bluuebunny/crossref_metadata_2025 huggingface dataset:
Rethinking the Industrial Heritage of Ayvalik through Trajectories on Extracting Olive Oil and Soap Making
Authors: Yıldız Gözde , Şahin Güçhan Neriman
Published: October 2020

Ayvalik, a city located in northwest Anatolia, has been at the forefront of olive-based industries since the 1880s, when the industrialization of Europe led to the growth of commerce and agriculture in Anatolia, including first Istanbul and Izmir, followed by Ayvalik, due to their strategic locations. Ayvalik, which was an important Greek settlement under Ottoman rule, experienced a major turning point with the population exchange between Greece and Turkey in 1923, an event that caused dramatic changes in the political, demographic, and economic structure of all of Anatolia. Nonetheless, Ayvalik has maintained its importance through its ongoing olive-based industries and well-preserved historical urban fabric, the likes of which represents one of an exceptional example of living testimony of continuing land-use by Turks. Following the relocation of industrial activities in the 1980s, many of the industrial heritage buildings became non-functional, while half of them were converted into different cultural-touristic sites in the 2000s. This study presents a comprehensive view of the industrial heritage of Ayvalik by performing an up-to-date synthesis of the cultural material related to trajectories on industry and production processes to understand the evolution of the industrial heritage and how urban and daily life have been reflected and transformed.
Mixed methods pilot evaluation of interpersonal psychotherapy for body image for adolescents
Authors: Duffy Fiona , Sharpe Helen , Beveridge Emily , Osborne Kate , Richards Cathy
Published: October 2020

Body dissatisfaction is common in adolescence and associated with poor outcomes. The aim of this mixed method pilot evaluation was to determine acceptability, feasibility and preliminary efficacy of Interpersonal Psychotherapy for Body Image (IPT-BI), a school-based group intervention for young people with high levels of body dissatisfaction. Eighteen participants (11–13 years, 78% female) took part in two IPT-BI groups ( n = 10; n = 8). Feasibility was measured by recruitment and attrition rates; acceptability using a treatment satisfaction questionnaire and focus groups; and clinical outcomes at baseline, each session and post intervention. The majority of young people (72%, n = 18/25) who were referred or expressed interest went on to take part. Average session attendance was 100% and 89%. Participants expressed high levels of treatment satisfaction with 94% ( n = 16/17) rating IPT-BI as ‘quite helpful’ or ‘very helpful’ and 94% ( n = 16/17) stating they would recommend it to others. Preliminary exploration of efficacy showed significant improvements in body image and significant reductions in interpersonal difficulties and appearance-based conversations. Young people valued specific IPT-BI skills (role play, communication strategies), alongside generic therapeutic factors (therapeutic alliance, group cohesion). IPT-BI is feasible and acceptable with promising provisional clinical outcomes indicating the need for a fully powered randomised controlled trial.
Lost data reconstruction for structural health monitoring using deep convolutional generative adversarial networks
Authors: Lei Xiaoming , Sun Limin , Xia Ye
Published: October 2020

In the application of structural health monitoring, the measured data might be temporarily or permanently lost due to sensor fault or transmission failure. The measured data with a high data loss ratio undermine its ability for modal identifications and structural condition evaluations. To reconstruct the lost data in the field of structural health monitoring, this study proposes a deep convolutional generative adversarial network which includes a generator with encoder–decoder structure and an adversarial discriminator. The proposed generative adversarial network model needs to understand the content of the complete signals, as well as produce realistic hypotheses for the lost signals. Given the data stably measured before the occurrence of data loss, the generator is trained to extract the features maintained in the data set and reconstruct lost signals using the responses of the remaining functional sensors alone. The discriminator feeds back the distinguished results to the generator to improve its reconstruction accuracy. When training the model, the reconstruction loss and the adversarial loss are employed to better handle the low-frequency features and high-frequency features of the signals. The effectiveness and efficiency of the proposed method are validated by two case studies. As the number of training epoch increases, the reconstructed signals learn the features from low-frequency to high-frequency, and the amplitude of the reconstructed signals gradually increases. It can be seen that the final reconstruction signals match well with the real signals in the time domain and frequency domain. To further demonstrate the applicability of the reconstructed signals in data analysis, the reconstructed acceleration data are used to accurately identify the modal parameters in the numerical case, and the vehicle-induced responses are precisely decomposed from the reconstructed strain data in the field case. Finally, the reconstruction capacity is also investigated with the different numbers of the faulted strain gauges.
Hybrid composite laminates reinforced with flax-basalt-glass woven fabrics for lightweight load bearing structures
Authors: Attia Mohamed A , El-baky Marwa A Abd , Abdelhaleem Mostafa M , Hassan Mohamed A
Published: October 2020

