bluuebunny/crossref_metadata_2025 huggingface dataset:
Determination of Glucose-Independent Racial Disparity in HbA1c for Youth With Type 1 Diabetes in the Era of Continuous Glucose Monitoring
Authors: Christakis Nicholas J. , Gioe Marcella , Gomez Ricardo , Felipe Dania , Soros Arlette , McCarter Robert , Chalew Stuart
Published: September 2023

Background:

The magnitude and importance of higher HbA1c levels not due to mean blood glucose (MBG) in non-Hispanic black (B) versus non-Hispanic white (W) individuals is controversial. We sought to clarify the relationship of HbA1c with glucose data from continuous glucose monitoring (CGM) in a young biracial population.

Methods:

Glycemic data of 33 B and 85 W, healthy youth with type 1 diabetes (age 14.7 ± 4.8 years, M/F = 51/67, duration of diabetes 5.4 ± 4.7 years) from a factory-calibrated CGM was compared with HbA1c. Hemoglobin glycation index (HGI) = assayed HbA1c − glucose management index (GMI).

Results:

B patients had higher unadjusted levels of HbA1c, MBG, MBGSD, GMI, and HGI than W patients. Percent glucose time in range (TIR) and percent sensor use (PSU) were lower for B patients. Average HbA1c in B patients 8.3% was higher than 7.7% for W (P < .0001) after statistical adjustment for MBG, age, gender, insulin delivery method, and accounting for a race by PSU interaction effect. Higher HbA1c persisted in B patients when TIR was substituted for MBG. Predicted MBG was higher in B patients at any level of PSU. The 95th percentile for HGI was 0.47 in W patients, and 52% of B patients had HGI ≥ 0.5. Time below range was similar for both.

Conclusions:

Young B patients have clinically relevant higher average HbA1c at any given level of MBG or TIR than W patients, which may pose an additional risk for diabetes complications development. HGI ≥ 0.5 may be an easy way to identify high-risk patients.
Identifying Built Environment Risk Factors to Provider Workflow and Patient Safety Using Simulation-Based Evaluation of a Pediatric ICU Room
Authors: Mihandoust Sahar , Joseph Anjali , Colman Nora
Published: September 2023

Objective:

This study aimed to identify latent conditions in a pediatric intensive care unit (PICU) by analyzing characteristics of flow disruptions (FD) during a simulation of a three-phased scenario.

Background:

The built environment of healthcare facilities contributes to FD that can lead to clinical errors and patient harm. In the facility design process, there is an opportunity to identify built environment features that cause FD and pose safety risks. Simulation-based evaluation of proposed designs may help in identifying and mitigating safety concerns before construction and occupancy.

Methodology:

During design development for a new 400-bed children’s hospital, a series of simulations were conducted using physical mock-ups in a large warehouse. A three-phased scenario, (1) admission and intubation, (2) cardiac arrest, and (3) bedside surgery involving a cannulation to extracorporeal membrane oxygenation, was conducted in a PICU room mock-up. Each scenario was video recorded from four angles. The videos were systematically coded to identify FD.

Results:

Analysis identified FDs in three ICU zones: respiratory therapists (RT) zone, nurse zone, and head of the patient. Challenges in these zones were related to spatial constraints in the RT zone and head of the bed, equipment positioning in the RT zone and nurse zone, and impeded visibility related to the location of the boom monitor in the nurse zone.

Conclusion:

Simulation-based evaluation of prototypes of patient care spaces can help identify characteristics of minor and major FD related to the built environment and can provide valuable information to inform the iterative design process.
The Red Square: A Healthcare Sterile Cockpit to Reduce Medication Errors
Authors: Giddens Christy Bartell , Blankenship Julie Ann
Published: September 2023

