bluuebunny/crossref_metadata_2025 huggingface dataset:
Inequities in people with gout: a focus on Māori (Indigenous People) of Aotearoa New Zealand
Authors: Te Karu Leanne , Dalbeth Nicola , Stamp Lisa K
Published: June 2021

Health equity can be defined as the absence of systematic disparities in health between more and less advantaged social groups. Gout is one of the most common forms of arthritis and disproportionally affects Indigenous peoples, including Māori in Aotearoa New Zealand. Inequities in gout management are well documented and clearly evidenced in Indigenous populations. For example, while gout occurs at a younger age and is more severe in Māori, there is less regular dispensing of urate-lowering therapies. Indigenous peoples are also under-represented in clinical trials. Herein, we will review inequities in gout using Aoteoaroa New Zealand as an example. We will explore reasons for health inequities and challenges that need to be faced to achieve health equity.
Combining simple motion measurement, lean analysis technique and historical data review for countering negative labor cost variance: A case study
Authors: Adeyemi Bami , Ogbeyemi Akinola , Zhang Wenjun
Published: June 2021

Negative labor cost variance (NLCV) is an important problem in many manufacturing companies today. NLCV refers to the situation that expected or standard costs are less than actual labor costs in production. Management of NLCV, including the identification of causes for NLCV and the elimination or significant reduction of NLCV, is the topic discussed in this paper. The question studied in this paper is thus: what is an effective methodology in the environment of strong privacy protection to identify causes for NLCV and to significantly reduce it? The study presented in this paper proposed a methodology by combining a simple motion measurement (stopwatch), lean analysis techniques, and historical data review to study the NLCV problem. A case study was taken on a particular company called ABC to test the effectiveness of this methodology. Specifically, the result of the study revealed that (1) the employees in ABC waited for one reason or the other for almost 5 h (idle time) in a 16-h daily operation period (2 shifts running at 8 h each), which accounts for 32% of the total productive time, and (2) the elimination of the waiting time or idle time over the years concerned could account for 83% of all identified wastes in ABC. Through this case study, the effectiveness of the proposed methodology was demonstrated and the applicability of the proposed methodology was also implied.
Using Local School Wellness Policies to Build a Culture of Health for Students With Chronic Health Conditions: The School Nurse Role
Authors: Bobo Nichole , Olson Jan , Simmons-Wright Shauvon
Published: June 2021

Local school wellness policies (LWP) guide school districts’ efforts to establish school environments that promote students’ health, well-being, and ability to learn that include school U.S. Department of Agriculture nutrition and physical activity requirements. Looking through the lens of the Whole School, Whole Community, Whole Child model and NASN’s Framework for 21st Century School Nursing Practice™, LWP can be expanded beyond the tradition focus of nutrition and physical activity to address the health and academic needs of students with chronic health conditions. School nurses need to be actively involved on district wellness councils as schools prepare to conduct their required triennial assessment of current LWP equipped with an understanding of the Alliance for a Healthier Generations’ updated model wellness policy and NASN’s supplemental wellness policy language to address management of students with chronic health conditions.
Undifferentiated pleomorphic sarcoma in oropharyngeal mucosa of patients with multiple basal cell carcinomas
Authors: Dekanić Andrea , Velepič Marko , Gobić Margita Belušić , Hadžisejdić Ita , Jonjić Nives
Published: June 2021

Malignant mesenchymal tumors of oropharyngeal mucosa are rare. Those with fibroblastic and histiocytic differentiation in the skin are called atypical fibroxanthoma (AFX) and in the soft tissue undifferentiated pleomorphic sarcoma (UPS). Here we present a case of an older patient with a history of multiple basal cell carcinomas and recently with a rapidly growing polypoid lesion in the mucosa of posterior oropharyngeal wall with AFX/UPS morphology. The differential diagnosis, histological pitfalls of this poorly characterized mesenchymal lesions, and the challenges associated with treatment are discussed.
J. J. Gibson’s “Ground Theory of Space Perception”
Authors: Sedgwick H. A.
Published: June 2021

J. J. Gibson's ground theory of space perception is contrasted with Descartes’ theory, which reduces all of space perception to the perception of distance and angular direction, relative to an abstract viewpoint. Instead, Gibson posits an embodied perceiver, grounded by gravity, in a stable layout of realistically textured, extended surfaces and more delimited objects supported by these surfaces. Gibson's concept of optical contact ties together this spatial layout, locating each surface relative to the others and specifying the position of each object by its location relative to its surface of support. His concept of surface texture—augmented by perspective structures such as the horizon—specifies the scale of objects and extents within this layout. And his concept of geographical slant provides surfaces with environment-centered orientations that remain stable as the perceiver moves around. Contact-specified locations on extended environmental surfaces may be the unattended primitives of the visual world, rather than egocentric or allocentric distances. The perception of such distances may best be understood using Gibson's concept of affordances. Distances may be perceived only as needed, bound through affordances to the particular actions that require them.
Serum cartilage oligomeric matrix protein is decreased in patients with pulmonary hypertension: a potential protective factor
Authors: Chen Dan‐dan , Hu Wei‐ping , Xie Liang , Xiang Gui‐ling , Wu Qin‐han , Qu Jie‐ming , Li Shan‐qun , Guan Li‐hua , Liu Dong
Published: June 2021

