Study Participants Research Articles

COVID-19 Incidence, Risk Factors, Impact, and Related Stigma Among a Cohort of Persons With HIV in Washington, DC.

Studies on the incidence of COVID-19 among persons with HIV (PWHs) present varied results. Few studies have investigated the impact of COVID-19 infection on health and socioeconomic factors or COVID-19 stigma. We sought to measure the incidence and severity of COVID-19 infection among a cohort of PWHs, characterize associated risk factors and impact, and document perceptions of COVID-19-related stigma. Data for this cross-sectional study come from the COVID-19 survey of participants in the DC Cohort longitudinal study from October 30, 2020, through December 31, 2022. Survey results were linked to electronic health records, including HIV laboratory test results and COVID test results. We conducted analyses comparing demographic, socioeconomic, HIV measures, and stigma among those with and without self-reported COVID-19. Of 1972 survey respondents, 17% self-reported COVID-19 infection, with the greatest incidence in the Omicron wave of the pandemic. We found statistically significant differences by age, employment status, essential worker status, education, and household income. Longer duration of HIV diagnosis was associated with greater incidence of COVID-19. PWHs who were overweight or obese had a greater incidence of COVID-19 compared with those who were not. Over 40% of PWHs with COVID-19 reported experiencing at least 1 form of COVID-19-related stigma. We observed a high incidence of COVID-19 infection among PWHs in DC. Furthermore, a substantial proportion of PWHs with COVID-19 reported experiencing COVID-19-related stigma. These findings add to the existing literature on COVID-19 coinfection among PWHs and highlight the need for awareness and support for those experiencing COVID-19 stigma.

A plain language summary of the results from the phase 2b HERIZON-BTC-01 study of zanidatamab in participants with HER2-amplified biliary tract cancer.

Researchers wanted to study whether the research drug zanidatamab could help people with a type of cancer called biliary tract cancer. In some people, biliary tract cancer cells make extra copies of a gene called HER2 (also called ERBB2). This is known as being HER2-amplified. Zanidatamab is an antibody designed to destroy cancer cells that have higher-than-normal HER2 protein or gene levels. Zanidatamab is currently under research and is not yet approved for any diseases. Participants in this phase 2b clinical study had tumors that were HER2-amplified and at the advanced or metastatic stage. Participants also had cancer which had become worse after previous chemotherapy or had side effects that were too bad to continue chemotherapy. They also had to meet other requirements to be enrolled. Researchers measured the amount of HER2 protein in the tumor samples of the participants who were enrolled. There were 80 participants with tumors that were both HER2 amplified and had higher-than-normal HER2 protein amounts (considered to be 'HER2-positive'). There were 7 participants with tumors that were HER2-amplified, but had little-to-no levels of the HER2 protein (considered to be 'HER2-low'). All participants in the study were treated with zanidatamab and no other cancer treatments once every 2weeks. In the HER2-positive group, 33 of 80 (41%) participants had their tumors shrink by 30% or more of their original size. In half of these participants, their tumors did not grow for 13months or longer. No participant in the HER2-low group had their tumors shrink by 30% or more. In total, 63 of 87 participants (72%) had at least one side effect believed to be related to zanidatamab treatment. Most side effects were mild or moderate in severity. No participant died from complications related to zanidatamab. Diarrhea was one of the more common side effects and was experienced by 32 of 87 participants (37%). Side effects related to receiving zanidatamab through the vein, such as chills, fever, or high blood pressure, were experienced by 29 of 87 participants (33%). The results of this study support the potential for zanidatamab as a new therapy for people with HER2-positive biliary tract cancer after they had already received chemotherapy. More research is occurring to support these results.Clinical Trial Registration: NCT04466891 (HERIZON-BTC-01 study).

Management of acute uncomplicated diverticulitis and adherence to current guidelines-a multicentre SNAPSHOT study.