An experimental investigation on the mechanical performance of interlayer hybrid flax-basalt-glass woven fabrics reinforced epoxy composite laminates has been performed. The tensile, flexural, in-plane shear, interlaminar shear, bearing, and impact properties of the fabricated laminates were investigated. Test specimens were fabricated using vacuum bagging process. Failure modes of all specimens were recorded and discussed. Results proved that the mechanical properties of flax-basalt-glass hybrid laminates are highly dominated by the reinforcement combinations and plies stacking sequence. Hybridizing flax fiber reinforced composite with basalt and/or glass fabrics provides an effective method for enhancing its tensile, flexural, in-plane shear, interlaminar shear, and bearing properties as well as controls the impact strength of the composite. The fabricated hybrids are found to have good specific mechanical properties benefits. Amongst the studied flax/basalt/glass hybrids, FBGs has the highest tensile properties, GBFs has the highest flexural and impact properties, and GFBs has the best shear and bearing properties. Flax-basalt-glass hybrid composites with different layering sequence seem to be an appropriate choice for lightweight load bearing structures.
Analysis of Changes in Cancer-Related Fatigue of Breast Cancer Patients Receiving an Integrative Medicine Program
Authors: Schad Friedemann , Thronicke Anja , von Trott Phillipp , Oei Shiao Li
Published: October 2020

Introduction:

Cancer-related fatigue (CRF) occurs frequently in breast cancer patients. The aim of this real-world study was to analyze the longitudinal changes of CRF in breast cancer patients receiving an integrative medicine program, which includes the application of non-pharmacological interventions (NPIs) and Viscum album L. (VA) extracts.

Methods:

All data were collected from the clinical register of the Network Oncology of a German certified breast cancer center of the Gemeinschaftskrankenhaus Havelhöhe (GKH). Primary breast cancer patients, treated upon initial diagnosis with integrated NPIs, comprising art and exercise therapy, nursing interventions, and educational components, during their hospital stay, and who had answered the German Cancer-Fatigue Scale (CFS-D) questionnaire at first diagnosis and 12 months later, were included. The associations between NPIs and CFS-D changes were analyzed with adjusted multivariable regression analyses, considering received treatment regimens and demographic variables, using the software R.

Results:

231 female breast cancer patients of all tumor stages were evaluated. While chemotherapy exhibited significant severe deterioration, add-on VA applications seem to partially mitigate this impairment on CRF. 36 separate multivariable regression analyses for all NPIs showed that in particular significant associations between CFS-D improvements and the interventions nursing compresses (6 point change; P = .0002; R² = 28%) or elaborate consultations and life review (ECLR) (4 point change; P = .0002; R² = 25%) were observed.

Conclusions:

Breast cancer patients benefit from a hospital-based integrative medicine program. To alleviate fatigue symptoms during oncological therapy, an expansion of this concept should be developed in the future.
A Music-Based Digital Therapeutic: Proof-of-Concept Automation of a Progressive and Individualized Rhythm-Based Walking Training Program After Stroke
Authors: Hutchinson Karen , Sloutsky Regina , Collimore Ashley , Adams Benjamin , Harris Brian , Ellis Terry D. , Awad Louis N.
Published: October 2020

Background

The rhythm of music can entrain neurons in motor cortex by way of direct connections between auditory and motor brain regions.

Objective

We sought to automate an individualized and progressive music-based, walking rehabilitation program using real-time sensor data in combination with decision algorithms.

Methods

A music-based digital therapeutic was developed to maintain high sound quality while modulating, in real-time, the tempo (ie, beats per minute, or bpm) of music based on a user’s ability to entrain to the tempo and progress to faster walking cadences in-sync with the progression of the tempo. Eleven individuals with chronic hemiparesis completed one automated 30-minute training visit. Seven returned for 2 additional visits. Safety, feasibility, and rehabilitative potential (ie, changes in walking speed relative to clinically meaningful change scores) were evaluated.

Results

A single, fully automated training visit resulted in increased usual (∆ 0.085 ± 0.027 m/s, P = .011) and fast (∆ 0.093 ± 0.032 m/s, P = .016) walking speeds. The 7 participants who completed additional training visits increased their usual walking speed by 0.12 ± 0.03 m/s after only 3 days of training. Changes in walking speed were highly related to changes in walking cadence ( R2 > 0.70). No trips or falls were noted during training, all users reported that the device helped them walk faster, and 70% indicated that they would use it most or all of the time at home.

Conclusions

In this proof-of-concept study, we show that a sensor-automated, progressive, and individualized rhythmic locomotor training program can be implemented safely and effectively to train walking speed after stroke. Music-based digital therapeutics have the potential to facilitate salient, community-based rehabilitation.
Trump against Germany: Examining How News about Donald Trump’s Anti-German Utterances Affect Anti-Americanism in Germany—A Moderated Mediation Model
Authors: von Sikorski Christian
Published: October 2020

