bluuebunny/crossref_metadata_2025 huggingface dataset:
My address is the Soviet Union – or is it? Baltic identity in souvenir production within the Soviet discourse
Authors: Jerlei Triin
Published: November 2021

In the 1960s, tourism in the Soviet Union underwent radical changes. While previously the focus had been on showcasing the rapid modernization of the empire, this new type of tourism focused on introducing foreigners to the regional vernacular culture in the Soviet Union. As the number of tourists increased, the need for wider mass production of souvenirs emerged. This research focuses on the identity of souvenirs produced in Baltic states as a case study for identifying the existence and nature of regionalism within the Soviet system. This study found that within Baltic souvenir production, two separate types of identities manifested. Firstly, the use of national or vernacular symbols was allowed and even promoted throughout the Soviet Union. A famous slogan of the era was ‘Socialist in content, national in form’, which suggested that national form was suitable for conveying socialist ideals. These products were usually made of local materials and employed traditional national ornament. However, this research identified a secondary identity within the souvenirs manufactured in the Baltic countries, which was based on a shared ‘European past’. The symbol often chosen to convey it was the pre-Soviet Old Town, which was in all three states based on Western and Central European architectural traditions. This research suggests that this European identity validated through the use of Old Town as a recurring motif on souvenirs, distinguished Baltic states from the other regions of the Soviet Union. While most souvenirs manufactured in the Soviet Union emphasized the image of locals as the exotic ‘Other’, Baltic souvenirs inspired by Old Town conveyed the idea of familiarity to European tourists.
Making sense of the past to understand the present: Attributions for historical trauma predict contemporary social and political attitudes
Authors: Hirschberger Gilad , Imhoff Roland , Kahn Dennis , Hanke Katja
Published: November 2021

Research indicates that the memory of collective trauma influences attitudes towards contemporary social and political issues. We suggest that the specific attributions for trauma that members of victim and perpetrator groups make provide a more nuanced understanding of this relationship. Thus, we constructed and validated a measure of attributions for the Holocaust. Then, we ran a preregistered study on representative samples in Germany ( N = 504) and Israel ( N = 469) to examine whether attributing the Holocaust to essentialist or contextual causes influences attitudes towards the immigration crisis and the Israeli–Palestinian conflict. Results indicated that, among Germans, attributing the Holocaust to German character was associated with positive attitudes to immigration via collective guilt. Among Israelis, attributions to German character were associated with negative attitudes to non-Jewish immigration, a hawkish stance in the Palestinian–Israeli conflict, and pro-Israel attitudes via a sense of perpetual victimization. Results reveal how attributions about past trauma affect contemporary social and political attitudes among victims and perpetrators.
COVID-19 pandemic and the impact of cross-cultural differences on crisis management: A conceptual model of transcultural crisis management
Authors: Bajaj Gita , Khandelwal Surabhi , Budhwar Pawan
Published: November 2021

In this paper, leadership tasks and stakeholder response during transboundary crisis management are analyzed based on findings from Hofstede’s study, GLOBE Project, and theoretical concepts in cross-cultural management. Accordingly, a conceptual model of transcultural crisis management is proposed. Seven propositions (P) and sixteen sub-propositions (SP) are developed and then tested using the case method. The case of the COVID-19 pandemic is studied to note the effects of cross-cultural differences and intercultural communication in the pre-crisis, crisis, and post-crisis stages. Cross-cultural differences are found to affect sense-making, decision-making, sense-giving and meaning-making during pre-crisis and crisis management stages. Implications of these findings and further research agenda are discussed.
Estimating human error probability in transporting steel cargo with bulk carriers using a hybrid approach
Authors: Kaptan Mehmet
Published: November 2021

Maritime operations include potential human-made hazards. For this reason, evaluating human-made hazards for cost-effective ship management is of vital importance in the maritime industry. From past to present, researchers have attempted to offer preventive approaches to minimise human-made hazards. In this context, the present article proposes a hybrid approach through the integration of the Delphi, Analytic Hierarchy Process (AHP) and Human Error Assessment and Reduction Technique (HEART) methods. With this approach, human-made claims occurring during the handling and transport of steel cargo in bulk carriers were analysed. The outputs of the present article contribute to the improvement of overall safety levels of steel cargo and bulk carriers by considering the potential hazards in risk management.
The Added Value of Intraoperative Near-Infrared Fluorescence Imaging in Elective Laparoscopic Cholecystectomy
Authors: Iacuzzo Cristiana , Bressan Livia , Troian Marina , Germani Paola , Giudici Fabiola , Bortul Marina
Published: November 2021

Bile duct injury is a major complication of laparoscopic cholecystectomy (LC). Intraoperative cholangiogram is useful, but faster techniques are available to assist the surgeon, like near-infrared fluorescent cholangiography (NIFC) with indocyanine green (ICG). The aim of our study is to evaluate the usefulness of NIFC during LC. This is a retrospective study conducted on prospectively recorded data of the General Surgery department of Trieste Academic Hospital, Italy. All patients underwent elective LC from January 2016 to January 2020. Patients were randomly divided in 2 groups: in one group, only white light imaging was used (n = 98 patients), in the NIFC group (n = 63) ICG was used. NIFC has been chosen more frequently by residents than consultants ( P = .002). Operative time and length of stay resulted shorter in ICG group ( P = .002 and .006), and this group showed also fewer intraoperative complications ( P = .007). NIFC does not require any learning curve and makes surgery faster and safer.
Grains of Sound: Visual and Sonic Textures in Sand or Peter and the Wolf
Authors: Skjerseth Amy
Published: November 2021