To explore whether previous participation in clinical studies increases adherence to management guidelines in acute uncomplicated diverticulitis (AUD). This retrospective cohort study was designed to give a SNAPSHOT of the management of AUD at six hospitals, three of which had participated in the AVOD trial comparing antibiotic versus non-antibiotic treatment of AUD. Patients with AUD were included from March 2019 through June 2020 and followed for 90days. The primary outcome was treatment of AUD categorised by antibiotic treatment and inpatient or outpatient management compared between AVOD and non-AVOD hospitals. Descriptive statistics were compiled, and differences between hospitals were assessed with Pearson's chi-squared test. The cohort included 449 patients with AUD of which 63% were women and the median age was 63 (IQR: 52-73) years. Patient characteristics were comparable across the hospitals. Antibiotics were administered to 84 (19%) patients and 113 (25%) patients were managed as inpatients. Management varied significantly between AVOD and non-AVOD hospitals. The mean proportion of patients treated with antibiotics was 7% at AVOD hospitals compared to 38% at non-AVOD hospitals (p < 0.001). The mean proportion of in-hospital management was 18% at AVOD hospitals versus 38% at non-AVOD hospitals (p < 0.001). Most patients with AUD were managed according to current guidelines. However, the management varies between hospitals and previous participation in clinical studies may increase knowledge of and adherence to guidelines.

Outcome of intradiscal condoliase injection therapy for patients with recurrent lumbar disc herniation.

Retrospective cohort study. This study aimed to compare data from patients who received intradiscal condoliase (chondroitin sulfate ABC endolyase) injection for primary lumbar disc herniation (LDH) and recurrent LDH. Chemonucleolysis with condoliase for LDH is a treatment with relatively good results and a high safety profile; however, few studies have reported recurrence after LDH surgery. The study participants were 249 patients who underwent intradiscal condoliase injection for LDH at nine participating institutions, including 241 patients with initial LDH (group C) and eight with recurrent LDH (group R). Patient characteristics including age, sex, body mass index, disease duration, intervertebral LDH level, smoking history, and diabetes history were evaluated. Low back pain/leg pain Numerical Rating Scale (NRS) scores and the Oswestry Disability Index (ODI) were used to evaluate clinical symptoms before treatment and at 6 months and 1 year after treatment. Low back pain NRS scores (before treatment and at 6 months and 1 year after treatment, respectively) in group C (4.9 → 2.6 → 1.8) showed significant improvement until 1 year after treatment. Although a tendency for improvement was observed in group R (3.5 → 2.8 → 2.2), no significant difference was noted. Groups C (6.6 → 2.4 → 1.4) and R (7.0 → 3.1 → 3.2) showed significant improvement in the leg pain NRS scores after treatment. Group C (41.4 → 19.5 → 13.7) demonstrated significant improvement in the ODI up to 1 year after treatment; however, no significant difference was found in group R (35.7 → 31.7 → 26.4). Although intradiscal condoliase injection is less effective for LDH recurrence than for initial cases, it is useful for improving leg pain and can be considered a minimally invasive and safe treatment method.

Informality, affordability, and mortgage stress during the COVID-19 pandemic: A mixed-methods study of urban low-income households in Mumbai’s periphery

ABSTRACT The preexisting global urban housing affordability crisis worsened during the COVID-19 pandemic. Within nations, households belonging to various socioeconomic strata differentially experienced housing affordability issues, with the low-income households disproportionately bearing the affordability stress compared to the higher-income households. We use a mixed-methods approach to investigate the consequences of COVID-19-induced mortgage stress in 154 low-income homebuyers living in the periphery of the Mumbai Metropolitan Region in India. We draw upon the Conservation of Resources theory to study the stress outcomes due to affordability issues and understand its linkages with household financial wellbeing. A quantitative survey of 154 study participants revealed a significant relationship between mortgage stress and financial well-being mediated by financial stress. Further, qualitative analysis of in-depth interviews of 16 study participants using a comparative lens suggested that the pandemic-induced affordability issues disproportionately affected households with informal employment. Overall, the findings highlight a dynamic nature of affordability and its peculiar interplay with informality, emphasizing the urgency to reorient housing policies toward affordability and informality issues.