Cartilage oligomeric matrix protein (COMP) was a protective factor in the cardiovascular system. Previous studies showed that hypoxia led to decreased COMP in rat models of pulmonary hypertension. However, the expression pattern of COMP in the pulmonary hypertension population was unclear. A total of 35 patients newly diagnosed with pulmonary hypertension and 70 controls were enrolled in the study. Circulating COMP concentrations of serum samples were measured by enzyme‐linked immunosorbent assay and were analyzed the association with multiple clinical variables. Serum COMP concentrations in the pulmonary hypertension group were significantly declined in comparison with age‐ and sex‐matched normal controls, especially in the female subgroup. No significant difference of COMP concentrations was observed in the etiological classification, heart function classification, and risk stratification. Major hemodynamic parameters, six‐minute walk distance, N‐terminal pro brain natriuretic peptide, and short‐term prognosis were not statistically associated with COMP. However, some echocardiography parameters, like tricuspid annular plane systolic excursion and mean right atrial pressure, were found the negative relation to COMP concentrations. In conclusion, serum COMP levels were decreased in the patients with pulmonary hypertension, which was in accordance with its known biological effects. Its association with long‐term prognosis was worth further exploring.
The burden of serious fungal infections in Sierra Leone: a national estimate
Authors: Lakoh Sulaiman , Orefuwa Emma , Kamara Matilda N. , Jiba Darlinda F. , Kamara Joseph B. , Kpaka Sylaju , Denning David W.
Published: June 2021

Sierra Leone is a small, resource-limited country that has a low national prevalence of human immunodeficiency virus (HIV) and a very high burden of tuberculosis (TB). Fungal diseases are probably common, but poorly documented. In this article, we reviewed the existing literature on fungal epidemiology in Sierra Leone using national, regional, and international data, identified knowledge gaps, and propose solutions to address the challenges on the prevention and control of fungal diseases in Sierra Leone and similar countries. In advanced HIV disease, we estimate 300 cryptococcal meningitis, 640 Pneumocystis pneumonia, and over 4000 esophageal candidiasis cases annually. Chronic lung disease is common, with an estimated 6000 cases of chronic pulmonary aspergillosis, many mistaken for TB, 5000 adults with allergic bronchopulmonary aspergillosis complicating asthma, and probably over 6600 cases of severe asthma with fungal sensitization. Invasive aspergillosis is estimated at 478 cases. None of these diagnoses are made in Sierra Leone at present. Major burdens are recurrent vulvovaginal candidiasis (85,400) and tinea capitis in children (266,450). Improvement in fungal disease diagnosis in Sierra Leone will enable better estimates to be made and reduce morbidity and mortality.
Kinematic analysis of two scapholunate ligament reconstruction techniques
Authors: Chae Seungbum , Nam Junho , Park Il-Jung , Shin Steven S. , McGarry Michelle H. , Lee Thay Q
Published: June 2021

Purpose:

This study compares the kinematic changes after the procedures for scapholunate interosseous ligament (SLIL) reconstruction—the modified Brunelli technique (MBT) and Mark Henry’s technique (MHT).

Methods:

Ten cadaveric wrists were used. The scapholunate (SL) interval and angle and radiolunate (RL) angle were recorded using the MicroScribe system. The SL interval was measured by dividing the volar and dorsal portions. Four motions of the wrist were performed—neutral, flexion, extension, and clenched fist (CF) positions—and compared among five conditions: (1) intact wrist, (2) volar SLIL resection, (3) whole SLIL resection, (4) MBT reconstruction, and (5) MHT reconstruction.

Results:

Under the whole SLIL resection condition, the dorsal SL intervals were widened in all positions. In all positions, the dorsal SL intervals were restored after MBT and MHT. The volar SL interval widened in the extension position after volar SLIL resection. The volar SL interval was not restored in the extension position after MBT and MHT. The SL angle increased in the neutral and CF positions under the whole SLIL resection condition. The SL angle was not restored in the neutral and CF positions after MBT and MHT. The RL angle increased in the neutral and CF positions under the whole SLIL resection condition. The RL angle was not restored in the neutral and CF positions after MBT and MHT.

Conclusion:

The MBT and MHT may restore the dorsal SL interval. No significant differences in restoration of the SL interval between MBT and MHT were found in the cadaveric models.

Clinical relevance:

No significant differences between MBT and MHT were found in the cadaveric models for SLIL reconstruction. When considering the complications due to volar incision and additional procedures in MHT, MBT may be a more efficient technique in terms of operative time and injury of the anterior structures during surgery, but further research is needed.
Inverted Internal Limiting Membrane Flap vs Complete Internal Limiting Membrane Peeling for Large Macular Holes in Nonposturing Surgery
Authors: Rahman Rubina , Sarfraz Mohammad Waseem , El-Wardani Mohamad
Published: June 2021

Purpose:

This study compared anatomical and functional outcomes of the inverted internal limiting membrane flap (ILMF) technique with complete ILM peeling (ILMP) in nonposturing surgery for large, full-thickness macular holes (MHs).

Methods:

This was a retrospective, comparative, single-surgeon study. Eyes with idiopathic large full-thickness MHs (minimum diameter > 400 μm) were included. A total of 46 patients including 22 ILMF cases and 24 ILMP cases were analyzed. No positioning instructions were advised postoperatively.

Results:

Primary hole closure was achieved in all patients (100%) in both groups. Mean logMAR visual acuity (VA) improved significantly in both groups compared with the preoperative values (ILMF: 0.60 [SD, 0.26] postoperatively, vs 0.93 [SD, 0.3] preoperatively, P = .032; ILMP: 0.43 [SD, 0.22] postoperatively vs 0.83 [SD, 0.16] preoperatively, P < .01). However, ILMP showed a statistically significant improvement in VA compared with ILMF ( P = .02).

