bluuebunny/crossref_metadata_2025 huggingface dataset:
The “Be All and End All”? Young People, Online Sexual Health Information, Science and Skepticism
Authors: Farrugia Adrian , Waling Andrea , Pienaar Kiran , Fraser Suzanne
Published: April 2021

In this article, we investigate young people’s trust in online sexual health resources. Analyzing interviews with 37 young people in Australia using Irwin and Michael’s account of science–society relations and Warner’s conceptualization of “publics,” we explore the processes by which they assess the credibility of online sexual health information. We suggest that when seeking medical information, young people opt for traditionally authoritative online sources that purport to offer “facts.” By contrast, when seeking information about relationships or sexual practices, participants indicated a preference for websites presenting “experiences” rather than or as well as “facts.” Regardless of content, however, our participants approached online sexual health information skeptically and used various techniques to appraise its quality and trustworthiness. We argue that these young people are productively understood as a skeptical public of sexual health. We conclude by exploring the implications of our analysis for the provision of online sexual health information.
Elucidating the mechanisms of damage in foam core sandwich composites under impact loading and low temperatures
Authors: Castellanos Alejandra G , Prabhakar Pavana
Published: April 2021

Recent interest in Arctic exploration has brought new challenges concerning the mechanical behavior of lightweight materials for offshore structures. Exposure to seawater and cold temperatures are known to degrade the mechanical properties of several materials, thus, compromising the safety of personnel and structures. This study aims to investigate the low-velocity impact behavior of woven carbon/vinyl ester sandwich composites with Polyvinyl chloride (PVC) foam core at low temperatures for marine applications. The tests were performed in a drop tower impact system with an in-built environmental chamber. Impact responses, such as the contact force, displacement and absorbed energy, at four impact energies of 7.5 J, 15 J, 30 J, and 60 J were determined at four in-situ temperatures of 25°C, 0°C, −25°C and −50°C. Results showed that temperature has a significant influence on the dynamic impact behavior of sandwich composites. The sandwich composites were rendered stiff and brittle as the temperature decreased, which has a detrimental effect on their residual strength and durability. At 7.5 J at all temperatures, the samples experienced matrix cracking, fiber fracture, and delamination at the top face sheet. The samples impacted at 15 J at all temperatures experienced fiber fracture, matrix cracking, and delamination at the top facesheet and localized core crushing/fracture. At 30 J for all the temperatures, the samples exhibited perforation of the top facesheet and penetration into the core. As the temperature decreased, the penetration of the striker into the core increased. At 60 J for all temperatures, the samples experienced perforation of the top facesheet and core, and the back facesheet exhibited varying extent of damage. At −25°C and −50°C, the sandwich composite samples were almost completely perforated. In general, low temperatures rendered the sandwich composites stiff and brittle, resulting in an increase in the degree of damage and more pronounced damage modes. At all impact energies, the sandwich composites were rendered stiff and brittle as the temperature decreased, which has a detrimental effect on their residual strength and durability.
The economic determinants of tourism in Central Asia: A gravity model applied approach
Authors: Ibragimov Khusen , Perles-Ribes José Francisco , Ramón-Rodríguez Ana Belén
Published: April 2021

This article explores the determinants of tourist arrivals to Central Asia using traditional gravity models and panel data analyses of 108 countries for the period 2008–2018. The research focuses on relevant variables such as income, relative price, travel costs, or the so-called economic determinants. The results reveal that tourism in Central Asia is considered to be more distance elastic and price inelastic. Tourists from North and South America regions are more travel costs elastic compared with Asia and the Pacific. Sharing a common language and border greatly increases the volume of tourism in Central Asia. The political instability in the destination has a negative effect on tourism flows. Conversely, political instability at the country of origin in the case of Asia and the Pacific significantly increases outbound flows especially to Central Asia, suggesting a different reason for travel.
‘I’m nearly as active as the boys who play football’: A multiple-case study of social identification among least active pupils
Authors: Bentholm Anette , Pawlowski Charlotte , Agergaard Sine
Published: April 2021

Polarisation between the least and most active pupils is increasing both in Denmark and worldwide, and the least active pupils often have poorer mental health and low physical self-esteem. However, the least active pupils’ perspectives on physical activity in school are underrepresented in the research. This study explores how the least active pupils describe the purpose of physical activity at school and how active they consider themselves to be in relation to their classmates. To establish the above, we draw on Jenkins’ theory of social identity, which points to the dialectics between internal identification and external categorisation. Three schools were selected for a qualitative multiple-case study, focusing on the least active Year 3 pupils (aged 9–10). Thirty individual semi-structured interviews with these pupils were conducted, combined with 15 days of participant observations, at each school in 2018. Data were analysed using an abductive approach. The findings showed that the least active pupils’ descriptions of why they were active mainly referred to narrow understandings of physical health in line with broader societal explanations. Further, the pupils depicted a stigmatic categorisation of overweight and inactive pupils and described them as a group they did not belong to. Instead, they identified themselves with the active pupils, for example, in stating that they were almost as active as the ‘football boys’. To change pupils’ narrow identifications and stigmatic categorisations, school professionals should focus less on health as an argument for physical activity.
Damping effect on seismic input energy and its verification by shake table tests
Authors: Gullu Ahmet , Yuksel Ercan , Yalcin Cem , Buyukozturk Oral
Published: April 2021