There is a tendency in animation studies to discuss sound in the language of images, stressing sound’s alignment with visual cues (as in mickey mousing and leitmotifs). But sounds do not only mimic images: they add textures and emotions that change what we see. This article explores grain (texture) and timbre (tone color produced by specific instruments and techniques) as qualities shared by visual and sonic material. To do so, the author closely reads Sand or Peter and the Wolf (1969), where Caroline Leaf’s haptic sand animation is matched by Michael Riesman’s electroacoustic score. Leaf painstakingly molds animals by scraping away individual sand grains, and Riesman sculpts sonic textures with tiny adjustments to knobs and touch-sensitive pads on the Buchla modular synthesizer. Their collective improvisation with sands and sounds reveals new ways to think about artists’ material practices and the friction and interplay between images and sounds. They encourage spectators to perceive the animals as not merely plasmatic, or Sergei Eisenstein’s notion of contour-bending character animation. Instead, Leaf and Riesman deploy what the author calls ‘granular modulation’, expressing sand and animals with sensuous materiality. In Leaf’s and Riesman’s improvisations, grainy textures are the seeds of understanding how sound and vision become symbiotic – and encounter friction – in animation.
Integrative Analysis to Uncover the Molecular Mechanisms of Caesalpinia sappan L. for Anti-Cancer Activity
Authors: Liu Bing , Lian Hao
Published: November 2021

Objectives: Caesalpinia Sappan L. is a traditional Chinese medicine with a long history. Recent studies have confirmed that Sappan has an antitumor effect, but its specific mechanism is still unclear. Methods: In this study, we used network pharmacology to predict the target and signal pathway of Sappan. In addition, the Cancer Genome Atlas and cancer cell lines encyclopedia large-scale genomic databases were used to analyze the relationship between different subtypes of Akt. Based on molecular docking technology, the interaction mode between small molecule compounds and protein targets was explored. Finally, we studied the effect of Sappan on Akt protein expression by Western blot in vitro. Results: AKT1 and AKT2 were significantly expressed in breast cancer cells, but they were significantly different from AKT3. Finally, molecular docking analysis showed that (3R,5R)-1,3,4,5-tetrakis(((E)-3-(3,4-dihydroxyphenyl)acryloyl)oxy)cyclohexane-1-carboxylic acid had a very ideal binding mode with Akt. Subsequent experiments showed that Sappan extract could induce apoptosis of HepG2 cells in a dose-dependent manner, and down regulate the phosphorylation level of Akt protein thr308 in a dose-dependent manner. Conclusions: This study provides new ideas for Sappan's anticancer research through the strategy of system pharmacology.
Awareness and knowledge of diabetic retinopathy in diabetic patients at a General Hospital in Northwest Ethiopia
Authors: Mersha Getasew Alemu , Alimaw Yezinash Addis , Woredekal Asamere Tsegaw , Assaye Aragaw Kegne , Zeleke Tarekegn Chekilie
Published: November 2021

Objective:

Diabetic retinopathy is an evident complication of diabetes on eye and contributes for significant portion of blindness worldwide. In Ethiopia, data are lacking on awareness and knowledge of diabetic retinopathy in diabetic patients. This study desired to assess knowledge of diabetic retinopathy and it is relating factors among diabetic patients attending at a General Hospital in Ethiopia.

Methods:

We have interviewed 306 diabetic patients who were attending at Debre Tabor General Hospital. Binary logistic regression model was used to recognize associated factors to good knowledge of diabetic retinopathy. Adjusted odds ratio was used to show the power of association. A p-value of less than 0.05 was set to determine its statistical significance.

Result:

The diabetic patients had a median age of 45 (range = 30) years. From the total diabetic patients, 242 (79.10%) knew that diabetes could affect the eye and 81 (26.50%) were aware of diabetic retinopathy. From those who were informed of diabetic retinopathy, 32 (39.50%) (95% confidence interval = 27.90–51.20) had good knowledge of diabetic retinopathy. High educational status (adjusted odds ratio = 4.08, 95% confidence interval = 1.00–16.50) and non-government employee (adjusted odds ratio = 0.19, 95% confidence interval = 0.05–0.70) were significantly associated with good knowledge of diabetic retinopathy. Physicians and eye doctors were the most frequent source of information for the awareness of diabetic retinopathy.