Conclusions:

All MHs in both groups closed after surgery (100%). There was a statistically significant improvement of VA in the ILMP group compared with the ILMF group ( P = .02). Not posturing after surgery did not compromise surgical success in both groups.
Artificial intelligence for identification and characterization of colonic polyps
Authors: Parsa Nasim , Byrne Michael F.
Published: June 2021

Colonoscopy remains the gold standard exam for colorectal cancer screening due to its ability to detect and resect pre-cancerous lesions in the colon. However, its performance is greatly operator dependent. Studies have shown that up to one-quarter of colorectal polyps can be missed on a single colonoscopy, leading to high rates of interval colorectal cancer. In addition, the American Society for Gastrointestinal Endoscopy has proposed the “resect-and-discard” and “diagnose-and-leave” strategies for diminutive colorectal polyps to reduce the costs of unnecessary polyp resection and pathology evaluation. However, the performance of optical biopsy has been suboptimal in community practice. With recent improvements in machine-learning techniques, artificial intelligence–assisted computer-aided detection and diagnosis have been increasingly utilized by endoscopists. The application of computer-aided design on real-time colonoscopy has been shown to increase the adenoma detection rate while decreasing the withdrawal time and improve endoscopists’ optical biopsy accuracy, while reducing the time to make the diagnosis. These are promising steps toward standardization and improvement of colonoscopy quality, and implementation of “resect-and-discard” and “diagnose-and-leave” strategies. Yet, issues such as real-world applications and regulatory approval need to be addressed before artificial intelligence models can be successfully implemented in clinical practice. In this review, we summarize the recent literature on the application of artificial intelligence for detection and characterization of colorectal polyps and review the limitation of existing artificial intelligence technologies and future directions for this field.
Independent pseudogenizations and losses of sox15 during amniote diversification following asymmetric ohnolog evolution
Authors: Ogita Yusaku , Tamura Kei , Mawaribuchi Shuuji , Takamatsu Nobuhiko , Ito Michihiko
Published: June 2021

Background

Four ohnologous genes (sox1, sox2, sox3, and sox15) were generated by two rounds of whole-genome duplication in a vertebrate ancestor. In eutherian mammals, Sox1, Sox2, and Sox3 participate in central nervous system (CNS) development. Sox15 has a function in skeletal muscle regeneration and has little functional overlap with the other three ohnologs. In contrast, the frog Xenopus laevis and zebrafish orthologs of sox15 as well as sox1-3 function in CNS development. We previously reported that Sox15 is involved in mouse placental development as neofunctionalization, but is pseudogenized in the marsupial opossum. These findings suggest that sox15 might have evolved with divergent gene fates during vertebrate evolution. However, knowledge concerning sox15 in other vertebrate lineages than therian mammals, anuran amphibians, and teleost fish is scarce. Our purpose in this study was to clarify the fate and molecular evolution of sox15 during vertebrate evolution.

Results

We searched for sox15 orthologs in all vertebrate classes from agnathans to mammals by significant sequence similarity and synteny analyses using vertebrate genome databases. Interestingly, sox15 was independently pseudogenized at least twice during diversification of the marsupial mammals. Moreover, we observed independent gene loss of sox15 at least twice during reptile evolution in squamates and crocodile-bird diversification. Codon-based phylogenetic tree and selective analyses revealed an increased dN/dS ratio for sox15 compared to the other three ohnologs during jawed vertebrate evolution.

Conclusions

The findings revealed an asymmetric evolution of sox15 among the four ohnologs during vertebrate evolution, which was supported by the increased dN/dS values in cartilaginous fishes, anuran amphibians, and amniotes. The increased dN/dS value of sox15 may have been caused mainly by relaxed selection. Notably, independent pseudogenizations and losses of sox15 were observed during marsupial and reptile evolution, respectively. Both might have been caused by strong relaxed selection. The drastic gene fates of sox15, including neofunctionalization and pseudogenizations/losses during amniote diversification, might be caused by a release from evolutionary constraints.
Cutaneous Leishmaniasis in Pakistan: a neglected disease needing one health strategy
Authors: Kayani Behzad , Sadiq Shakera , Rashid Hamad Bin , Ahmed Naseer , Mahmood Altaf , Khaliq Muhammad Shakeel , Maqsood Rubab , Rashid Haroon , Hasan Saima , Mushtaq Muhammad Hassan , Zia Ubaid-ur-Rehman , Chaudhry Mamoona
Published: June 2021

Background

Cutaneous Leishmaniasis (CL) is a neglected tropical disease, which mainly affects poor communities. It is one of the major vector-borne disease and endemic in Pakistan.

Methods

A case-control study to evaluate potential risk factors of human-CL was conducted in Khewra region, District Jhelum, Pakistan from January–April 2014. Case data about 90 cases registered during October 2012 to November 2013 was retrieved from Municipal Hospital. Controls were matched (1,1 ratio) on the date of registration with cases from same hospital. Both cases and controls were invited to participate and data was collected in a face-to-face interview. A prospective study of canine leishmaniasis (canine-CL) was also conducted at Civil Veterinary Hospital in the same area. Suspected dogs with skin ulceration signs were included in the study and blood samples were collected. Statistical analyses were conducted to determine association between various parameters and outcome of interest.