Seismic input energy per unit mass ( EI/m) imparted into a structure is a function of earthquake (duration, frequency content, amplitude etc.), soil (shear velocity, dominant period etc.) and the structural (vibrational periods etc.) characteristics. Generally, the damping properties of the structure is assumed negligible for seismic input energy. Most of the existing spectral equations derived for SDOF systems generally use a constant damping ratio of 5%. In this study, the damping effect on EI/m is investigated experimentally and numerically on SDOF systems with distinct damping ratios. Experimental investigation and numerical computations proved that seismic input energy is very sensitive to variation of damping within the vicinity of fundamental frequencies. Specifically, up to 50% increment was observed in the plateau region of the input energy spectrum, where maximum EI/m values occur, by variation of damping from 2% to 10%. Hence, a novel damping modification factor ( DMF), which could be utilized for existing energy spectra, is proposed in this paper. Validation studies of the proposed DMF are achieved through the various energy spectra found in the literature.
Professionalisation of early childhood education and care practitioners: Working conditions in Ireland
Authors: Mooney Simmie Geraldine , Murphy Dawn
Published: April 2021

The last decade has revealed a global (re)configuring of the relationships between the state, society and educational settings in the direction of systems of performance management. In this article, the authors conduct a critical feminist inquiry into this changing relationship in relation to the professionalisation of early childhood education and care practitioners in Ireland, with a focus on dilemmatic contradictions between the policy reform ensemble and practitioners’ reported working conditions in a doctoral study. The critique draws from the politics of power and education, and gendered and classed subjectivities, and allows the authors to theorise early childhood education and care professionalisation in alternative emancipatory ways for democratic pedagogy rather than a limited performativity. The findings reveal the state (re)configured as a central command centre with an over-reliance on surveillance, alongside deficits of responsibility for public interest values in relation to the working conditions of early childhood education and care workers, who are mostly part-time ‘pink-collar’ women workers in precarious roles. The study has implications that go beyond Ireland for the professionalisation of early childhood education and care workers and meeting the early developmental needs of young children.
Correlation between adolescent orthodontic quality of life and ABO Discrepancy Index in an orthodontic treatment-seeking population: A cross-sectional study
Authors: Swan Matthew , Tabbaa Sawsan , Buschang Peter , Toubouti Youssef , Bashir Rehana
Published: April 2021

Objective:

To evaluate the association between adolescents’ orthodontic quality of life before initiating orthodontic treatment and their objective case complexity as measured by the American Board of Orthodontics’ Discrepancy Index (DI).

Design and setting:

A single-centre, cross-sectional survey study.

Methods:

The Orthodontic Quality of Life Assessment Survey (OQoLAS) was administered to 240 adolescents (aged 11–14 years) during their record-gathering appointment. After completion of the survey, a DI score was calculated for each patient based on pretreatment measurements. Pearson correlation coefficients, r, were used to assess the association of DI scores with OQoLAS total and subdomain scores. A multiple linear regression of OQoLAS total scores adjusting for age, gender and DI scores was conducted.

Results:

The study did not find a strong correlation between OQoLAS and DI scores (r = 0.10; P = 0.6497). On average, the OQoLAS scores (functional, emotional and social subdomains of OQoLAS) were slightly higher among girls than among boys but there was no statistical difference for total OQoLAS score between boys and girls (42.4 vs. 45.4, P = 0.2005). However, there was a significant difference in oral health perception rating between boys and girls, with girls being more likely to rate their oral health positively (adjusted P = 0.0226). The total DI scores of boys with respect to girls were not statistically different ( P = 0.4256). The components of the DI that showed highest score were for cephalometric measures, followed by overjet; and the lowest scores were for lateral open bite and buccal posterior crossbite. The measure of association analysis did not show any strong correlation between the OQoLAS (total score and subdomain scores), and DI score or any of its components.

Conclusion:

Malocclusion severity was not found to be correlated with orthodontic quality of life in adolescents aged 11–14 years seeking orthodontic treatment.
“It’s ok, mom. I got it!”: Exploring the experiences of young adults with intellectual disabilities in a postsecondary program affected by the COVID-19 pandemic from their perspective and their families’ perspective
Authors: Spencer Patricia , Van Haneghan James P , Baxter Abigail , Chanto-Wetter Alexandra , Perry Lauren
Published: April 2021

Students’ resilience in a postsecondary program for individuals with an intellectual disability impacted by the COVID-19 disruption and the challenges they faced during this time was captured in the context of social network analysis interviews that included students’ and families’ experiences as they managed the pandemic. Students’ experiences spoke to their resilience in using the skills they gained through the program to navigate the COVID-19 disruption even though it was sometimes tricky. Parents’ experiences revealed their increased confidence and sense of pride in their adult children when they observed growth in independence, self-determination, and familiarity with technology. Innovative and engaging instructional practices and e-mentoring support offered by peer mentors motivated students in their academics and encouraged their social development during this time. Student and parent experiences offer hope that young adults with an intellectual disability can gain skills in a postsecondary program that better prepares them to meet life’s challenges.
The case for skin camouflage in the management of upper limb scarring – A case series
Authors: Adamson Laura , Selby Anna
Published: April 2021

Introduction

For some people the appearance of their hands is as important as function. Upper limb scarring can cause some patients distress. Skin camouflage is an intervention that can be used to reduce the visual impact of a scar but there is limited published evidence for its use for hand scarring.