Donald Trump frequently attacks foreign countries such as Germany (e.g., via Twitter). Drawing from social identity theory and intergroup threat theory, I theorized that exposure to news about Trump’s anti-German utterances indirectly increases anti-Americanism in Germany. First, I theorized that Trump’s utterances result in negative attitudes toward Trump and, in turn, increase anti-Americanism (spillover effect). Second, I theorized that Trump’s anti-German utterances indirectly affect anti-Americanism via increased European Union (EU) popularity. Furthermore, I assumed that effects would be stronger for individuals low in political interest. A quota-based online experiment ( N = 428) revealed that Trump’s anti-German utterances increased EU’s popularity. This effect was moderated by political interest. EU’s popularity was increased for moderately interested individuals and individuals low in political interest. No effects were detected for highly interested individuals. EU popularity, in turn, increased anti-Americanism. Therefore, Trump’s anti-German utterances indirectly increased anti-Americanism burdening relations between Germany and the United States. Implications for journalistic news coverage are discussed.
What and why: the current situation and future prospects of “ivy sign” in moyamoya disease
Authors: Yu Jin , Du Qian , Xie Hui , Chen Jiayi , Chen Jincao
Published: October 2020

“Ivy sign” is a special imaging manifestation of moyamoya disease (MMD), which shows continuous linear or punctate high intensity along the cortical sulci and subarachnoid space on magnetic resonance images. Ivy sign was reported to reflect the development of compensatory collaterals, and to be closely related to hemodynamic changes and clinical symptoms, and to indicate the postoperative prognosis, in MMD patients. It is a unique and critical marker for MMD. However, due to the lack of consistent criteria, such as definition, grading, and identification standards, ivy sign has not received much attention. We undertook a comprehensive literature search and summarized the current situation regarding ivy sign in MMD in terms of baseline characteristics, detection methods, definition, regional division and distribution patterns, grading criterions, incidence, related factors, the mechanism of ivy sign, and the effects of treatments. We also provided related concerns raised and future prospects relevant to studies about ivy sign in MMD.
Recurrent hemarthrosis after total knee arthroplasty in rheumatoid arthritis successfully treated with selective embolization: A case report
Authors: Mammoto Takeo , Irie Toshiyuki , Takahashi Nobuyuki , Nakajima Shun , Hirano Atsushi
Published: October 2020

Recurrent hemarthrosis after total knee arthroplasty is a rare complication. This usually occurs in osteoarthritis, but is relatively rare in rheumatoid arthritis. This is a report of recurrent hemarthrosis after total knee arthroplasty in a rheumatoid arthritis patient. An 85-year-old woman with rheumatoid arthritis had received total knee arthroplasty without acute complications. At 6 months after surgery, the first hemarthrosis occurred and an initial conservative treatment failed. Contrast computed tomography showed prominent synovial enhancement in the superior lateral suprapatellar pouch. Selective catheterization revealed an abnormal hyperemic blush supplied from the branches of the superior lateral genicular artery. After embolization with N-butyl-2-cyanoacrylate, abnormal staining of the synovium diminished and knee swelling and pain disappeared without complications. Selective embolization is favorable for successful treatment of recurrent hemarthrosis after total knee arthroplasty in patients with rheumatoid arthritis.
Lived Experiences of Females With Entrepreneurship in Sudan: Networking, Social Expectations, and Family Support
Authors: Said Ibrahim , Enslin Christine
Published: October 2020

Extensive research exists on female entrepreneurship in developed countries such as North America and Europe; however, there is limited research on women entrepreneurs in African nations, specifically in Sudan. This descriptive phenomenological research was designed to explore, discover, and describe the perceptions and lived experiences of successful Sudanese female entrepreneurs concerning overcoming the challenges and obstacles faced in the beginning and managing new businesses in the region of Khartoum, capital of Sudan. This article uses the salient theories and concepts of entrepreneurship value creation theory, social role theory, challenges, and barriers facing women entrepreneurs. All these theories and concepts have been instrumental in understanding the lived experiences of challenges and barriers facing women entrepreneurs in Khartoum, Sudan. Data gathered from 19 female entrepreneurs purposively selected across Khartoum, Sudan, revealed that women struggle (a) having to secure funds; (b) society’s perception of suitable work for women; (c) access to networking; and (d) inadequate support from the government. The research also revealed that factors that influence factors to be successful are women’s family support and motivation; adjusting to social expectations. In addition to the strategies used to manage a successful business, there is a need for training and development skills and being persistent and believing in oneself. The research results showed that women experience mixed feelings during establishing and operating the business. The experience of women with the barriers and challenges includes fear, frustration, stress, and anger when they begin to manage the business. However, women also experienced positive feelings include risk-taking, courage, passion for learning, empowerment, fearlessness, ambition, determination, persistence, and believing in oneself. The women in this research were creative and initiative and managed to begin and operate a successful business.
“We Are All Alive . . . But Dead”: Cultural Meanings of War Trauma in the Tamil Diaspora and Implications for Service Delivery
Authors: Kanagaratnam Pushpa , Rummens Joanna Anneke , TonerVA Brenda
Published: October 2020