Results

The ages of cases ranged from 1 to 76 years (median = 15 years) and proved to be protective factor i.e. increase in each year in age reduced the likelihood of being infected with human-CL [Odds Ratio (OR) = 0.4, 95% Confidence Interval (CI) = 0.25–0.76]. People sleeping outsides in an open area were more likely to become a case (OR = 8.7, 95% CI = 2.90–26.37) than a control. Poor sanitary condition inside the house (OR = 3.3, 95% CI 1.03–10.56) and presence of other animals in house (livestock, poultry) (OR = 3.6, 95% CI = 1.07–12.12) also identified as risk factors of high significance. The proportion of positive dogs with canine-CL was 21.05% and was significantly associated with human-CL cases in the same area (p < 0.05).

Conclusions

We concluded that adopting self-protections measures against sand-fly, and maintaining good hygiene may lower the risk of human-CL. One-Health Strategy is suggested to control leishmaniasis in human and dog population.
Hospital discharge on the first compared with the second day after a planned cesarean delivery had equivalent maternal postpartum outcomes: a randomized single-blind controlled clinical trial
Authors: Ghaffari Parvin , Vanda Raziyeh , Aramesh Shahintaj , Jamali Leila , Bazarganipour Fatemeh , Ghatee Mohammad Amin
Published: June 2021

Objective

Determining the effect of discharge time after elective cesarean section on maternal outcomes.

Methods

This study is a randomized clinical trial that performed on 294 women who undergo elective cesarean section. The patients were randomized in two groups by simple randomization method: Group A (discharge 24 h after cesarean) and group B (discharge for 48 h after cesarean). In both groups, during the first 24 h, they received intravenous antibiotic (cefazolin as routine order) and pethidine at the time of pain. The patients were discharged with the hematinic and mefenamic acid. The main outcome variables were satisfaction of the patient, surgical site infection, separation of incision, endometritis, urinary tract infection, gastrointestinal complications, rehospitalization, secondary postpartum hemorrhage and pain of the patient on discharge day, one and six weeks after cesarean.

Results

Satisfaction scores and pain score at discharge day, one and six weeks after discharge were not significant different in the study groups (P > 0.05). Another key finding of this paper was no significant difference in the incidence of surgical site infection, separation of incision, endometritis, urinary tract infection, gastrointestinal complications, rehospitalization, secondary postpartum hemorrhage at one and six weeks after discharge in the study groups(P > 0.05).

Conclusion

The time of discharge can be reduced to 24 h after surgery if the mother to be at good general condition, the vital signs are stable, the patient has no underlying problem and disease, and it is financed for the patient and the health system.
Factors associated with emergency-onset diagnosis, time to treatment and type of treatment in colorectal cancer patients in Norway
Authors: Nilssen Yngvar , Eriksen Morten Tandberg , Guren Marianne G. , Møller Bjørn
Published: June 2021

Background

International differences in survival among colorectal cancer (CRC) patients may partly be explained by differences in emergency presentations (EP), waiting times and access to treatment.

Methods

CRC patients registered in 2015–2016 at the Cancer Registry of Norway were linked with the Norwegian Patient Registry and Statistics Norway. Multivariable logistic regressions analysed the odds of an EP and access to surgery, radiotherapy and systemic anticancer treatment (SACT). Multivariable quantile regression analysed time from diagnosis to treatment.

Results

Of 8216 CRC patients 29.2% had an EP before diagnosis, of which 81.4% were admitted to hospital with a malignancy-related condition. Higher age, more advanced stage, more comorbidities and colon cancer were associated with increased odds of an EP (p < 0.001). One-year mortality was 87% higher among EP patients (HR=1.87, 95%CI:1.75–2.02). Being married or high income was associated with 30% reduced odds of an EP (p < 0.001). Older age was significantly associated with increased waiting time to treatment (p < 0.001). Region of residence was significantly associated with waiting time and access to treatment (p < 0.001). Male (OR = 1.30, 95%CI:1.03,1.64) or married (OR = 1.39, 95%CI:1.09,1.77) colon cancer patients had an increased odds of SACT. High income rectal cancer patients had an increased odds (OR = 1.48, 95%CI:1.03,2.13) of surgery.

Conclusion

Patients who were older, with advanced disease or more comorbidities were more likely to have an emergency-onset diagnosis and less likely to receive treatment. Income was not associated with waiting time or access to treatment among CRC patients, but was associated with the likelihood of surgery among rectal cancer patients.
Reporting of post-operative rehabilitation interventions for Total knee arthroplasty: a scoping review
Authors: Bakaa Nora , Chen Lu Hsi , Carlesso Lisa , Richardson Julie , Macedo Luciana
Published: June 2021

Objective

The aim of this study was to evaluate the completeness of reporting of exercise adherence and exercise interventions delivered as part of clinical trials of post-operative total knee replacement (TKA) rehabilitation.

Design: Scoping review

Literature search

A literature search was conducted in PubMed, EMBASE, AMED, CINAHL, SPORTDiscus and Cochrane Library.

Study selection criteria

All randomized controlled trials (RCT) that examined post-operative exercise-based interventions for total knee arthroplasty were eligible for inclusion. Studies that were multifactorial or contained exercise interventions for both hip and knee arthroplasty were also included.

Data synthesis

The definition, type of measurement used and outcome for exercise adherence were collected and analyzed descreptively. Quality of reporting of exercise interventions were assessed using the Consensus for Exercise Reporting Tool (CERT) and the Cochrane Risk of Bias Tool.

