bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of COVID-19 school closures on adolescent sleep duration: an uncontrolled before-after study
Authors: Lian Qiguo , Zuo Xiayun , Zhong Xiangyang , Tu Xiaowen , Zhang Jiashuai , Shu Chang , Yu Chunyan , Lou Chaohua
Published: August 2021

Background

The coronavirus disease 2019 (COVID-19) pandemic affected almost 1.6 billion students or more than 90% of learners globally. However, the effect of school closures during COVID-19 pandemic on adolescent sleep duration remains unclear.

Methods

We undertook a cross-sectional electronic survey in six junior and senior high schools in Shanghai, China from late June to early July 2020. We evaluated the changes of sleep duration on weekdays by comparing sleep duration hours and insufficient sleep (< 9 h for children aged 6–13 years or < 8 h for teenagers aged 14–17 years) in COVID-19 school closures and after school reopening. We also investigated possible sex differences in the changes of sleep duration.

Results

A total of 3265 students completed the survey, the mean age was 14.56 ± 1.99 years, 1567 (47.99%) were girls and 1344 (41.17%) were in grades 10–12. The overall sleep duration decreased from 8.88 h in school closures to 7.77 h after school reopening, and the change (difference: − 1.11 h; 95%CI: − 1.16, − 1.07; P < 0.001) was statistically significant. The prevalence of insufficient sleep increased sharply from 21.10 to 63.98%, and the change (ratio:3.03; 95%CI:2.84, 3.23; P < 0.001) was statistically significant. Besides, the changes were greater in girls than in boys.

Conclusion

Results of this study revealed that sleep duration was longer and percentage of sufficient sleep was higher during COVID-19 school closures in adolescent students.
Self-esteem, job insecurity, and psychological distress among Chinese nurses
Authors: Liu Yun , Yang Chunyan , Zou Guiyuan
Published: August 2021

Background

Many studies investigate the variables relating to psychological distress among nurses, but little is known about the underlying mechanism(s) among job insecurity, self-esteem, and psychological distress.

Aims

This cross-sectional study examines the prevalence of psychological distress among nurses and the relationships among job insecurity, self-esteem, and psychological distress; it also explores how self-esteem might mediate between job insecurity and psychological distress.

Methods

Questionnaires that assess job insecurity, self-esteem, and psychological distress were collected from 462 nurses in a tertiary hospital in Shandong Province, China.

Results

Our results show an 83.3 % prevalence rate for psychological distress among nurses. Regression analysis results show that job insecurity positively correlates with psychological distress, explaining 17.5 % of the variance in psychological distress. Mediation analysis results show that self-esteem partially mediates the effect of the two dimensions of job insecurity on psychological distress.

Conclusions

Psychological distress is prevalent among Chinese nurses. Nursing administrators should take effective measures to improve self-esteem and reduce the negative impacts of job insecurity on nurses, including psychological distress.
Barriers to antigen detection and avoidance in chronic hypersensitivity pneumonitis in the United States
Authors: Aronson Kerri I. , O’Beirne Ronan , Martinez Fernando J. , Safford Monika M.
Published: August 2021

Background

Chronic hypersensitivity pneumonitis (CHP) is an interstitial lung disease (ILD) caused by long term exposure to an offending antigen. Antigen avoidance is associated with improved outcomes. We are unable to identify the antigen source in approximately half of patients. When an antigen is successfully identified, patients have difficulty with avoidance.

Methods

We conducted three structured group discussions with US based ILD specialists utilizing the nominal group technique (NGT). Participants listed barriers to antigen detection and avoidance in CHP. Each participant ranked what they perceived to be the top three barriers in the list in terms of importance. The master list of barriers was consolidated across the three groups into themes that were prioritized based on receiving the highest rankings by participants.

Results

Twenty-five physicians participated; 56% had experience caring for CHP patients for ≥ 16 years. Sixty barriers to antigen detection were categorized into seven themes of which the top three were: 1. unclear significance of identified exposures; 2. gaps in clinical knowledge and testing capabilities; 3. there are many unknown and undiscovered antigens. Twenty-eight barriers to antigen avoidance were categorized into five themes of which the top three were: 1. patient limitations, financial barriers and lack of resources; 2. individual patient beliefs, emotions and attachments to the antigen source; and 3. gaps in clinical knowledge and testing capabilities.

Conclusions

This study uncovered challenges at the individual patient, organizational, and societal levels and ranked them in terms of level of importance. These findings provide information to guide development and validation of multidisciplinary support and interventions geared towards antigen identification and avoidance in CHP.
High-risk coronary artery plaque in asymptomatic patients with type 2 diabetes: clinical risk factors and coronary artery calcium score
Authors: Heinsen Laurits Juhl , Pararajasingam Gokulan , Andersen Thomas Rueskov , Auscher Søren , Sheta Hussam Mahmoud , Precht Helle , Lambrechtsen Jess , Egstrup Kenneth
Published: August 2021

Background

High-risk coronary artery plaque (HRP) is associated with increased risk of acute coronary syndrome.

We aimed to investigate the prevalence of HRP in asymptomatic patients with type 2 diabetes (T2D), and its relation to patient characteristics including cardiovascular risk factors, diabetes profile, and coronary artery calcium score (CACS).