Changes in roles and feelings among "Kaigoyobou leaders" responsible for community prevention activities over 10 years

Objectives Community residents experience changes over time, including those in the care prevention system, governmental expectations, and their motivations. To support community-based prevention activities, it is necessary to clarify these changes. This study used a qualitative research method to examine changes in roles and feelings among "Kaigoyobou leaders" who had been involved in community-based care prevention activities for 10 years.Methods The study participants were nine leaders (six men and three women) who had been active in community-based care prevention for approximately 10 years. Through one-hour semi-structured interviews, we explored their current activities, reasons for taking the leader training course, changes in the content of their activities since completing the course, changes in their roles in activities and feelings about the activities, and what they recognized as important in their activities. Interviews were transcribed verbatim and analyzed using a modified grounded theory approach. From the transcripts, we extracted "concepts" related to changes among the leaders and generated "categories" to summarize the concepts.Results The analysis identified 28 concepts summarized into 12 categories. The categories included: "belief in the activities" (e.g., "focusing on preventive effects"), "learning through trial and error" (e.g., "learning continuously"), "developing the activities" (e.g., "expanding the activities"), "commitment to the community" (e.g., "valuing connections with people involved in the activities"), "increasing required roles" (e.g., "taking consultations from juniors"), "relationship with the government" (e.g., "responding to requests from the government"), "benefits from the activities" (e.g., "receiving a sense of accomplishment and satisfaction from the activities"), "burden due to the activities" (e.g., "a shortage of group members"), "aging of stakeholders" (e.g., "increasing age of the participants"), "preparing for continuity" (e.g., "new people wishing to participate"), "considering ending activities" (e.g., "reducing activities due to increasing age of the leaders themselves"), and "impact of the coronavirus."Conclusion Leaders' strong belief in their activities and their ability to adapt based on successful experiences were crucial. They responded effectively to environmental changes, including evolving government relationships. Fostering leadership belief, highlighting the benefits of activities, and supporting collaborative responses to environmental changes are essential for ongoing success.

Mutant Huntingtin Drives Development of an Advantageous Brain Early in Life: Evidence in Support of Antagonistic Pleiotropy.

Huntington's disease (HD) is a neurodegenerative disease caused by a triplet repeat expansion within the gene huntingtin (HTT). Antagonistic pleiotropy is a theory of aging that posits that some genes, facilitating individual fitness early in life through adaptive evolutionary changes, also augment detrimental aging-related processes. Antagonistic pleiotropy theory may explain a positive evolutionary pressure toward functionally advantageous brain development that is vulnerable to rapid degeneration. The current study investigated antagonistic pleiotropy in HD using a years-to-onset paradigm in a unique sample of children and young adults at risk for HD. Cognitive, behavioral, motor, and brain structural measures from premanifest gene-expanded (n = 79) and gene nonexpanded (n = 112) participants (6-21 years) in the Kids-HD study were examined. All measures in the gene-expanded group were modeled using a mixed-effects regression approach to assess years-to-onset-based changes while controlling for normal growth. Simultaneously, structure-function associations were also examined. Decades from motor onset, gene-expanded participants showed significantly better cognitive, behavioral, and motor scores versus gene nonexpanded controls, along with larger cerebral volumes and cortical features. After this initial peak, a prolonged deterioration was observed in both functional and structural measures. Far from onset, brain measures were positively correlated with functional measures, supporting the view that functional advantages were mediated by structural differences. Mutant HTT may drive the development of a larger than normal brain that subserves superior early-life function. These findings support the antagonistic pleiotropy theory of HTT in HD, where this gene drives early advantage followed by accelerated aging processes. ANN NEUROL 2024.

Community Integration Challenges of Men and Women After Traumatic Brain Injury: A Reflexive Thematic Analysis of Lived Experiences Through a Gender Lens.