Results

There were a total of 112 RCTs included in this review. The majority of RCTs (63%,n = 71) did not report exercise adherence. Only 23% (n = 15) of studies provided a definition of adherence. RCTs were of poor quality, with 85% (n = 95) of studies having high or unclear risk of bias. Reporting of exercise interventions was poor, with only 4 items (of 19) (21%) of the CERT adequately reported (88–99%), with other items not fulfilled on at least 60% of the RCTs. There were no RCTs that had fulfilled all the criteria for the CERT.

Conclusion

The RCTs included in this study poorly reported exercise adherence, as well as description of the post-operative TKA rehabilitation intervention. Future RCTs should use valid and reliable measures of adherence and a proper tool for reporting of exercise interventions (e.g., CERT, TiDER).

Pre-registration

OSF:https://osf.io/9ku8a/
Menopausal symptoms are associated with oral sensory complaints in perimenopausal women: an observational study
Authors: Taga Tomoharu , Ito Kayoko , Takamatsu Kiyoshi , Ogawa Mariko , Funayama Saori , Inoue Makoto
Published: June 2021

Background

Perimenopausal women experience a wide variety of systemic symptoms: hot flashes, sweating, mental health concerns and various oral sensory complaints (OSC). OSC in perimenopausal women include xerostomia, taste disturbance and burning mouth. However, the factors associated with these OSC have not been identified. The purpose of this investigation was to elucidate the factors associated with OSC in perimenopausal women.

Methods

The study cohort comprised 43 perimenopausal women aged 45–55 years. Data on medical history, medications, menstrual status, menopausal symptoms, quality of life, xerostomia, taste disturbance and burning mouth were collected. Volumes of unstimulated and stimulated saliva were measured. Tongue coating was evaluated according to a tongue coating index. Univariate analysis was performed to identify factors significantly associated with having xerostomia, taste disturbance, burning mouth and more than two OSC (2OSC). Next, the factors strongly associated with these symptoms were examined by logistic regression analysis.

Results

The number of menopausal symptoms was significantly higher, and volume of unstimulated saliva was significantly lower in participants with xerostomia, taste disturbance, burning mouth or 2OSC than in those without these characteristics. Agents targeting the central nervous system were more frequently taken by participants with burning mouth and 2OSC than by those without these characteristics. According to logistic regression analysis, the number of menopausal symptoms was an explanatory variable for xerostomia, taste disturbance, burning mouth and 2OSC.

Conclusions

Our findings suggested that OSC associated with the number of menopausal symptoms. Management of menopausal symptoms may decrease OSC, leading to improved quality of life of perimenopausal women.
Detailed pedigree analyses and prenatal diagnosis for a family with mucopolysaccharidosis type II
Authors: Zhang Chuan , Hao Shengju , Meng ZhaoYan , Hui Ling , Wang Yan , Xuan Feng , Chen Xue , Wang Xing , Zheng Furong , Zheng Lei , Zhou Bingbo , Wu Xinqi , Zhang Qinghua , Cao Zongfu
Published: June 2021

Background

Mucopolysaccharidosis type II (MPS II) is an X-linked multisystem disorder caused by mutations in the gene encoding iduronate 2-sulfatase (IDS). The clinical manifestations of MPS II include skeletal deformities, airway obstruction, cardiomyopathy, and neurologic deterioration. MPS II has high genetic heterogeneity disorder, and ~ 658 variants of IDS have been reported.

Methods

We undertook a detailed pedigree analysis of four patients within the same family by targeted next-generation sequencing and Sanger sequencing.

Results

We identified a novel heterozygous frameshift variant, c.1224delC(p.Pro408ProfsTer31), of IDS in three patients. We defined c.1224delC as a pathogenic variant according to the 2015 guidelines set by the American College of Medical Genetics and Genomics.

Conclusion

We reported the second Chinese female MPS II patient. We helped to ensure that these two families had healthy babies. Our findings have enlarged the mutational spectrum of IDS, and these findings could be useful for genetic counseling and the prenatal diagnosis of MPS II.
COVID‐19 lockdown disrupts support networks integral to maintaining foot health: a mixed‐methods study
Authors: Cherry Lindsey , Gates Lucy , Culliford David , Walker‐Bone Karen , Portillo Mari Carmen
Published: June 2021

Background

In response to the COVID‐19 pandemic, populations were advised to remain at home to control viral spread. Government‐mandated restrictions on free movement affected individuals' engagement with physical activity, with reported increases leading to biopsychosocial health benefits and conversely increased sedentary behaviour leading to poorer health. Good foot health is key to enabling physical activity and maximal participation in activities of occupation and daily living.

Methods

A population‐based cross‐sectional study was performed, using a web‐based platform. Quantitative and qualitative data were captured through responses to closed and open survey questions. Anybody with a foot health condition was eligible to participate in the online survey. Links were sent through professional networks, support groups and charities, using a snowball strategy to maximise participation.