Methods

This is a case series study with a primary objective to determine whether skin camouflage reduces distress in patients with an upper limb scar and to evaluate this new service. Patients experiencing distress from an upper limb scar were recruited from a hand therapy outpatient clinic. The intervention delivered was a one hour skin camouflage session. Photographs of the upper limb pre and post skin camouflage intervention were taken. The patient-rated Michigan Hand Questionnaire (MHQ) and Derriford Appearance Scale (DAS24) were completed before treatment, at 1 week and 1 month after treatment.

Results

Six participants reporting distress from an upper limb scar received skin camouflage intervention. Only three out of six participants completed all follow-up. All three showed improvement in at least two domains of the MHQ (function and aesthetics) at one month post treatment. Increased confidence during functional and work-based activities was also reported on the DAS24. Participants reported increased engagement in daily activities as a result of being able to camouflage their scars.

Conclusions

This small case series shows that skin camouflage intervention may be beneficial for some patients who are experiencing distress related to an upper limb scar by increasing function and self-confidence.
Interactions of the microbiome with pharmacological and non-pharmacological approaches for the management of ageing-related musculoskeletal diseases
Authors: Papageorgiou Maria , Biver Emmanuel
Published: April 2021

Despite major progress in the understanding of the pathophysiology and therapeutic options for common ageing-related musculoskeletal conditions (i.e. osteoporosis and associated fractures, sarcopenia and osteoarthritis), there is still a considerable proportion of patients who respond sub optimally to available treatments or experience adverse effects. Emerging microbiome research suggests that perturbations in microbial composition, functional and metabolic capacity (i.e. dysbiosis) are associated with intestinal and extra-intestinal disorders including musculoskeletal diseases. Besides its contributions to disease pathogenesis, the role of the microbiome is further extended to shaping individuals’ responses to disease therapeutics (i.e. pharmacomicrobiomics). In this review, we focus on the reciprocal interactions between the microbiome and therapeutics for osteoporosis, sarcopenia and osteoarthritis. Specifically, we identify the effects of therapeutics on microbiome’s configurations, functions and metabolic output, intestinal integrity and immune function, but also the effects of the microbiome on the metabolism of these therapeutics, which in turn, may influence their bioavailability, efficacy and side-effect profile contributing to variable treatment responses in clinical practice. We further discuss emerging strategies for microbiota manipulation as preventive or therapeutic (alone or complementary to available treatments) approaches for improving outcomes of musculoskeletal health and disease.
How Parallel Should Parallel Passages Be?
Authors: Wade Martha L.
Published: April 2021

The Parallel Passages tool in the Bible translation software Paratext is a powerful tool. As with all powerful tools, it can have both positive and negative impacts on a project. Consultants need to be aware of some of the known “issues” that will sometimes result in false positives or false negatives in the highlighting of which parts of the vernacular verse are parallel. Correct usage of the tool will help a team improve the quality of the translation, but incorrectly used it can lead to a lack of naturalness and accuracy because the grammatical features of the vernacular will not allow perfect parallels in certain contexts. In this article, the positive and negative features of the tool will be illustrated with examples from the Apal language in Papua New Guinea. The article will conclude with a list of suggestions for consultants with respect to the Parallel Passages tool.
Adding a Cubit to Bible Understanding: A Study of Notes in the Chinese Union Version Bible and the Sigao Bible
Authors: Xu Xiaojun
Published: April 2021

The note as a paratextual element has played an important role in Bible translation. This article collects the translational notes from the New Testament in the Chinese Protestant Union Version Bible (CUV) and the Chinese Catholic Sigao Bible (SBV) to uncover the ideological leanings of translators as well as the types and functions of translational notes in these versions. With a quantitative and qualitative analysis of eight selected notes, the article shows that: (1) CUV followed the “without note or comment” principle for unbiased comments and thus employed more linguistic notes, but SBV followed the Catholic tradition in writing exegetical comments; (2) the notes help readers understand the reasons for textual variations and the problem of selectivity in translating; and (3) CUV translators took account of the Chinese literati’s taste, whereas SBV aimed to reach the common people. Further research is needed for a more in-depth interpretation.
“God’s Righteousness Is Revealed in Every Believer from Faith to Faithfulness” (Rom 1.17): A Possible Reading
Authors: Lee Yongbom
Published: April 2021

