bluuebunny/crossref_metadata_2025 huggingface dataset:
Experience with placing peritoneal dialysis catheters in the iliac fossa in cases of frozen pelvis
Authors: Fredlund Martyn , Van Niekerk Henry , Cullis Brett
Published: August 2021

Peritoneal dialysis (PD) is a modality frequently preferred by patients for the management of their end-stage kidney disease; however, a major factor in its success is PD catheter placement and subsequent function. Optimal placement of PD catheters is generally accepted to be in the true pelvis, for this reason, many patients who are found to have a pelvic cavity obliterated by adhesions are often denied the opportunity to do PD. We report on four cases of an alternative advanced laparoscopic technique used in patients with inaccessible pelvic cavities, with three catheter placements in the intraperitoneal left iliac fossa/paracolic gutter and one case in the right paracolic gutter with subsequent good outcomes. This report suggests that a ‘frozen pelvis’ is not a contraindication to successful PD, with alternative catheter tip placement in the iliac fossa.
Dynamic modelling of a servo self-pierce riveting (SPR) process
Authors: Tang Daniel , Evans Mike , Briskham Paul , Susmel Luca , Sims Neil
Published: August 2021

Self-pierce riveting (SPR) is a complex joining process where multiple layers of material are joined by creating a mechanical interlock via the simultaneous deformation of the inserted rivet and surrounding material. Due to the large number of variables which influence the resulting joint, finding the optimum process parameters has traditionally posed a challenge in the design of the process. Furthermore, there is a gap in knowledge regarding how changes made to the system may affect the produced joint. In this paper, a new system-level model of an inertia-based SPR system is proposed, consisting of a physics-based model of the riveting machine and an empirically-derived model of the joint. Model predictions are validated against extensive experimental data for multiple sets of input conditions, defined by the setting velocity, motor current limit and support frame type. The dynamics of the system and resulting head height of the joint are predicted to a high level of accuracy. Via a model-based case study, changes to the system are identified, which enable either the cycle time or energy consumption to be substantially reduced without compromising the overall quality of the produced joint. The predictive capabilities of the model may be leveraged to reduce the costs involved in the design and validation of SPR systems and processes.
Influences of Caregiving on Development: A Sensitive Period for Biological Embedding of Predictability and Safety Cues
Authors: Gee Dylan G. , Cohodes Emily M.
Published: August 2021

Across species, caregivers exert a powerful influence on the neural and behavioral development of offspring. Increasingly, both animal and human research has highlighted specific patterns in caregivers’ behavior that may be especially important early in life, as well as neurobiological mechanisms linking early caregiving experiences with long-term affective behavior. Here we delineate evidence for an early sensitive period during infancy and toddlerhood when caregiver inputs that are predictable and associated with safety may become biologically embedded via influences on corticolimbic circuitry involved in emotion regulation. We propose that these caregiver signals prime corticolimbic circuitry to be receptive to later stage-specific caregiver influences, such as caregivers’ external regulation of children’s emotional reactivity. Following adversity that disrupts the predictability and safety associated with caregivers during this sensitive period, accelerated maturation of children’s corticolimbic circuitry may foreshorten the protracted period of plasticity and caregiver influence that is characteristic of humans. This work has implications for both prevention and intervention efforts targeting children exposed to adversity early in life.
Analysis of Causes and Coping Strategies of Food Insecurity: The Case of Central and North Gondar Zone, Ethiopia
Authors: Awoke Wondim , Eniyew Kefale , Meseret Belete
Published: August 2021

In Ethiopia, food insecurity is a major problem, which affects the livelihood of rural communities. Hence, this study was conducted in Central and North Gondar Zones with the main aim of analysing causes and coping strategies of food insecurity. Primary data were collected through an interview schedule, key informant interviews and focus group discussions. A total of 500 sample respondents were selected through a systematic sampling technique. Data were analysed through simple descriptive statistics and a chi-square test. Frequently used coping strategies by sample respondents were planting early maturing crop (82.4%), turning to low-quality and cheaper foodstuff (81.2%), changing cropping pattern (78.6%), sale of livestock (75.6%) and purchasing food on cash 75.0%. Sex, educational status, fertiliser utilisation, livelihood diversification and off-farm activities had an association and significant with a food security status of sample respondents at p ≤ 0.01. Furthermore, farmland and on-farm were significantly associated with food security status at 0.01 < p ≤ 0.05 and 0.05 < p ≤ 0.10, respectively. To ensure food security, different organisations that support rural households should be aware of peak food insecurity seasons. Moreover, due attention should be paid to practical-oriented education and training to diversify the household’s livelihood.
Eye movement desensitization and reprocessing treatment in functional neurological symptom disorder with psychogenic nonepileptic seizures: A study of two cases
Authors: Demirci Onur O , Sagaltici Eser
Published: August 2021