Conclusion:

From the total diabetic patients recruited in the study, 39.5% of them obtained information about diabetic retinopathy and the overall knowledge was poor among them. Knowledge of diabetes can affect the eye and it causes blindness was good among majority of the participants. Higher educational status and being a non-government employee were determined to be important predisposing factors of good knowledge. It is also better to involve diabetic educators and counselors in educating diabetic patients on the serious complication of diabetes on eye.
Changes in Medial Elbow Joint Space When Elbow Valgus Stress Is Applied at Different Limb Positions and Loads In Vivo
Authors: Yoshioka Kanta , Matsuzawa Kanta , Ikuta Tomoya , Maruyama Sae , Edama Mutsuaki
Published: November 2021

Background:

Ulnar collateral ligament (UCL) injury is a common sports injury among overhead-throwing athletes and causes medial elbow pain and instability. UCL injury is generally diagnosed based on symptoms, physical findings, and image evaluation. To standardize the method for evaluating elbow valgus instability, more information is needed regarding changes in the medial elbow joint space (JS) in healthy elbows.

Purpose/Hypothesis:

The purpose of this study was to measure the JS during the application of elbow valgus stress at different elbow flexion angles and loads and to clarify the presence of defensive muscle contractions during elbow valgus stress. It was hypothesized that the JS will differ according to different limb positions and loads and that defensive contractions will occur when elbow valgus stress is >90 N.

Study Design:

Controlled laboratory study.

Methods:

Elbow joints on the nondominant side were examined in 20 healthy male university students (mean age, 21 ± 0.2 years) at 30°, 60°, and 90° of elbow flexion. To create valgus stress on the elbow, loads of 30, 60, 90, 120, and 150 N were applied with a Telos stress device and with gravity stress on the forearm. The medial JS was measured ultrasonographically during the application of elbow valgus stress. Electrodes were attached to the pronator teres muscle, and defensive muscle contractions were measured using electromyography during the application of elbow valgus stress. Repeated-measures analysis of variance and paired t tests were used to compare the JS at each elbow angle and each valgus stress load, and the Bonferroni method was used as a post hoc test.

Results:

At 30° of elbow flexion, the JS was significantly higher at 30 N versus 0 N and at 60 N versus 0 or 30 N ( P ≤ .018 for all). At 60° of flexion, the JS was significantly higher at 30 N versus 0 N, at 60 N versus 0 and 30 N, and at 90 N versus 0, 30, and 60 N ( P ≤ .024 for all). At 90° of elbow flexion, the JS was significantly higher at 30 N versus 0 N and at 60 N versus 0 and 30 N ( P ≤ .028 for all). Defensive muscle contraction did not occur at any elbow flexion angles at elbow valgus stress ≤60 N.

Conclusion:

The lack of muscular contraction at elbow valgus stress ≤60 N may reflect the function of the medial collateral ligament.

Clinical Relevance:

Elbow valgus stress ≤60 N allows for the evaluation of the joint opening.
Aping Blackness: Reading and Evaluating Racialized Images in Cartagena, Colombia
Authors: Valle Melissa M.
Published: November 2021

Why are residents of a city racialized as Black overwhelmingly in favor of representations of Blackness that caricature Afro-descendants as subservient, hypersexual and licentious, jovial, uninhibited and libertine, primitive (folklorized), and violent? This article bridges the literatures on the sociology of culture and cognition, racial signification, and frame theory to explore the various sociomental lenses and schemata that people use to perceive racial symbols and evaluate their legitimacy. It uses semi-structured and open-ended photo-elicitation interviews, primarily with residents of a largely-Afro-descendant community in Cartagena, Colombia, to systematically generate a collection of readings and evaluations of racialized imagery, resulting in an empirical example of the socio-optical construction of race within the Colombian cultural context. These readings and evaluations of external cultural primers such as photographs of racialized performance and ritual reveal (1) how a Colombian Atlantic Coastal “optical community” connects the signifiers and signifieds of Blackness; (2) that racial frames evoke three primary schemas (personal, spatiotemporal, and explicitly ideological), which interpreters use to decode and evaluate images; (3) that interpreters read the racial frames transmitted by cultural producers (e.g., performance artists and festival goers) via the visual language of racialized imagery as collectively credible and/or personally salient, and that this visual resonance is how the racialized imagery gain legitimacy and; (4) that personal experience, cultural knowledge, and social location account for variations in whether people consider racialized imagery credible and salient and, as such, legitimate forms of recognition.
Older Adults Living in Sheltered Housing’s Experiences of Involvement in Pro Re Nata Decisions. A Narrative Positioning Analysis
Authors: Nilsen Marianne Kollerøs , Blix Bodil H. , Sletvold Hege , Olsen Rose Mari
Published: November 2021

Decisions regarding pro re nata medications might be challenging due to the complex nature of the practice. The aim of this study was to expand our understanding of the experiences of older people living in sheltered housings with regard to shared decision-making concerning pro re nata medications. In this study, we conducted in-depth interviews with residents living in Norwegian sheltered housings. The analysis was inductive, based on a narrative positioning analysis. Twelve residents were interviewed, and three narratives representing participants’ variation are presented. People take different positions in shared decision-making of pro re nata medication, and they position themselves variously at different levels and situations. Prevailing master narratives affect the residents’ positions in shared decision-making. Contrasts in older adults’ experiences indicate that shared decision-making is not straightforward and is highly reliant on the context. Seemingly, they wish to be involved and not involved at the same time, a contradiction that healthcare providers need to consider.
Seismic fragility models of a bridge system based on copula method
Authors: Chen Libo , Huang Caigui , Chen Haiqiang , Zheng Zhenfeng
Published: November 2021