Methods

Asymptomatic patients with T2D and no previous coronary artery disease (CAD) were studied using coronary computed tomography angiography (CCTA) in this descriptive study. Plaques with two or more high-risk features (HRP) defined by low attenuation, positive remodeling, spotty calcification, and napkin-ring sign were considered HRP. In addition, total atheroma volume (TAV), proportions of dense calcium, fibrous, fibrous-fatty and necrotic core volumes were assessed. The CACS was obtained from non-enhanced images by the Agatston method. Cardiovascular and diabetic profiles were assessed in all patients.

Results

In 230 patients CCTA was diagnostic and 161 HRP were detected in 86 patients (37%). Male gender (OR 4.19, 95% CI 1.99–8.87; p < 0.01), tobacco exposure in pack years (OR 1.02, 95% CI 1.00–1.03; p = 0.03), and glycated hemoglobin (HbA1c) (OR 1.04, 95% CI 1.02–1.07; p < 0.01) were independent predictors of HRP. No relationship was found to other risk factors. HRP was not associated with increased CACS, and 13 (23%) patients with zero CACS had at least one HRP.

Conclusion

A high prevalence of HRP was detected in this population of asymptomatic T2D. The presence of HRP was associated with a particular patient profile, but was not ruled out by the absence of coronary artery calcium. CCTA provides important information on plaque morphology, which may be used to risk stratify this high-risk population.

Trial registrationThis trial was retrospectively registered at clinical trials.gov January 11, 2017 trial identifier NCT03016910.
A smartphone-based online system for fall detection with alert notifications and contextual information of real-life falls
Authors: Harari Yaar , Shawen Nicholas , Mummidisetty Chaithanya K. , Albert Mark V. , Kording Konrad P. , Jayaraman Arun
Published: August 2021

Background

Falls are a leading cause of accidental deaths and injuries worldwide. The risk of falling is especially high for individuals suffering from balance impairments. Retrospective surveys and studies of simulated falling in lab conditions are frequently used and are informative, but prospective information about real-life falls remains sparse. Such data are essential to address fall risks and develop fall detection and alert systems. Here we present the results of a prospective study investigating a proof-of-concept, smartphone-based, online system for fall detection and notification.

Methods

The system uses the smartphone’s accelerometer and gyroscope to monitor the participants’ motion, and falls are detected using a regularized logistic regression. Data on falls and near-fall events (i.e., stumbles) is stored in a cloud server and fall-related variables are logged onto a web portal developed for data exploration, including the event time and weather, fall probability, and the faller’s location and activity before the fall.

Results

In total, 23 individuals with an elevated risk of falling carried the phones for 2070 days in which the model classified 14,904,000 events. The system detected 27 of the 37 falls that occurred (sensitivity = 73.0 %) and resulted in one false alarm every 46 days (specificity > 99.9 %, precision = 37.5 %). 42.2 % of the events falsely classified as falls were validated as stumbles.

Conclusions

The system’s performance shows the potential of using smartphones for fall detection and notification in real-life. Apart from functioning as a practical fall monitoring instrument, this system may serve as a valuable research tool, enable future studies to scale their ability to capture fall-related data, and help researchers and clinicians to investigate real-falls.
Is there an optimal timing for surgical treatment of pediatric supracondylar humerus fractures in the first 24 hours?
Authors: Okkaoglu Mustafa Caner , Ozdemir Fırat Emin , Ozdemir Erdi , Karaduman Mert , Ates Ahmet , Altay Murat
Published: August 2021

Background

We aimed to determine the ideal surgical timing in the first 24 hours after admission to the hospital of pediatric supracondylar humerus fractures (SHF) that do not require emergent intervention.

Materials and Methods

Patients who underwent surgery in our institution between January 2011 and January 2019 due to pediatric Gartland type 3 SHFs were evaluated retrospectively. Open fractures, fractures associated with vascular injury and compartment syndrome, flexion type fractures were excluded. A total of 150 Gartland type 3 were included. The effect of early (<12 hours) or late (>12 hours) surgical interventions, daytime or night-time surgeries, working or non-working hour surgeries on operative parameters (operative duration and open reduction rate, reduction quality on postoperative early radiographs) were evaluated in pediatric SHFs.

Results

Early (<12 hours) or late (>12 hours), daytime or nighttime, working or non-working hour surgeries were found to be similar in Gartland type 3 patients regarding early postoperative reduction quality, duration of surgery, open reduction rate (p>0.05). Mean times passed from first admission to hospital until surgery were longer in working hour, late (>12 hours) and daytime surgery groups than non-working hour, early (<12 hours) and night-time surgery groups (p<0.001).

Conclusion

Although delaying the operation to the working hours seems to prolong the time until surgery in pediatric Gartland type 3 SHF patients who do not require emergent intervention such as open fractures, neurovascular impairment and compartment syndrome, there may not be a time interval that makes a difference for the patients if surgery is performed within the first 24 hours, thus the surgery could be scheduled according to the surgeons’ preference.

Level of Evidence: Level 3, Retrospective cohort study
Traditional growing rod for early-onset scoliosis in high-altitude regions: a retrospective study
Authors: Jiang Haijun , Hai Junrui Jonathan , Yin Peng , Su Qingjun , Zhu Shiqi , Pan Aixing , Wang Yunsheng , Hai Yong
Published: August 2021

Background

Children with early-onset scoliosis living in high-altitude areas have severe deformities and poor nutritional status. However, no reports on early-onset scoliosis treatment using traditional growing rods in such children exist. Thus, we analyzed the outcomes of traditional growing rods treatment in such patients and the effect of altitude on therapy.