To investigate community integration (CI) challenges following traumatic brain injury (TBI) through a gender lens. Rehabilitation research-teaching hospital. Adult participants (22 men and 20 women) with a primary diagnosis of mild or moderate-severe TBI, in the acute or chronic stages after injury, were recruited using purposive sampling. Qualitative study. Data were collected through semistructured interviews, and thematic analysis was used to identify themes of CI challenges. Three overarching themes emerged: (1) lack of a "graduated home plan": difficulty enacting gendered roles and responsibilities at home, (2) "Something that I cannot handle": mismatch between occupational demands and abilities, and (3) "Slipping away": disrupted connections with self and others. Men consistently voiced struggles with and inability to fulfill household tasks, whereas women detailed ways of adapting domestic responsibilities because of postinjury limitations. Productivity challenges resonated with a substantial number of participants, and a gendered pattern was observed: More women reported an inability, whereas more men reported a limited ability to meet occupational demands. Both genders conveyed disruptions in recreational and leisure activities, although women predominantly discussed challenges relating to social activities and men a tendency to avoid social situations because of anticipated stigma and/or shame. Across all themes, a pervasive sense of diminished community contributions and disrupted identities was observed. The incongruence between preinjury roles and responsibilities and postinjury abilities resulted in difficulties across multiple CI domains for the study participants and did not go unnoticed by them. It is important for health care professionals to assist patients in addressing gendered challenges at home, work, and in the social circle for a smoother transition back into the community.

Impact of a community-based participatory research project with underserved communities at risk for hepatitis C virus in Ho Chi Minh City, Vietnam: an evaluation study

BackgroundParticipatory approaches have become a widely applied research approach. Despite their popularity, there are many challenges associated with the evaluation of participatory projects. Here we describe an evaluation of a community-based participatory research study of underserved communities in Ho Chi Minh City (HCMC), Vietnam at risk for hepatitis C virus. The goals of our evaluation were to explore the main benefits and challenges of implementing and participating in a participatory study and to describe study impacts.MethodsWe conducted two meetings with leaders and members of the participating groups followed by in-depth interviews with 10 participants. We then held a dissemination meeting with over 70 participants, including the representatives of each group, researchers from non-governmental organizations (community-based, national and international), and govenrment officials from the Vietnam Ministry of Health and the Department of Health of HCMC.ResultsResults include four categories where we describe first the participatory impacts, followed by the collaborative impacts. Then we describe the benefits and challenges of creating and belonging to one of the groups, from members’ and leaders’ points of view. Finally, we describe the key suggestions that participants provided for future research.ConclusionIn conclusion, the evaluation approach led to both a research reflection on the ‘success’ of the project and enabled participants themselves to reflect on the outcomes and benefits of the study from their point of view.

TLR8 is expressed in monocytes in contrast to plasmacytoid dendritic cells and mediates aberrant IL-10 responses in patients with systemic sclerosis (SSc).

Systemic sclerosis (SSc) is a severe rheumatic disease, causing fibrotic tissue rearrangement. Aberrant Toll-like receptor 8 (TLR8) transcripts in plasmacytoid dendritic cells (pDC) were recently linked to SSc pathogenesis, which is at least partially mediated by increased type I interferon (IFN-I) responses. Here, we addressed the functional role of TLR8 signaling in different immune cell subsets of patients with SSc. Monocytes, conventional dendritic cells (cDC), and pDC, from blood and skin of patients with SSc were analyzed for TLR8 protein expression. To assess TLR function, cytokine responses upon TLR7 and TLR8 stimulation were studied. To identify relevant alterations specific for SSc (n=16), patients with primary Sjögren's syndrome (pSS) (n=10) and healthy controls (HC) (n=13) were included into the study. In all individuals, TLR8 was expressed in monocytes and cDC, but not in pDC. The TLR8 expression levels were overall similar in patients with SSc, pSS, and HC. Additionally, in all study participants, TLR8 stimulation of pDC did not induce IFN-I expression. In contrast, monocytes from patients with SSc revealed increased interleukin-10 (IL-10) responses upon TLR8 (SSc vs.HC: p=0.0126) and TLR7/8 stimulation (SSc vs. HC: p=0.0170). TLR8 protein is not expressed in pDC of patients with SSc. Accordingly, they do not respond to TLR8 stimulation. In contrast, monocytes of patients with SSc respond to TLR8 stimulation with increased IL-10 responses. Therefore, TLR8 signaling in monocytes participates in SSc pathogenesis by conferring aberrant IL-10 expression.