This study proposes understanding Rom 1.17 as: “For God’s righteousness is revealed in every believer from faith to faithfulness, as it was written, ‘The righteous will live by faith,’” based on various exegetical considerations in both its syntagmatic and literary context and its role in the overall shape of Romans. It highlights Paul’s holistic and dynamic picture of Christian life in which justification by faith produces its fruits in a believer’s everyday life.
An anti-racist and anti-colonial Anthropocene for compromised times
Authors: Brown Nicholas A , Kanouse Sarah E
Published: April 2021

The anticipated formal adoption of the Anthropocene by the International Union of Geological Sciences offers an opportunity to develop forms of praxis informed by anti-racist and anti-colonial critiques of the Anthropocene and its mid-twentieth century start date. Moving beyond the impasse of the Anthropocene debates requires a broad suite of methods and voices. This short essay places Michael Egan’s concept of “survival science” in dialog with unexpected interlocutors historian Ibram X. Kendi and philosopher Alexis Shotwell to argue for explicitly anti-racist and anti-colonial praxis grounded in an ethic of humility. Reflections on a seminar organized by the authors for the recent research platform Mississippi. An Anthropocene River ground the theoretical work of Kendi and Shotwell in a concrete, if experimental attempt to work with the Anthropocene concept in anti-racist and anti-colonial ways, responsive to the specific entanglements of place.
Study, truth, and personal formation: Reflections on John Paul II’s Pastores dabo vobis
Authors: Walz Matthew D
Published: April 2021

Although John Paul II published “Pastores dabo vobis” specifically for the formation of seminarians for Catholic priesthood, it nonetheless contains much wisdom regarding the formation of any young person on the cusp of full adulthood. John Paul outlines a framework of personal formation according to its human, spiritual, intellectual, and pastoral dimensions. I articulate those dimensions through the lens of a fourfold causal analysis, attending especially to the intellectual dimension and its proper activity, study. My thesis is that study—that is, the serious and diligent exercise of our innate capacity for truth—is the primary driver of successful personal formation.
Uncommon Pigmented Carcinoma In Situ: Case Report and Brief Review
Authors: Soares Andresa Borges , de Araújo Vera Cavalcanti , Passador-Santos Fabricio , Thomaz Luiz Alexandre , de Freitas Andre Luis Santana , Mautoni Mario Claudio , Stelini Rafael Fantelli , Cintra Maria Leticia
Published: April 2021

Pigmented lesions of the oral mucosa encompass several benign and malignant conditions that may be a matter of concern under both clinical and histopathological views. We reported a case of a 62-year-old woman, presenting with an asymptomatic, deeply pigmented lesion on the soft palate. On examination, it appeared asymmetrical, with irregular borders and an area of ulceration. A biopsy, taken to rule out melanoma, revealed a pigmented carcinoma in situ. Throughout the tumor thickness, numerous interspersed melanocytes were found that did not extend to neighboring epithelium. These were large, richly dendritic, and presented abundance of melanin granules and small nuclei. Mild melanin incontinence was found. Scanty transfer of pigment to dysplastic epithelial cells was found through Fontana Masson staining. On immunohistochemical analyses, there were pancytokeratin-stained tumor epithelial cells; increased cell proliferation throughout the entire thickness of the tumor was emphasized by Ki-67 immunomarking. P16 was negative. The dendritic cells were selectively stained for S-100, HMB45 and Melan A. Wide spectrum in situ hybridization for human papillomavirus (HPV) was negative. Unfortunately, following diagnosis, the patient refused any treatment option. Pigmented squamous cell carcinoma with melanocyte colonization must be taken into account in the differential diagnosis of pigmented lesions of the oral cavity.
Prison gangs in Iran: Between violence and safety
Authors: Rahimipour Anaraki Nahid
Published: April 2021

This article aims to bridge the gap in our knowledge about Iranian prisons and the sociodynamic relations that animate them by illuminating the characteristics and activities of prison gangs in Iran. The interaction between gang affiliation and drug networks, security and violence will be discussed in detail. The in-depth qualitative research, which is informed by grounded theory, serves as the first academic study of gangs in Iranian prisons. Research participants included 38 males and 52 females aged 10–65 years. They were recruited in several different settings, both governmental and non-governmental organizations. The study employed theoretical sampling and in-depth, semi-structured interviewing. Results show that gang-affiliated inmates in Iranian prisons gain monopoly over the drugs market inside prison networks, which leads to inevitable extortion of both prisoners and correctional officers. Gang affiliation blurs the lines between violence and safety, while providing a sense of identity, belonging and financial and emotional support. Prison gang membership also offers some benefits to prisoners and staff, as their existence underpins an informal social order that can be used to govern prisoners. The article discusses this less well-known and unexplored dimension of the topic.
Carceral experiences and custodial lifeworld of prisoners’ families: The impacts of ion scan technology in Canadian prisons
Authors: Garneau Brianna , Lehalle Sandra
Published: April 2021