Medication administration is one of many duties and responsibilities of school nurses and involves both scheduled and as-needed (prn) medications. When administering medications, school nurses also experience unscheduled student health room visits, as well as interruptions such as staff member inquiries, miscellaneous phone calls, and occasional safety drills, to name a few. These distractions, inherent to the school nursing position, can lead to medication errors and pose a risk to students. This article describes the concept of a health care sterile cockpit (red square) and a school district’s use of innovation in the health room to improve medication safety and reduce errors. Other benefits of implementing the red square will be discussed.
The Belt and Road Initiative in Nepal: Potential impacts and implications
Authors: Prasai Khagendra
Published: September 2023

The Belt and Road Initiative is emerging as a global phenomenon with a potential of bearing on almost all nations on Earth in different ways. In this context, this article, generally, is an attempt to demonstrate that impacts and implications of the BRI in Nepal will be governed by important national (Chinese) and international factors. Specifically, it argues that factors that have high developmental potential for Nepal include China's persistent rise and concomitant creation of the multipolar world, China's upholding of its international polices and the BRI principles, reproduction of the BRI experiences of other countries in Nepal, China's continuous pursuit of its socialism-aspiring path of development, its potential embarkment on a predominantly socialist path in the future. It argues that China’s future embarkment on a predominantly capitalist path can have ambivalent impacts ranging from highly appropriative to highly supportive. Likewise, the US–China conflict can also have ambivalent impacts ranging from boosting of Nepal’s negotiating power between the two powers to compromising of Nepal’s sovereignty and stability. The US–China conflict can also push China to treat Nepal as strategically highly important and, therefore, as a favored nation, pouring massive investments. It shows that the Chinese investment will enhance Nepal’s status vis-a-vis the US, the EU and India by cutting down its age-long dependencies on them; and will be conducive to the geographically-distributed development and capital accumulation.
Scripture in Stormont: Incidental reference to the Bible in Northern Irish politics
Authors: Doole J. Andrew
Published: September 2023

The Bible has long permeated Northern Irish culture and politics and continues to play a role even today, as politicians appeal to the words of Scripture in reference to their position on social policy issues such as equal marriage and abortion. In this article, however, I will show that the Bible also appears incidentally in Northern Irish politics, employed in discourse to demean, console, or entertain, and not to direct policy decisions. I discuss examples of reference to the Bible in the Northern Ireland Assembly and show that by comparing others (or oneself) to characters from the Bible, members are mostly engaging in criticism or mild attack of political opponents, but not without a certain role for humor in what might be designated “biblical banter.” I thus illuminate one aspect of the cultural role played by the Bible in the everyday language of politics in Northern Ireland.
Global Burden of Disease 2017 estimates for Major Depressive Disorder: a critical appraisal of the epidemiological evidence
Authors: Lyus R. , Buamah C. , Pollock A.M. , Cosgrove L. , Brhlikova P.
Published: September 2023

Objectives

To critically appraise the quality of the studies underpinning the Global Burden of Disease (GBD) 2017 estimates for Major Depressive Disorder (MDD) with respect to i) the GBD 2017 inclusion criteria and ii) population coverage.

Design

Systematic critical appraisal.

Setting

Not applicable.

Participants

Not applicable.

Main outcome measures

Each study was critically appraised with respect to the four GBD 2017 inclusion criteria: representativeness, study method and sample, diagnostic criteria and publication from 1980 onwards. Population coverage was calculated.

Results

Less than half of studies (221/467, 47.3%) were nationally representative. Only 262/467 (56.1%) of studies reported specifically on MDD and more than a third did not use DSM or ICD diagnostic criteria: 94/467 (20.1%) did not specify any diagnostic criteria and 68/467 (14.6%) relied on self-reported depression for diagnosis. Only 62/467 (13.3%) of studies were conducted during the period 2011-2017. Only 107/195 (54.9%) of countries had one or more prevalence studies.

Conclusions

GBD 2017 estimates for MDD are based on incomplete country and population coverage. The inclusion of studies with non-representative populations, that do not use diagnostic criteria and the lack of specific data on MDD reduces the reliability of estimates and limits their value for policy making.
Treatment of older patients with multiple sclerosis: Results of an International Delphi Survey
Authors: Tumani Hayrettin , Coyle Patricia K , Cárcamo Claudia , Cordioli Cinzia , López Pablo A , Peterka Marek , Ramo-Tello Cristina , Zuluaga María I , Koster Thijs , Vignos Megan
Published: September 2023

Background

People over age 50–55 have historically been excluded from randomized clinical trials for multiple sclerosis (MS). However, more than half of those living with an MS diagnosis are over 55.