Methods

Between September 2007 and December 2017, 59 consecutive patients with EOS underwent systematic surgical correction using traditional growing rods. They were divided into the high-altitude and low-altitude groups, and differences in surgical efficacy and complications between the groups were analyzed pre- and postoperatively. Radiographic measurements, including the Cobb angle, thoracic kyphosis, lumbar lordosis, T1–S1 and T1–T12 heights, sagittal and coronal balance, distance between C7PL and sagittal vertical axis, pelvic incidence, sacral slope, and pelvic tilt were assessed preoperatively, postoperatively, and at the last follow-up. Continuous data were analyzed using paired or independent Student’s t tests, and they were compared preoperatively, postoperatively, and at the last follow-up using a repeated measures analysis of variance. Enumerated data were analyzed using the χ2 test.

Results

The mean patient age at the initial surgery and mean follow-up duration were 8.9 ± 2.4(5–14) years and 51.91 ± 25.23 months, respectively. Altogether, 234 operations were conducted for all patients with an average interval between operations of 11.4 ± 3.0 months. The average Cobb angle was similar in both groups preoperatively and at the last follow-up, it was significantly different postoperatively. TK was significantly different in all three periods. T1–S1 and T1–T12 heights were significantly different only during the preoperative period. The overall rates of complications and implant-related complications did not differ significantly between the groups.

Conclusions

Deformity in patients with EOS in high-altitude areas was more severe, and treatment using TGRs yielded a satisfactory therapeutic effect.
Limited effects on patient outcomes of conjoint tendon release in anterolateral muscle-sparing total hip arthroplasty
Authors: Tanaka Hidetatsu , Yamada Norikazu , Kurishima Hiroaki , Mori Yu , Sakamoto Takashi , Oyama Masamizu , Aizawa Toshimi
Published: August 2021

Background

The anterolateral muscle-sparing total hip arthroplasty (THA) in the supine position is advantageous owing to the very low-dislocation rate and excellent leg length discrepancy control. However, femur exposure is challenging. Although the conjoined external rotators tendon (CERT) release is effective in improving femoral access, the effects on clinical outcomes remain unclear. The purpose of this study was to evaluate the clinical and radiographic results of CERT release in the anterolateral muscle-sparing THA approach.

Methods

The study was performed as a retrospective cohort study and included 85 hips in 85 patients who underwent primary anterolateral THA. Clinical and radiographic outcomes were investigated 6 months and 1 year after THA (CERT-preserved and non-released patients). The Japanese Orthopaedic Association (JOA) hip score, JOA Hip-disease Evaluation Questionnaire (JHEQ), forgotten joint score (FJS), and the 36 short-form questionnaires (SF-36 mental and physical) were evaluated. The leg length discrepancy, cup inclination and stem orientation were evaluated with radiographs.

Results

Among all the included hips, 37 patients (43.5%) retained the CERT, and 48 patients (56.5%) included the released CERT. There were no significant differences in the JOA hip scores, JHEQ, FJF-12 and SF-36 between the released and non-released groups. There were significant differences in sagittal stem alignments between groups.

Conclusion

The CERT release in anterolateral muscle-sparing THA has a limited effect on post-operative clinical outcomes. The CERT release improved the femur exposure and is more invasive than the preserved CERT. We infer that the CERT should be maintained in patients with a wide range of motions, and release the CERT in inadequate femur canal preparation cases.
The GoodHope Ehlers Danlos Syndrome Clinic: development and implementation of the first interdisciplinary program for multi-system issues in connective tissue disorders at the Toronto General Hospital
Authors: Mittal Nimish , Mina Daniel Santa , McGillis Laura , Weinrib Aliza , Slepian P. Maxwell , Rachinsky Maxim , Buryk-Iggers Stephanie , Laflamme Camille , Lopez-Hernandez Laura , Hussey Laura , Katz Joel , McLean Lianne , Rozenberg Dmitry , Liu Louis , Tse Yvonne , Parker Colleen , Adler Arnon , Charames George , Bleakney Robert , Veillette Christian , Nielson Christopher J. , Tavares Sandra , Varriano Stephanie , Guzman Juan , Faghfoury Hanna , Clarke Hance
Published: August 2021

Ehlers-Danlos Syndrome (EDS) are a heterogeneous group of genetic connective tissue disorders, and typically manifests as weak joints that subluxate/dislocate, stretchy and/or fragile skin, organ/systems dysfunction, and significant widespread pain. Historically, this syndrome has been poorly understood and often overlooked. As a result, people living with EDS had difficulty obtaining an accurate diagnosis and appropriate treatment, leading to untold personal suffering as well as ineffective health care utilization. The GoodHope EDS clinic addresses systemic gaps in the diagnosis and treatment of EDS. This paper describes a leap forward—from lack of awareness, diagnosis, and treatment—to expert care that is tailored to meet the specific needs of patients with EDS. The GoodHope EDS clinic consists of experts from various medical specialties who work together to provide comprehensive care that addresses the multi-systemic nature of the syndrome. In addition, EDS-specific self-management programs have been developed that draw on exercise science, rehabilitation, and health psychology to improve physical and psychosocial wellbeing and overall quality of life. Embedded into the program are research initiatives to shed light on the clinical presentation, underlying mechanisms of pathophysiology, and syndrome management. We also lead regular educational activities for community health care providers to increase awareness and competence in the interprofessional management of EDS beyond our doors and throughout the province and country.
Foot care practice and associated factors among patients with lymphoedema in Boreda district, Gamo zone, southern Ethiopia, 2020. Implications for elimination of podoconiosis and lymphatic filariasis
Authors: Churko Chuchu , Yohanes Tsegaye , Kassahun Alemayehu Bekele , Desalegn Nathan , Endashaw Gesila , Asfaw Mekuria Asnakew
Published: August 2021