The effects of imprisonment have been well-documented to go beyond the walls of carceral institutions and beyond the individual subjected to confinement. This article analyzes the expansion of carceral experiences in the lives of family members of Canadian prisoners, focusing on the use of the Ion Mobility Spectrometry device during prison visits. Drawing on testimonies, this article explores how the ion scanner not only affects the experiences of families in carceral spaces but also how the impacts are carried out into their everyday lives outside prison walls. The socialization undergone due to “secondary prisonization” leads family members to adopt a “custodial citizenship” which ultimately shapes how they interact and navigate the world—a citizenship and way of life that is unique to having an incarcerated loved one.
Preimplantation genetic testing for aneuploidy in uterus transplant patients
Authors: Chattopadhyay Rhea , Richards Elliott , Libby Valerie , Flyckt Rebecca
Published: April 2021

Uterus transplantation is an emerging treatment for uterine factor infertility. In vitro fertilization with cryopreservation of embryos prior is required before a patient can be listed for transplant. Whether or not to perform universal preimplantation genetic testing for aneuploidy should be addressed by centers considering a uterus transplant program. The advantages and disadvantages of preimplantation genetic testing for aneuploidy in this unique population are presented. The available literature is reviewed to determine the utility of preimplantation genetic testing for aneuploidy in uterus transplantation protocols. Theoretical benefits of preimplantation genetic testing for aneuploidy include decreased time to pregnancy in a population that benefits from minimization of exposure to immunosuppressive agents and decreased chance of spontaneous abortion requiring a dilation and curettage. Drawbacks include increased cost per in vitro fertilization cycle, increased number of required in vitro fertilization cycles to achieve a suitable number of embryos prior to listing for transplant, and a questionable benefit to live birth rate in younger patients. Thoughtful consideration of whether or not to use preimplantation genetic testing for aneuploidy is necessary in uterus transplant trials. Age is likely a primary factor that can be useful in determining which uterus transplant recipients benefit from preimplantation genetic testing for aneuploidy.
IGVL gene region usage correlates with distinct clinical presentation in IgM vs non-IgM light chain amyloidosis
Authors: Sidana Surbhi , Dasari Surendra , Kourelis Taxiarchis V. , Dispenzieri Angela , Murray David L. , King Rebecca L. , McPhail Ellen D. , Ramirez-Alvarado Marina , Kumar Shaji K. , Gertz Morie A.
Published: April 2021

Patients with immunoglobulin M (IgM) light chain (AL) amyloidosis have a distinct clinical presentation compared with those with non-IgM amyloidosis. We hypothesized that differential immunoglobulin light-chain variable region (IGVL) gene usage may explain the differences in organ involvement, because IGVL usage correlates with organ tropism. IGVL usage was evaluated by mass spectrometry of amyloid deposits (IgM, n = 45; non-IgM, n = 391) and differed across the 2 groups. In the λ family, LV2-08 (13% vs 2%; P < .001) and LV2-14 (36% vs 10%; P < .001) usage was more common in IgM vs non-IgM amyloidosis, whereas LV1-44 (0% vs 10%; P = .02) and LV6-57 (2% vs 18%; P = .004) usage was less common. In the κ family, there was a trend toward higher KV4-01 (11% vs 4%; P = .06) usage in IgM amyloidosis. IGVL usage correlated with disease characteristics/organ tropism. LV2-14 (more common in IgM amyloidosis) has historically been associated with peripheral nerve involvement and lower light chain burden, which were more frequent in IgM amyloidosis. LV1-44 (less common in IgM), associated with cardiac involvement, was less frequent in IgM patients. LV6-57 (less common in IgM) is associated with t(11;14), which was less frequent in IgM patients. In conclusion, IGVL gene usage differs in patients with IgM vs non-IgM amyloidosis and may explain the distinct clinical presentation.
Evolution of pathogen response genes associated with increased disease susceptibility during adaptation to an extreme drought in a Brassica rapa plant population
Authors: O’Hara Niamh B. , Franks Steven J. , Kane Nolan C. , Tittes Silas , Rest Joshua S.
Published: April 2021

Background

Pathogens are key components in natural and agricultural plant systems. There is evidence of evolutionary changes in disease susceptibility as a consequence of climate change, but we know little about the underlying genetic basis of this evolution. To address this, we took advantage of a historical seed collection of a Brassica rapa population, which we previously demonstrated evolved an increase in disease susceptibility to a necrotrophic fungal pathogen following a drought.

Results

Previously, we combined a resurrection experiment with genome-wide sequencing of 124 pooled ancestral and descendant plants. Here, using these previously generated sequence data (Franks et al. in Mol Ecol 25(15):3622–3631, 2016), we show that well-characterized necrotrophic fungal pathogen response (NFPR) genes have evolved, as indicated by changes in allele frequency, between ancestors and descendants, with several of them identified as extreme FST outliers. The jasmonic acid (JA) signaling pathway in particular seems to underlie the evolution of disease susceptibility, in addition to its well characterized role in plastic disease response. We identify a list of 260 genes that are both NFPR genes and are differentially expressed in response to drought, based on publicly available data. We present evidence that five of these genes evolved between ancestors and descendants, suggesting that the drought acted as the evolutionary driver, and that the accompanying increase in disease susceptibility may have been a consequence of genetic pleiotropy.