Effect of simulation-based emergency airway management education on the knowledge, skills and perceived confidence of medical interns

Background: An effective airway management education program is a crucial part of the undergraduate medical education curriculum. Theoretical instructions and practical demonstrations are the major modalities of medical education in Nepal. Simulation-based education (SBE) programs have not yet been implemented effectively. We aimed to determine the effects of an SBE program on the knowledge, skills, and perceived confidence of medical interns regarding emergency airway management. Methods: This mixed methods study comprised both quantitative and qualitative components. The study participants were 47 medical interns who had participated in the SBE program. Results: The mean age of the 47 participants was 24.74 years. There were 33 (70.21%) male and 14 (29.79%) female participants. The knowledge, skills, and perceived confidence scores of the participants for airway management preparation, basic airway management, endotracheal intubation, and laryngeal mask airway (LMA) insertion improved significantly following the SBE program (P&lt;0.001). Analysis of the participants’ feedback indicated that they largely approved of the SBE program. The majority of students and faculty expressed a willingness to include similar programs in the undergraduate medical education curriculum. Conclusion: This study demonstrated through quantitative and qualitative metrics that SBE can enhance the knowledge, skills, and perceived confidence in performing emergency airway management among medical interns. We recommend measures to include and effectively implement SBE in the undergraduate medical education curriculum of Nepal.

Public value judgments about the criteria for reimbursement of medicines in South Korea

ABSTRACT Objectives This study quantified the public value (PV) of the criteria and sub-criteria in the current drug reimbursement systems in South Korea and examined sociodemographic factors that associated with PV. Methods The Analytic Hierarchy Process (AHP) was used to quantify the PVs of criteria and sub-criteria. We developed a questionnaire to generate pairwise comparison matrices among criteria and sub-criteria. From 27 March to 1 April 2023, we recruited 1,000 study participants using a quota sampling method stratified by age, sex, and region based on Korean census data. Results The PVs for the criteria were highest for clinical usefulness (28.5%), followed by cost-effectiveness (27.1%), budget impact (24.3%), and reimbursement in other countries (20.1%). The sociodemographic characteristics of the participants had a significant impact on the PVs of the criteria. Willingness to pay additional premiums for national health insurance was negatively associated with PV for clinical usefulness and cost-effectiveness and positively associated with PV for reimbursement in other countries. Conclusions The public prioritized clinical usefulness and cost-effectiveness as the main criteria. However, the PVs of the criteria were divergent and associated with sociodemographic factors. Divergent public interests require an evidence-informed deliberative process for reimbursement decisions.

Continuous Monitoring of Heart Rate Variability in Free-Living Conditions Using Wearable Sensors: Exploratory Observational Study.

Wearable physiological monitoring devices are promising tools for remote monitoring and early detection of potential health changes of interest. The widespread adoption of such an approach across communities and over long periods of time will require an automated data platform for collecting, processing, and analyzing relevant health information. In this study, we explore prospective monitoring of individual health through an automated data collection, metrics extraction, and health anomaly analysis pipeline in free-living conditions over a continuous monitoring period of several months with a focus on viral respiratory infections, such as influenza or COVID-19. A total of 59 participants provided smartwatch data and health symptom and illness reports daily over an 8-month window. Physiological and activity data from photoplethysmography sensors, including high-resolution interbeat interval (IBI) and step counts, were uploaded directly from Garmin Fenix 6 smartwatches and processed automatically in the cloud using a stand-alone, open-source analytical engine. Health risk scores were computed based on a deviation in heart rate and heart rate variability metrics from each individual's activity-matched baseline values, and scores exceeding a predefined threshold were checked for corresponding symptoms or illness reports. Conversely, reports of viral respiratory illnesses in health survey responses were also checked for corresponding changes in health risk scores to qualitatively assess the risk score as an indicator of acute respiratory health anomalies. The median average percentage of sensor data provided per day indicating smartwatch wear compliance was 70%, and survey responses indicating health reporting compliance was 46%. A total of 29 elevated health risk scores were detected, of which 12 (41%) had concurrent survey data and indicated a health symptom or illness. A total of 21 influenza or COVID-19 illnesses were reported by study participants; 9 (43%) of these reports had concurrent smartwatch data, of which 6 (67%) had an increase in health risk score. We demonstrate a protocol for data collection, extraction of heart rate and heart rate variability metrics, and prospective analysis that is compatible with near real-time health assessment using wearable sensors for continuous monitoring. The modular platform for data collection and analysis allows for a choice of different wearable sensors and algorithms. Here, we demonstrate its implementation in the collection of high-fidelity IBI data from Garmin Fenix 6 smartwatches worn by individuals in free-living conditions, and the prospective, near real-time analysis of the data, culminating in the calculation of health risk scores. To our knowledge, this study demonstrates for the first time the feasibility of measuring high-resolution heart IBI and step count using smartwatches in near real time for respiratory illness detection over a long-term monitoring period in free-living conditions.