Providing culturally appropriate mental health services to war-affected refugees residing in the West continues to pose many challenges. Gaining firsthand knowledge from the refugee communities themselves is crucial to improving our knowledge and guiding our interventions. The purpose of this study is to understand perceptions of war trauma in the Tamil diaspora. Fifty-one Sri Lankan Tamils living in the Greater Toronto Area, Canada, were interviewed. Transcripts were thematically analyzed using content analysis. Findings indicate that war trauma is not viewed by the diaspora as a pathological notion. Positioned within a moral context, and independent from isolated events of war, manifestations of war trauma were discussed at an interpersonal and collective level. Diagnostic categories, including post-traumatic stress disorder (PTSD), do not seem to fully capture the breadth of war trauma in this diaspora community. Implications for service delivery, and for incorporating the unique aspects of suffering resulting from a fragmented community, are discussed.
Participatory Action Research: A Tool for Enhancing Inclusive Teaching Practices Among Teachers in South African Full-Service Schools
Authors: Ayaya Gladys , Makoelle Tsediso Michael , van der Merwe Martyn
Published: October 2020

Previous studies conducted on the implementation of inclusive education in South African full-service schools showed that teachers lacked knowledge and expertise in inclusive teaching practices. Furthermore, in some international studies, it is recommended that, to enhance inclusive teaching, it was necessary to involve the teaching communities concerned, using their in-depth understanding of the problem at hand, to come up with emancipatory solutions that could assist in the design of effective teaching strategies to enhance inclusive teaching. Therefore, this study investigated the role of participatory action research (PAR) in enhancing teachers’ inclusive teaching practices in full-service schools. This qualitative PAR study was conducted for 6 months by a research team comprising 12 teachers in a full-service school in the Johannesburg East District of South Africa. Data were collected through PAR stages of planning, observation, action, and reflection. To analyze data, during PAR, group interpretative meetings were held with coresearchers and, after PAR process, an inductive qualitative thematic content data analysis was done by the researcher. Among the findings from the study was that teachers’ understandings of inclusive education were varied. Their conceptions about what it meant to be an inclusive teacher in a full-service school context were also vague. However, the study has found that through PAR participation teachers were able to share and develop own understandings of these concepts. Furthermore, the study identified a need for teachers in a full-service school to be reflective, critical, and innovative about their teaching practices to cater for diverse learner needs in the classroom, which are skills necessary for enhancing inclusive teaching and learning. The study has confirmed PAR as a viable change strategy of teaching toward inclusion.
The Perception and Culture of Operational Risk in the Banking Sector: Evidence From Northern Cyprus
Authors: Kirikkaleli Dervis , Yaylali Pelin , Safakli Okan Veli
Published: October 2020

This study aims to analyze the attitudes toward and the perception of the risk culture with regard to operational risk (OR) among Northern Cyprus (TRNC) banking sector employees working in related departments. Although most previous studies have concentrated on the measurement and management of OR, the research remains extremely limited on the perception side as well as the formation of cultural background by human resources departments. The novelty of this study lies in the fact that it investigates OR from the perspective of human perceptions and cultural development in the context of a small banking industry. In addition, via addressing the relationship between personnel structure and the prevention of ORs in small banking sectors, this study fills an important gap in the literature. For this purpose, a survey was designed and the collected data has been analyzed by using Factor Analysis. The results are gathered under eight factors where both OR perception and cultural formation were analyzed under these eight factors. The sensitivity of perception and cultural development were then analyzed by taking into account the demographic information of the respondents. The results indicate that employees working in the treasury department are strongly sensitive toward OR. Furthermore, older staff who have experienced a banking crisis are more sensitive compared with their younger counterparts. Other findings include that developments in the financial sector increase the OR, senior management appropriation decreases the OR, and an effective OR database is required. The findings of this study can potentially serve as a guide for senior executives in the banking sector in terms of policy development and applications related to internal systems, particularly in small economies.
Secondary Transition Predictors of Postschool Success: An Update to the Research Base
Authors: Mazzotti Valerie L. , Rowe Dawn A. , Kwiatek Stephen , Voggt Ashley , Chang Wen-Hsuan , Fowler Catherine H. , Poppen Marcus , Sinclair James , Test David W.
Published: October 2020

Research suggests youth with disabilities are less likely to experience positive outcomes compared to peers without disabilities. Identification of in-school predictors of postschool success can provide teachers (e.g., special education, general education, career technical education), administrators, district-level personnel, and vocational rehabilitation counselors with information to design, evaluate, and improve transition programs. The purpose of this systematic literature review was to examine secondary transition correlational literature to identify additional evidence to support existing predictors and identify new predictors of postschool success. Results provided additional evidence for 14 existing predictors and identified three new predictors. Limitations and implications for research, policy, and practice are discussed.
Metagenomic insights into the diversity of carbohydrate-degrading enzymes in the yak fecal microbial community
Authors: Gong Ga , Zhou Saisai , Luo Runbo , Gesang Zhuoma , Suolang Sizhu
Published: October 2020

Background

Yaks are able to utilize the gastrointestinal microbiota to digest plant materials. Although the cellulolytic bacteria in the yak rumen have been reported, there is still limited information on the diversity of the major microorganisms and putative carbohydrate-metabolizing enzymes for the degradation of complex lignocellulosic biomass in its gut ecosystem.