Patients with functional neurological symptom disorder (FND) have many diverse symptoms including psychogenic nonepileptic seizures (PNES), positive movements such as tremor, dystonia, or gait abnormalities, loss of motor function such as leg or arm paresis, and loss of sensory functions, such as blindness, deafness, or loss of feeling in the limbs. Eye movement desensitization and reprocessing (EMDR) is a therapy method that includes some techniques arising from psychodynamic, cognitive, and behavioral approaches. EMDR is known as a proven psychotherapeutic approach in post-traumatic stress disorder, but there are also numerous studies reporting its efficacy in other psychiatric disorders and trauma-associated symptoms, in patients with comorbid psychiatric disorders. This article presents the outcome of EMDR treatment of two patients’ cases, a 13-year-old female and a 16-year-old male, who were diagnosed as FND with PNES, according to the DSM-5 diagnostic criteria. In both cases, there was a significant decrease in Adolescent Dissociative Experiences Scale scores and no pseudo seizures were found, even at the sixth-month follow-up visits. These case studies suggest that EMDR can be an effective method in the long-term treatment of FND with PNES and a useful alternative to other treatment methods.
Evaluating the thermal conductivity coefficient of polypropylene/graphene nanocomposites: A hierarchical investigation
Authors: Ahmadi Masoud , Rouhi Saeed , Ansari Reza
Published: August 2021

In this article, we study the thermal conductivity coefficient of the polypropylene composite reinforced by graphene sheets. A hierarchical approach is used for the investigation, which is started by molecular dynamics simulation to evaluate the thermal conductivity coefficient of graphene sheets and continued by the finite element analysis to evaluate the thermal conductivity coefficient of graphene reinforced polypropylene at different temperatures. It is shown that inclusion of the graphene sheets can lead to increasing the thermal conductivity coefficient of the polypropylene, especially when the nanosheets are directed along the temperature difference. Moreover, the higher volume percentages of the graphene sheets in the polymer matrix enhance the thermal conductivity.
Zining as artful method: Facilitating zines as participatory action research within art museums
Authors: French Jade , Curd Emeri
Published: August 2021

‘DIY’ publications called zines have long been a way for marginalized communities to record their stories, spread information and organize. However, this article presents zines as a potential research tool for action researchers who are working within organisational contexts. The authors, both museum professionals, action researchers and zinesters, use examples from their research within art museums to examine the value of zines as a methodology. Though the research projects take place within art organisations, using the four themes of aesthetics, communities of practice, counter-narratives and plurality it considers how zines could be used more broadly as a research tool in other knowledge-based settings. The authors provide a recommendation for practitioners to explore zining to engender dialogic cultures in their organisations as well as their potential in shaping ‘major’ and ‘minor’ organisational change.
Evaluation of Auto-Planning for Left-Side Breast Cancer After Breast-Conserving Surgery Based on Geometrical Relationship
Authors: Li Yijiang , Bai Han , Huang Danju , Chen Feihu , Xia Yaoxiong
Published: August 2021

Purpose:

This study aimed to evaluate (1) the performance of the Auto-Planning module embedded in the Pinnacle treatment planning system (TPS) with 30 left-side breast cancer plans and (2) the dose-distance correlations between dose-based patients and overlap volume histogram-based (OVH) patients.

Method:

A total of 30 patients with left-side breast cancer after breast-conserving surgery were enrolled in this study. The clinical manual-planning (MP) and the Auto-Planning (AP) plans were generated by Monaco and by the Auto-Planning module in Pinnacle respectively. The geometric information between organ at risk (OAR) and planning target volume (PTV) of each patient was described by the OVH. The AP and MP plans were ranked to compare with the geometry-based patients from OVH. The Pearson product-moment correlation coefficient (R) was used to describe the correlations between dose-based patients (APs and MPs) and geometry-based patients (OVH). Dosimetric differences between MP and AP plans were evaluated with statistical analysis.

Result:

The correlation coefficient (mean R = 0.71) indicated that the AP plans have a high correlation with geometry-based patients from OVH, whereas the correlation coefficient (mean R = 0.48) shows a weak correlation between MP plans and geometry-based patients. The dosimetric comparison revealed a statistically significant improvement in the ipsilateral lung V5Gy and V10Gy, and in the heart V5Gy of AP plans compared to MP plans, while statistical reduction was seen in PTV V107% for MP plans compared to AP plans.

Conclusion:

The overall results of AP plans were superior to MP plans. The dose distribution in AP plans was more consistent with the distance-dose relationship described by OVH. After eliminating the interference of human factors, the AP was able to provide more stable and objective plans for radiotherapy patients.
Reaching A Female Majority: A Silent Transition for Dentistry in the United Kingdom
Authors: Gallagher Jennifer E. , Scambler Sasha
Published: August 2021

This paper highlights the process of transition to a female majority for dentistry, examines various influences on this trajectory, and considers the implications for the profession, health systems and patients, as well as individual dentists.

This celebratory transition has been facilitated by educational systems that provide both males and females with equal opportunities and is supported by legislation, as well as societal change that has spanned decades. In crossing this gender representation threshold, we have outperformed doctors nationally.

In order to embrace our highly educated workforce and support them to better serve their patients and the population, urgent debate and action aimed at reshaping current systems of dental care provision are required. In this regard, flexible working arrangements, together with reshaping professional leadership to better represent the workforce, as well as changes in terminology can all play their part; however, we will need careful discussions about how this might happen effectively.