Objective

Explore the unique considerations of treating older people with MS (PwMS) using an iterative and structured Delphi-based assessment to gather expert opinions.

Methods

Eight MS neurologists with an interest in older PwMS developed a 2-round survey. Survey respondents were qualified neurologists with ≥3 years’ experience, personally responsible for treatment decisions, and treating ≥20 patients per month, of whom ≥10% were ≥50 years old. Consensus was defined as ≥75% agreement on questions with categorical responses or as a mean score ≥4 on questions with numerical responses.

Results

In Survey 1, 224 neurologists responded; 180 of these completed Survey 2. Limited consensus was reached with varying levels of agreement on several topics including identification and assessment of older patients; factors relating to treatment decisions including immunosenescence and comorbidities; considerations for high-efficacy treatments; de-escalation or discontinuation of treatment; effects of COVID-19; and unmet needs for treating this population.

Conclusion

The results of this Delphi process highlight the need for targeted studies to create guidance for the care of older PwMS.
October 1: Metaphorizing Nigeria’s Collective Trauma of Colonization
Authors: Ezepue Ezinne Michaelia , Nwafor Chidera G.
Published: September 2023

Analogies have been drawn between therapeutic recovery and decolonization. This will mean that one can interrogate psychological effects of trauma on cultures or nations that undergo or have undergone colonization. If decolonization is perceived a form of therapy, colonialism is adjudged potential trauma. This paper is interested in understanding how colonialism could potentially traumatize a nation or given culture. It equally explores decolonization as a form of therapy. It thus analyses the trauma of colonialism in Kunle Afolayan’s October 1 (2014). No scholarly work has been done on the analysis of colonial trauma in Nollywood film texts. This might be as a result of the paucity of film texts that speak to the theme. This paper is therefore interested in understanding how Nollywood ace filmmaker, Kunle Afolayan, uses his October 1 as a metaphor to mirror the traumatic effect of colonialism on Nigeria as a nation. It explores how the film’s major characters’ relations to their traumatic pasts provide insight to Nigeria’s social history. This study attempts to visualize in Afolayan’s characters, a Nigeria traumatized by colonialism. It further envisions the possible paths to Nigeria’s survival of colonial trauma in these characters’ chosen paths to recovery. Using psychoanalysis as framework, this qualitative analysis explores decolonization as therapeutic and contributes to decolonization discourses in African film studies.
Identifying the Drivers of Food Waste in University Canteens in China: A Qualitative Approach
Authors: Cui Qingming , Lin Guanzhu , Qiu Shuhua , Duan Tao
Published: September 2023

The global food crisis has made food waste reduction an important area for research and practice. In China, food is frequently wasted in university canteens. Identifying the factors involved is critical for reducing waste and preserving resources and the environment. In contrast to previous studies of canteen food waste, which have mainly used quantitative research methods, this study adopted a qualitative approach to reveal the self-reported causes of food waste by students who eat at the canteens of a university in South China. The study identified material, economic, psychological, social, cultural, and health dimensions that influence food waste in university canteens. The results validate some previous findings and add novel factors not previously identified. This study argues that food waste is embedded in a complicated socio-cultural context, and hence it is difficult to take simple and direct management measures to reduce waste. Measures should be implemented to improve both the consumers’ consciousness of frugality and ecological conservation, and the quality and palatability of the served food.
Pathways Between Intersectional Stigma and HIV Treatment Engagement Among Men Who Have Sex with Men (MSM) in India
Authors: Bhutada Kiran , Chakrapani Venkatesan , Gulfam Fazlur R. , Ross Jonathan , Golub Sarit A. , Safren Steven A. , Prasad Rita , Patel Viraj V.
Published: September 2023