Evaluation of a group-based online informed consent conversation (eConsent) in participants from a low-risk vaccination clinical trial

BackgroundElectronic informed consent (eConsent) usage has expanded in recent years in Europe, especially during the pandemic. Slow recruitment rate and limitations in participant outreach are the challenges often faced in clinical research. Given the benefits of eConsent and group counselling reported in the literature, group eConsent was implemented in recruitment for the SWITCH-ON study. We aim to explore the experience of participants who attended group eConsent for the SWITCH-ON study and evaluate its potential for future use.MethodsSWITCH-ON study aims to analyse the immunogenicity of a healthy population following bivalent COVID-19 booster vaccination. Four hundred thirty-four healthcare workers aged 18–65 were successfully recruited and sent a questionnaire about their experience with group eConsent. Out of 399 completed questionnaires (response rate 92%), 39 participants did not join group eConsent. The remaining 360 responses were included in the final analysis. Quantitative and qualitative data were reported using descriptive statistical analysis and thematic analysis respectively.ResultsParticipants found that group eConsent was an efficient method that it allowed them to hear each other’s questions and concerns and created a sense of togetherness. However, limited privacy, barriers to asking questions in a group, and peer pressure can limit the use of group eConsent. One hundred sixty-five (46%) participants thought that group eConsent was suitable to recruit participants with diseases or conditions, while 87 (24%) reported limitations with this method. The remaining participants suggested that applicability of group eConsent depended on the diseases or conditions of the study population, and one-to-one conversation should always be available. Participants who had experienced both one-to-one and group eConsent shared different preferred consent formats for future studies.ConclusionGroup eConsent was positively evaluated by the participants of a low-risk vaccination study. Participants advised using webinars to provide general information about the study, followed by an individual session for each participant, would retain the benefits of group eConsent and minimise the limitations it posed. This proposed setting addresses privacy questions and makes group eConsent easier to implement.Trial registrationClinicalTrials.gov NCT05471440 (registered on 22nd of July, 2022).

A Falls Prevention Program for People After Stroke in Guyana: An International Collaboration.

The objective was to describe the social, environmental, and cultural adaptations to an existing falls program and assess acceptability and preliminary effectiveness of the program in reducing fear, reducing falls, and improving function among individuals poststroke in Guyana. A quasi-experimental pilot study with a pretest/ posttest in-group design was developed through a collaboration of researchers in Guyana and the US. Participants took part in the falls prevention program for 8weeks. Outcome measures included a 10-meter walk test, Five Times Sit to Stand, and subjective questionnaires for falls incidence and balance confidence at the beginning and end. Twenty participants completed the study. One participant experienced medical complications and their data were excluded from analysis. Fifteen participants (78.9%) demonstrated improvements in comfortable and fast walking speed. Twelve participants completed the Five Times Sit to Stand Test. Eleven (91.67%) improved their time at posttest, with 9 (81.8%) demonstrating a clinically important improvement. Nineteen participants had sustained at least 1 fall prior to the study. Only 1 participant reported a fall during the program. Initially, the majority of participants (11/19) were very concerned about falling. At the end, only 1 was very concerned about falling, and the majority (15/19) were not concerned at all. Post-test surveys of participants indicated acceptability of the program. This pilot program helped reduce fall risk and improve confidence, gait speed and community mobility of the study participants. Future research at other rehabilitation departments in Guyana would help increase generalizability of the program. The program can be used clinically by physical therapists in Guyana both in departments and as a home program. Shared knowledge and experience of researchers considering research evidence and the environmental, social, and economic conditions of people living in Guyana were important in developing an effective program.