A collaborative effort between the dental profession and wider health systems is required to ensure that there are opportunities for everyone to flourish and contribute back to the profession and society. Our medical counterparts have been considering how healthcare should be shaped creatively, particularly in relation to working patterns, economic models and quality patient care: we need to catch up.
Nurses’ realisation of an inadequate toolbox for approaching adolescents with a parent suffering from cancer: A constructivist grounded theory study
Authors: Tafjord Trine , Ytterhus Borgunn
Published: August 2021

How to approach adolescents (aged 13–18 years) when their parent is suffering from cancer has become a relevant issue in healthcare, as parental cancer may have an impact on adolescents’ health and development. Nurses are well positioned to identify adolescents’ needs and provide information and support to them but often feel ill equipped to approach them appropriately. The aim of this study was to explore nurses’ experiences of approaching adolescents whose parent had cancer. Interviews with 12 nurses were conducted and analysed in line with a constructivist grounded theory approach. Nurses made efforts to create welcoming environments for adolescents but realised that the contact was unsatisfactory. Primarily, the nurses offered face-to-face conversations with adolescents, which did not correspond with adolescents’ communication channels. To better provide information and support to adolescents, nurses must expand their nursing toolbox so that it is better adapted to adolescents’ communication channels.
Intention to Receive COVID-19 Vaccine by U.S. Health Sciences University Employees
Authors: Dowdle Travis S. , Dennis Jeff , Nugent Kenneth M. , Byrd Theresa
Published: August 2021

Objectives:

Understanding vaccine intentions and attitudes of health professionals is critical as the Pfizer-BioNTech and the Moderna COVID19 vaccines are being administered throughout the United States. This study estimates the level of vaccine hesitancy at a health sciences center in West Texas prior to the distribution of the vaccines.

Methods:

An analytical cross-sectional study was performed via anonymous Qualtrics survey administered to approximately 4500 faculty, staff, postdoctoral research associates/medical residents, and employees at a multi-campus health sciences university in the United States. Respondents were asked demographic questions and intention to receive the vaccine. Factors associated with the intention to receive a vaccine were determined using logistic regression analysis.

Results:

A total sample of 2258 subjects were evaluated (50.0% response rate). Among all respondents, 64.6% reported that they would probably or definitely receive the COVID-19 vaccine. Men had higher levels of intention to receive the vaccine (OR = 2.11, 95% CI 1.64-2.71); respondents who indicated yearly influenza vaccines are necessary were also more likely to receive the vaccine (OR = 6.04, 95% CI 4.70-7.75). Eighty-three percent of faculty and 56% of the staff reported intention to receive the vaccine. Respondents who had previously tested positive for COVID-19 reported more interest in receiving the vaccine (58.5% yes vs 41.5% no).

Conclusion:

In this study, the intention to receive the COVID-19 vaccination at a United States health sciences center falls below the necessary herd immunity estimates. Public health initiatives must be developed to decrease vaccine hesitancy, especially among health professionals.
Understanding Teacher Learning Through Teacher-Created Knowledge Products and Transactions
Authors: Yang Xiaozhe , Cheng Pei-Yu , Huang Yueh-Min
Published: August 2021

Mutual learning between teachers and their colleagues plays a vital role in their professional growth. However, previous studies show that collaborative teacher learning tends to be confined to small groups, and that it is difficult to make it explicit, showcase, or transfer teachers’ tacit knowledge. This study explores this problem by creating a digital system that allows teachers to create, display, and trade their knowledge products; 508 teachers from one K–12 school created and traded their knowledge products, while 1,148 teachers from other schools participated in the knowledge product transaction on the digital system. Using social network analysis, we discovered that teachers use this method to generate a lot of interaction and that teachers who taught similar subject areas communicated more with one another. There is a significant correlation among each teacher’s number of created knowledge products, knowledge products sold, and the number of knowledge products purchased from others. The study has potential to contribute to research on teacher learning, thinking, and actions.
Hepatosplenic Abscess From Klebsiella pneumoniae in Poorly Controlled Diabetic
Authors: Ejikeme Chidinma , Nwachukwu Onyeka , Ayad Sarah , Rath Payal , Ejikeme Ifunanya , Salamera Julius
Published: August 2021

Invasive Klebsiella pneumoniae infection and pyogenic liver abscess in patients with underlying diabetes mellitus has been well described over the past 3 decades, predominantly in the Southeast Asian population, especially in Taiwan and Korea. K pneumoniae has now become the most common causative pathogen of pyogenic liver abscess in Asian countries. This shift from Escherichia coli to K pneumoniae may also be increasingly occurring in the United States of America and European countries. Compared with the >80% incidence described in Taiwan, the incidence in the United States is still reported to be lower, around 30% to 40%. However, as more evidence and reports come to light, it has become of prime importance to recognize Klebsiella as a significant emerging cause of metastatic infections in patients with uncontrolled diabetes in the United States and not just Southeast Asia, given the significant morbidity and mortality associated with the condition. In this article, we discuss the case of a 53-year-old African American female who presented with diabetic ketoacidosis and was subsequently found to have K pneumoniae pyogenic liver abscess primarily in the left hepatic lobe, bacteremia, and septic metastases to the spleen. She required extensive percutaneous drainage of abscesses and a prolonged course of multiple antibiotics. This case illustrates the growing incidence of invasive K pneumoniae infection in the diabetic population in the United States, and better patient outcomes from prompt recognition and treatment.
Evaluation of an Initiation Regimen of Warfarin for International Normalized Ratio Target 2.0 to 3.0
Authors: Mohamed Sahimi , Mei Fong Chan , Jie Ming Yew , Naila Kori Ahlam , Abdul Wahab Sopian , Mohd Ali Zarina
Published: August 2021