In India and other low-and-middle-income countries, little is known about how intersectional stigma affects MSM engagement in ART. Informed by the Health Stigma and Discrimination Framework, we qualitatively examined how multiple stigmas influence ART engagement among Indian MSM. We conducted 3 focus groups (N = 22) with MSM living with HIV, aged 21–58 years, in Delhi and Hyderabad to identify potential intervention targets and solutions to improve treatment outcomes. Framework analysis and techniques were used to code and analyze translated audio-recordings. Findings revealed enacted stigma, associated with HIV and MSM identity, manifested as familial shame and healthcare discrimination, inhibiting access to support, and decreasing HIV care engagement. Anticipated stigma led to worry about disclosure and societal repercussions. Community-Based-Organizations, ART centers, and family members were primary sources of support, leading to increased ART initiation and retention. Potential solutions included using MSM peer-counselors, increasing social support, and providing HIV education to the general community.
A Qualitative Study of the Latter Effects of the COVID-19 Pandemic on Patients Living With Chronic Pain
Authors: Hapidou Eleni , Borg Debono Victoria , Schwarz Saxon , Anthonypillai Jennifer
Published: September 2023

This qualitative study examined the effects of the COVID-19 pandemic on the lives of patients living with chronic pain (CP). Patients referred to an interdisciplinary pain management program between July and December of 2021 were asked to respond to the question: “How did the COVID-19 pandemic affect your life?” Fifty-four patients provided comments in response to this question. The comments were analyzed using an inductive approach. Ten themes emerged: (1) psychological state, (2) limitations on social life and activities, (3) minimal to no effect, (4) beliefs and opinions associated with COVID-19, (5) family dynamics, (6) healthcare disruptions, (7) pandemic-related fear, (8) changes in work, (9) change in pain, and (10) getting COVID-19. These themes mirror those found during the onset of the pandemic, with the addition of theme #4. Themes demonstrate the challenges experienced by individuals living with CP, in addition to new developments in the latter portion of the COVID-19 pandemic. It is important to understand the ramifications of shutdowns, so we are better able to address issues that occur in their aftermath.
Psychological Capital, Entrepreneurial Efficacy, Alertness and Agency Among Refugees in Uganda: Perceived Behavioural Control as a Moderator
Authors: Baluku Martin Mabunda , Nansubuga Florence , Nantamu Simon , Musanje Khamisi , Kawooya Kenneth , Nansamba Joyce , Ruto Grace
Published: September 2023

Integrating refugees into the economic set-up is a daunting task for host countries. The dilemma is even bigger in low-income countries with many economic challenges; hence, refugees need help to obtain meaningful paid employment. However, entrepreneurship is emerging as an avenue for refugees to flourish in the economic space. Extant research suggests that personal agency is essential for utilising such opportunities. The current study examines the interactive effects of psychological capital and perceived behavioural control on refugees’ entrepreneurial agency (entrepreneurial intentions) of refugees in low-income settings and the underlying mediating effects of entrepreneurial self-efficacy and alertness. Using data collected from a sample of 212 refugees in Uganda, our findings supported the moderated mediation model, involving a double mediation through entrepreneurial self-efficacy and alertness. We also found moderation effects of perceived behavioural control, suggesting that psychological capital is more likely to boost personal entrepreneurial agency when a refugee has a strong perceived behavioural control.
Identifying Your Superpower to Develop Entrepreneurial Self-Efficacy
Authors: Fleck Emma , Asmuth Jennifer , Jouflas Georgann
Published: September 2023