Results

Two hundred fifty‐five respondents completed the survey. Most (n = 193, 75.69%) reported an ongoing foot pain or problem that had been present for 4 weeks or longer, whilst 49 respondents (19.22%) noted a new pain or problem. Pain was the most frequently reported symptom (n = 139, 54.51%), whilst change in appearance of the foot was also commonly reported (n = 122, 47.84%), often alongside the observable presence of swelling. Musculoskeletal foot symptoms were frequently reported (n = 123, 48%), and were significantly associated with reported reduced physical activity (X2 = 6.61, p = 0.010). Following qualitative analysis five themes and 11 subthemes emerged, informed by 49 independent codes. A central theme of lockdown disrupting support networks, both formal (healthcare providers) and informal (friends or family members) emerged. The 5 sub‐themes were: 1. foot pain is a constant companion, 2. self‐care, 3. ‘cope or crumble’ scenarios, 4. future intent to access healthcare and 5. reduced ability to undertake physical activity.

Conclusions

Pain was the most frequently reported foot problem during COVID‐19 lockdown restriction. Lockdown restrictions disrupted support networks integral to maintaining foot health. Poor foot health impacted people's ability to remain physically active. Complaints previously considered relatively ‘minor’ such as support for skin and nail care, were found to be exacerbated by restricted support networks, leading to greater negative impact.
Description of call handling in emergency medical dispatch centres in Scandinavia: recognition of out-of-hospital cardiac arrests and dispatcher-assisted CPR
Authors: Hardeland Camilla , Claesson Andreas , Blom Marieke T. , Blomberg Stig Nikolaj Fasmer , Folke Fredrik , Hollenberg Jacob , Kramer-Johansen Jo , Lippert Freddy , Nord Anette , Nygaard Anne Mette , Olasveengen Theresa Mariero , Ringh Mattias , Svensson Leif , Møller Thea Palsgaard
Published: June 2021

Background

The European resuscitation council have highlighted emergency medical dispatch centres as an important key player for early recognition of Out-of-Hospital Cardiac Arrest (OHCA) and in providing dispatcher assisted cardiopulmonary resuscitation (CPR) before arrival of emergency medical services. Early recognition is associated with increased bystander CPR and improved survival rates. The aim of this study is to describe OHCA call handling in emergency medical dispatch centres in Copenhagen (Denmark), Stockholm (Sweden) and Oslo (Norway) with focus on sensitivity of recognition of OHCA, provision of dispatcher-assisted CPR and time intervals when CPR is initiated during the emergency call (NO-CPRprior), and to describe OHCA call handling when CPR is initiated prior to the emergency call (CPRprior).

Methods

Baseline data of consecutive OHCA eligible for inclusion starting January 1st 2016 were collected from respective cardiac arrest registries. A template based on the Cardiac Arrest Registry to Enhance Survival definition catalogue was used to extract data from respective cardiac arrest registries and from corresponding audio files from emergency medical dispatch centres. Cases were divided in two groups: NO-CPRpriorand CPRpriorand data collection continued until 200 cases were collected in the NO-CPRprior-group.

Results

NO-CPRpriorOHCA was recognised in 71% of the calls in Copenhagen, 83% in Stockholm, and 96% in Oslo. Abnormal breathing was addressed in 34, 7 and 98% of cases and CPR instructions were started in 50, 60, and 80%, respectively. Median time (mm:ss) to first chest compression was 02:35 (Copenhagen), 03:50 (Stockholm) and 02:58 (Oslo). Assessment of CPR quality was performed in 80, 74, and 74% of the cases. CPRpriorcomprised 71 cases in Copenhagen, 9 in Stockholm, and 38 in Oslo. Dispatchers still started CPR instructions in 41, 22, and 40% of the calls, respectively and provided quality assessment in 71, 100, and 80% in these respective instances.

Conclusions

We observed variations in OHCA recognition in 71–96% and dispatcher assisted-CPR were provided in 50–80% in NO-CPRpriorcalls. In cases where CPR was initiated prior to emergency calls, dispatchers were less likely to start CPR instructions but provided quality assessments during instructions.
ReCOV: recovery and rehabilitation during and after COVID-19 – a study protocol of a longitudinal observational study on patients, next of kin and health care staff
Authors: Rydwik E. , Anmyr L. , Regardt M. , McAllister A. , Zarenoe R. , Åkerman E. , Orrevall Y. , Bragesjö M. , Dahl O. , Kemani M. K. , Nordstrand L. , Ekman U. , Holmström L. , Nygren-Bonnier M.
Published: June 2021

Background

The knowledge of the long-term consequences of covid-19 is limited. In patients, symptoms such as fatigue, decreased physical, psychological, and cognitive function, and nutritional problems have been reported. How the disease has affected next of kin, as well as staff involved in the care of patients with covid-19, is also largely unknown. The overall aim of this study is therefore three-fold: (1) to describe and evaluate predictors of patient recovery, the type of rehabilitation received and patients’ experiences of specialized rehabilitation following COVID-19 infection; (2) to study how next of kin experienced the hospital care of their relative and their experiences of the psychosocial support they received as well as their psychological wellbeing; (3) to describe experiences of caring for patients with COVID-19 and evaluate psychological wellbeing, coping mechanisms and predictors for development of psychological distress over time in health care staff.

Methods

This observational longitudinal study consists of three cohorts; patients, next of kin, and health care staff. The assessments for the patients consist of physical tests (lung function, muscle strength, physical capacity) and questionnaires (communication and swallowing, nutritional status, hearing, activities of daily living, physical activity, fatigue, cognition) longitudinally at 3, 6 and 12 months. Patient records auditing (care, rehabilitation) will be done retrospectively at 12 months. Patients (3, 6 and 12 months), next of kin (6 months) and health care staff (baseline, 3, 6, 9 and 12 months) will receive questionnaires regarding, health-related quality of life, depression, anxiety, sleeping disorders, and post-traumatic stress. Staff will also answer questionnaires about burnout and coping strategies. Interviews will be conducted in all three cohorts.