Background: he number of patients on warfarin therapy is rising steadily. Although warfarin is beneficial, it carries a high risk of bleeding, especially if the international normalized ratio (INR) values exceed 3.0. Currently, no warfarin initiation regimens have been developed for the Asian population, especially for Malaysians. Objective: This article describes the efficacy and safety of a new initiation regimen for warfarin among warfarin-naive patients. Method: Data were retrospectively collected from the ambulatory and inpatient settings. Results: A total of 165 patients who each had a target INR of 2.0 to 3.0 were included in the study. The mean age was 57.2 years and 94 patients were male. A total of 108 patients used Regimen 1 (5 mg/5 mg/3mg) and the rest of the patients used Regimen 2 (5 mg/3 mg/3 mg). Most patients used warfarin either for atrial fibrillation (52.1%) or for venous thromboembolism (29.7%). Overall, 88 of the patients had INR values above 50% from the baseline on Day 4. Additionally, 13 patients had INR values of >3.2, which required withholding and lower dose of warfarin. The predicted weekly maintenance warfarin dose (23 ± 0.5 mg/week) was found to have correlated closely with the actual maintenance dose (22.8 ± 0.5 mg/week; r2 = 0.75). Nearly two thirds (70.3%) of the patients achieved the target INR on Day 11. Conclusion: The warfarin initiation regimens in this study was simple, safe, and suitable to be used in both ambulatory and inpatient settings for managing warfarin therapy.
Spatial distribution and contamination assessment of heavy metal pollution of sediments in coastal reclamation areas: a case study in Shenzhen Bay, China
Authors: Zhang Qiuying , Ren Futian , Xiong Xiangyun , Gao Hongjie , Wang Yudong , Sun Wenjun , Leng Peifang , Li Zhao , Bai Yangwei
Published: August 2021

Background

With the continuous advancement of global urbanisation, humans have begun to overutilise or improperly utilise the natural resources of bay areas, which has led to a series of ecological and environmental problems. To evaluate the spatial distributions and potential ecological risks of heavy metals in sediments of Shenzhen Bay, China, an analysis of As, Cd, Cr, Cu, Pb, and Zn regarding their content, correlation (Pearson coefficient), pollution degree, and potential ecological risks was conducted.

Results

The heavy metal contents in the sediments decreased in the order of Zn > Cu > Cr > Pb > As > Cd, with contents of 175.79 mg kg−1, 50.75 mg kg−1, 40.62 mg kg−1, 37.10 mg kg−1, 18.27 mg kg−1, and 0.20 mg kg−1, respectively. The results showed that the overall sediment quality in Shenzhen Bay generally met the China Marine Sediment Quality criteria, and the heavy metal contents were significantly lower than those reported in the same type of bay area worldwide. Furthermore, the order of grade of potential ecological risk of the heavy metals was as follows: As and Cd were found to pose moderate ecological risks, with their potential hazard indices reaching a high level, whereas the potential ecological hazard indices of Cu, Pb, Zn, and Cr were all at relatively low levels.

Conclusions

The potential hazard indices of the heavy metals decreased from the inner bay toward the outside. The accumulation and content of the analysed heavy metals in the Shenzhen Bay sediments are mainly controlled by historical land-source pollution and land reclamation projects. This study presents the current state of sediment quality in Shenzhen Bay. The results may assist in the definition of future bay area management measures specifically targeted at monitoring heavy metal contamination.
Premature neonatal gut microbial community patterns supporting an epithelial TLR-mediated pathway for necrotizing enterocolitis
Authors: Shaw Alexander G. , Sim Kathleen , Rose Graham , Wooldridge David J. , Li Ming-Shi , Misra Raju V. , Gharbia Saheer , Kroll J. Simon
Published: August 2021

Background

Necrotising enterocolitis (NEC) is a devastating bowel disease, primarily affecting premature infants, with a poorly understood aetiology. Prior studies have found associations in different cases with an overabundance of particular elements of the faecal microbiota (in particular Enterobacteriaceae or Clostridium perfringens), but there has been no explanation for the different results found in different cohorts. Immunological studies have indicated that stimulation of the TLR4 receptor is involved in development of NEC, with TLR4 signalling being antagonised by the activated TLR9 receptor. We speculated that differential stimulation of these two components of the signalling pathway by different microbiota might explain the dichotomous findings of microbiota-centered NEC studies. Here we used shotgun metagenomic sequencing and qPCR to characterise the faecal microbiota community of infants prior to NEC onset and in a set of matched controls. Bayesian regression was used to segregate cases from control samples using both microbial and clinical data.