In the last 15 years, there has been a surge of superhero stories within popular culture. This learning experience is not focused on the external heroism of the individual and their achievements, but on the internal growth that the hero experiences as they discover their powers and learn how to use them for success. This popular journey narrative is consistent with the following: (1) The superhero first gains the self-knowledge of their powers. (2) They develop this power over time to achieve mastery. (3) The superhero must develop a belief in their capacity to use their power (i.e., self-efficacy), and finally (4) use this superpower to succeed. Consistent with this narrative approach of the superhero’s discovery journey, this experiential learning activity helps learners first recognize that they also possess an important skill or personal resource. Then, the participant is challenged to trace the growth of this skill as it evolved to become their “superpower.” In doing so, the learner begins to realize that they already have a growth mindset, although they may have not been explicitly aware of it, which can be leveraged and applied to their entrepreneurial aspirations. This, in turn, leads to increased entrepreneurial self-efficacy.
Motivation of Young Project Professionals: Their Needs for Autonomy, Competence, Relatedness, and Purpose
Authors: Lechler Ruth Christine , Huemann Martina
Published: September 2023

Most of our workforce consists of members of Generation Y, making it necessary to understand their motivations to work on projects. In this article we investigate the motivation of young project professionals in the context of four case studies. Based on self-determination theory, we outline the Conceptual Model of Young Project Professional Motivation, which is comprised of autonomy, competence, relatedness, and purpose. The study offers several contributions to theory and practice. First, the article extends the understanding to self-determination theory by operationalizing the different needs of young project professionals in projects. Second, it explicitly adds the need for purpose as a central motivator to our theoretical understanding. Third, it puts the motivators in contexts and shows that these motivators have varying levels of importance in different project and organizational contexts. From a practice perspective, the study contributes to a better understanding of how to attract and retain young project professionals in organizations, for example, by fostering work environments and career opportunities that are aligned with their needs. We conclude this article with a research agenda.
Working in fours: generational communication in the emergency department
Authors: Guptill Mindi , Reibling Ellen , Phan Tammy , Khoo Bryant , Lin Stephen , Donham Corbin , Wang Cheryl , Walters E. Lea
Published: September 2023

Background

This study examined the conflicts between different generations working in US emergency departments (ED). We sought to record generational differences involving communication preferences, perceived areas of conflict, work motivations, and attitudes regarding work-life balance.

Methods

We developed a survey to assess the physician perspective on generational conflict in the ED. The survey was distributed to members of the American College of Emergency Physicians, a professional organization comprising emergency medicine physicians in the USA.

Results

We received 696 completed responses. Men represented 60% of respondents and the largest proportion of respondents were emergency physicians working in community settings (53%); 11% were residents. Generation representation was smallest for Traditionalist (2%) and largest for Gen X (43%). Seventy percent reported observing conflict due to generational communication with the largest frequency being once a week (26%). In the associated open-ended questions, 247 (33%) provided 316 anecdotal descriptions of observed conflict. Responses clustered into seven themes (ordered by frequency): Work Ethic, Treatment Approach, Technology Application, Entitlement, Professionalism, Work Life/Balance, and Communication Style. Comparing Work Ethic responses, 52–70-year-olds reported that younger providers are less interested in “accomplishing anything” while 26–34-year-olds resented that attitude. Respondents completing the open-ended questions regarding preventing and responding to conflict provided some insight into helpful strategies including actions supportive of clear communication and standardized policies and expectations. Only 5% of respondents reported that they had discussed generational communication in department meetings with the odds of a woman reporting conflict being less than males (p = .01).

Conclusion

Conflicts in the ED in the USA can be attributed to how an individual views the values of someone from another generation. Understanding the frequency and areas of generational conflict in the ED can help medical leaders find strategies to mitigate negative workplace interactions.
Effects of adverse semen parameters on total oxidation status and DNA/chromatin integrity
Authors: Imani Maryam , Raad Minoo Vahedi , Afsari Maliheh , Fesahat Farzaneh
Published: September 2023

Background

Infertility is a major health problem that affects 7% of the men’s population. Oxidative stress (OS) plays a significant role in the pathophysiology of male infertility. The purpose of this study comparatively evaluated the total anti-oxidation status and DNA/chromatin integrity in semen samples among different infertile men’s groups compared with the normozoospermic men.