Seismic fragility assessment widely uses a probabilistic measure for assessing the seismic performance of structural components or systems. This article proposes a copula-based seismic fragility (CBSF) method to derive the system-level damage probabilities of reinforced concrete bridges and to consider the correlation among seismic demands of components. First, the marginal distribution functions of the random variables are calibrated, and three Archimedean copula models are considered. Subsequently, the relevant parameters of the copula models are estimated using the semi-parametric maximum likelihood method. Next, the damage probabilities of a bridge system are calculated based on the joint distribution model with the most suitable copula model and the calibrated marginal distribution functions. Finally, the CBSF method is used to estimate the damage probability of a simply supported box girder bridge. The performance of the CBSF method is validated by a comparison of fragility curves obtained using the CBSF method and the probabilistic seismic demand analysis (PSDA) method. The comparative results demonstrate that the fragility curves obtained by the CBSF method are better than those obtained using the PSDA method. The proposed CBSF model can serve as a tool for assessing the seismic performance of structures and estimating the economic loss of existing bridge systems.
HaplotypeTools: a toolkit for accurately identifying recombination and recombinant genotypes
Authors: Farrer Rhys A.
Published: November 2021

Background

Identifying haplotypes is central to sequence analysis in diploid or polyploid genomes. Despite this, there remains a lack of research and tools designed for physical phasing and its downstream analysis.

Results

HaplotypeTools is a new toolset to phase variant sites using VCF and BAM files and to analyse phased VCFs. Phasing is achieved via the identification of reads overlapping ≥ 2 heterozygous positions and then extended by additional reads, a process that can be parallelized across a computer cluster. HaplotypeTools includes various utility scripts for downstream analysis including crossover detection and phylogenetic placement of haplotypes to other lineages or species. HaplotypeTools was assessed for accuracy against WhatsHap using simulated short and long reads, demonstrating higher accuracy, albeit with reduced haplotype length. HaplotypeTools was also tested on real Illumina data to determine the ancestry of hybrid fungal isolate Batrachochytrium dendrobatidis (Bd) SA-EC3, finding 80% of haplotypes across the genome phylogenetically cluster with parental lineages BdGPL (39%) and BdCAPE (41%), indicating those are the parental lineages. Finally, ~ 99% of phasing was conserved between overlapping phase groups between SA-EC3 and either parental lineage, indicating mitotic gene conversion/parasexuality as the mechanism of recombination for this hybrid isolate. HaplotypeTools is open source and freely available from https://github.com/rhysf/HaplotypeTools under the MIT License.

Conclusions

HaplotypeTools is a powerful resource for analyzing hybrid or recombinant diploid or polyploid genomes and identifying parental ancestry for sub-genomic regions.
Successful intergeneric transfer of a major apple scab resistance gene (Rvi6) from apple to pear and precise comparison of the downstream molecular mechanisms of this resistance in both species
Authors: Perchepied L. , Chevreau E. , Ravon E. , Gaillard S. , Pelletier S. , Bahut M. , Berthelot P. , Cournol R. , Schouten H. J. , Vergne E.
Published: November 2021

Background

Scab is the most important fungal disease of apple and pear. Apple (Malus x domestica Borkh.) and European pear (Pyrus communis L.) are genetically related but they are hosts of two different fungal species: Venturia inaequalis for apple and V. pyrina for European pear. The apple/V. inaequalis pathosystem is quite well known, whereas knowledge about the pear/V. pyrina pathosystem is still limited. The aim of our study was to analyse the mode of action of a major resistance gene of apple (Rvi6) in transgenic apple and pear plants interacting with the two scab species (V. inaequalis and V. pyrina), in order to determine the degree of functional transferability between the two pathosystems.

Results

Transgenic pear clones constitutively expressing the Rvi6 gene from apple were compared to a scab transgenic apple clone carrying the same construct. After inoculation in greenhouse with V. pyrina, strong defense reactions and very limited sporulation were observed on all transgenic pear clones tested. Microscopic observations revealed frequent aborted conidiophores in the Rvi6 transgenic pear / V. pyrina interaction. The macro- and microscopic observations were very comparable to the Rvi6 apple / V. inaequalis interaction. However, this resistance in pear proved variable according to the strain of V. pyrina, and one of the strains tested overcame the resistance of most of the transgenic pear clones. Comparative transcriptomic analyses of apple and pear resistant interactions with V. inaequalis and V. pyrina, respectively, revealed different cascades of molecular mechanisms downstream of the pathogen recognition by Rvi6 in the two species. Signal transduction was triggered in both species with calcium (and G-proteins in pear) and interconnected hormonal signaling (jasmonic acid in pear, auxins in apple and brassinosteroids in both species), without involvement of salicylic acid. This led to the induction of defense responses such as a remodeling of primary and secondary cell wall, lipids biosynthesis (galactolipids in apple and cutin and cuticular waxes in pear), systemic acquired resistance signal generation (in apple) or perception in distal tissues (in pear), and the biosynthesis of phenylpropanoids (flavonoids in apple but also lignin in pear).

