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Manual therapists in Sweden during the COVID-19 pandemic -they remained in business, but how was their work environment and practice impacted?
Background The Swedish governmental strategy during the COVID-19-pandemic was to impose voluntary recommendations to limit viral spread, but to keep health care and important societal functions running. The objective of this study was to describe the work environment and practice of manual therapists, who were challenged by this strategy, in Sweden during a year of the pandemic. Methods The cohort study Corona And Manual Professions (CAMP) was studying chiropractors and naprapaths, registered in the public register of licensed manual therapists in Sweden, during the pandemic. Mixed methods were used to answer the research aims. Surveys were distributed in November 2020, during the second wave, and in February, May and November of 2021. The quantitative data were presented descriptively, with the development over time illustrated in graphs. The qualitative data from the free-text answers were analyzed using content analysis. Results In total, 816 manual therapists (47% of the invited sample) were included in the study, of which between 275 and 662 participants answered the free-text questions. At baseline, most (60–65%) rated their knowledge of viral infections and their spread, of vulnerable patient groups, and of protective gear as fairly good or good. Most (68–70%) were able to follow the official recommendations, but decreased numbers of patients and changes in clinic routines were reported. There was a positive trend in caring adequately for patients and having access to protective gear. Manual therapists reported that they were unable to care for vulnerable patient groups, had to adhere to routines perceived as onerous, and found care to be less personalized. Conclusion At the time of the outbreak of the COVID-19 pandemic, manual therapists in Sweden encountered challenges regarding knowledge about pandemics and availability of protective equipment. Sweden’s official recommendations were possible to implement by the manual therapists, but had adverse impacts on clinic activities and patient care. Despite this, over 50% were able to deliver adequate care for their patients.
Gastrodia protects HT22 cells from damage caused by oxygen glucose deprivation and reperfusion through inhibiting ferroptosis
Epigenetic regulation of individual components of combined hepatocellular-cholangiocarcinoma
Combined hepatocellular carcinoma-cholangiocarcinoma (HCC-CCA) is a rare liver tumor comprising histologic features of both HCC and CCA. Due to its heterogeneous nature, treatment of combined HCC-CCA is a significant clinical challenge and prognosis remains poor. Therefore, further understanding of the tumor biology underlying the individual subtypes of this mixed tumor is required to improve treatment stratification and optimize treatment strategies. This study sought to identify altered epigenetic regulation and gene expression patterns in the individual components of combined HCC-CCA. Formalin fixed paraffin embedded (FFPE) tumor specimens from 9 patients diagnosed with combined HCC-CCA were utilized in this study. Hematoxylin and eosin (H&E) staining was performed for each sample, and regions representative of the individual HCC and CCA components were delineated. Adjacent unstained slides were cut and dissected to separate HCC and CCA components. DNA and RNA extraction was performed for each sample for DNA methylation (n = 7 HCC and 7 CCA) and gene expression (n = 7 HCC and 8 CCA) profiling via reduced representation bisulfite sequencing (RRBS) and RNA-seq, respectively. Samples did not cluster by tumor type when comparing genome-wide DNA methylation or gene expression patterns. Of the 5 patients with DNA methylation data available for both subtypes, 4 clustered by patient as opposed to cancer subtype, suggesting similar epigenetic regulatory patterns arising from development in the same microenvironment and genetic background. Differential analysis resulted in the identification of 57 differentially expressed genes (DEGs) and 808 differentially methylated regions (DMRs) between the HCC and CCA subtypes. Genes associated with DMRs were associated with Wnt signaling, voltage-gated channels, metal binding, and cellular regulation. Finally, increased expression of several genes previously implicated in tumor aggressiveness, prognosis, and treatment responses were identified. These results highlight the potential importance of accounting for underlying HCC and CCA tumor biology when determining the optimal course of treatment for this deadly disease.
Serious adverse drug reactions associated with anti-SARS-CoV-2 vaccines and their reporting trends in the EudraVigilance database
Medical rationing choices of laypeople and clinicians are often illogical and inconsistent with their own stated preferences
The sudden onset, rapid spread, and later surges of the Covid-19 pandemic resulted in shortages of ventilators, pharmaceuticals, and other critical resources, leaving individual clinicians to make rationing decisions for which they had little expertise or training. In two pre-registered experiments with large samples of laypeople (N = 2007) and clinicians (N = 1256), conducted during the first year of the pandemic, we found evidence of two inconsistencies in hypothetical rationing decisions: (1) The choice of which of two patients should receive a medical treatment can be systematically affected by adding a third patient who logically should not receive the treatment (an instance of the attraction effect); (2) Decisions as to which patient should receive the treatment are inconsistent with general rationing policies that participants themselves endorse. We argue that our results provide empirical support for the necessity of predetermined policies administered by independent decision-makers to ensure fairness and consistency, as required by law and ethics, in healthcare rationing choices.
