aims to identify the association between diabetes diagnosis, health outcomes, insurance scheme, and the quality of county-level primary care in a cohort of older Chinese adults.Design and settingData from the China Health and Retirement Longitudinal Study, a nationally-representative panel survey of people aged 45 and over in China.ParticipantsAmong participants with valid diabetes-related and hypertension-related medical history and biomarkers (n=8207), participants with diabetes (n=1318) were identified using biomarkers and self-reported medical history. Individual models were run using complete case analysis.ResultsAmong 1318 individuals with diabetes in 2011, 59.8% were unaware of their disease status. Diagnosis rates were significantly higher among participants with more generous public health insurance coverage (OR 3.58; 95% CI 2.15 to 5.98) and among those with other comorbidities such as dyslipidemia (OR 2.88; 95% CI 2.03 to 4.09). After adjusting for demographics, individuals with more generous public health insurance coverage did not have better glucose control at 4 years follow-up (OR 0.55; 95% CI 0.26 to 1.18) or fewer inpatient hospital admissions at 4 years (OR 1.29; 95% CI 0.72 to 2.33) and 7 years follow-up (OR 1.12; 95% CI 0.62 to 2.05). Individuals living in counties with better county-level primary care did not have better glucose control at 4 years follow-up (OR 0.69; 95% CI 0.01 to 33.36), although they did have fewer inpatient hospital admissions at 4 years follow-up (OR 0.03; 95% CI 0.00 to 0.95). Diabetes diagnosis was a significant independent predictor of both better glucose control at 4 years follow-up (OR 13.33; 95% CI 8.56 to 20.77) and increased inpatient hospital stays at 4 years (OR 1.72; 95% CI 1.20 to 2.47) and 7 years (OR 1.82; 95% CI 1.28 to 2.58) follow-up.ConclusionsThese findings suggest that participants with diabetes are often diagnosed concurrently with other comorbid disease conditions or after diabetes-related complications have already developed, thus leading to worse health outcomes in subsequent years despite improvements in health associated with better primary care. These findings suggest the importance of strengthening primary care and insurance coverage among older adults to focus on diagnosing and treating diabetes early, in order to prevent avoidable health complications and promote healthy aging.
Incidence and risk factors of gestational diabetes mellitus in Goba town, Southeast Ethiopia: a prospective cohort study
Authors: Atlaw Daniel , Sahiledengle Biniyam , Assefa Tesfaye , Negash Wogene , Tahir Anwar , Regasa Tadele , Tekalegn Yohannes , Mamo Ayele , Enegeda Zinash Teferu , Solomon Damtew , Gezahegn Habtamu , Bekele Kebebe , Zenbaba Demisu , Desta Fikreab , Tasew Alelign , Nugusu Fikadu , Beressa Girma , Shiferaw Zerihun , Feleke Zegeye , Regassa Zegeye , Duguma Negesso , Chattu Vijay Kumar 
Published: September 2022

ObjectiveGestational diabetes mellitus (GDM) is becoming a public health concern in low/middle-income countries, and is known to cause severe morbidity and mortality for mothers and newborns. However, evidence reported for the incidence and risk factors of GDM is scant in Ethiopia. We aimed to assess the incidence of, and risk factors for, GDM in Goba town, Southeast Ethiopia.DesignProspective cohort study.SettingGoba town, Southeast Ethiopia.ParticipantsFour hundred eighty pregnant women on antenatal care follow-up from 30 April to 30 September 2021.Primary and secondary outcomesIncidence and risk factors of GDM using fasting capillary blood glucose. Log-binomial model was used to identify the risk factors of GDM. Adjusted relative risk (aRR), along with 95% CIs, were calculated to estimate the strength of associations.ResultsThe cumulative incidence rate of GDM in this study was 15.7% (95% CI: 12.3% to 19.2%). Being unemployed (aRR=2.73; 95% CI: 1.36 to 5.47), having a family history of diabetes mellitus (DM) (3.01; 2.09 to 4.35), low physical activity (2.43; 1.11 to 5.32), inadequate dietary diversity (1.48; 1.29 to 1.92), anaemia (2.51; 1.32 to 3.54) and antenatal depression (4.95; 3.35 to 7.31) were significantly associated with GDM.ConclusionThe cumulative incidence of GDM was relatively high among the study participants. Having antenatal depression symptoms, low physical activity, inadequate dietary diversity, being unemployed, anaemia and a family history of DM were significant risk factors for GDM.
Patients’ and oncologists’ perceptions towards the discussion on high-cost innovative cancer therapies: findings from a qualitative study
Authors: Bashkin Osnat , Dopelt Keren , Asna Noam 
Published: September 2022