Conclusion

This study is the first example of a successful intergeneric transfer of a resistance gene among Rosaceae, with a resistance gene functioning towards another species of pathogen.
Hybrid repair of aberrant right subclavian artery with aortic dissection caused by Kommerell diverticulum
Authors: Li Tieyan , Zou Lin , Feng Yunzhen , Fan Guoliang , Xin Yuanfeng
Published: November 2021

Background

Aberrant right subclavian artery (ARSA) with associated Kommerell diverticulum (KD) is a rare congenital aortic disease. KD patients have a high risk of rupture, dissection, and compression of adjacent structures. Although several treatment options have been proposed (traditional surgery, hybrid operation, and endovascular intervention), a consensus regarding optimal surgical management has not yet been established.

Case presentation

A case of successful hybrid repair of distal aortic arch dissection aneurysm by dissecting KD and ARSA with debranching of right and left common carotid arteries, left subclavian artery, and stent grafting was presented.

Conclusions

The hybrid operation is suitable for elderly patients or those with high risks. Along with intervention, the hybrid operation needs to be developed as a minimally invasive method.
Acute myocardial infarction with left main coronary artery ostial negative remodelling as the first manifestation of Takayasu arteritis: a case report
Authors: Zhou Shiqiang , Gao Chao , Li Fei
Published: November 2021

Background

Takayasu arteritis is a chronic inflammatory disease involving the aorta and its major branches. Acute myocardial infarction rarely but not so much presents in patients with Takayasu arteritis, and the preferable revascularization strategy is still under debate.

Case presentation

A 22-year-old female with Takayasu arteritis presented with acute myocardial infarction. Coronary angiography and intravenous ultrasound (IVUS) showed that the right coronary artery (RCA) was occluded and that there was severe negative remodelling at the ostium of the left main coronary artery (LMCA). The patient was treated by primary percutaneous transluminal coronary angioplasty (PTCA) with a scoring balloon in the LMCA, without stent implantation. After 3 months of immunosuppressive medication, the patient received RCA revascularization by stenting. There was progressive external elastic membrane (EEM) enlargement of the LMCA ostium demonstrated by IVUS at 3 and 15 months post-initial PTCA.

Conclusion

Here, we report a case of Takayasu arteritis with involvement of the coronary artery ostium. Through PTCA and long-term immunosuppressive medication, we found that coronary negative remodelling might be reversible in patients with Takayasu arteritis.
Constrictive pericarditis in the setting of repeated chest trauma in a mixed martial arts fighter
Authors: Ferrel Meganne N. , Iriana Sentia , Raymond Thomason I. , Ma Christy L. , Tsarova Katsiaryna , Wilson Brent D. , McKellar Stephen H. , Ryan John J.
Published: November 2021

Background

Constrictive pericarditis (CP) is characterized by scarring and loss of elasticity of the pericardium. This case demonstrates that mixed martial arts (MMA) is a previously unrecognized risk factor for CP, diagnosis of which is supported by cardiac imaging, right and left heart catheterization, and histological findings of dense fibrous tissue without chronic inflammation.

Case presentation

A 47-year-old Caucasian male former mixed martial arts (MMA) fighter from the Western United States presented to liver clinic for elevated liver injury tests (LIT) and a 35-pound weight loss with associated diarrhea, lower extremity edema, dyspnea on exertion, and worsening fatigue over a period of 6 months. Past medical history includes concussion, right bundle branch block, migraine headache, hypertension, chronic pain related to musculoskeletal injuries and fractures secondary to MMA competition. Involvement in MMA was extensive with an 8-year history of professional MMA competition and 13-year history of MMA fighting with recurrent trauma to the chest wall. The patient also reported a 20-year history of performance enhancing drugs including testosterone. Physical exam was notable for elevated jugular venous pressure, hepatomegaly, and trace peripheral edema. An extensive workup was performed including laboratory studies, abdominal computerized tomography, liver biopsy, echocardiogram, and cardiac magnetic resonance imaging. Finally, right and left heart catheterization—the gold standard—confirmed discordance of the right ventricle-left ventricle, consistent with constrictive physiology. Pericardiectomy was performed with histologic evidence of chronic pericarditis. The patient’s hospital course was uncomplicated and he returned to NYHA functional class I.

Conclusions

CP can be a sequela of recurrent pericarditis or hemorrhagic effusions and may have a delayed presentation. In cases of recurrent trauma, CP may be managed with pericardiectomy with apparent good outcome. Further studies are warranted to analyze the occurrence of CP in MMA so as to better define the risk in such adults.
Pediatric triage variations among nurses, pediatric and emergency residents using the Canadian triage and acuity scale
Authors: Alshaibi Saleh , AlBassri Tala , AlQeuflie Suliman , Philip Winnie , Alharthy Nesrin
Published: November 2021

Background

Emergency care continues to be a challenge, since patients’ arrival is unscheduled and could occur at the same time which may fill the Emergency Department with non-urgent patients. Triaging is an integral part of every busy ED. The Canadian Triage and Acuity Scale (CTAS) is considered an accurate tool to be used outside Canada. This study aims to identify the chosen triage level and compare the variation between registered nurses, pediatric and adult emergency residents by using CTAS cases.