Conclusions

Our study provides evidence that for this population, standing variation in NFPR genes is affected by natural selection related to climate change. Our results reveal potentially important candidates that may underlie trait evolution in both crops and natural systems. Additionally, this trade-off between adaptation to biotic and abiotic stresses is an example of how climate change can have diverse and unexpected consequences.
Early postnatal irradiation‐induced age‐dependent changes in adult mouse brain: MRI based characterization
Authors: Ren Bo Xu , Huen Isaac , Wu Zi Jun , Wang Hong , Duan Meng Yun , Guenther Ilonka , Bhanu Prakash K. N. , Tang Feng Ru
Published: April 2021

Background

Brain radiation exposure, in particular, radiotherapy, can induce cognitive impairment in patients, with significant effects persisting for the rest of their life. However, the main mechanisms leading to this adverse event remain largely unknown. A study of radiation-induced injury to multiple brain regions, focused on the hippocampus, may shed light on neuroanatomic bases of neurocognitive impairments in patients. Hence, we irradiated BALB/c mice (male and female) at postnatal day 3 (P3), day 10 (P10), and day 21 (P21) and investigated the long-term radiation effect on brain MRI changes and hippocampal neurogenesis.

Results

We found characteristic brain volume reductions in the hippocampus, olfactory bulbs, the cerebellar hemisphere, cerebellar white matter (WM) and cerebellar vermis WM, cingulate, occipital and frontal cortices, cerebellar flocculonodular WM, parietal region, endopiriform claustrum, and entorhinal cortex after irradiation with 5 Gy at P3. Irradiation at P10 induced significant volume reduction in the cerebellum, parietal region, cingulate region, and olfactory bulbs, whereas the reduction of the volume in the entorhinal, parietal, insular, and frontal cortices was demonstrated after irradiation at P21. Immunohistochemical study with cell division marker Ki67 and immature marker doublecortin (DCX) indicated the reduced cell division and genesis of new neurons in the subgranular zone of the dentate gyrus in the hippocampus after irradiation at all three postnatal days, but the reduction of total granule cells in the stratum granulosun was found after irradiation at P3 and P10.

Conclusions

The early life radiation exposure during different developmental stages induces varied brain pathophysiological changes which may be related to the development of neurological and neuropsychological disorders later in life.
Integrated pulmonary index can predict respiratory compromise in high‐risk patients in the post‐anesthesia care unit: a prospective, observational study
Authors: Kuroe Yasutoshi , Mihara Yuko , Okahara Shuji , Ishii Kenzo , Kanazawa Tomoyuki , Morimatsu Hiroshi
Published: April 2021

Background

Respiratory compromise (RC) including hypoxia and hypoventilation is likely to be missed in the postoperative period. Integrated pulmonary index (IPI) is a comprehensive respiratory parameter evaluating ventilation and oxygenation. It is calculated from four parameters: end-tidal carbon dioxide, respiratory rate, oxygen saturation measured by pulse oximetry (SpO2), and pulse rate. We hypothesized that IPI monitoring can help predict the occurrence of RC in patients at high-risk of hypoventilation in post-anesthesia care units (PACUs).

Methods

This prospective observational study was conducted in two centers and included older adults (≥ 75-year-old) or obese (body mass index ≥ 28) patients who were at high-risk of hypoventilation. Monitoring was started on admission to the PACU after elective surgery under general anesthesia. We investigated the onset of RC defined as respiratory events with prolonged stay in the PACU or transfer to the intensive care units; airway narrowing, hypoxemia, hypercapnia, wheezing, apnea, and any other events that were judged to require interventions. We evaluated the relationship between several initial parameters in the PACU and the occurrence of RC. Additionally, we analyzed the relationship between IPI fluctuation during PACU stay and the occurrences of RC using individual standard deviations of the IPI every five minutes (IPI-SDs).

Results

In total, 288 patients were included (199 elderly, 66 obese, and 23 elderly and obese). Among them, 18 patients (6.3 %) developed RC. The initial IPI and SpO2 values in the PACU in the RC group were significantly lower than those in the non-RC group (6.7 ± 2.5 vs. 9.0 ± 1.3, p < 0.001 and 95.9 ± 4.2 % vs. 98.3 ± 1.9 %, p = 0.040, respectively). We used the area under the receiver operating characteristic curves (AUC) to evaluate their ability to predict RC. The AUCs of the IPI and SpO2 were 0.80 (0.69–0.91) and 0.64 (0.48–0.80), respectively. The IPI-SD, evaluating fluctuation, was significantly greater in the RC group than in the non-RC group (1.47 ± 0.74 vs. 0.93 ± 0.74, p = 0.002).

Conclusions

Our study showed that low value of the initial IPI and the fluctuating IPI after admission to the PACU predict the occurrence of RC. The IPI might be useful for respiratory monitoring in PACUs and ICUs after general anesthesia.
Clinical prognosis of isolated anterior cerebral artery territory infarction: a retrospective study
Authors: Park Hyungjong , Jeong Young Seok , Lee Seo Hyeon , Jang Seong Hwa , Kwon Doo Hyuk , Hong Jeong-Ho , Sohn Sung-Il , Yoo Joonsang
Published: April 2021

Background

Isolated anterior cerebral artery territory (ACA) infarction is a rare phenomenon, and is known to have distinctive clinical features. Little is known regarding the clinical prognosis of isolated ACA territory infarction with associated factors, and its impact on dwelling and job status. We investigated the short- and long-term outcomes of anterior cerebral artery (ACA) territory infarction, and the associated factors involved in the development of the distinctive symptoms.