ObjectivesIn the last decades, innovative technologies for cancer treatment were developed rapidly. In most cases, their price is high, with no funding offered by public health systems. The present study examined the perceptions of oncologists, patients and family members regarding the challenges in discussing innovative cancer treatments.DesignQualitative study, using in-depth semistructured interviews. Interviews examined public versus private financing, therapist–patient–family discourse, modes of decision making and implications on health policy and inequalities.ParticipantsSixteen cancer patients, six family members of cancer patients and 16 oncologists participated in the study.ResultsFour themes emerged from data analysis: the economic consideration in the decision on cancer treatment, the options of funding high-cost private treatments, psychosocial aspects of the discussion on treatment costs and health policy in oncology and its social aspects.ConclusionsFindings emphasise the importance of considering costs when recommending expensive care and addressing the emotional element of innovative treatment, as most patients expect. The findings present various psychosocial aspects taking part in the complicated decision to use unfunded cancer treatment and its broad implications, which may use as a basis for developing a guided framework for oncologist–patient discourse.
Economic evaluation of endovascular treatment for acute ischaemic stroke in Thailand
Authors: Rattanavipapong Waranya , Worakijthamrongchai Thanaboon , Soboon Budsadee , Luankongsomchit Vilawan , Kongmuangpuk Mananchaya , Isaranuwatchai Wanrudee , Teerawattananon Yot , Nilanont Yongchai 
Published: September 2022

ObjectivesEndovascular therapy (EVT) has proven to be clinically effective in treating large vessel occlusion acute ischaemic stroke (AIS), either alone or in combination with intravenous alteplase. Despite this, there is a limited evidence on the cost-effectiveness of EVT in Thailand and other low-income and middle-income countries. This study aims to assess whether EVT is a cost-effective therapy for AIS, and to estimate the fiscal burden to the Thai government through budget impact analysis.MethodsAn economic evaluation was performed to compare AIS therapy with and without EVT from a societal perspective. The primary outcome was incremental cost-effectiveness per quality-adjusted life year (QALY) gained. Clinical parameters were derived from both national and international literature, while cost and utility data were collected locally. The analysis applied a cost-effectiveness threshold of 160 000 Baht (~$5000) per QALY, as set by the Thai government.ResultsBoth EVT alone and EVT combined with intravenous alteplase, among patients who are ineligible and eligible for intravenous alteplase, respectively, improved health outcomes but incurred additional cost. The combination of EVT and intravenous alteplase was associated with an incremental cost-effectiveness ratio (ICER) of 146 800 THB per QALY gained compared with intravenous alteplase alone, and the ICER of EVT alone compared with supportive care among patients ineligible for intravenous alteplase was estimated at 115 000 THB per QALY gained. Sensitivity analysis showed that the price of EVT has the greatest impact on model outcomes. Over a time horizon of 5 years, the introduction of EVT into the Thai health benefit package would require an additional budget of 887 million THB, assuming 2000 new cases per year.ConclusionsEVT represents good value for money in the Thai context, both when provided to patients eligible for intravenous alteplase, and when provided alone to those who are ineligible for intravenous alteplase.
Anterior quadratus lumborum block does not reduce postoperative opioid consumption following laparoscopic hemicolectomy: a randomized, double-blind, controlled trial in an ERAS setting
Authors: Tanggaard Katrine , Hasselager Rune Petring , Hølmich Emma Rosenkrantz , Hansen Christian , Dam Mette , Poulsen Troels Dirch , Bærentzen Finn Østergård , Eriksen Jens Ravn , Gögenur Ismail , Børglum Jens 
Published: September 2022