Environmental effects on surface lead–calcium apatite formation on Roman wall paintings
Validation of facial attributions in leadership: Trustworthiness and age in Chinese mid-level management
The attributions made to faces are well described by two dimensions of apparent trustworthiness (valence or warmth) and apparent competence (dominance and power) (Todorov A, Mende-Siedlecki P, Dotsch R. Curr Opin Neurobiol, 2013, 23, 373–80). This model has been extended to include a third dimension of apparent age and attractiveness (Sutherland CAM, Oldmeadow JA, Santos IM, Towler J, Michael Burt D, Young AW. Cognition, 2013, 127, 105–18). Previous research has tested the association between appearance and leadership attainment for high-level leaders such as elite politicians and chief executive officers of top performing organisations in the US and Western Europe. Here we focus on a Chinese organisational context and explore how facial attributions are associated with appointment at mid-level managerial positions. Participants rated leadership, competence, trustworthiness, attractiveness and age of faces of male employees of a Chinese Real Estate company. Our findings reveal that apparent trustworthiness and age are more critical predictors of leadership attainment than competence or attractiveness in the context of mid-level management in China. The study supports the three-dimensional attribution framework and reaffirms the importance of facial cues in leadership selection across diverse cultural settings.
Vaccination delay and associated factors among children of age 12–23 months in Gomma district, Oromia, Ethiopia, 2022
Perception of People Living with HIV and Healthcare Workers on Differentiated Service Delivery Programs in Nigeria: A Qualitative Study
Nigeria, home to approximately 1.9 million people living with HIV (PLHIV), faces significant challenges in providing adequate care and treatment to the teeming number of PLHIV, particularly following the adoption of the ‘test and treat’ policy and the HIV ‘SURGE’ initiative. The Differentiated Service Delivery (DSD) model was introduced to address the increased burden on the healthcare system, offering patient-centered care through diverse methods like community-based care, fast-track drug refills, and task-shifting to lower-level healthcare providers. This study, conducted by the National AIDS and STI Control Program (NASCP) in collaboration with ICAP at Columbia University, evaluates the perspectives of healthcare workers and PLHIV on DSD programs in Nigeria. This is a qualitative study involving key informant interviews (KIIs) with 12 healthcare workers and focus group discussions (FGDs) with 153 PLHIV across four Nigerian states (Anambra, Kaduna, Lagos, Taraba). Healthcare workers with at least one year of ART service experience and PLHIV on ART for at least one year with suppressed viral loads were included in the study. Data was analyzed using an inductive, thematic approach to identify emergent patterns and themes. The study revealed that DSD models, such as peer-led Facility ART groups and community pharmacy ART refills, were widely implemented. The primary factors influencing the deployment of DSD models included client convenience and the need to alleviate healthcare worker load. Positive experiences with DSD were associated with convenience, confidentiality, and affordability, whereas negative perceptions stemmed from high service costs, poor healthcare worker attitudes, and confidentiality concerns. Additionally, the study highlighted the necessity for continuous training of healthcare workers, engagement with PLHIV, and increased awareness programs to improve DSD service delivery. Overall, the study underscores the importance of addressing financial barriers, enhancing healthcare worker training, and ensuring confidentiality in optimizing DSD models and improving HIV care outcomes in Nigeria.
Spatiotemporal and kinematic gait characteristics in older patients with type 2 diabetes mellitus with and without sarcopenia
Abstract To investigate the differences in gait characteristics between older patients with type 2 diabetes with and without sarcopenia, using a three-dimensional motion analysis system. This cross-sectional study included 38 patients with type 2 diabetes aged ≥ 65 years and capable of independently performing activities of daily living. Participants’ demographic data, spatiotemporal gait parameters, and ranges of motion of the pelvis, hip, knee, and ankle joints during a gait cycle were collected. The participants were classified into sarcopenic ( n = 15) and non-sarcopenic ( n = 23) groups and compared. Significant reductions in walking speed, shorter stride lengths, longer stride time, stance and double support times, and decreased cadence were observed in participants with sarcopenia. In addition, participants with sarcopenia exhibited a significantly smaller range of motion for ankle joint plantar dorsiflexion. In patients with type 2 diabetes, gait characteristics differ depending on the presence or absence of sarcopenia. These findings may contribute to the development of new qualitative assessment methods to facilitate the timely detection of sarcopenia in this patient population.