Discussion

This study will be able to answer different research questions from a quantitative and qualitative perspective, by describing and evaluating long-term consequences and their associations with recovery, as well as exploring patients’, next of kins’ and staffs’ views and experiences of the disease and its consequences. This will form a base for a deeper and better understanding of the consequences of the disease from different perspectives as well as helping the society to better prepare for a future pandemic.
The effect of a shoulder injury prevention programme on proprioception and dynamic stability of young volleyball players; a randomized controlled trial
Authors: Zarei Mostafa , Eshghi Saeed , Hosseinzadeh Mahdi
Published: June 2021

Background

The “FIFA 11 + Shoulder” programme has been reported to reduce the incidence of upper extremity injuries among soccer goalkeepers. It has also been recommended for overhead sports. The purpose of this study was therefore to investigate the effect of an 8-week “FIFA 11 + shoulder” (11 + S) programme on shoulder joint position sense (JPS), threshold to detect passive motion (TTDPM) and upper quarter Y Balance Test in young male volleyball players.

Methods

Thirty-two healthy young elite male volleyball players (17.49 ± 1.47 years) participated in this quasi-experimental study. Participants, recruited from two clubs participating in Iranian premier league, were randomly assigned into two groups; (1) the intervention group who performed the “FIFA 11 + shoulder” programme as their warm up protocol, three times per week, and (2) the control group who kept their routine warm up protocol meanwhile. Proprioception tests including JPS and TTDPM of internal and external rotator muscles of the dominant shoulder were recorded via the isokinetic system pro 4. The upper quarter Y Balance Test determined the shoulder dynamic stability.

Results

No statistically significant differences were observed for JPS and TTDPM of shoulder internal and external rotator muscles; shoulder stability however significantly increased only in the intervention group (p = 0.03, ηp2=0.02).

Conclusion

Upper quarter dynamic stability improvement due to the 11+S programme leads to volleyball players’ performance and may therefore contribute to a reduction in risk of sustaining injury if applied long-term.

Trial registration

The trial was retrospectively registered atIranian Registry of Clinical Trials with the number of IRCT20201030049193N1 at 04/12/2020.
Latent tuberculosis infection among patients with and without type-2 diabetes mellitus: results from a hospital case-control study in Atlanta
Authors: Salindri Argita D. , Haw J. Sonya , Amere Genet A. , Alese Joyce T. , Umpierrez Guillermo E. , Magee Matthew J.
Published: June 2021

Objective

The purpose of this study is to compare the prevalence of latent TB infection (LTBI) among patients with type-2 diabetes mellitus (T2DM) to healthy controls without T2DM. To achieve this objective, we conducted a case-control study in a large hospital in Atlanta from 2016 to 2019.

Results

We enrolled 98 cases; 119 potential controls were screened, 84 of which had HbA1c  ≥  5.7% and one did not have QFT result, leaving 34 (28.6%) individuals enrolled as controls. LTBI prevalence was 9.2% among cases and 14.7% among controls (crude odds ratio 0.59, 95% CI 0.19–2.04). After adjusting for age and sex, the adjusted odds of LTBI among patients with T2DM was 0.45 (95% CI 0.13, 1.71) times the controls. We did not observe a statistically significant association between LTBI and T2DM. However, we reported a positive correlation between HbA1c level and nil count among individuals with LTBI (R2  =  0.55, p  <  0.01). In addition, we reported a high prevalence of LTBI among adults with T2DM and family members without T2DM.
A novel blood-based assay for treatment monitoring of tuberculosis
Authors: Zimmer Alexandra J. , Schumacher Samuel G. , Södersten Erik , Mantsoki Anna , Wyss Romain , Persing David H. , Banderby Sara , Strömqvist Meuzelaar Linda , Prieto Jacqueline , Gnanashanmugam Devasena , Khatri Purvesh , Ongarello Stefano , Ruhwald Morten , Denkinger Claudia M.
Published: June 2021

Objectives

A novel 3-gene host transcriptional signature (GBP5, DUSP3 and KLF2) has been validated for tuberculosis (TB) treatment monitoring using laboratory-based RNA sequencing platforms. The signature was recently translated by Cepheid into a prototype cartridge-based test that can be run on the GeneXpert instrument. In this study, we prospectively evaluated the change in the expression of the cartridge-based 3-gene signature following treatment initiation among pulmonary TB patients who were microbiologically cured at the end of treatment.

Results

The 3-gene signature expression level (TB score) changed significantly over time with respect to baseline among 31 pulmonary TB patients. The greatest increase in TB score occurred within the first month of treatment (median fold-increase in TB score: 1.08 [IQR 0.54–1.52]) and plateaued after 4 months of treatment (median TB score: 1.97 [IQR: 1.03–2.33]). The rapid and substantial increase of the TB score in the first month of treatment holds promise for the early identification of patients that respond to TB treatment. The plateau in TB score at 4 months may indicate early clearance of disease and could direct treatment to be shortened. These hypotheses need to be further explored with larger prospective treatment monitoring studies.
Predictive value of hepatic transaminases during febrile phase as a predictor of a severe form of Dengue: analysis of adult Dengue patients from a tertiary care setting of Sri Lanka
Authors: Priyangika Dickowita Kankanamge Dilani , Premawansa Gayani , Adikari Madura , Thillainathan Sharmila , Premawansa Sunil , Jayamanne Bernard Deepal Wanniarachchi , Premaratna Ranjan
Published: June 2021

Objectives

Dengue viral infection is an ongoing epidemic in Sri Lanka, causing significant mortality and morbidity. A descriptive-analytical study was carried out using serologically confirmed Dengue patients during a 6 month period. The relationship between the elevation of hepatic enzymes and severity of Dengue was assessed after stratifying recorded maximum AST/ALT (SGOT/SGPT) values 2–15 times elevated and by the phases of the illness. Sensitivity, specificity, predictive values, and ROC curves were assessed using maximum values for AST and ALT.