Central neurodegeneration in Kennedy’s disease accompanies peripheral motor dysfunction

Spinal and bulbar muscular atrophy (SBMA), or Kennedy’s disease (KD), is a rare hereditary neuromuscular disorder demonstrating commonalities with amyotrophic lateral sclerosis (ALS). The current study aimed to define functional and central nervous system abnormalities associated with SBMA pathology, their interaction, and to identify novel clinical markers for quantifying disease activity. 27 study participants (12 SBMA; 8 ALS; 7 Control) were recruited. SBMA patients underwent comprehensive motor and sensory functional assessments, and neurophysiological testing. All participants underwent whole-brain structural and diffusion MRI. SBMA patients demonstrated marked peripheral motor and sensory abnormalities across clinical assessments. Increased abnormalities on neurological examination were significantly associated with increased disease duration in SBMA patients (R2 = 0.85, p < 0.01). Widespread juxtacortical axonal degeneration of corticospinal white matter tracts were detected in SBMA patients (premotor; motor; somatosensory; p < 0.05), relative to controls. Increased axial diffusivity was significantly correlated with total neuropathy score in SBMA patients across left premotor (R2 = 0.59, p < 0.01), motor (R2 = 0.63, p < 0.01), and somatosensory (R2 = 0.61, p < 0.01) tracts. The present series has identified involvement of motor and sensory brain regions in SBMA, associated with disease duration and increasing severity of peripheral neuropathy. Quantification of annualized brain MRI together with Total Neuropathy Score may represent a novel approach for clinical monitoring.

Interference of prototypical geometry representations in students’ construction of concepts and development of proofs

ABSTRACT This study investigates the impact of prototypical geometric representations on students’ ability to construct accurate geometric concepts and their subsequent performance in proving tasks related to those concepts. Ninety-one 11th-grade students participated in the study. We intentionally designed and utilized a questionnaire as the primary data-collection tool. We used the questionnaire items and findings as a basis for semi-structured interviews that we conducted with approximately 10% of the study participants. This allowed the integration of the quantitative and qualitative analyses, to provide a comprehensive understanding of the learning processes. Our analysis reveals that many Grade 11 students struggle with geometric concept formation due to an overreliance on prototypical examples, which in turn hinders their ability to construct proofs concerning the attributes of these concepts, highlighting the need for more diverse representations in geometry instruction.

Effects of stress on burnout among infection control nurses during the COVID-19 pandemic: the mediating effects of social support and self-efficacy

BackgroundThis study investigated the mediating effects of self-efficacy and social support on the relationship between stress and burnout among infection control nurses (ICNs) during an emerging infectious disease pandemic.MethodsThe study participants encompassed 210 ICNs with at least six months’ experience in an infection control unit at a general hospital in South Korea during the COVID-19 pandemic. Data were analyzed using independent t-tests or one-way analysis of variance (ANOVA), while descriptive statistics were performed using SPSS/WIN 26.0 software. Hayes’s PROCESS macro 4.2 software was used to verify the significance of the indirect effects of the mediators.ResultsStress had a significant positive effect on burnout (β = 0.80, p < .001), accounting for 73% of the variance. Self-efficacy (β = − 0.26, p < .001) and social support (β = − 0.11, p = .034) had a significant negative effect on burnout, accounting for 78% of the variance. Stress was lower when self-efficacy and social support were entered into the model (β = 0.80 → 0.59), indicating that self-efficacy and social support mediated the relationship between stress and burnout.ConclusionThis study is significant in that it confirms the effects of self-efficacy and social support on the relationship between stress and burnout among ICNs. The results highlight the importance of establishing organizational support systems and developing and implementing programs for enhancing self-efficacy in order to reduce burnout among ICNs.