Results

Here, this study aimed to decode biomass-degrading genes and genomes in the yak fecal microbiota using deep metagenome sequencing. A comprehensive catalog comprising 4.5 million microbial genes from the yak feces were established based on metagenomic assemblies from 92 Gb sequencing data. We identified a full spectrum of genes encoding carbohydrate-active enzymes, three-quarters of which were assigned to highly diversified enzyme families involved in the breakdown of complex dietary carbohydrates, including 120 families of glycoside hydrolases, 25 families of polysaccharide lyases, and 15 families of carbohydrate esterases. Inference of taxonomic assignments to the carbohydrate-degrading genes revealed the major microbial contributors wereBacteroidaceae,Ruminococcaceae,Rikenellaceae,Clostridiaceae, andPrevotellaceae. Furthermore, 68 prokaryotic genomes were reconstructed and the genes encoding glycoside hydrolases involved in plant-derived polysaccharide degradation were identified in these uncultured genomes, many of which were novel species with lignocellulolytic capability.

Conclusions

Our findings shed light on a great diversity of carbohydrate-degrading enzymes in the yak gut microbial community and uncultured species, which provides a useful genetic resource for future studies on the discovery of novel enzymes for industrial applications.
Serum miRNA125a-5p, miR-125b-5p, and miR-433-5p as biomarkers to differentiate between posterior circulation stroke and peripheral vertigo
Authors: Kijpaisalratana Naruchorn , Nimsamer Pattaraporn , Khamwut Ariya , Payungporn Sunchai , Pisitkun Trairak , Chutinet Aurauma , Utoomprurkporn Nattawan , Kerr Stephen J. , Vongvasinkul Pakkawan , Suwanwela Nijasri C.
Published: October 2020

Background

Acute vertigo is a common presentation of inner ear disease. However, it can also be caused by more serious conditions, especially posterior circulation stroke. Differentiating between these two conditions by clinical presentations and imaging studies during the acute phase can be challenging. This study aimed to identify serum microRNA (miRNA) candidates that could differentiate between posterior circulation stroke and peripheral vertigo, among patients presenting with acute vertigo.

Methods

Serum levels of six miRNAs including miR-125a-5p, miR-125b-5p, miR-143-3p, miR-342-3p, miR-376a-3p, and miR-433-5p were evaluated. Using quantitative reverse-transcription polymerase chain reaction (RT-qPCR), the serum miRNAs were assessed in the acute phase and at a 90 day follow-up visit.

Results

A total of 58 patients with posterior circulation stroke (n = 23) and peripheral vertigo (n = 35) were included in the study. Serum miR-125a-5p (P = 0.001), miR-125b-5p (P <  0.001), miR-143-3p (P = 0.014) and miR-433-5p (P = 0.0056) were present at significantly higher levels in the acute phase, in the patients with posterior circulation infarction. Based on the area under the receiver operating characteristic curve (AUROC) only miR-125a-5p (0.75), miR-125b-5p(0.77), and miR-433-5p (0.71) had an acceptable discriminative ability to differentiate between the central and peripheral vertigo. A combination of miRNAs revealed no significant improvement of AUROC when compared to single miRNAs.

Conclusion

This study demonstrated the potential of serum miR-125a-5p, miR-125b-5p, and miR-433-5p as biomarkers to assist in the diagnosis of posterior circulation infarction among patients presenting with acute vertigo.
Traumatic index extensor tendon attenuation mimicking closed tendon rupture: two case reports
Authors: Miyashima Yusuke , Uemura Takuya , Yokoi Takuya , Hama Shunpei , Okada Mitsuhiro , Konishi Sadahiko , Nakamura Hiroaki
Published: October 2020

Background

While some traumatic closed index extensor tendon ruptures at the musclotendinous junction have been previously reported, closed index extensor tendon pseudorupture due to intertendinous attenuation is exceedingly rare with only one case report of a gymnastics-related sports injury in the English literature. Herein, we report two non-sports injury related cases of traumatic index extensor tendon attenuation mimicking closed tendon rupture, including the pathological findings and intraoperative video of the attenuated extensor indicis proprius tendon.

Case presentation

A 28-year-old man and a 30-year-old man caught their hands in a high-speed drill and lathe, respectively, which caused a sudden forced flexion of their wrists. They could not actively extend the metacarpophalangeal joints of their index fingers. Intraoperatively, although the extensor indicis proprius and index extensor digitorum communes tendons were in continuity without ruptures, both tendons were attenuated and stretched. The attenuated index extensor tendons were reconstructed either with shortening by plication or step-cut when the tendon damage was less severe or, in severely attenuated tendons, with tendon grafting (ipsilateral palmaris longus) or tendon transfer. Six months after the operation, the active extension of the index metacarpophalangeal joints had recovered well.