Correction: Profound gene expression changes in the epithelial monolayer of active ulcerative colitis and Crohn’s disease
Assessment of agricultural drought severity using multi-temporal remote sensing data in Lorestan region
Protocol for an umbrella review of systematic reviews evaluating the efficacy of digital health solutions in supporting adult cancer survivorship care
Introduction The growing number of people living with, through and beyond cancer poses a new challenge for sustainable survivorship care solutions. Digital health solutions which incorporate various information and communication technologies are reshaping healthcare; offering huge potential to facilitate health promotion, support healthcare efficiencies, improve access to healthcare and positively impact health outcomes. Digital health solutions include websites and mobile applications, health information technologies, telehealth solutions, wearable devices, AI-supported chatbots and other technologically assisted provision of health information, communication and services. The breadth and scope of digital health solutions necessitate a synthesis of evidence on their use in supportive care in cancer. This umbrella review will identify, synthesise, and compare systematic reviews which have evaluated the efficacy or effectiveness of digital solutions for adult cancer survivorship care with a particular focus on surveillance and management of physical effects, psychosocial effects, new cancer/ recurring cancers and supporting health promotion and disease prevention. Methods and analysis An umbrella review of published systematic reviews will be undertaken to explore the types of digital health solutions used, their efficacy or effectiveness as a form of supportive care, and the barriers and enablers associated with their implementation. The umbrella review will be reported according to the Preferred Reporting Items for Overviews of Reviews (PRIOR) checklist. A search will be conducted across key databases. Records will be assessed independently by two review authors for eligibility against predefined criteria and will undergo two stage title, abstract and full text screening. All systematic reviews that meet the inclusion criteria will be assessed for quality using the AMSTAR 2 checklist with quality assessment and data extraction by two reviewers. The degree of publication overlap of primary studies across the included reviews will also be calculated and a mapping of the evidence will also be presented. Ethics and dissemination As this research proposes using systematic reviews that are already published, ethical approval is not required. Results from this umbrella review will be published in a peer-reviewed journal where any significant deviations from the protocol will be justified.
Machine learning-driven imaging data for early prediction of lung toxicity in breast cancer radiotherapy
Abstract One possible adverse effect of breast irradiation is the development of pulmonary fibrosis. The aim of this study was to determine whether planning CT scans can predict which patients are more likely to develop lung lesions after treatment. A retrospective analysis of 242 patient records was performed using different machine learning models. These models showed a remarkable correlation between the occurrence of fibrosis and the hounsfield units of lungs in CT data. Three different classification methods (Tree, Kernel-based, k-Nearest Neighbors) showed predictive values above 60%. The human predictive factor (HPF), a mathematical predictive model, further strengthened the association between lung hounsfield unit (HU) metrics and radiation-induced lung injury (RILI). These approaches optimize radiation treatment plans to preserve lung health. Machine learning models and HPF can also provide effective diagnostic and therapeutic support for other diseases.
Research on the coordinated measurement and spatiotemporal evolution of digital economy empowering ecotourism
Although the internet economy in China has had enormous growth in recent years, the country’s ecotourism business has shown a far slower rate of expansion. There is an immediate need to discuss how to leverage the digital economy to advance ecotourism and achieve synchronized development between the two. The coupling and coordination between China’s digital economy and ecotourism are examined in this study using a coupling coordination model to evaluate their temporal and geographical growth. Panel data that was gathered from 30 provinces between 2011 and 2022 served as the basis for the research. The historical and geographical evolution of their attributes is examined by the application of standard deviational ellipse analysis, kernel density estimation, and Dagum Gini coefficient. The results show a steady improvement in the degree of connectivity and synchronization between the digital economy and ecotourism. This improvement follows a general geographical trend of being robust in the eastern regions and feeble in the western regions, while being prominent in the southern areas and less significant in the northern areas. The primary cause of the unequal growth of the digital economy and ecotourism in various places is regional inequities, as evidenced by the variable drop in the Gini coefficient of coupling coordination degree. A distinct polarization tendency in the national, eastern, and western areas, along with an annual expansion of the right tail in the national kernel density, cause the kernel density curve to continuously move to the right. The standard deviational ellipse shows that the geographical inequalities between ecotourism and the digital economy are gradually diminishing. The three primary regions are seeing a dynamic reduction in the size of the ellipse, and the distribution of places is becoming more focused. The article suggests enhancing digital transformation in ecotourism and promoting industry growth for better-coordinated development.
Assessing climate and land use impacts on surface water yield using remote sensing and machine learning
Registration-based transfer listing system and high-tech SME innovation: Research on China’s specialized and sophisticated SMEs listed on the National Equities Exchange and Quotations.