Method

This study was conducted at King Abdulaziz Medical City,Saudi Arabia. A cross-sectional self-administered questionnaire was used, and which contains 15 case scenarios with different triage levels. All cases were adopted from a Canadian triage course after receiving permission. Each case provides the patient’s symptoms, clinical signs and mode of arrival to the ED. The participants were instructed to assign a triage level using the following scale. A non-random sampling technique was used for this study. The rates of agreement between residents were calculated using kappa statistics (weighted-kappa) (95%CI).

Result

A total of 151 participants completed the study questionnaire which include 15 case scenarios. 73 were nurses and 78 were residents. The results showed 51.3, 56.6, and 59.9% mis-triaged the cases among the nurses, emergency residents, and pediatric residents respectively. Triage scores were compared using the Kruskal Wallis test and were statistically significant with a p value of 0.006. The mean ranks for nurses, emergency residents and pediatric residents were 86.41, 73.6 and 59.96, respectively. The Kruskal Wallis Post-Hoc test was performed to see which groups were statistically significant, and it was found that there was a significant difference between nurses and pediatrics residents (P value = 0.005). Moreover, there were no significant differences found between nurses and ER residents (P value> 0.05).

Conclusion

The triaging system was found to be a very important tool to prioritize patients based on their complaints. The results showed that nurses had the greatest experience in implementing patients on the right triage level. On the other hand, ER and pediatric residents need to develop more knowledge about CTAS and become exposed more to the triaging system during their training.
Bayesian maximum entropy-based prediction of the spatiotemporal risk of schistosomiasis in Anhui Province, China
Authors: Wang Fuju , Liu Xin , Bergquist Robert , Lv Xiao , Liu Yang , Gao Fenghua , Li Chengming , Zhang Zhijie
Published: November 2021

Background

“Schistosomiasis” is a highly recurrent parasitic disease that affects a wide range of areas and a large number of people worldwide. In China, schistosomiasis has seriously affected the life and safety of the people and restricted the economic development. Schistosomiasis is mainly distributed along the Yangtze River and in southern China. Anhui Province is located in the Yangtze River Basin of China, with dense water system, frequent floods and widespread distribution of Oncomelania hupensis that is the only intermediate host of schistosomiasis, a large number of cattle, sheep and other livestock, which makes it difficult to control schistosomiasis. It is of great significance to monitor and analyze spatiotemporal risk of schistosomiasis in Anhui Province, China. We compared and analyzed the optimal spatiotemporal interpolation model based on the data of schistosomiasis in Anhui Province, China and the spatiotemporal pattern of schistosomiasis risk was analyzed.

Methods

In this study, the root-mean-square-error (RMSE) and absolute residual (AR) indicators were used to compare the accuracy of Bayesian maximum entropy (BME), spatiotemporal Kriging (STKriging) and geographical and temporal weighted regression (GTWR) models for predicting the spatiotemporal risk of schistosomiasis in Anhui Province, China.

Results

The results showed that (1) daytime land surface temperature, mean minimum temperature, normalized difference vegetation index, soil moisture, soil bulk density and urbanization were significant factors affecting the risk of schistosomiasis; (2) the spatiotemporal distribution trends of schistosomiasis predicted by the three methods were basically consistent with the actual trends, but the prediction accuracy of BME was higher than that of STKriging and GTWR, indicating that BME predicted the prevalence of schistosomiasis more accurately; and (3) schistosomiasis in Anhui Province had a spatial autocorrelation within 20 km and a temporal correlation within 10 years when applying the optimal model BME.

Conclusions

This study suggests that BME exhibited the highest interpolation accuracy among the three spatiotemporal interpolation methods, which could enhance the risk prediction model of infectious diseases thereby providing scientific support for government decision making.
Comparison of mortality risk evaluation tools efficacy in critically ill COVID-19 patients
Authors: Vicka Vaidas , Januskeviciute Elija , Miskinyte Sigute , Ringaitiene Donata , Serpytis Mindaugas , Klimasauskas Andrius , Jancoriene Ligita , Sipylaite Jurate
Published: November 2021

Background

As the COVID-19 pandemic continues, the number of patients admitted to the intensive care unit (ICU) is still increasing. The aim of our article is to estimate which of the conventional ICU mortality risk scores is the most accurate at predicting mortality in COVID-19 patients and to determine how these scores can be used in combination with the 4C Mortality Score.

Methods

This was a retrospective study of critically ill COVID-19 patients treated in tertiary reference COVID-19 hospitals during the year 2020. The 4C Mortality Score was calculated upon admission to the hospital. The Simplified Acute Physiology Score (SAPS) II, Acute Physiology and Chronic Health Evaluation (APACHE) II, and Sequential Organ Failure Assessment (SOFA) scores were calculated upon admission to the ICU. Patients were divided into two groups: ICU survivors and ICU non-survivors.