Background and aimsAn opioid-sparing postoperative analgesic regimen following laparoscopic hemicolectomy is optimal to promote minimal postoperative pain, early mobilization, and improved quality of recovery. Various regional anesthesia techniques have been tested to improve postoperative pain management after laparoscopic hemicolectomy. In this study, we aimed to assess the effect of administering a preoperative bilateral ultrasound-guided anterior quadratus lumborum nerve block on postoperative opioid consumption after laparoscopic colon cancer surgery.MethodsIn this randomized, controlled, double-blinded trial, 69 patients undergoing laparoscopic hemicolectomy due to colon cancer were randomized to receive an anterior quadratus lumborum block with ropivacaine 0.375% 30 mL on each side or isotonic saline (placebo). The primary outcome measure was total opioid consumption during the first 24 hours postsurgery. The secondary outcome measures were pain scores, accumulated opioid consumption in 6-hour intervals, nausea and vomiting, ability of postoperative ambulation, time to first opioid, orthostatic hypotension or intolerance, postoperative Quality of Recovery-15 scores, surgical complications, length of hospital stay, and adverse events.ResultsThe total opioid consumption in the first 24 hours postsurgery was not significantly reduced in the ropivacaine group compared with the saline group (mean 129 mg (SD 88.4) vs mean 127.2 mg (SD 89.9), p=0.93). In addition, no secondary outcome measures showed any statistically significant intergroup differences.ConclusionThe administration of a preoperative bilateral anterior quadratus lumborum nerve block as part of a multimodal analgesic regimen for laparoscopic hemicolectomy did not significantly reduce opioid consumption 24 hours postsurgery.Trial registration numberNCT03570541.
Palliative care phenotypes among critically ill patients and family members: intensive care unit prospective cohort study
Authors: Cox Christopher E , Olsen Maren K , Parish Alice , Gu Jessie , Ashana Deepshikha Charan , Pratt Elias H , Haines Krista , Ma Jessica , Casarett David J , Al-Hegelan Mashael S , Naglee Colleen , Katz Jason N , O’Keefe Yasmin Ali , Harrison Robert W , Riley Isaretta L , Bermejo Santos , Dempsey Katelyn , Wolery Shayna , Jaggers Jennie , Johnson Kimberly S , Docherty Sharron L 
Published: September 2022

ObjectiveBecause the heterogeneity of patients in intensive care units (ICUs) and family members represents a challenge to palliative care delivery, we aimed to determine if distinct phenotypes of palliative care needs exist.MethodsProspective cohort study conducted among family members of adult patients undergoing mechanical ventilation in six medical and surgical ICUs. The primary outcome was palliative care need measured by the Needs at the End-of-Life Screening Tool (NEST, range from 0 (no need) to 130 (highest need)) completed 3 days after ICU admission. We also assessed quality of communication, clinician–family relationship and patient centredness of care. Latent class analysis of the NEST’s 13 items was used to identify groups with similar patterns of serious palliative care needs.ResultsAmong 257 family members, latent class analysis yielded a four-class model including complex communication needs (n=26, 10%; median NEST score 68.0), family spiritual and cultural needs (n=21, 8%; 40.0) and patient and family stress needs (n=43, 31%; 31.0), as well as a fourth group with fewer serious needs (n=167, 65%; 14.0). Interclass differences existed in quality of communication (median range 4.0–10.0, p<0.001), favourable clinician–family relationship (range 34.6%–98.2%, p<0.001) and both the patient centredness of care Eliciting Concerns (median range 4.0–5.0, p<0.001) and Decision-Making (median range 2.3–4.5, p<0.001) scales.ConclusionsFour novel phenotypes of palliative care need were identified among ICU family members with distinct differences in the severity of needs and perceived quality of the clinician–family interaction. Knowledge of need class may help to inform the development of more person-centred models of ICU-based palliative care.
Adult Atlantic salmon (Salmo salar) delayed below dams rapidly deplete energy stores
Authors: Rubenstein Sarah R. , Peterson Erin , Christman Paul , Zydlewski Joseph D. 
Published: September 2022

Atlantic salmon ( Salmo salar) return to rivers in spring for an energetically costly upstream migration for spawning. These fish are often delayed in the lower river below dams, subjecting them to warmer waters than occur in upstream sections of river, that may increase metabolic costs. We sought to quantify the energetic cost of dam-mediated delays in migrating adults in the Penobscot and Kennebec rivers, ME. We radio-tagged fish at the lower most dams, released them downstream (18 and 14 km), and tracked their movements back upstream. We used a Distell Fish Fatmeter as a noninvasive measurement of full-body energy at tagging and then again after re-ascending the fish-way at the dams. We found that adults ( n = 99) experienced average delays of 16–23 days at dams, losing 11%–22% of initial fat reserves. Using linear regressions, we showed thermal experience as a strong predictor of fat loss. Delay time was also a contributing factor. Extensive delays at dams expose migrating Atlantic salmon to warmer temperatures and increase the depletion rate of energy reserves required for spawning and post-spawn survival.
Wnt/β-catenin inhibitor pyrivinium attenuates cisplatin-induced acute kidney injury by possibly reducing platinum uptake and accumulation mediated by reduced organic cation transporter-2 expressions
Authors: Pandey Sneha , Gupta Kirti , Bagang Newly , Singh Gaaminepreet , Rajput Sakshi 
Published: September 2022