In China, high-tech small and medium-sized enterprises (SMEs) are a crucial component of the innovation ecosystem, and how to effectively promote innovation within these firms has become a pressing challenge for the government. Against the backdrop of the registration-based reform, we use a sample of specialized and sophisticated SMEs listed on the National Equities Exchange and Quotations (NEEQ) from 2016 to 2022 to empirically examine the impact of the registration-based transfer listing system (RTLS) on the innovation activities of NEEQ high-tech SMEs. We find that RTLS can enhance innovation input by improving stock liquidity. Meanwhile, we find that RTLS can also promote substantive innovation output by strengthening information disclosure. We further document that the positive effect is more pronounced in highly marketized regions and among non-state-owned enterprises. Further analysis shows that RTLS can enhance innovation efficiency and lessen reliance on fiscal subsidies to promote innovation for NEEQ high-tech SMEs.
Nasal dominance potentiates intranasal oxytocin’s anxiolytic effects
Abstract The nasal cycle is a phenomenon whereby alterations in airflow alternate between left and right nostrils. During a nostril’s decongested – or dominant – state, the contralateral nostril is congested, or non-dominant. Intranasal oxytocin may elicit anxiolytic effects. To date, no study has investigated whether there is an optimal nasal pathway for oxytocin’s effects. Forty-four female adolescents aged 16 to 17 years were included in this exploratory study investigating effects of nasal dominance on intranasal oxytocin delivery. We show that intranasal oxytocin significantly reduces stress relative to placebo ( p = 0.012, ηp 2 = 0.145) and greater stress reduction occurs when oxytocin is delivered to the dominant, rather than non-dominant, nostril ( p = 0.034, ηp 2 = 0.113). We postulate that oxytocin administration may reduce stress and be most effective in the context of anxiolysis when administered to the dominant nostril. Further research investigating whether other intranasal psychotropic drugs have nostril-specific effects might benefit clinical practice.
Cardiovascular and renal comorbidities among saudi patients with type 2 diabetes: A cross-sectional observational study
Objective This study aims to investigate the prevalence and patterns of cardiovascular and renal complications among patients with T2DM in the Saudi population and elucidate the extent of these comorbidities and their potential risk factors. Methods A cross-sectional observational study was conducted across three research locations in Riyadh, Saudi Arabia. The study incorporated the first 248 T2DM patients who met the criteria and provided their consent. The sites for this research comprised one secondary care public hospital, one public primary care clinic, and one private medical facility. Efforts were made to evenly distribute patients across the six locations, spanning three distinct sectors. Should any location fall short of its patient target, other sites would step in to balance the deficit. Patient data was gathered during their enrollment visit as well as the patient’s medical records. These encompassed variables such as age, gender, race, smoking status, residential location, duration of T2DM, most recent HbA1c, blood pressure, lipid levels, kidney function, and most recent weight/body mass index (BMI). Results Those with diabetes for five years or longer were more likely to have CKD (2.1 times higher), CAD (3.2 times higher), cerebrovascular disease (4.3 times higher), and hypertension (6.2 times higher). Most participants knew diabetes was a common health problem, and those with diabetic relatives were at a higher risk. In the present study, patients with uncontrolled HbA1C diabetes demonstrated a notably increased prevalence of various comorbidities CKD (OR=3.9, p < 0.0001), CAD (OR=2.3, p = 0.007), CHF (OR=3.1, p = 0.0001), cerebrovascular disease (OR=2.4, p = 0.0004), CVD (OR=4.2, p=<0.0001) and hypertension (OR=3.5, p = 0.0001) compared to those without uncontrolled HbA1C diabetes. However, CVD and hypertension shows a stronger association with diabetes The analysis demonstrated that diabetes was highly correlated to neuropathy (t = 2.204, p = 0.002), coronary artery disease (t = 1.53, p = 0.03), congestive heart failure (CHF) (t = 1.34, p = 0.05), cerebrovascular Disease (t = 2.65, p = 0.009), and hypertension (t = 5.05, p = 0.000). Conclusion We concluded that patients who had diabetes for five years or more had considerably greater risks of developing comorbidities such as chronic kidney disease, coronary artery disease, cerebrovascular disease, and hypertension. Among others hypertension being a major comorbidity that significantly influences the progression or presence of diabetes. This highlights the necessity of beginning treatment as early as possible and maintaining glycemic control to reduce the risk of diabetes-related problems in the long run. One limitation of this study is its cross-sectional design, which only captures data at a single point in time, preventing the establishment of causal relationships between variables.