Results

Out of 255 patients, 107(42%) were females. The majority (52.9%) were in the 20–39 year age group. Only 19.6% had DHF. No statistically significant difference was noticed in the values of maximum transaminases during the febrile phase among DF and DHF patients. Higher sensitivity and low specificity with the 1–5 times elevation range was noticed, and a higher cut-off level of more than 5 times elevation showed low sensitivity and higher specificity. The combination of both transaminases cut-offs with age and sex also does not show clinically significant predictability of severe disease.

The AST and ALT elevations are not showing discriminatory predictive value on dengue severity. As different serotypes cause different epidemics, it is important to carry out large-scale specific studies considering the serotypes.
Quality assessment of nine paracetamol 500 mg tablet brands marketed in Saudi Arabia
Authors: AlSwayeh Reem , Alvi Syed N. , Hammami Muhammad M.
Published: June 2021

Objective

To evaluate in-vitro quality of paracetamol 500 mg tablet brands marketed in Saudi Arabia.

Results

Two reference (R1 and R2) and seven generic (G1-G7) brands were commercially available. Four brands were single-drug, containing paracetamol only (R1, G1-G3) and five contained additional active ingredients (R2, G4-G7). All brands were immediate-release. Weight variation (n = 20, range as percent difference from mean), active substance content (n = 20, mean (SD) as percent difference from label), breaking force (n = 10, mean (SD)), and friability (n = 20, as percent weight loss) ranged from 97 to 102%, 96.1% (2.9%) to 99.8% (1.1%), 9.9 (0.4) to 21.0 (0.9) kg, and 0.017% to 0.809%, respectively. Disintegration (water medium) time (n = 6, minute: second) ranged from 02:35–03:09 to 12:49–13:10. Dissolution (phosphate buffer, pH 5.8) profile showed a mean release at 30 min of 87% to 97% of label content, with seven brands passing stage-1 (≥ 85% for each of 6 test units) and two passing stage-2 (mean of 12 test units ≥ 85%) criteria. Despite statistically significant differences between R1 and R2 and some of their corresponding generic brands in active substance content, breaking force, and amount dissolved at 30 min, all nine brands met the pre-specified quality standards.
Combined prenatal Lactobacillus reuteri and ω-3 supplementation synergistically modulates DNA methylation in neonatal T helper cells
Authors: Huoman Johanna , Martínez-Enguita David , Olsson Elin , Ernerudh Jan , Nilsson Lennart , Duchén Karel , Gustafsson Mika , Jenmalm Maria C.
Published: June 2021

Background

Environmental exposures may alter DNA methylation patterns of T helper cells. As T helper cells are instrumental for allergy development, changes in methylation patterns may constitute a mechanism of action for allergy preventive interventions. While epigenetic effects of separate perinatal probiotic or ω-3 fatty acid supplementation have been studied previously, the combined treatment has not been assessed. We aimed to investigate epigenome-wide DNA methylation patterns from a sub-group of children in an on-going randomised double-blind placebo-controlled allergy prevention trial using pre- and postnatal combined Lactobacillus reuteri and ω-3 fatty acid treatment. To this end, > 866000 CpG sites (MethylationEPIC 850K array) in cord blood CD4+ T cells were examined in samples from all four study arms (double-treatment: n = 18, single treatments: probiotics n = 16, ω-3 n = 15, and double placebo: n = 14). Statistical and bioinformatic analyses identified treatment-associated differentially methylated CpGs and genes, which were used to identify putatively treatment-induced network modules. Pathway analyses inferred biological relevance, and comparisons were made to an independent allergy data set.

Results

Comparing the active treatments to the double placebo group, most differentially methylated CpGs and genes were hypermethylated, possibly suggesting induction of transcriptional inhibition. The double-treated group showed the largest number of differentially methylated CpGs, of which many were unique, suggesting synergy between interventions. Clusters within the double-treated network module consisted of immune-related pathways, including T cell receptor signalling, and antigen processing and presentation, with similar pathways revealed for the single-treatment modules. CpGs derived from differential methylation and network module analyses were enriched in an independent allergy data set, particularly in the double-treatment group, proposing treatment-induced DNA methylation changes as relevant for allergy development.

Conclusion

Prenatal L. reuteri and/or ω-3 fatty acid treatment results in hypermethylation and affects immune- and allergy-related pathways in neonatal T helper cells, with potentially synergistic effects between the interventions and relevance for allergic disease. Further studies need to address these findings on a transcriptional level, and whether the results associate to allergy development in the children. Understanding the role of DNA methylation in regulating effects of perinatal probiotic and ω-3 interventions may provide essential knowledge in the development of efficacious allergy preventive strategies.

Trial registration ClinicalTrials.gov, ClinicalTrials.gov-ID: NCT01542970. Registered 27th of February 2012—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT01542970.