Background

Lymphatic filariasis is ranked as the second leading cause of disability world‐wide. The current global programme to eliminate lymphatic filariasis is based on the interruption of transmission and the alleviation of disability and suffering.

Objective

to assess foot care practice and associated factors among lymphoedema patients in Boreda district, Gamo zone Southern Ethiopia.

Methods

a community based cross sectional study was employed from December 2020 to June 2021 in Boreda district. Simple random sampling technique was used for selecting participants. Pretested structured interviewer administered questionnaire was prepared in English and translated to local language.

Findings

a total of 280 lymphedema patients were involved in this study. More than half 153 (54.6%) had poor practice towards foot care practice with 95% CI (48.7, 60.4%). Patients who fetched 50 l of water or below and wore shoes at the age above 20 years were negatively associated with foot care practice, (AOR = 0.383, 95%CI: 0.155, 0.945) and (AOR = 0.261, 95%CI: 0.107, 0.63), respectively. Patients who owned only one pair and two pairs were negatively associated with foot care practice (AOR = 0.04, 95%CI: 0.009, 0.182) and (AOR = 0.27, 95%CI: 0.087, 0.85), respectively. On the other hand, attending LMMDP service and frequency of adenolymphangitis once and twice or more per month were positively associated with foot care practice (AOR = 3.339, 95%CI: 1.53, 7.285) and (AOR = 8.15, 95% CI: 3.157, 21.058) and (AOR = 9.35, 95% CI: 3.118, 28.059), respectively.

Conclusion

this study indicated foot care practice among lymphedema patients in Boreda district was poor. Number of litre of water collected per day, age at which footwear first worn, number of shoes owned, attending LMMDP and frequency of adenolymphangitis were significantly associated with foot care practice. Standard foot care practice should be emphasized to control progression of lymphedema. Foot care practices like skin care, exercise and elevation, washing legs, bandaging and massaging are important factors that influence in reduction of lymphedema volume and acute attacks among people who are suffering from the diseases.
Using single-nucleus RNA-sequencing to interrogate transcriptomic profiles of archived human pancreatic islets
Authors: Basile Giorgio , Kahraman Sevim , Dirice Ercument , Pan Hui , Dreyfuss Jonathan M. , Kulkarni Rohit N.
Published: August 2021

Background

Human pancreatic islets are a central focus of research in metabolic studies. Transcriptomics is frequently used to interrogate alterations in cultured human islet cells using single-cell RNA-sequencing (scRNA-seq). We introduce single-nucleus RNA-sequencing (snRNA-seq) as an alternative approach for investigating transplanted human islets.

Methods

The Nuclei EZ protocol was used to obtain nuclear preparations from fresh and frozen human islet cells. Such preparations were first used to generate snRNA-seq datasets and compared to scRNA-seq output obtained from cells from the same donor. Finally, we employed snRNA-seq to obtain the transcriptomic profile of archived human islets engrafted in immunodeficient animals.

Results

We observed virtually complete concordance in identifying cell types and gene proportions as well as a strong association of global and islet cell type gene signatures between scRNA-seq and snRNA-seq applied to fresh and frozen cultured or transplanted human islet samples.

Conclusions

We propose snRNA-seq as a reliable strategy to probe transcriptomic profiles of freshly harvested or frozen sources of transplanted human islet cells especially when scRNA-seq is not ideal.
Transfer learning between preclinical models and human tumors identifies a conserved NK cell activation signature in anti-CTLA-4 responsive tumors
Authors: Davis-Marcisak Emily F. , Fitzgerald Allison A. , Kessler Michael D. , Danilova Ludmila , Jaffee Elizabeth M. , Zaidi Neeha , Weiner Louis M. , Fertig Elana J.
Published: August 2021

Background

Tumor response to therapy is affected by both the cell types and the cell states present in the tumor microenvironment. This is true for many cancer treatments, including immune checkpoint inhibitors (ICIs). While it is well-established that ICIs promote T cell activation, their broader impact on other intratumoral immune cells is unclear; this information is needed to identify new mechanisms of action and improve ICI efficacy. Many preclinical studies have begun using single-cell analysis to delineate therapeutic responses in individual immune cell types within tumors. One major limitation to this approach is that therapeutic mechanisms identified in preclinical models have failed to fully translate to human disease, restraining efforts to improve ICI efficacy in translational research.

Method

We previously developed a computational transfer learning approach called projectR to identify shared biology between independent high-throughput single-cell RNA-sequencing (scRNA-seq) datasets. In the present study, we test this algorithm’s ability to identify conserved and clinically relevant transcriptional changes in complex tumor scRNA-seq data and expand its application to the comparison of scRNA-seq datasets with additional data types such as bulk RNA-seq and mass cytometry.