Methods

This cross-sectional study contains four experimental groups, including teratozoospermia (Exp I), asthenoteratozoospermia (Exp II), oligoasthenoteratozoospermia (Exp III), and azoospermia (Exp IV), as well as the control group of normozoospermic men. The total antioxidant capacity (TAC) and total oxidant status (TOS) were assessed by applying the enzyme-linked immunosorbent assay. The chromatin/DNA damage was assessed in semen samples of all study groups by applying chromomycin A3 (CMA3) and toluidine blue (TB) staining methods.

Results

The results showed significantly higher proportions of TB+ and CMA3 positive sperm in all experimental groups compared to controls (P < 0.001). TAC, TOS, and the ratio of TAC to TOS were significantly different in all experimental groups compared to the normozoospermic men (P < 0.001).

Conclusion

Our study demonstrated that at least one sperm parameter abnormality, such as teratozoospermia could cause serious defects at the levels of DNA/chromatin as well as the antioxidants to oxidant balance of human spermatozoa in subfertile men with abnormal spermogram. Infertile men with sperm morphological abnormalities may benefit from simultaneous assessment of sperm DNA defects and OS.
Agricultural GMOs and their associated pesticides: misinformation, science, and evidence
Authors: Antoniou Michael N. , Robinson Claire , Castro Irina , Hilbeck Angelika
Published: September 2023

Misinformation has always existed, but it became a major preoccupation during the COVID-19 pandemic due to its ability to affect public health choices, decisions, and policy. In their article, “Misinformation in the media: Global coverage of GMOs 2019–2021” (GM Crops & Food, 17 Nov 2022), Mark Lynas et al. characterise critics of agricultural genetically modified organisms (GMOs) and their associated pesticides as purveyors of “misinformation”. They draw an equivalence between critics of agricultural GMOs and people who make false claims about climate change, COVID-19, and vaccines. We examined their main claims on these GMOs—for example, that there is a scientific consensus that they are safe for health and the environment—in the light of the scientific evidence and public discussion on this topic. We found that their claims are biased and misleading and ignore or omit crucial evidence. We conclude that based on the evidence provided, Lynas et al. article can itself be classed as misinformation and could therefore mislead the general public as well as the scientific community.
Micronutrient supplements as antioxidants in improving sperm quality and reducing DNA fragmentation
Authors: Nguyen Nguyen Dac , Le Minh Tam , Tran Nhu Quynh Thi , Nguyen Quoc Huy Vu , Cao Thanh Ngoc
Published: September 2023

Background

Spermatogenesis and sperm quality may be negatively impacted by an increase in reactive oxygen species. This study investigates the efficacy of combined antioxidant therapy for treating male infertility, as measured by semen analyses and the sperm DNA fragmentation index (DFI). Infertile men with a high sperm DNA fragmentation index were instructed to take two oral micronutrient capsules daily for three months. Each antioxidant formulation contained 60 mg vitamin E, 400 µg folic acid, 30 mg selenium, 125 mg L-arginine, 220 mg L-carnitine, 7.5 mg coenzyme Q10, 40 mg L-glutathione, and 20 mg zinc citrate. At entry and post-treatment, the general characteristics, semen analysis, and sperm chromatin dispersion assays were recorded and compared.

Results

After three months of treatment with antioxidant compounds, the quality of spermatozoa improved significantly, as indicated by a decrease in the mean DNA fragmentation index from 45.6 ± 17.2% to 34.8 ± 20.3%; an increase in sperm concentration from 29.7 × 106/mL to 35.7 × 106/mL (p < 0.001), an increase in a total number of spermatozoa from 72.1 × 106 to 95.5 × 106 (p = 0.012), and an increase in the vitality from 75.5 ± 17.1 to 81.1 ± 14.4% viable forms (p < 0.001).

Conclusions

Micronutrient supplementation can improve sperm quality and DNA integrity in infertile men. Men with infertility and significant sperm DNA fragmentation who take antioxidants for three months experience a reduction in DNA fragmentation index and an increase in sperm quality as measured by the semen analysis.