Methods

This retrospective study in a prospective cohort of acute ischaemic stroke patients included consecutively enrolled patients with isolated ACA territory infarction. We investigated the functional status using the modified Rankin scale (mRS) score at discharge, three months’ post-discharge, and one-year post-discharge. We also investigated the occlusion site of the ACA (proximal vs. distal); presence of distinctive symptoms of ACA territory infarction including behaviour changes, indifference, aphasia, and urinary incontinence; and the effect of these symptoms on dwelling and job status one year after discharge.

Results

Between April 2014 and March 2019, 47 patients with isolated ACA territory infarction were included. Twenty-nine patients (61.7 %) had good outcomes (mRS ≤ 2) at discharge; however, the mRS score increased at three months (40; 85.1 %, p < 0.001) and one year (41; 87.2 %) post-discharge. Occlusion of the ACA proximal segment was independently associated with the development of distinctive symptoms (adjusted odds ratio, 17.68; 95 % confidence interval: 2.55–122.56, p < 0.05). Twenty-one (48.8 %) patients with good outcomes at one year experienced a change in dwelling status and job loss; 20 (95.2 %) of them had distinctive ACA territory symptoms with proximal ACA occlusion.

Conclusions

Short- and long-term outcomes of isolated ACA territory infarction were favourable. However, proximal segment occlusion was associated with the development of distinctive symptoms, possibly related to future dwelling and job status.
Caregivers’ perceptions, challenges and service needs related to tackling childhood overweight and obesity: a qualitative study in three districts of Shanghai, China
Authors: Wu Yanting , Ma Xiaoying , Fraser William D. , Li Mu , Wang Wei , Huang Hefeng , Landry Myriam , Hao Yanhui , Liu Han , Semenic Sonia , Zhang Yan , Wang Haiqin , Zhang Jingya , Yu Jiale , La Xuena , Zhang Congcong , Marc Isabelle , Jiang Hong
Published: April 2021

Background

Childhood overweight and obesity (OWO) has become a major public concern worldwide including in Shanghai, one of the most developed areas of China. Understanding perceptions and challenges of tackling childhood OWO among caregivers of children is critical to provide services in need.

Methods

A qualitative descriptive study including in-depth interviews with seven parents and six focus group discussions with a total of 32 parents or grandparents of children zero to 6 years of age. Participants lived in three districts of Shanghai and indexed children included both those with OWO or non-OWO children. Data were analyzed using qualitative thematic analysis.

Results

Caregivers tended to underestimate children’s weight status, and to regard chubby children as a sign of good parental care. Some caregivers even suggested that there were positive effects of childhood overweight. Caregivers identified a number of challenges to prevention of OWO in children, including difficulties in controlling dietary intake or increasing children’s physical activities; discordant views between parents and grandparents, and barriers to accessing professional guidance. Caregivers desired more detailed advice regarding children’s nutrition intake and physical activity, and preferred online approaches.

Conclusions

Misconceptions regarding childhood overweight were found in caregivers of children in Shanghai. Professional guidance on childhood weight control for caregivers is desired via digital applications such as mobile phone applications and social media.
Examining the educational impact of the mini-CEX: a randomised controlled study
Authors: Martinsen Susanne Skjervold Smeby , Espeland Torvald , Berg Erik Andreas Rye , Samstad Eivind , Lillebo Børge , Slørdahl Tobias S.
Published: April 2021

Background

The purpose of this study is to evaluate the mini-Clinical Evaluation Exercise (mini-CEX) as a formative assessment tool among undergraduate medical students, in terms of student perceptions, effects on direct observation and feedback, and educational impact.

Methods

Cluster randomised study of 38 fifth-year medical students during a 16-week clinical placement. Hospitals were randomised to provide a minimum of 8 mini-CEXs per student (intervention arm) or continue with ad-hoc feedback (control arm). After finishing their clinical placement, students completed an Objective Structured Clinical Examination (OSCE), a written test and a survey.

Results

All participants in the intervention group completed the pre-planned number of assessments, and 60% found them to be useful during their clinical placement. Overall, there were no statistically significant differences between groups in reported quantity or quality of direct observation and feedback. Observed mean scores were marginally higher on the OSCE and written test in the intervention group, but not statistically significant.

Conclusions

There is considerable potential in assessing medical students during clinical placements and routine practice, but the educational impact of formative assessments remains mostly unknown. This study contributes with a robust study design, and may serve as a basis for future research.
The moderating effect of spiritual beliefs on job dissatisfaction related to the futile care
Authors: Alazmani-Noodeh Farshid , Abdi Kamel , Ranjbar Hadi
Published: April 2021

Introduction

This study aimed to assess the experience of providing futile care among intensive care unit nurses and to examine the moderating effect of spiritual beliefs on job dissatisfaction related to the sense of futile care among nurses in Intensive Care Units.