Results

We found a conserved signature of NK cell activation in anti-CTLA-4 responsive mouse and human tumors. In human metastatic melanoma, we found that the NK cell activation signature associates with longer overall survival and is predictive of anti-CTLA-4 (ipilimumab) response. Additional molecular approaches to confirm the computational findings demonstrated that human NK cells express CTLA-4 and bind anti-CTLA-4 antibodies independent of the antibody binding receptor (FcR) and that similar to T cells, CTLA-4 expression by NK cells is modified by cytokine-mediated and target cell-mediated NK cell activation.

Conclusions

These data demonstrate a novel application of our transfer learning approach, which was able to identify cell state transitions conserved in preclinical models and human tumors. This approach can be adapted to explore many questions in cancer therapeutics, enhance translational research, and enable better understanding and treatment of disease.
On solving initial value problems for partial differential equations in maple
Authors: Thota Srinivasarao
Published: August 2021

Objectives

In this paper, we present and employ symbolic Maple software algorithm for solving initial value problems (IVPs) of partial differential equations (PDEs). From the literature, the proposed algorithm exhibited a great significant in solving partial differential equation arises in applied sciences and engineering.

Results

The implementation include computing partial differential operator (), Greens function () and exact solution () of the given IVP. We also present syntax, , to apply the partial differential operator to verify the solution of the given IVP obtained from . Sample computations are presented to illustrate the maple implementation.
Review of The collapse of a pastoral economy: The Datoga of central and northern Tanzania from the 1830s to the 2000s by Samwel Shanga Mhajida: Gottingen University Press 2019
Authors: McCabe J. Terrence
Published: August 2021

Book details

Samwel Shanga Mhajida, 2019. The collapse of a pastoral economy: The Datoga of central and northern Tanzania from the 1830s to the 2000s. Gottingen University Press. Pp. 262. ISBN: 978-3-86395-401-7, doi: 10.17875/gup2019-1143.
P/FP ratio: incorporation of PEEP into the PaO2/FiO2 ratio for prognostication and classification of acute respiratory distress syndrome
Authors: Palanidurai Sunitha , Phua Jason , Chan Yiong Huak , Mukhopadhyay Amartya
Published: August 2021

Background

The current Berlin definition of acute respiratory distress syndrome (ARDS) uses the PaO2/FiO2 (P/F) ratio to classify severity. However, for the same P/F ratio, a patient on a higher positive end-expiratory pressure (PEEP) may have more severe lung injury than one on a lower PEEP.

Objectives

We designed a new formula, the P/FP ratio, incorporating PEEP into the P/F ratio and multiplying with a correction factor of 10 [(PaO2*10)/(FiO2*PEEP)], to evaluate if it better predicts hospital mortality compared to the P/F ratio post-intubation and to assess the resultant changes in severity classification of ARDS.

Methods

We categorized patients from a dataset of seven ARDS network trials using the thresholds of ≤ 100 (severe), 101–200 (moderate), and 201–300 (mild) for both P/F (mmHg) and P/FP (mmHg/cmH2O) ratios and evaluated hospital mortality using areas under the receiver operating characteristic curves (AUC).

Results

Out of 3,442 patients, 1,057 (30.7%) died. The AUC for mortality was higher for the P/FP ratio than the P/F ratio for PEEP levels > 5 cmH2O: 0.710 (95% CI 0.691–0.730) versus 0.659 (95% CI 0.637–0.681), P < 0.001. Improved AUC was seen with increasing PEEP levels; for PEEP ≥ 18 cmH2O: 0.963 (95% CI 0.947–0.978) versus 0.828 (95% CI 0.765–0.891), P < 0.001. When the P/FP ratio was used instead of the P/F ratio, 12.5% and 15% of patients with moderate and mild ARDS, respectively, were moved to more severe categories, while 13.9% and 33.6% of patients with severe and moderate ARDS, respectively, were moved to milder categories. The median PEEP and FiO2 were 14 cmH2O and 0.70 for patients reclassified to severe ARDS, and 5 cmH2O and 0.40 for patients reclassified to mild ARDS.

Conclusions

The multifactorial P/FP ratio has a greater predictive validity for hospital mortality in ARDS than the P/F ratio. Changes in severity classification with the P/FP ratio reflect both true illness severity and the applied PEEP strategy.

Trial registration: ClinialTrials.gov–NCT03946150.
Inequalities in utilization and provision of dental services: a scoping review
Authors: Ghanbarzadegan Arash , Bastani Peivand , Luzzi Liana , Brennan David
Published: August 2021

Background

There are many determinants that can affect inequality in oral and dental health. This study is aimed to explore the main determinants of inequality in both utilization and provision of dental services in Organization for Economic Co-operation and Development (OECD) countries.

Methods

Four databases including PubMed, ISI WOS, Scopus, and ProQuest were searched up to 8 Aug 2020, applying the relevant keywords. Thematic analysis was used for synthesizing and extracting data. Trend analysis was applied to determine the trends of the inequality determinants.

Results

Thematic analysis led to 6 main themes, 13 sub-themes, and 53 sub-sub-themes. The main themes represent the main inequality determinants for both utilization and provision of dental services. The streamgraph illustrated that fewer studies have been conducted on social and cultural determinants, and for almost all determinants the trend of published articles has been increasing since 2007, with the exception of health policies.