Trial registration

NCT04509583. Registered 12 August 2020, Hue University of Medicine and Pharmacy Ethics Committee—Retrospectively registered.
Effects of plant-derived protein and rapeseed oil on growth performance and gut microbiomes in rainbow trout
Authors: Zhang Cunfang , Hu Lingyong , Hao Jiahui , Cai Weijie , Qin Minxin , Gao Qiang , Nie Miaomiao , Qi Delin , Ma Rui
Published: September 2023

Background

Rainbow trout (Oncorhynchus mykiss) is becoming popular with the increased demand for fish protein. However, the limited resources and expense of fish meal and oil have become restrictive factors for the development of the rainbow trout related industry. To solve this problem, plant-derived proteins and vegetable oils have been developed as alternative resources. The present study focuses on evaluating the effects of two experimental diets, FMR (fish meal replaced with plant-derived protein) and FOR (fish oil replaced with rapeseed oil), through the alteration of the gut microbiota in triploid rainbow trout. The commercial diet was used in the control group (FOM).

Results

Amplicon sequencing of the 16S and 18S rRNA genes was used to assess the changes in gut bacteria and fungi. Our analysis suggested that the α-diversity of both bacteria and fungi decreased significantly in the FMR and FOR groups, and β-diversity was distinct between FOM/FMR and FOM/FOR based on principal coordinate analysis (PCoA). The abundance of the Planctomycetota phylum increased significantly in the FMR group, while that of Firmicutes and Bacteroidetes decreased. We also found that the fungal phylum Ascomycota was significantly increased in the FMR and FOR groups. At the genus level, we found that the abundance of Citrobacter was the lowest and that of pathogenic Schlesneria, Brevundimonas, and Mycoplasma was highest in the FMR and FOR groups. Meanwhile, the pathogenic fungal genera Verticillium and Aspergillus were highest in the FMR and FOR groups. Furthermore, canonical correspondence analysis (CCA) and network analysis suggested that the relatively low-abundance genera, including the beneficial bacteria Methylobacterium, Enterococcus, Clostridium, Exiguobacterium, Sphingomonas and Bacteroides and the fungi Papiliotrema, Preussia, and Stachybotrys, were positively correlated with plant protein or rapeseed oil. There were more modules that had the above beneficial genera as the hub nodes in the FMR and FOR groups.

Conclusions

Our study suggested that the FMR and FOR diets could affect the gut microbiome in rainbow trout, which might offset the effects of the dominant and pathogenic microbial genera. This could be the underlying mechanism of explaining why no significant difference was observed in body weight between the different groups.
Genetic imprints of grafting in wild iron walnut populations in southwestern China
Authors: Liu Jie , Magige Ephie A. , Fan Peng-Zhen , Wambulwa Moses C. , Luo Ya-Huang , Qi Hai-Ling , Gao Lian-Ming , Milne Richard I.
Published: September 2023

Background

Anthropogenic activities are causing unprecedented loss of genetic diversity in many species. However, the effects on genetic diversity from large-scale grafting onto wild plants of crop species are largely undetermined. Iron walnut (Juglans sigillata Dode) is a deciduous nut tree crop endemic to southwestern China with a long history of cultivation. Due to the rapid expansion of the walnut industry, many natural populations are now being replaced by cultivars grafted onto wild rootstocks. However, little is known about the potential genetic consequences of such action on natural populations.

Results

We sampled the scion and the rootstock from each of 149 grafted individuals within nine wild populations of J. sigillata from Yunnan Province which is the center of walnut diversity and cultivation in China, and examined their genetic diversity and population structure using 31 microsatellite loci. Scions had lower genetic diversity than rootstocks, and this pattern was repeated in seven of the nine examined populations. Among those seven populations, AMOVA and clustering analyses showed a clear genetic separation between all rootstocks and all scions. However, the two remaining populations, both from northern Yunnan, showed genetic similarity between scions and rootstocks, possibly indicating that wild populations here are derived from feralized local cultivars. Moreover, our data indicated probable crop-to-wild gene flow between scions and rootstocks, across all populations.