Conclusions

Two cases of traumatic index extensor tendon attenuation were treated successfully by shortening the attenuated tendon in combination with tendon graft or transfer. We recommend WALANT (wide-awake local anesthesia and no tourniquet) in the reconstruction surgery of index extensor tendon attenuation to determine the appropriate amount of tendon shortening or optimal tension for tendon grafting or transfer. Intraoperative voluntary finger movement is essential, as it is otherwise difficult to judge the stretch length of intratendinous elongation and extent of traumatic intramuscular damage affecting tendon excursion.
A cluster randomized controlled trial on a multifaceted implementation strategy to promote integrated palliative care in COPD: study protocol of the COMPASSION study
Authors: Broese Johanna M. C. , van der Kleij Rianne M. J. J. , Kerstjens Huib A. M. , Verschuur Els M. L. , Engels Yvonne , Chavannes Niels H.
Published: October 2020

Background

Despite the urgent need for palliative care for patients with advanced chronic obstructive pulmonary disease (COPD), it is not yet daily practice. Important factors influencing the provision of palliative care are adequate communication skills, knowing when to start palliative care and continuity of care. In the COMPASSION study, we address these factors by implementing an integrated palliative care approach for patients with COPD and their informal caregivers.

Methods

An integrated palliative care intervention was developed based on existing guidelines, a literature review, and input from patient and professional organizations. To facilitate uptake of the intervention, a multifaceted implementation strategy was developed, comprising a toolbox, (communication) training, collaboration support, action planning and monitoring. Using a hybrid effectiveness-implementation type 2 design, this study aims to simultaneously evaluate the implementation process and effects on patient, informal caregiver and professional outcomes. In a cluster randomized controlled trial, eight hospital regions will be randomized to receive the integrated palliative care approach or to provide care as usual. Eligible patients are identified during hospitalization for an exacerbation using the Propal-COPD tool. The primary outcome is quality of life (FACIT-Pal) at 6 months. Secondary outcome measures include spiritual well-being, anxiety and depression, unplanned healthcare use, informal caregiver burden and healthcare professional’s self-efficacy to provide palliative care. The implementation process will be investigated by a comprehensive mixed-methods evaluation assessing the following implementation constructs: context, reach, dose delivered, dose received, fidelity, implementation level, recruitment, maintenance and acceptability. Furthermore, determinants to implementation will be investigated using the Consolidated Framework for Implementation Research.

Discussion

The COMPASSION study will broaden knowledge on the effectiveness and process of palliative care integration into COPD-care. Furthermore, it will improve our understanding of which strategies may optimize the implementation of integrated palliative care.

Trial registration

Netherlands Trial Register (NTR):NL7644. Registration date: April 7, 2019.
Variation in surgical demand and time to hip fracture repair: a Canadian database study
Authors: Sheehan Katie J. , Sobolev Boris , Guy Pierre , Kim Jason D. , Kuramoto Lisa , Beaupre Lauren , Levy Adrian R. , Morin Suzanne N. , Sutherland Jason M. , Harvey Edward J. ,   for the Canadian Collaborative Study on Hip Fractures, Beaupre Lauren , Bohm Eric , Dunbar Michael , Griesdale Donald , Guy Pierre , Harvey Edward , Hellsten Erik , Jaglal Susan , Kreder Hans , Kuramoto Lisa , Levy Adrian , Morin Suzanne N. , Sheehan Katie J. , Sobolev Boris , Sutherland Jason M. , Waddell James
Published: October 2020

Background

Competing demands for operative resources may affect time to hip fracture surgery. We sought to determine the time to hip fracture surgery by variation in demand in Canadian hospitals.

Methods

We obtained discharge abstracts of 151,952 patients aged 65 years or older who underwent surgery for a hip fracture between January, 2004 and December, 2012 in nine Canadian provinces. We compared median time to surgery (in days) when demand could be met within a two-day benchmark and when demand required more days, i.e. clearance time, to provide surgery, overall and stratified by presence of medical reasons for delay.

Results

For persons admitted when demand corresponded to a 2-day clearance time, 68% of patients underwent surgery within the 2-day benchmark. When demand corresponded to a clearance time of one week, 51% of patients underwent surgery within 2 days. Compared to demand that could be served within the two-day benchmark, adjusted median time to surgery was 5.1% (95% confidence interval [CI] 4.1–6.1), 12.2% (95% CI 10.3–14.2), and 22.0% (95% CI 17.7–26.2) longer, when demand required 4, 6, and 7 or more days to clear the backlog, respectively. After adjustment, delays in median time to surgery were similar for those with and without medical reasons for delay.