Results

We found that the infants suffering from NEC fell into two groups based on their microbiota; one with low levels of CpG DNA in bacterial genomes and the other with high abundances of organisms expressing LPS. The identification of these characteristic communities was reproduced using an external metagenomic validation dataset. We propose that these two patterns represent the stimulation of a common pathway at extremes; the LPS-enriched microbiome suggesting overstimulation of TLR4, whilst a microbial community with low levels of CpG DNA suggests reduction of the counterbalance to TLR4 overstimulation.

Conclusions

The identified microbial community patterns support the concept of NEC resulting from TLR-mediated pathways. Identification of these signals suggests characteristics of the gastrointestinal microbial community to be avoided to prevent NEC. Potential pre- or pro-biotic treatments may be designed to optimise TLR signalling.
Effect of d-limonene and its derivatives on breast cancer in human trials: a scoping review and narrative synthesis
Authors: Chebet Joy J. , Ehiri John E. , McClelland Deborah Jean , Taren Douglas , Hakim Iman A.
Published: August 2021

Background

D-limonene and its derivatives have demonstrated potential chemopreventive and anticancer activity in preclinical and clinical studies. The aim of this scoping review was to assess and critically appraise current literature on the effect of these bioactive citrus peel compounds on breast cancer in human trials and to identify knowledge gaps for exploration in future studies.

Methods

This study followed a scoping review framework. Peer-reviewed journal articles were included if they reported the effect of d-limonene or its derivatives on breast cancer in human subjects. Articles were retrieved from academic databases – PubMed, EMBASE, CINAHL, Web of Science, and Cochrane reviews – and iteratively through review of bibliographies of relevant manuscripts. Titles and abstracts were appraised against the aforementioned inclusion criteria in a first round of screening. Through consensus meetings and full article review by authors, a final set of studies were selected. Results were reported according to the PRISMA extension for scoping reviews.

Results

Our search strategy yielded 367 records. Following screening and adjudication, five articles reporting on phase 1(n = 2), phase 2 (n = 2) and both trial phases (n = 1) were included as the final dataset for this review. Trials evaluating the effect of d-limonene (n = 2) showed it was well tolerated in subjects. One study (n = 43 participants) showed d-limonene concentrated in breast tissue (mean 41.3 μg/g tissue) and reduction in tumor cyclin D1 expression, which is associated with tumor proliferation arrest. This study did not show meaningful change in serum biomarkers associated with breast cancer, except for a statistically significant increase in insulin-like growth factor-1 (IGF-I) levels. While elevation of IGF-I is associated with increased cancer risk, the clinical implication of this study remains uncertain given its short duration. Trials with perillyl alcohol (n = 3) showed low tolerance and no effect on breast cancer.

Conclusion

This review demonstrated a dearth of clinical studies exploring the effect of d-limonene and its derivatives on breast cancer. Limited literature suggests d-limonene is safe and tolerable in human subjects compared to its derivative, perillyl alcohol. Our review demonstrates the need for additional well-powered placebo-controlled trials that assess d-limonene’s efficacy on breast cancer compared to other therapies.
Morphological changes after lower eyelid epiblepharon surgery in Asian children
Authors: Lee Sang Jae , Lee Shin-Hyo , Lee Min Sub , Jo Youn Hye , Shin Hyun Jin , Lee Andrew G.
Published: August 2021

Background

This study aimed to determine the morphological changes in Asian lower eyelid epiblepharon patients after surgery.

Methods

The medical records of 59 patients who underwent lower eyelid epiblepharon repair were reviewed retrospectively. Eighty-nine patients who underwent strabismus surgery were set as the control group. The photographs for each group were analyzed based on the following factors: inferior half area (IHA) of the eye, eyelash angular direction (EAD), angle between the eyelashes and the cornea, marginal reflex distance 1 (MRD1) and marginal reflex distance 2 (MRD2).

Results

After surgery, the medial EAD changed from 92.45° ± 20.21° (mean ± SD) to 79.43° ± 23.31°, while the central and lateral EADs were unchanged. IHA increased from 36.33 ± 9.78 mm3 to 43.06 ± 10.57 mm3, and MRD1 increased from 1.92 ± 0.99 mm to 2.50 ± 0.93 mm, whereas MRD2 did not change. The mean angle between the eyelashes and the cornea increased from 39.64° to 72.19° immediately postoperatively, but had reduced to 58.75° 3 months later, followed by no further significant change at the 6-month and 9-month postoperative follow-ups.

Conclusions

There is morphological changes of the eyelid after lower eyelid epiblepharon surgery, with increases in the IHA and MRD1. In addition, contact between the eyelashes and the cornea occurred mainly in the medial portion of the eyelid the position, which everted and stabilized over 3 months. Thus, follow-up observations are required for at least 3 months to properly evaluate the surgical outcome.
Health literacy, health status and health behaviors of German students– study protocol for the “Healthy Habits” cohort study
Authors: Lange Martin , Löwe Alexandra , Stassen Gerrit , Schaller Andrea
Published: August 2021

Background

The emerging adulthood is traditionally viewed as a time of optimal health, but also as a critical life span, characterized by changing life circumstances and the establishment of an individual lifestyle. Especially university life seems to hold several challenges impeding the manifestation of a health supporting manner, as many students tend to show a poorer health behavior and a higher amount of health-related problems than comparable age groups. This, along with a steady growth of the higher education sector, brings increased attention to the university setting in the context of prevention.