Conclusions

Inequality in the utilization and provision of dental services is addressed by various factors including individual, social, cultural and economic determinants, health policies, and availability of services. The first four determinants are related to utilization and the last two are related to the provision of services. All these aspects must be considered to reduce inequality in dental services.
Impulsive synchronization of fractional-order complex-variable dynamical network
Authors: Xiong Yu , Wu Zhaoyan
Published: August 2021

The impulsive synchronization of a fractional-order complex-variable network is investigated. Firstly, static impulsive controllers are designed and the corresponding synchronization criteria are derived. From the criteria, the impulsive gains can be calculated. Secondly, adaptive impulsive controllers are designed. Noticeably, the impulsive gains can be adjusted to the needed values adaptively. Finally, numerical examples are provided to verify the results.
SARS-CoV-2 nosocomial infection acquired in a French university hospital during the 1st wave of the Covid-19 pandemic, a prospective study
Authors: Landoas A. , Cazzorla F. , Gallouche M. , Larrat S. , Nemoz B. , Giner C. , Le Maréchal M. , Pavese P. , Epaulard O. , Morand P. , Mallaret M.-R. , Landelle C.
Published: August 2021

Background

In healthcare facilities, nosocomial transmissions of respiratory viruses are a major issue. SARS-CoV-2 is not exempt from nosocomial transmission. Our goals were to describe COVID-19 nosocomial cases during the first pandemic wave among patients in a French university hospital and compliance with hygiene measures.

Methods

We conducted a prospective observational study in Grenoble Alpes University Hospital from 01/03/2020 to 11/05/2020. We included all hospitalised patients with a documented SARS-CoV-2 diagnosis. Nosocomial case was defined by a delay of 5 days between hospitalisation and first symptoms. Hygiene measures were evaluated between 11/05/2020 and 22/05/2020. Lockdown measures were effective in France on 17/03/2020 and ended on 11/05/2020. Systematic wearing of mask was mandatory for all healthcare workers (HCW) and visits were prohibited in our institution from 13/03/2021 and for the duration of the lockdown period.

Results

Among 259 patients included, 14 (5.4%) were considered as nosocomial COVID-19. Median time before symptom onset was 25 days (interquartile range: 12–42). Eleven patients (79%) had risk factors for severe COVID-19. Five died (36%) including 4 deaths attributable to COVID-19. Two clusters were identified. The first cluster had 5 cases including 3 nosocomial acquisitions and no tested HCWs were positive. The second cluster had 3 cases including 2 nosocomial cases and 4 HCWs were positive. Surgical mask wearing and hand hygiene compliance were adequate for 95% and 61% of HCWs, respectively.

Conclusions

The number of nosocomial COVID-19 cases in our hospital was low. Compliance regarding mask wearing, hand hygiene and lockdown measures drastically reduced transmission of the virus. Monitoring of nosocomial COVID-19 cases during the first wave enabled us to determine to what extent the hygiene measures taken were effective and patients protected.

Trial registration Study ethics approval was obtained retrospectively on 30 September 2020 (CECIC Rhône-Alpes-Auvergne, Clermont-Ferrand, IRB 5891).
A perspective on therapies for amyotrophic lateral sclerosis: can disease progression be curbed?
Authors: Xu Xiaojiao , Shen Dingding , Gao Yining , Zhou Qinming , Ni You , Meng Huanyu , Shi Hongqin , Le Weidong , Chen Shengdi , Chen Sheng
Published: August 2021

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease involving both upper and lower motor neurons, leading to paralysis and eventually death. Symptomatic treatments such as inhibition of salivation, alleviation of muscle cramps, and relief of spasticity and pain still play an important role in enhancing the quality of life. To date, riluzole and edaravone are the only two drugs approved by the Food and Drug Administration for the treatment of ALS in a few countries. While there is adequate consensus on the modest efficacy of riluzole, there are still open questions concerning the efficacy of edaravone in slowing the disease progression. Therefore, identification of novel therapeutic strategies is urgently needed. Impaired autophagic process plays a critical role in ALS pathogenesis. In this review, we focus on therapies modulating autophagy in the context of ALS. Furthermore, stem cell therapies, gene therapies, and newly-developed biomaterials have great potentials in alleviating neurodegeneration, which might halt the disease progression. In this review, we will summarize the current and prospective therapies for ALS.
Formulation in eating disorder focused family therapy: why, when and how?
Authors: Baudinet Julian , Simic Mima , Eisler Ivan
Published: August 2021

In the broadest sense, formulation, or case conceptualisation, is the process of collaborative sense-making. It is something all clinicians are doing constantly, whether formally and consciously or not. Most clinicians are familiar with the general principals and need to formulate as it is a core part of clinical training across most disciplines. Treatment manuals often discuss formulation, but the practical steps involved and the process of developing, building upon and revising formulations are not always provided. In clinical practice, the active use and continued development of formulation during treatment is not always prioritised, especially beyond the initial assessment. This could be due to a number of reasons, such as a potential lack of clarity, understanding or confidence in the use of formulation across treatment, a lack of dedicated time and reflective space for formulation in the context of increasingly busy clinical settings, or a perception that it may be less necessary in the context of treatment approaches that are more structured and prescriptive. This article outlines the use of formulation in family therapy for child and adolescent eating disorders, provides guidance on how to actively include formulation more throughout treatment and discusses why this might be useful.
Ferulic acid production by metabolically engineered Escherichia coli
Authors: Lv Huajun , Zhang Ying , Shao Jie , Liu Haili , Wang Yong
Published: August 2021