Conclusion

Increases in demand for operative resources were associated with dose-response increases in the time needed for half of hip fracture patients to undergo surgery. Such delays may be mitigated through better anticipation of day-to-day supply and demand and increased response capability.
Development of genetic tools for the thermophilic filamentous fungus Thermoascus aurantiacus
Authors: Gabriel Raphael , Prinz Julia , Jecmenica Marina , Romero-Vazquez Carlos , Chou Pallas , Harth Simon , Floerl Lena , Curran Laure , Oostlander Anne , Matz Linda , Fritsche Susanne , Gorman Jennifer , Schuerg Timo , Fleißner André , Singer Steven W.
Published: October 2020

Background

Fungal enzymes are vital for industrial biotechnology, including the conversion of plant biomass to biofuels and bio-based chemicals. In recent years, there is increasing interest in using enzymes from thermophilic fungi, which often have higher reaction rates and thermal tolerance compared to currently used fungal enzymes. The thermophilic filamentous fungus Thermoascus aurantiacus produces large amounts of highly thermostable plant cell wall-degrading enzymes. However, no genetic tools have yet been developed for this fungus, which prevents strain engineering efforts. The goal of this study was to develop strain engineering tools such as a transformation system, a CRISPR/Cas9 gene editing system and a sexual crossing protocol to improve the enzyme production.

Results

Here, we report Agrobacterium tumefaciens-mediated transformation (ATMT) of T. aurantiacus using the hph marker gene, conferring resistance to hygromycin B. The newly developed transformation protocol was optimized and used to integrate an expression cassette of the transcriptional xylanase regulator xlnR, which led to up to 500% increased xylanase activity. Furthermore, a CRISPR/Cas9 gene editing system was established in this fungus, and two different gRNAs were tested to delete the pyrG orthologue with 10% and 35% deletion efficiency, respectively. Lastly, a sexual crossing protocol was established using a hygromycin B- and a 5-fluoroorotic acid-resistant parent strain. Crossing and isolation of progeny on selective media were completed in a week.

Conclusion

The genetic tools developed for T. aurantiacus can now be used individually or in combination to further improve thermostable enzyme production by this fungus.
Engineering endogenous ABC transporter with improving ATP supply and membrane flexibility enhances the secretion of β-carotene in Saccharomyces cerevisiae
Authors: Bu Xiao , Lin Jing-Yuan , Cheng Jing , Yang Dong , Duan Chang-Qing , Koffas Mattheos , Yan Guo-Liang
Published: October 2020

Background

Product toxicity is one of the bottlenecks for microbial production of biofuels, and transporter-mediated biofuel secretion offers a promising strategy to solve this problem. As a robust microbial host for industrial-scale production of biofuels, Saccharomyces cerevisiae contains a powerful transport system to export a wide range of toxic compounds to sustain survival. The aim of this study is to improve the secretion and production of the hydrophobic product (β-carotene) by harnessing endogenous ABC transporters combined with physiological engineering in S. cerevisiae.

Results

Substrate inducibility is a prominent characteristic of most endogenous transporters. Through comparative proteomic analysis and transcriptional confirmation, we identified five potential ABC transporters (Pdr5p, Pdr10p, Snq2p, Yor1p, and Yol075cp) for β-carotene efflux. The accumulation of β-carotene also affects cell physiology in various aspects, including energy metabolism, mitochondrial translation, lipid metabolism, ergosterol biosynthetic process, and cell wall synthesis. Here, we adopted an inducible GAL promoter to overexpress candidate transporters and enhanced the secretion and intracellular production of β-carotene, in which Snq2p showed the best performance (a 4.04-fold and a 1.33-fold increase compared with its parental strain YBX-01, respectively). To further promote efflux capacity, two strategies of increasing ATP supply and improving membrane fluidity were following adopted. A 5.80-fold increase of β-carotene secretion and a 1.71-fold increase of the intracellular β-carotene production were consequently achieved in the engineered strain YBX-20 compared with the parental strain YBX-01.

Conclusions

Overall, our results showcase that engineering endogenous plasma membrane ABC transporters is a promising approach for hydrophobic product efflux in S. cerevisiae. We also highlight the importance of improving cell physiology to enhance the efficiency of ABC transporters, especially energy status and cell membrane properties.
An adolescent girl with premature ovarian failure, Graves’ disease, and chronic urticaria: a case report
Authors: Lin Danhong , Quan Huibiao , Chen Kaining , Lin Lu , Lin Leweihua , Ji Qun
Published: October 2020

Background

Premature ovarian failure is characterized by amenorrhea, hypoestrogenism, and hypergonadotropinism, and occurs in women under 40 years of age. The prevalence of premature ovarian failure in women younger than 20 years of age is only 0.01%. Immune disorders are one of the causes of premature ovarian failure. Graves’ disease and chronic urticaria are also associated with immune disorders.

Case presentation

We report a case of a 15-year-old Han Chinese girl with premature ovarian failure complicated by Graves’ disease and chronic urticaria. She experienced menarche at 13 years of age and presented with amenorrhea after 7 months of irregular menstruation. Laboratory examinations indicated hypoestrogenism and hypergonadotropinism. Ultrasound imaging revealed that her uterus and ovaries were small in size. Gene and antibody tests related to premature ovarian failure returned negative results. Both thyroid peroxidase autoantibody and thyrotropin receptor antibody were positive.

After reviewing the literature on the relationship between these three diseases and immune disorders, our patient was diagnosed as having atypical autoimmune polyglandular syndrome. After taking small doses of estrogen for 6 months, the size of her uterus increased, and her psychological anxiety was relieved.