To date, there are few empirical longitudinal and coherent cross-sectional data on the status of students’ health literacy, health status, and health behaviors, and on the impact of the study format on students’ health. The aim of this prospective cohort study is to reduce this research gap.

Methods

Starting during winter semester 2020/21, the prospective cohort study collects data on health literacy, health status and health behavior on a semester-by-semester basis. All enrolled students of the IST University of Applied Sciences, regardless of study format and discipline, can participate in the study at the beginning of their first semester. The data are collected digitally via a specifically programmed app. A total of 103 items assess the subjectively perceived health status, life and study satisfaction, sleep quality, perceived stress, physical activity, diet, smoking, alcohol consumption, drug addiction and health literacy. Statistical analysis uses (1) multivariate methods to look at changes within the three health dimensions over time and (2) the association between the three health dimensions using multiple regression methods and correlations.

Discussion

This cohort study collects comprehensive health data from students on the course of study. It is assumed that gathered data will provide information on how the state of health develops over the study period. Also, different degrees of correlations of health behavior and health literacy will reveal different impacts on the state of students’ health. Furthermore, this study will contribute to empirically justified development of target group-specific interventions.

Trial registration

German Clinical Trials Register: DRKS00023397 (registered on October 26, 2020).
Operationalising the “One Health” approach in India: facilitators of and barriers to effective cross-sector convergence for zoonoses prevention and control
Authors: Asaaga F. A. , Young J. C. , Oommen M. A. , Chandarana R. , August J. , Joshi J. , Chanda M. M. , Vanak A. T. , Srinivas P. N. , Hoti S. L. , Seshadri T. , Purse B. V.
Published: August 2021

Background

There is a strong policy impetus for the One Health cross-sectoral approach to address the complex challenge of zoonotic diseases, particularly in low/lower middle income countries (LMICs). Yet the implementation of this approach in LMIC contexts such as India has proven challenging, due partly to the relatively limited practical guidance and understanding on how to foster and sustain cross-sector collaborations. This study addresses this gap by exploring the facilitators of and barriers to successful convergence between the human, animal and environmental health sectors in India.

Methods

A mixed methods study was conducted using a detailed content review of national policy documents and in-depth semi-structured interview data on zoonotic disease management in India. In total, 29 policy documents were reviewed and 15 key informant interviews were undertaken with national and state level policymakers, disease managers and experts operating within the human-animal-environment interface of zoonotic disease control.

Results

Our findings suggest that there is limited policy visibility of zoonotic diseases, although global zoonoses, especially those identified to be of pandemic potential by international organisations (e.g. CDC, WHO and OIE) rather than local, high burden endemic diseases, have high recognition in the existing policy agenda setting. Despite the widespread acknowledgement of the importance of cross-sectoral collaboration, a myriad of factors operated to either constrain or facilitate the success of cross-sectoral convergence at different stages (i.e. information-sharing, undertaking common activities and merging resources and infrastructure) of cross-sectoral action. Importantly, participants identified the lack of supportive policies, conflicting departmental priorities and limited institutional capacities as major barriers that hamper effective cross-sectoral collaboration on zoonotic disease control. Building on existing informal inter-personal relationships and collaboration platforms were suggested by participants as the way forward.

Conclusion

Our findings point to the importance of strengthening existing national policy frameworks as a first step for leveraging cross-sectoral capacity for improved disease surveillance and interventions. This requires the contextual adaptation of the One Health approach in a manner that is sensitive to the underlying socio-political, institutional and cultural context that determines and shapes outcomes of cross-sector collaborative arrangements.
Low and unequal use of outpatient health services in public primary health care facilities in southern Ethiopia: a facility-based cross-sectional study
Authors: Areru Hiwot Abera , Dangisso Mesay Hailu , Lindtjørn Bernt
Published: August 2021

Background

Outpatient department visits per individual for each year are one of the core indicators of healthcare delivery to assess accessibility or quality of services. In addition, this study aimed to assess health service utilisation and disease patterns in southern Ethiopia, by including the health authorities’ suggestions to improve the services. No study has assessed this in Ethiopia previously.

Methods

An institution-based cross-sectional design study was done in 65 primary health care units in Dale and Wonsho districts, in Sidama region, for all patients visiting health facilities from 1 July 2017 to 30 June 2018. We estimated the utilisation rate as visits per person per year, the odds ratio for health use and proportions of diseases’ diagnoses. The results of our study were presented to local health authorities, and their suggestions for improvements were incorporated into the analysis.