Serum ferritin level and associated factors among uncontrolled adult type II diabetic follow-up patients: comparative based cross-sectional study

BackgroundUncontrolled type 2 diabetes mellitus (UT2DM) and its associated consequences nowadays have been a global health crisis, especially for adults. Iron has the property to oxidize and reduce reversibly, which is necessary for metabolic processes and excess accumulation of iron indicated by serum ferritin levels could have a significant impact on the pathophysiology of T2DM via generation of reactive oxygen species (ROS). However, no conclusive evidence existed about the association of serum ferritin with the state of glycemic control status. Therefore, this study aimed to evaluate serum ferritin levels and associated factors in uncontrolled T2DM patients and compare them with those of controlled T2DM and non-diabetic control groups.MethodsA hospital-based comparative cross-sectional study was conducted among conveniently selected 156 study participants, who were categorized into three equal groups of uncontrolled T2DM, controlled T2DM, and non-diabetic control groups from October 2 to December 29, 2023 at St. Paul’s Hospital Millennium Medical College. A pre-tested structured questionnaire was used to collect socio-demographic and diabetes-related information. The laboratory tests were done using an automated chemistry analyzer and IBM-SPSS statistical software (version-27) was utilized for data entry and analysis with a significance level of p < 0.05.ResultThe mean serum ferritin level was noticeably higher in uncontrolled T2DM patients as compared to controlled T2DM and control groups (p < 0.001). It was significantly correlated with HbA1c [r = 0.457, p < 0.001], fasting blood sugar (FBs) [r = 0.386, p < 0.001], serum iron [r = 0.430, p < 0.001], and systolic blood pressure (SBP) [r = 0.195, p = 0.047] in T2DM patients. A multivariate logistic regression model revealed that a rise in HbA1c (AOR = 3.67, 95% CI(1.50–8.98), serum iron (AOR = 1.02, 95% CI(1.01–1.04), male gender (AOR = 0.16, 95% CI(0.05–0.57) and being on oral hypoglycemic agent (OHA) monotherapy (AOR = 0.26, 95% CI(0.07–0.95) were key associated factors for the elevated serum ferritin among T2DM patients.ConclusionThe present study demonstrated that T2DM patients had elevated serum ferritin levels which might be related to the existence of long-term hyperglycaemia and that serum ferritin had a significant positive association with HbA1c and FBs, implying that it could be used as an additional biomarker to predict uncontrolled T2DM patients.

Validation of a checklist to facilitate serious illness conversations in adult emergency in China: a single-centre pilot study

BackgroundAdvances in emergency and critical care have improved outcomes, but gaps in communication and decision-making persist, especially in the emergency department (ED), prompting the development of a checklist to aid in serious illness conversations (SIC) in China.MethodsThis was a single-centre prospective interventional study on the quality improvement of SIC for life-sustaining treatment (LST). The study recruited patients consecutively for both its observational baseline and interventional stages until its conclusion. Eligible participants were adults over 18 years old admitted to the Emergency Intensive Care Unit (EICU) of a tertiary teaching hospital, possessing full decisional capacity or having a legal proxy. Exclusions were made for pregnant women, patients deceased upon arrival, those who refused participation, and individuals with incomplete data for analysis. First, a two-round Delphi process was organized to identify major elements and generate a standard process through a checklist. Subsequently, the efficacy of SIC in adult patients admitted to the EICU was compared using the Decisional Conflict Scale (DCS) score before (baseline group) and after (intervention group) implementing the checklist.ResultsThe study participants presented with the most common comorbidities, such as diabetes, myocardial infarction, cerebrovascular disease, moderate-to-severe renal disease, congestive heart failure, and chronic pulmonary disease. The median Charlson Index did not differ between the baseline and intervention cohorts. The median length of hospital stay was 11.0 days, and 82.9% of patients survived until hospital discharge. The total DCS score was lower in the intervention group than in the baseline group. Three subscales, including the informed, values clarity, and support subscales, demonstrated significant differences between the intervention and baseline groups. Fewer intervention group patients agreed with and changed their minds about cardiopulmonary resuscitation (CPR) compared to the baseline group.ConclusionThe use of a SIC checklist in the EICU reduced the DCS score by increasing medical information disclosure, patient value awareness, and decision-making support.