Ferulic acid (p-hydroxy-3-methoxycinnamic acid, FA) is a natural active substance present in plant cell walls, with antioxidant, anticancer, antithrombotic and other properties; it is widely used in medicine, food, and cosmetics. Production of FA by eco‐friendly bioprocess is of great potential. In this study, FA was biosynthesized by metabolically engineered Escherichia coli. As the first step, the genes tal (encoding tyrosine ammonia-lyase, RsTAL) from Rhodobacter sphaeroides, sam5 (encoding p-coumarate 3-hydroxylase, SeSAM5) from Saccharothrix espanaensis and comt (encoding Caffeic acid O-methytransferase, TaCM) from Triticum aestivum were cloned in an operon on the pET plasmid backbone, E. coli strain containing this construction was proved to produce FA from L-tyrosine successfully, and confirmed the function of TaCM as caffeic acid O-methytransferase. Fermentation result revealed JM109(DE3) as a more suitable host cell for FA production than BL21(DE3). After that the genes expression strength of FA pathway were optimized by tuning of promoter strength (T7 promoter or T5 promoter) and copy number (pBR322 or p15A), and the combination p15a-T5 works best. To further improve FA production, E. coli native pntAB, encoding pyridine nucleotide transhydrogenase, was selected from five NADPH regeneration genes to supplement redox cofactor NADPH for converting p-coumaric acid into caffeic acid in FA biosynthesis process. Sequentially, to further convert caffeic acid into FA, a non-native methionine kinase (MetK from Streptomyces spectabilis) was also overexpressed. Based on the flask fermentation data which show that the engineered E. coli strain produced 212 mg/L of FA with 11.8 mg/L caffeic acid residue, it could be concluded that it is the highest yield of FA achieved by E. coli K-12 strains reported to the best of our knowledge.
Integrated malaria prevention in rural communities in Uganda: a qualitative feasibility study for a randomised controlled trial
Authors: Musoke David , Namata Carol , Ndejjo Rawlance , Ssempebwa John C. , Musoke Miph B.
Published: August 2021

Background

A randomised controlled trial (RCT) on integrated malaria prevention, which advocates the use of several malaria prevention methods holistically, has been proposed. However, before conducting an RCT, it is recommended that a feasibility study is carried out to provide information to support the main study, particularly for such a complex intervention. Therefore, a feasibility study for an RCT on integrated malaria prevention in Uganda was conducted.

Methods

The qualitative study carried out in Wakiso District employed focus group discussions (FGDs) and key informant interviews (KIIs) to explore community willingness to participate in the RCT as well as assess stakeholder perspectives on the future study. The participants of the FGDs were community members, while the key informants were selected from malaria stakeholders including Ministry of Health officials, health practitioners, local leaders, district health team members, and community health workers (CHWs). Thematic analysis was employed with the support of NVivo.

Results

A total of 12 FGDs and 19 KIIs were conducted. Five main themes emerged from the study: malaria prevention practices related to integrated malaria prevention; preferred malaria prevention methods in the integrated approach; potential challenges of integrated malaria prevention; perspectives on the proposed RCT; and sustainability of integrated malaria prevention. Despite a few methods being employed holistically in the community, insecticide-treated nets were the most widely used and preferred method for malaria prevention mainly because they were provided free by the government. The main challenges in the integrated approach were the high cost of some methods such as house screening, and concerns about the potential side effects of insecticide-based methods such as indoor residual spraying. Participants expressed high willingness to participate in the RCT to promote the use of multiple methods in their households and community. Involvement of CHWs during implementation was proposed as a sustainability strategy for the RCT interventions.

Conclusion

There was high willingness to participate in the proposed RCT on integrated malaria prevention. However, high cost and perceived negative health effects from some methods were identified as potential challenges. The type of methods to be included as well as sustainability mechanisms needs to be considered during the design of the RCT.
Pediatric case of presacral ganglioneuroma: diagnostic considerations and therapeutic strategy
Authors: Ammar Saloua , Cheikhrouhou Taycir , Jallouli Mohamed , Chtourou Rahma , Sellami Sahla , Zitouni Hayet , Mhiri Riadh
Published: August 2021

Background

Ganglioneuroma (GN) is an uncommon tumor belonging to the neuroblastic tumors group and is often localized in the posterior mediastinum, retroperitoneum, and adrenal gland. Presacral (PS) location is extremely rare. Its management remains a challenge.

Case presentation

A 4-year-old child presented to our department for an isolated abdominal mass. Para-clinical exams concluded to PSGN. Subtotal surgical excision was performed through an anterior transperitoneal approach. The size of the residual tumor did not progress after the 6-year follow-up period and the patients were asymptomatic.