Result

A total of 81,129 patients visited the health facilities. The annual outpatient health service utilisation was 0.18 (95% CI: 0.18–0.19) new visits per person per year. The health service utilisation rate per year for the rural population was lower than the urban utilisation by 91% (OR = 0.09; 95% CI: 0.08–0.09). Children in the age group of 5–14 years had lower odds of health service utilisation by 78% (OR = 0.22; 95% CI: 0.21–0.23), compared to children under 5 years of age. Females were four times (OR = 4.17; 95% CI: 4.09–4.25) more likely to utilise health services than males. Febrile illness constituted 17.9% (14,847 of 83,148) of the diagnoses in all age groups. Almost half of the febrile cases, 46.5% (3827 of 8233), were among children under 5 years of age. There were very few cases of non-communicable diseases diagnosed in the health facilities. The health authorities suggested improving diagnostic capacities at health centres, enhancing health professionals’ skill and attitudes, and improving affordability and physical accessibility of the services.

Conclusion

The health service utilisation rate was low in Sidama. The use of health services was lower among rural residents, men, children and elderly, and health post users. Improving the quality, affordability and accessibility of the health services, by involving responsible stakeholders could increase service usage.
Multi-factor regulatory network and different clusters in hypertrophic obstructive cardiomyopathy
Authors: Qin Xianyu , Huang Lei , Chen Sicheng , Chen Shaoxian , Wen Pengju , Wu Yueheng , Zhuang Jian
Published: August 2021

Background

Practical biosignatures and thorough understanding of regulatory processes of hypertrophic obstructive cardiomyopathy (HOCM) are still lacking.

Methods

Firstly, public data from GSE36961 and GSE89714 datasets of Gene Expression Omnibus (GEO), Gene database of NCBI (National Center of Biotechnology Information) and Online Mendelian Inheritance in Man (OMIM) database were merged into a candidate gene set of HOCM. Secondly, weighted gene co-expression network analysis (WGCNA) for the candidate gene set was carried out to determine premier co-expressed genes. Thirdly, significant regulators were found out by virtue of a multi-factor regulatory network of long non-coding RNAs (lncRNAs), messenger RNAs (mRNAs), microRNAs (miRNAs) and transcription factors (TFs) with molecule interreactions from starBase v2.0 database and TRRUST v2 database. Ultimately, HOCM unsupervised clustering and “tsne” dimensionality reduction was employed to gain hub genes, whose classification performance was evaluated by a multinomial model of lasso logistic regression analysis binded with receiver operating characteristic (ROC) curve.

Results

Two HOCM remarkably-interrelated modules were from WGCNA, followed by the recognition of 32 crucial co-expressed genes. The multi-factor regulatory network disclosed 7 primary regulatory agents, containing lncRNAs (XIST, MALAT1, and H19), TFs (SPI1 and SP1) and miRNAs (hsa-miR-29b-39 and has-miR-29a-3p). Four clusters of HOCM and 4 hub genes (COMP, FMOD, AEBP1 and SULF1) significantly expressing in preceding four subtypes were obtained, while ROC curve demonstrated satisfactory performance of clustering and 4 genes.

Conclusions

Our consequences furnish valuable resource which may bring about prospective mechanistic and therapeutic anatomization in HOCM.
Exertional intolerance and dyspnea with preserved lung function: an emerging long COVID phenotype?
Authors: Lam Grace Y. , Befus A. Dean , Damant Ronald W. , Ferrara Giovanni , Fuhr Desi P. , Stickland Michael K. , Varughese Rhea A. , Wong Eric Y. , Smith Maeve P.
Published: August 2021

The COVID-19 pandemic has resulted in significant acute morbidity and mortality worldwide. There is now a growing recognition of the longer-term sequelae of this infection, termed “long COVID”. However, little is known about this condition. Here, we describe a distinct phenotype seen in a subset of patients with long COVID who have reduced exercise tolerance as measured by the 6 min walk test. They are associated with significant exertional dyspnea, reduced health-related quality of life and poor functional status. However, surprisingly, they do not appear to have any major pulmonary function abnormalities or increased burden of neurologic, musculoskeletal or fatigue symptoms.
Sexualized drug injection among men who have sex with men in Madrid and Barcelona as the first episode of drug injecting
Authors: Guerras Juan-Miguel , García de Olalla Patricia , Belza María José , de la Fuente Luis , Palma David , del Romero Jorge , García-Pérez Jorge-Néstor , Hoyos Juan ,   the Methysos Project Group, Donat Marta , del Carmen Burgos María , Romero César Pérez , Bueno José Antonio San Juan , Urrestarazu Francisca Román , Ospina Jesus E , Gutiérrez Miguel Alarcón , Ayerdi Oskar , Rodríguez Carmen , del Corral Del Campo Sonsoles , Zamora Natividad Jerez , Fernández Marta Ruiz , Polo Montserrat González , Gracia María Jesús Barbera , Pérez Luis López , Cortes Claudia Broto , Martin Julio Morais
Published: August 2021

Background

We estimate the prevalence of drug injection, the variables associated with having ever injected and the proportion of ever injectors whose first drug injection was for having sex; we describe the first drug injection episode, analyze the drugs most frequently injected and estimate the prevalence of risky injecting behaviors.

Methods

The participants were 3387 MSM without a previous HIV diagnosis attending four HIV/STI diagnosis services in Madrid and Barcelona. Lifetime prevalence and prevalence ratios (PRs) by different factors were calculated using Poisson regression models with robust variance. We compared the characteristics of first drug injection episode, lifetime injection and risky injecting behaviors of those whose first injection was for sex (FIS) with those whose was not (non-FIS).