Results

A total of 249 patients were included in the study, of which 63.1% were male. The average age of all patients was 61.32 ± 13.3 years. The all-cause ICU mortality ratio was 41.4% (n = 103). To determine the accuracy of the ICU mortality risk scores a ROC-AUC analysis was performed. The most accurate scale was the APACHE II, with an AUC value of 0.772 (95% CI 0.714–0.830; p < 0.001). All of the ICU risk scores and 4C Mortality Score were significant mortality predictors in the univariate regression analysis. The multivariate regression analysis was completed to elucidate which of the scores can be used in combination with the independent predictive value. In the final model, the APACHE II and 4C Mortality Score prevailed. For each point increase in the APACHE II, mortality risk increased by 1.155 (OR 1.155, 95% CI 1.085–1.229; p < 0.001), and for each point increase in the 4C Mortality Score, mortality risk increased by 1.191 (OR 1.191, 95% CI 1.086–1.306; p < 0.001), demonstrating the best overall calibration of the model.

Conclusions

The study demonstrated that the APACHE II had the best discrimination of mortality in ICU patients. Both the APACHE II and 4C Mortality Score independently predict mortality risk and can be used concomitantly.
Umbilical artery thrombosis diagnosed at different gestational ages and fetal outcomes: a case series
Authors: Wei Jing , Li Qiaoyun , Zhai Hongbo
Published: November 2021

Background

Umbilical artery thrombosis is a rare complication of pregnancy strongly associated with poor fetal and perinatal outcomes, such as intrauterine asphyxia, fetal growth restriction, and stillbirth. Its pathogenesis remains unclear, and there is the added challenge of selecting an appropriate delivery time to achieve excellent neonatal outcomes.

Methods

Our Hospital is a critical maternal rescue center with approximately 7000 births annually. We present a series of 8 cases of umbilical artery thrombosis diagnosed at the hospital between Apr 1, 2018, and Jan 31, 2020. We identified the cases through a keyword search of the maternity and pathology information management systems.

Results

Three patients were diagnosed with a transabdominal ultrasound scan and hypoxia on fetal heart monitoring. All three patients had emergency cesarean section delivery. Four patients were observed closely for 5 to 13 weeks from initial detection by an ultrasound scan to delivery. Only one patient was diagnosed after vaginal delivery by Hematoxylin-eosin staining of umbilical cord sections. Seven patients had deliveries by cesarean section, and one patient had a vaginal delivery. All infants were born alive.

Conclusions

Umbilical artery thrombosis is a challenging and rare condition that can occur at different gestational ages, especially when diagnosed in the third trimester and accompanied by fetal growth restriction. Consequently, these patients require close monitoring of umbilical blood flow and fetal growth and intervention at the appropriate time to achieve an optimal outcome.
An effective N6-methyladenosine-related long non-coding RNA prognostic signature for predicting the prognosis of patients with bladder cancer
Authors: Ma Tianming , Wang Xiaonan , Meng Lingfeng , Liu Xiaodong , Wang Jiawen , Zhang Wei , Tian Zijian , Zhang Yaoguang
Published: November 2021

Background

Bladder cancer (BLCA) typically has a poor prognosis due to high relapse and metastasis rates. A growing body of evidence indicates that N6-methyladenosine (m6A) and long non-coding RNAs (lncRNAs) play crucial roles in the progression of BLCA and the treatment response of patients with BLCA. Therefore, we conducted a comprehensive RNA-seq analysis of BLCA using data from The Cancer Genome Atlas (TCGA) to establish an m6A-related lncRNA prognostic signature (m6A-RLPS) for BLCA.

Methods

Consensus clustering analysis was used to investigate clusters of BLCA patients with varying prognoses. The least absolute shrinkage and selection operator Cox regression were used to develop the m6A-RLPS. The ESTIMATE and CIBERSORT algorithms were used to evaluate the immune composition.

Results

A total of 745 m6A-related lncRNAs were identified using Pearson correlation analysis (|R| > 0.4, p < 0.001). Fifty-one prognostic m6A-related lncRNAs were screened using univariate Cox regression analysis. Through consensus clustering analysis, patients were divided into two clusters (clusters 1 and 2) with different overall survival rates and tumor stages based on the differential expression of the lncRNAs. Enrichment analysis demonstrated that terms related to tumor biological processes and immune-related activities were increased in patient cluster 2, which was more likely to exhibit low survival rates. Nine m6A-related prognostic lncRNAs were finally determined and subsequently used to construct the m6A-RLPS, which was verified to be an independent predictor of prognosis using univariate and multivariate Cox regression analyses. Further, a nomogram based on age, tumor stage, and the m6A-RLPS was generated and showed high accuracy and reliability with respect to predicting the survival outcomes of BLCA patients. The prognostic signature was found to be strongly correlated to tumor-infiltrating immune cells and immune checkpoint expression.

Conclusions

We established a novel m6A-RLPS with a favorable prognostic value for patients with BLCA. We believe that this prognostic signature can provide new insights into the tumorigenesis of BLCA and predict the treatment response in patients with BLCA.
Functional neurologic disorders in an adult with propionic acidemia: a case report
Authors: Tarrada Alexis , Frismand-Kryloff Solène , Hingray Coraline
Published: November 2021

Background

Inborn errors of metabolism are often characterized by various psychiatric syndromes. Previous studies tend to classify psychiatric manifestations into clinical entities. Among inborn errors of metabolism, propionic acidemia (PA) is a rare inherited organic aciduria that leads to neurologic disabilities. Several studies in children with PA demonstrated that psychiatric disorders are associated to neurological symptoms. To our knowledge, no psychopathological description in adult with propionic acidemia is available.