Conclusions

We report a case of an unusual association of premature ovarian failure, Graves’ disease, and chronic urticaria. This case presents an atypical combination of adolescent autoimmune polyglandular syndrome, which is worthy of the attention of clinicians and presents an important lesson for them. Our case highlights that premature ovarian failure in adolescents requires long-term follow-up and medical treatment as well as psychological counselling.
Negative pressure wound therapy in patients with wounds healing by secondary intention: a systematic review and meta-analysis of randomised controlled trials
Authors: Zens Yvonne , Barth Michael , Bucher Heiner C. , Dreck Katrin , Felsch Moritz , Groß Wolfram , Jaschinski Thomas , Kölsch Heike , Kromp Mandy , Overesch Inga , Sauerland Stefan , Gregor Sven
Published: October 2020

Background

Negative pressure wound therapy (NPWT) is a widely used method of wound treatment. We performed a systematic review of randomised controlled trials (RCTs) comparing the patient-relevant benefits and harms of NPWT with standard wound therapy (SWT) in patients with wounds healing by secondary intention.

Methods

We searched for RCTs in MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and study registries (last search: July 2018) and screened reference lists of relevant systematic reviews and health technology assessments. Manufacturers and investigators were asked to provide unpublished data. Eligible studies investigated at least one patient-relevant outcome (e.g. wound closure). We assessed publication bias and, if feasible, performed meta-analyses, grading the results into different categories (hint, indication or proof of a greater benefit or harm).

Results

We identified 48 eligible studies of generally low quality with evaluable data for 4315 patients and 30 eligible studies with missing data for at least 1386 patients. Due to potential publication bias (proportion of inaccessible data, 24%), we downgraded our conclusions. A meta-analysis of all wound healing data showed a significant effect in favour of NPWT (OR 1.56, 95% CI 1.15 to 2.13, p = 0.008). As further analyses of different definitions of wound closure did not contradict that analysis, we inferred an indication of a greater benefit of NPWT. A meta-analysis of hospital stay (in days) showed a significant difference in favour of NPWT (MD − 4.78, 95% CI − 7.79 to − 1.76, p = 0.005). As further analyses of different definitions of hospital stay/readmission did not contradict that analysis, we inferred an indication of a greater benefit of NPWT. There was neither proof (nor indication nor hint) of greater benefit or harm of NPWT for other patient-relevant outcomes such as mortality and adverse events.

Conclusions

In summary, low-quality data indicate a greater benefit of NPWT versus SWT for wound closure in patients with wounds healing by secondary intention. The length of hospital stay is also shortened. The data show no advantages or disadvantages of NPWT for other patient-relevant outcomes. Publication bias is an important problem in studies on NPWT, underlining that all clinical studies need to be fully reported.
Understanding surgical antimicrobial prescribing behaviour in the hospital setting: a systematic review and meta-ethnography protocol
Authors: Parker Hazel , Frost Julia , Britten Nicky , Robinson Sophie , Mattick Karen
Published: October 2020

Background

Surgical specialities use extensive amounts of antimicrobials, and misuse has been widely reported, making them a key target for antimicrobial stewardship initiatives. Interventions informed by, and tailored to, a clear understanding of the contextual barriers to appropriate antimicrobial use are more likely to successfully improve practice. However, this approach has been under utilised. Our aim is to synthesise qualitative studies on surgical antimicrobial prescribing behaviour (APB) in hospital settings to explain how and why contextual factors act and interact to influence APB amongst surgical teams. We will develop new theory to advance understanding and identify knowledge gaps to inform further research.

Methods

The meta-ethnography will follow the seven-phase method described by Noblit and Hare. We will conduct a comprehensive search using eight databases (AMED, CINAHL, EMBASE, MEDLINE, MEDLINE-in-process, Web of Science, Cochrane Library and PsycINFO) with no date restrictions; forwards and backwards citation searches; and contacting first authors of relevant papers. Studies will be dual screened and included if they use recognised qualitative methods and analysis; focus on contextual factors associated with surgical APB within hospital settings; are available in full in English; and are relevant to the research question. Any disagreements between reviewers will be resolved through discussion to reach consensus. Included studies will be read repeatedly to illuminate key concepts and the relationship between key concepts across studies. Then, key concepts will be sorted into conceptual categories or ‘piles’ which will be further abstracted to form a conceptual framework explaining surgical APB. During the synthesis, emerging interpretations will be discussed with stakeholders (including authors of included studies where possible; surgical and stewardship practitioners; and patient representatives) to ensure new knowledge is meaningful.

Discussion

This research has several strengths: (1) the protocol has been written with reference to established guidance maximising rigour and transparency; (2) the multi-disciplinary research team bring varied interpretative repertoires and relevant methodological skills; and (3) stakeholders will be involved to ensure that findings are relevant, and disseminated via suitable channels, to support improved patient care.

Systematic review registration

PROSPERO CRD42020184343