Materials and methods

The study had two phases. The first phase was a qualitative study. Twenty-two semi-structured interviews were conducted. In the second phase, we employed a cross-sectional design. The data from 236 nurses were collected using nurses’ perceptions of futile care questionnaire, Minnesota Satisfaction Questionnaire, and Spirituality and Spiritual Care Rating Scale.

Results

The main theme of the qualitative phase was a feeling of self as a useful tool in God’s hand. Sub-themes were providing care while knowing it is futile, not knowing the patient destiny, having hope for care to be fruitful, experiences patient recovery, acting to be a part of God’s plan. Futile care and job experience were two predictors of low job satisfaction. Spiritual well-being had a moderating effect and increased job satisfaction.

Conclusions

Futile care can decrease job satisfaction, while spiritual well-being can reduce its negative effect. Supporting spiritual aspects of nursing care can decrease turn-over intention among nurses.
Effect of burnout among physicians on observed adverse patient outcomes: a literature review
Authors: Mangory Kashan Yasin , Ali Lavin Yadgar , Rø Karin Isaksson , Tyssen Reidar
Published: April 2021

Background

Physician burnout has potentially harmful effects for both physicians and their patients. Despite relationships between physician burnout and lowered patient satisfaction and clinician-rated adverse patient outcomes, there is scarce literature regarding effects on objective patient outcomes. This study aimed to examine the relationship between physician burnout and observed adverse patient outcomes via a review of the literature.

Methods

A search was performed on the MEDLINE, EMBASE and PsychINFO databases, using keywords and Medical Subject Headings. The identified studies were in English, published from 2007 to 2019, measured burnout among physicians using the Maslach Burnout Inventory (MBI), and included observed adverse patient outcomes. In total, 360 eligible articles were identified, and 11 were included in the final review. All included studies measured patient outcomes by observed clinical measures (e.g. quality of care and medical errors).

Results

Four studies found a clear significant relationship between physician burnout and observed adverse patient outcomes, while 6 did not. One study found a significant relationship with one of the MBI subscales. Burnout was, in contrast to depression, only partly associated with observed patient outcomes.

Conclusions

This review illustrates the need for a validation of physician burnout measured by MBI with respect to observed patient outcomes. Further studies are required to investigate the effects of physician burnout on observed quality of their patient care.
Safety and efficacy of side-to-end anastomosis versus colonic J-pouch anastomosis in sphincter-preserving resections: an updated meta-analysis of randomized controlled trials
Authors: Hou Sen , Wang Quan , Zhao Shidong , Liu Fan , Guo Peng , Ye Yingjiang
Published: April 2021

Background

The application of side-to-end anastomosis (SEA) in sphincter-preserving resection (SPR) is controversial. We performed a meta-analysis to compare the safety and efficacy of SEA with colonic J-pouch (CJP) anastomosis, which had been proven effective in improving postoperative bowel function.

Methods

The protocol was registered in PROSPERO under number CRD42020206764. PubMed, Embase, Web of Science, and the Cochrane Register of Controlled Trials databases were searched. The inclusion criteria were randomized controlled trials (RCTs) that evaluated the safety or efficacy of SEA in comparison with CJP anastomosis. The outcomes included the pooled risk ratio (RR) for dichotomous variables and weighted mean differences (WMDs) for continuous variables. All outcomes were calculated with 95% confidence intervals (CI) by STATA software (Stata 14, Stata Corporation, TX, USA).

Results

A total of 864 patients from 10 RCTs were included in the meta-analysis. Patients undergoing SEA had a higher defecation frequency at 12 months after SPR (WMD = 0.20; 95% CI, 0.14–0.26; P < 0.01) than those undergoing CJP anastomosis with low heterogeneity (I2 = 0%, P = 0.54) and a lower incidence of incomplete defecation at 3 months after surgery (RR = 0.28; 95% CI, 0.09–0.86; P = 0.03). A shorter operating time (WMD = − 17.65; 95% CI, − 23.28 to − 12.02; P < 0.01) was also observed in the SEA group without significant heterogeneity (I2 = 0%, P = 0.54). A higher anorectal resting pressure (WMD = 6.25; 95% CI, 0.17–12.32; P = 0.04) was found in the SEA group but the heterogeneity was high (I2 = 84.5%, P = 0.84). No significant differences were observed between the groups in terms of efficacy outcomes including defecation frequency, the incidence of urgency, incomplete defecation, the use of pads, enema, medications, anorectal squeeze pressure and maximum rectal volume, or safety outcomes including operating time, blood loss, the use of protective stoma, postoperative complications, clinical outcomes, and oncological outcomes.

Conclusions

The present evidence suggests that SEA is an effective anastomotic strategy to achieve similar postoperative bowel function without increasing the risk of complications compared with CJP anastomosis. The advantages of SEA include a shorter operating time, a lower incidence of incomplete defecation at 3 months after surgery, and better sphincter function. However, close attention should be paid to the long-term defecation frequency after SPR.