Results

Lifetime prevalence of injection was 2.1% (CI 1.7–2.7). In the multivariate analysis, it was strongly associated with having been penetrated by more than five men in the last 12 months (aPR = 10.4; CI 2.5–43.4) and having met most of their partners at private parties (aPR = 7.5; CI 4.5–12.3), and less strongly with other factors. Of those who had ever injected drugs, 81.9% injected for sex the first time they injected drugs (FIS). At first injection, FIS participants had a mean age of 31 years, 62.7% used mephedrone and 32.2% methamphetamine on that occasion. Of this FIS group 39.0% had ever shared drugs or equipment and 82.6% had always shared for sex. Some 30.8% of non-FIS reported having also injected drugs for sex later on.

Conclusions

Only two out of a hundred had ever injected, most to have sex and with frequent drug or injecting equipment sharing. Injecting for sex is the most common first episode of drug injection and is the most efficient risky behavior for the transmission of HIV, hepatitis B or C and other blood-borne infections. MSM participating in private parties should be considered a priority group for prevention policies.
miR-381-3p suppresses breast cancer progression by inhibition of epithelial–mesenchymal transition
Authors: Yu Yong-Zheng , Mu Qiang , Ren Qian , Xie Li-Juan , Wang Qi-Tang , Wang Cui-Ping
Published: August 2021

Background

Accumulating evidence indicates that miRNAs are involved in multiple cellular functions and participate in various cancer development and progression, including breast cancer.

Methods

We aimed to investigate the role of miR-381-3p in breast cancer. The expression level of miR-381-3p and EMT transcription factors was examined by quantitative real-time PCR (qRT-PCR). The effects of miR-381-3p on breast cancer proliferation and invasion were determined by Cell Counting Kit-8 (CCK-8), colony formation, and transwell assays. The regulation of miR-381-3p on its targets was determined by dual-luciferase analysis, qRT-PCR, and western blot.

Results

We found that the expression of miR-381-3p was significantly decreased in breast cancer tissues and cell lines. Overexpression of miR-381-3p inhibited breast cancer proliferation and invasion, whereas knockdown of miR-381-3p promoted cell proliferation and invasion in MDA-MB-231 and SKBR3 cells. Mechanistically, overexpression of miR-381-3p inhibited breast cancer epithelial–mesenchymal transition (EMT). Both Sox4 and Twist1 were confirmed as targets of miR-381-3p. Moreover, transforming growth factor-β (TGF-β) could reverse the effects of miR-381-3p on breast cancer progression.

Conclusions

Our observation suggests that miR-381-3p inhibits breast cancer progression and EMT by regulating the TGF-β signaling via targeting Sox4 and Twist1.
DEAD-box helicase 27 enhances stem cell-like properties with poor prognosis in breast cancer
Authors: Li Shan , Ma Jinfei , Zheng Ang , Song Xinyue , Chen Si , Jin Feng
Published: August 2021

Background

Although the rapid development of diagnosis and treatment has improved prognosis in early breast cancer, challenges from different therapeutic response remain due to breast cancer heterogeneity. DEAD-box helicase 27 (DDX27) had been proved to influence ribosome biogenesis and identified as a promoter in gastric and colorectal cancer associated with stem cell-like properties, while the impact of DDX27 on breast cancer prognosis and biological functions is unclear. We aimed to explore the influence of DDX27 on stem cell-like properties and prognosis in breast cancer.

Methods

The expression of DDX27 was evaluated in 24 pairs of fresh breast cancer and normal tissue by western blot. We conducted Immunohistochemical (IHC) staining in paraffin sections of 165 breast cancer patients to analyze the expression of DDX27 and its correlation to stemness biomarker. The Cancer Genome Atlas-Breast Cancer (TCGA-BRCA) database and the Clinical Proteomic Tumor Analysis Consortium (CPTAC) database were used to analyze the expression of DDX27 in breast cancer. Kaplan–Meier survival analysis were used to investigate the implication of DDX27 on breast cancer prognosis. Western blot, CCK-8 assay, Transwell assay and wound-healing assay were carried out to clarify the regulation of DDX27 on stem cell-like properties in breast cancer cells. Gene Set Enrichment Analysis (GSEA) was performed to analyze the potential molecular mechanisms of DDX27 in breast cancer.

Results

DDX27 was significantly high expressed in breast cancer compared with normal tissue. High expression of DDX27 was related to larger tumor size (p = 0.0005), positive lymph nodes (p = 0.0008), higher histological grade (p = 0.0040), higher ki-67 (p = 0.0063) and later TNM stage (p < 0.0001). Patients with high DDX27 expression turned out a worse prognosis on overall survival (OS,p = 0.0087) and disease-free survival (DFS,p = 0.0235). Overexpression of DDX27 could enhance the expression of biomarkers related to stemness and promote stem cell-like activities such as proliferation and migration in breast cancer cells.

Conclusion

DDX27 can enhance stem cell-like properties and cause poor prognosis in breast cancer, also may be expected to become a potential biomarker for breast cancer therapy.