Case presentation

We aimed to compare the case of a 53-year-old woman with PA, to the previous psychiatric descriptions in children with PA and in adults with other inborn errors of metabolism. Our patient presented a large variety of signs: functional neurologic disorders, borderline personality traits (emotional dyregulation, dissociative and alexithymic trends, obsessive-compulsive disorders), occurring in a context of neurodevelopmental disorder.

Conclusion

Clinical and paraclinical examinations are in favor of a mild mental retardation since childhood and disorders of behavior and personality without any definite psychiatric syndrome, as already described in other metabolic diseases (group 3). Nonetheless, further studies are needed to clarify the psychiatric alterations within adult patients with PA.
Knowledge and transmission risk awareness of tuberculosis among the pilgrims attending a religious mass gathering in India: a cross-sectional study
Authors: Bäckdahl Tim , Sharma Megha
Published: November 2021

Background

Tuberculosis infection accounts for more annual deaths than any other single infectious disease, except the Corona Virus infection. It is a significant global issue and India is one of the most affected countries. Religious mass gatherings congregate millions of pilgrims at one place. Over-crowding is a high-risk factor for the transmission of tuberculosis. Knowledge and awareness of the disease are proven prerequisites for the spread-prevention and early diagnosis of tuberculosis. The present study was designed to explore the knowledge of tuberculosis and awareness of disease transmission risk among pilgrims attending a religious mass gathering, the Kumbh Mela (2016) in Ujjain, India.

Methods

Self-reported data on the pilgrims’ tuberculosis-knowledge were collected using a cross-sectional study design. A contextual, pre-tested questionnaire was used, using the convenience sampling method. In addition to the anonymous descriptive analyses, a composite knowledge-score was developed to enable comparisons between demographic groups.

Results

In total, 1665 pilgrims participated in the study with 38.8 years of mean age and 59% literacy rate. The most recognized symptoms of tuberculosis were “Cough for more than 15 days with sputum” (94%) and “Blood in sputum” (81%). Most participants knew that tuberculosis is an infectious disease (93%) and not hereditary (91%). Additionally, 84% considered it is a potentially lethal disease that requires extensive treatment. However, vaccine awareness was poor (4%). “Direct contact with tuberculosis patient” (78%) and “To be in a crowded area” (4%) were considered as the most important risk factors for tuberculosis transmission. For the composite knowledge-score, a significantly higher mean score was seen among those with at least ten years of schooling compared with illiterates (p <  0.001). Occupation and residency also affected the mean score.

Conclusion

Most pilgrims attending the Kumbh Mela had basic knowledge of the characteristics of tuberculosis, but some important knowledge gaps concerning the transmission risks associated with crowded situations existed. These gaps need to be addressed in future policies to enable safer mass gatherings and to end the TB epidemic, globally.
The function role of ubiquitin proteasome pathway in the ER stress-induced AECII apoptosis during hyperoxia exposure
Authors: Zhu Yue , Ju Huimin , Lu Hongyan , Tang Wei , Lu Junying , Wang Qiuxia
Published: November 2021

Background

Bronchopulmonary dysplasia (BPD) is a major cause of mortality and morbidity in premature infants, characterized by alveolar dysplasia and pulmonary microvascular remodeling. In the present study, we have investigated the functional roles of ubiquitin proteasome pathway (UPP) in BPD, and its relationship with endoplasmic reticulum stress (ERS) mediated type II alveolar epithelial cell (AECII) apoptosis.

Methods

A hyperoxia-induced BPD rat model was constructed and the pathologic changes of lung tissues were evaluated by hematoxylin–eosin staining. Cell apoptosis and protein expression were determined by TUNEL assay and Western blotting, respectively. Further reagent kit with specific fluorescent substrate was utilized to measure the activity of 20 s proteasome. Meanwhile, AECII were cultured in vitro and exposed to hyperoxia. AECII apoptosis were measured by flow cytometry. In contrast, MG132 treatment was induced to explore UPP during hyperoxia exposure on AECII apoptosis and ERS sensors expression.

Results

A significant increase in apoptosis and total ubiquitinated proteins expression were observed in BPD rats and AECII culture, and the change of UPP was associated with ERS. In order to confirm the role of UPP in AECII apoptosis of BPD, AECII cells were treated by MG132 with the concentration of 10 μmol/L under hyperoxia exposure. We found that the proteins expression of glucose-regulated protein 78 (GRP-78), PKR-like ER kinase (PERK), activating transcription factor 4 (ATF4), activating transcription factor 6 (ATF6) and C/EBP homologous protein (CHOP), as well as AECII apoptosis were increased following MG132 treatment. Furthermore, the relatively up-regulated in the levels of total ubiquitinated proteins expression and 20 s proteasome activity were correlated with increased ERS sensors expression.

Conclusions

Our findings indicate that UPP may participate in the ERS-induced AECII apoptosis under hyperoxia condition.