Conclusions

GN should be considered in the case of soft tissue presacral masses in pediatrics. Subtotal resection seems sufficient in case of an extension to the sacrum with low morbidity. The residual tumors are still stable and the prognosis seems conserved. Further, long-term follow-up in large studies is needed to confirm these findings.
Granger causality analysis of deviation in total electron content during geomagnetic storms in the equatorial region
Authors: Iyer Sumitra , Mahajan Alka
Published: August 2021

The total electron content (TEC) in the ionosphere widely influences Global Navigation Satellite Systems (GNSS) especially for critical applications by inducing localized positional errors in the GNSS measurements. These errors can be mitigated by measuring TEC from stations located around the world at various temporal and spatial scales and using them for advanced forecasting of TEC. The TEC can be used as a tool in understanding space weather phenomena such as geomagnetic storms which cause disruptions in the ionosphere. This paper examines the causal relationship between perturbations in TEC caused by geomagnetic storms. The causality between two geomagnetic indices auroral electrojet (AE) and disturbed storm index (Dst) and TEC is investigated using Granger causality at two low-latitude stations, Bangalore and Hyderabad. The outcomes of this study strengthen the regional understanding and modeling of ionospheric parameters which can contribute towards the global efforts for modeling and reducing the ionospheric effects on trans-ionospheric communication and navigation. The causal inferences combined with the data-driven model can be useful in identifying the correct and informative physical quantities to improve the forecasting models.
Evaluation of the Novel 4R Oncology Care Planning Model in Breast Cancer: Impact on Patient Self-Management and Care Delivery in Safety-Net and Non–Safety-Net Centers
Authors: Trosman Julia R. , Weldon Christine B. , Rapkin Bruce D. , Benson Al B. , Makower Della F. , Liang Su-Ying , Kulkarni Swati A. , Perez Claudia B. , Lo Shelly S. , Krueger Editha A. , Throckmorton Alyssa D. , Gallagher Christopher , Hoskins Kent , Schaeffer Cathleen M. , Van Horn Jennifer , Schapira Lidia , Ravelo Arliene , Yu Elaine , Gradishar William J.
Published: August 2021

PURPOSE:

Optimal cancer care requires patient self-management and coordinated timing and sequence of interdependent care. These are challenging, especially in safety-net settings treating underserved populations. We evaluated the 4R Oncology model (4R) of patient-facing care planning for impact on self-management and delivery of interdependent care at safety-net and non–safety-net institutions.

METHODS:

Ten institutions (five safety-net and five non–safety-net) evaluated the 4R intervention from 2017 to 2020 with patients with stage 0-III breast cancer. Data on self-management and care delivery were collected via surveys and compared between the intervention cohort and the historical cohort (diagnosed before 4R launch). 4R usefulness was assessed within the intervention cohort.

RESULTS:

Survey response rate was 63% (422/670) in intervention and 47% (466/992) in historical cohort. 4R usefulness was reported by 79.9% of patients receiving 4R and was higher for patients in safety-net than in non–safety-net centers (87.6%, 74.2%, P = .001). The intervention cohort measured significantly higher than historical cohort in five of seven self-management metrics, including clarity of care timing and sequence (71.3%, 55%, P < .001) and ability to manage care (78.9%, 72.1%, P = .02). Referrals to interdependent care were significantly higher in the intervention than in the historical cohort along all six metrics, including primary care consult (33.9%, 27.7%, P = .045) and flu vaccination (38.6%, 27.9%, P = .001). Referral completions were significantly higher in four of six metrics. For safety-net patients, improvements in most self-management and care delivery metrics were similar or higher than for non–safety-net patients, even after controlling for all other variables.

CONCLUSION:

4R Oncology was useful to patients and significantly improved self-management and delivery of interdependent care, but gaps remain. Model enhancements and further evaluations are needed for broad adoption. Patients in safety-net settings benefited from 4R at similar or higher rates than non–safety-net patients, indicating that 4R may reduce care disparities.
Associations of Homocysteine Metabolism With the Risk of Spinal Osteoarthritis Progression in Postmenopausal Women
Authors: Nakano Masaki , Nakamura Yukio , Urano Tomohiko , Miyazaki Akiko , Suzuki Takako , Watanabe Kazuki , Takahashi Jun , Shiraki Masataka
Published: August 2021

Context

Although homocysteine accumulation is a reported risk factor for several age-related disorders, little is known about its relationship with osteoarthritis (OA).

Objective

We investigated for associations of homocysteine and C677T polymorphism in methylenetetrahydrofolate reductase (MTHFR), which is involved in homocysteine clearance, with the development and progression of spinal OA through a combined cross-sectional and longitudinal cohort study.

Methods

A total of 1306 Japanese postmenopausal outpatients participating in the Nagano Cohort Study were followed for a mean 9.7-year period. Cross-sectional multiple logistic regression for spinal OA prevalence at registration by serum homocysteine level was performed with adjustment for confounders. In addition to Kaplan–Meier analysis, multivariate Cox regression was employed to examine the independent risk of MTHFR C677T variant for spinal OA progression.

Results

Multivariate regression analysis revealed a significant association between homocysteine and spinal OA prevalence (odds ratio 1.38; 95% CI 1.14-1.68). Kaplan–Meier curves showed a gene dosage effect of the T allele in MTHFR C677T polymorphism on the accelerated progression of spinal OA severity (P = 0.003). A statistically significant independent risk of the T allele for spinal OA advancement was validated by Cox regression analysis. Respective adjusted hazard ratios for the CT/TT and TT genotypes were 1.68 (95% CI, 1.16–2.42) and 1.67 (95% CI, 1.23–2.28).

Conclusion

Circulating homocysteine and C677T variant in MTHFR are associated with the prevalence rate and ensuing progression, respectively, of spinal OA. These factors may represent potential interventional targets to prevent OA development and improve clinical outcomes.