Aberrant activation of Wnt/β-catenin induces renal dysfunction by initiating pro-apoptotic cascades, fibrosis, oxidative and inflammatory burden. This study tested the therapeutic effects of Wnt/β-catenin inhibitor pyrvinium against cisplatin-induced acute kidney injury (AKI) in rats. Cisplatin was administered at a single dose of 5 mg/kg (i.p.) and renal cisplatin accumulation and uptake in cortical slices were determined after the fifth day by atomic absorption spectroscopy. Levels of pro-inflammatory cytokines were checked by ELISA, and organic cation transporter-2 (OCT-2) transcription and expression in renal tissue were evaluated by RT-PCR and immunohistochemical technique. Cisplatin administration produced renal dysfunction manifested as increase in serum creatinine, blood urea nitrogen, proteinuria, reduced clearance and electrolyte imbalance. Oxidative stress indices, pro-inflammatory cytokines, fibronectin, and caspase-3 activity were elevated in cisplatin-challenged rats. Moreover, increased renal OCT-2 transcription and immunostaining were detected in cisplatin kidneys which resulted in platinum accumulation. Additional docking studies depicted strong interaction between the β-catenin and OCT-2 protein. These manifestations induced mitochondrial dysfunction, histological damage and fibrosis. Notably, Wnt/β-catenin inhibitor pyrvinium (60 µg/kg; p.o.) treatment reduced the renal OCT-2 gene transcription causing a decline in platinum levels. Thus, the present study concludes that Wnt/β-catenin inhibition attenuates cisplatin-induced AKI in rats, partly by down-regulating OCT-2 expression.
Orai1 Inhibitors as Potential Treatments for Pulmonary Arterial Hypertension
Authors: Masson Bastien , Le Ribeuz Hélène , Sabourin Jessica , Laubry Loann , Woodhouse Emily , Foster Richard , Ruchon Yann , Dutheil Mary , Boët Angèle , Ghigna Maria-Rosa , De Montpreville Vincent Thomas , Mercier Olaf , Beech David J. , Benitah Jean-Pierre , Bailey Marc A. , Humbert Marc , Montani David , Capuano Véronique , Antigny Fabrice 
Published: September 2022

Background:

Pulmonary arterial hypertension (PAH) is characterized by progressive distal pulmonary artery (PA) obstruction, leading to right ventricular hypertrophy and failure. Exacerbated intracellular calcium (Ca
2+
) signaling contributes to abnormalities in PA smooth muscle cells (PASMCs), including aberrant proliferation, apoptosis resistance, exacerbated migration, and arterial contractility. Store-operated Ca
2+
entry is involved in Ca
2+
homeostasis in PASMCs, but its properties in PAH are unclear.

Methods:

Using a combination of Ca
2+
imaging, molecular biology, in vitro, ex vivo, and in vivo approaches, we investigated the roles of the Orai1 SOC channel in PA remodeling in PAH and determined the consequences of pharmacological Orai1 inhibition in vivo using experimental models of pulmonary hypertension (PH).

Results:

Store-operated Ca
2+
entry and Orai1 mRNA and protein were increased in human PASMCs (hPASMCs) from patients with PAH (PAH-hPASMCs). We found that MEK1/2 (mitogen-activated protein kinase kinase 1/2), NFAT (nuclear factor of activated T cells), and NFκB (nuclear factor-kappa B) contribute to the upregulation of Orai1 expression in PAH-hPASMCs. Using small interfering RNA (siRNA) and Orai1 inhibitors, we found that Orai1 inhibition reduced store-operated Ca
2+
entry, mitochondrial Ca
2+
uptake, aberrant proliferation, apoptosis resistance, migration, and excessive calcineurin activity in PAH-hPASMCs. Orai1 inhibitors reduced agonist-evoked constriction in human PAs. In experimental rat models of PH evoked by chronic hypoxia, monocrotaline, or Sugen/hypoxia, administration of Orai1 inhibitors (N-{4-[3,5-bis(Trifluoromethyl)-1H-pyrazol-1-yl]phenyl}-4-methyl-1,2,3-thiadiazole-5-carboxamide [BTP2], 4-(2,5-dimethoxyphenyl)-N-[(pyridin-4-yl)methyl]aniline [JPIII], or 5J4) protected against PH.

Conclusions:
In human PAH and experimental PH, Orai1 expression and activity are increased. Orai1 inhibition normalizes the PAH-hPASMCs phenotype and attenuates PH in rat models. These results suggest that Orai1 should be considered as a relevant therapeutic target for PAH.
Understanding the Policies of the brics Countries in R2P Cases: An English School Perspective
Authors: Tüzgen Nilay , Gök Gonca Oğuz 
Published: September 2022

Abstract
This article’s main aim is to evaluate the position of brics ‘as a group’ towards the Responsibility to Protect (r2p) norm by locating it in the framework of the English School’s pluralist versus solidarist debate. It traces the pluralist and solidarist elements in brics discourses and decisions towards r2p by scrutinising the content of the ten brics summit declarations between 2011 and 2020 and the voting of brics members on UN Security Council resolutions regarding seven cases involving atrocity crimes (Syria, Yemen, Mali, Ivory Coast, Central African Republic, South Sudan, Libya) discussed at the UN Security Council. The article argues that although there is an obvious quantitative increase in brics common pluralist agenda, they do not demonstrate group solidarity in practice and have not yet socialised to act as a group on the r2p as a key norm of global governance. Therefore, their position as a group towards r2p could best be framed as ‘Charter solidarism’ in principle per se, not in practice.
Avoidance of Overt Precipitation and Patient Harm Following Errant Y‐Site Administration of Calcium Chloride and Parenteral Nutrition Compounded With Sodium Glycerophosphate
Authors: Anderson Collin , Stidham Chanelle , Boehme Sabrina , Cash Jared 
Published: September 2022

AbstractCalcium phosphate precipitates present 1 of many challenges associated with parenteral nutrition (PN) compounding. Extensive research has led to the establishment of solubility curves to guide practitioners in the prescription and preparation of stable PN. Concurrent dosing of intravenous products via y‐site administration with PN can alter the chemical balance of the solution and modify solubility. Medications containing calcium or phosphate should not be administered in the same line as PN, due to the high potential for precipitation. Herein a case is reported from a pediatric cardiac intensive care unit where a physician ordered the administration of calcium chloride. The bedside nurse added the calcium chloride intermittent infusion as a y‐site administration with the patient’s PN. The patient’s PN had been compounded with sodium glycerophosphate, temporarily available in the United States during a sodium phosphate shortage. The patient did not experience any observable adverse effects from the y‐site administration with PN. Following this event, the scenario was replicated to investigate any precipitation risk associated with the y‐site administration. Additionally, a separate PN solution containing sodium phosphate rather than glycerophosphate was compounded and used in a laboratory setting to demonstrate the potential for harm had the patient’s PN been compounded with an inorganic phosphate source. This replication of the error demonstrates the additional safety gained in relation to precipitation risk when PN solutions are compounded with sodium glycerophosphate in place of sodium phosphate.
Strategies for the Enhancement of Nutrition Practice in a New York State Level 1 Trauma Center: A Hospital’s Journey
Authors: Musillo Lisa , Grguric Laryssa Marie , Coffield Edward , Aversano Frank , Bosworth Jeremy , Batista Richard 
Published: September 2022

AbstractBackground: Provision of enteral nutrition (EN) support is historically inadequate in the critically ill population. An interdisciplinary approach utilizing various strategies has been shown to improve initiation of timely EN support. The purpose of this study was to examine whether the implementation of a series of interventions led by an interdisciplinary team was associated with changes in the initiation of nutrition support in a level 1 trauma center. Methods: Patients admitted between 2009 and 2013 with isolated closed head trauma injuries were identified through the hospital’s trauma center database. The initial population consisted of 159 patients; after exclusion criteria, 141 patients were included in the statistical analyses. Two statistical analyses were conducted. The first calculated the average days to the initiation of nutrition start by admission year. The second estimated the association between admission year and time to nutrition initiation with a generalized linear model. Results: Time to initiate nutrition therapy was estimated to decrease by 1.46 days (47.31%) from 2009 to 2013. The time to initiate nutrition in 2013 was 1.63 days. A significant association was found between the time to initiate nutrition and the 2012 and 2013 binary variables while controlling for confounding variables. The time frame was estimated to be 1.09 (P = .008) and 1.75 (P = .000) days shorter in 2012 and 2013 relative to 2009. Conclusions: An interdisciplinary effort utilizing multiple strategies identified and addressed barriers, resulting in a reduction of variability and a proactive approach to early EN.