Conclusions

Our results indicate that large-scale grafting has been causing genetic diversity erosion and genetic structure breakdown in the wild material of J. sigillata within Yunnan. To mitigate these effects, we caution against the overuse of grafting in wild populations of iron walnut and other crop species and recommend the preservation of natural genotypes through in situ  and ex situ conservation.
Perspectives of patients and clinicians on older patient mobility on acute medical wards: a qualitative study
Authors: Herzog Philippe J. , Herzog-Zibi Rose D. L. , Mattmann Martina , Möri Charlotte , Mooser Blandine , Inauen Jennifer , Aubert Carole E.
Published: September 2023

Background

Low mobility during an acute care medical hospitalization is frequent and associated with adverse outcomes, particularly among older patients. Better understanding barriers and facilitators to improve mobility during hospitalization could help develop effective interventions. The goal of this study was to assess barriers and facilitators to older medical patients’ hospital mobility, from the point of view of patients and clinicians, to develop a framework applicable in clinical practice.

Methods

We conducted a qualitative study in one university and two non-university hospitals of two different language and cultural regions of Switzerland, including 13 focus groups (FGs; five with patients, eight with clinicians). We included 24 adults aged 60 years or older hospitalized on an acute general internal medicine ward of one of the three participating hospitals during the previous years, and 34 clinicians (15 physicians, nine nurses/nursing assistants, 10 physiotherapists) working on those wards. The FG guides included open-ended questions exploring mobility experiences, expectations, barriers and facilitators to mobility, consequences of low mobility and knowledge on mobility. We applied an inductive thematic analysis.

Results

We identified four themes of barriers and facilitators to mobility: 1) patient-related factors; 2) clinician-related factors; 3) social interactions; and 4) non-human factors. Clinician-related factors were only mentioned in clinician FGs. Otherwise, subthemes identified from patient and clinician FGs were similar and codes broadly overlapped. Subthemes included motivation, knowledge, expectations, mental and physical state (theme 1); process, knowledge – skills, mental state – motivation (theme 2); interpersonal relationships, support (theme 3); hospital setting – organization (theme 4).

Conclusions

From patients’ and clinicians’ perspectives, a broad spectrum of human and structural factors influences mobility of older patients hospitalized on an acute general internal medicine ward. New factors included privacy issues and role perception. Many of those factors are potentially actionable without additional staff resources. This study is a first step in participatory research to improve mobility of older medical inpatients.
Facilitators and barriers for implementation of a novel resuscitation quality improvement package in public referral hospitals of Nepal
Authors: Ekström Niina , Gurung Rejina , Humagain Urja , Basnet Omkar , Bhattarai Pratiksha , Thakur Nishant , Dhakal Riju , KC Ashish , Axelin Anna
Published: September 2023

Background

Improving the healthcare providers (HCP) basic resuscitation skills can reduce intrapartum related mortality in low- and middle-income countries. However, the resuscitation intervention’s successful implementation is largely dependent on proper facilitation and context. This study aims to identify the facilitators and barriers for the implementation of a novel resuscitation package as part of the quality improvement project in Nepal.

Methods

The study used a qualitative descriptive design. The study sites included four purposively chosen public hospitals in Nepal, where the resuscitation package (Helping Babies Breathe [HBB] training, resuscitation equipment and NeoBeat) had been implemented as part of the quality improvement project. Twenty members of the HCP, who were trained and exposed to the package, were selected through convenience sampling to participate in the study interviews. Data were collected through semi-structured interviews conducted via telephone and video calls. Twenty interview data were analyzed with a deductive qualitative content analysis based on the core components of the i-PARiHS framework.

Results

The findings suggest that there was a move to more systematic resuscitation practices among the staff after the quality improvement project’s implementation. This positive change was supported by a neonatal heart rate monitor (NeoBeat), which guided resuscitation and made it easier. In addition, seeing the positive outcomes of successful resuscitation motivated the HCPs to keep practicing and developing their resuscitation skills. Facilitation by the project staff enabled the change. At the same time, facilitators provided extra support to maintain the equipment, which can be a challenge in terms of sustainability, after the project. Furthermore, a lack of additional resources, an unclear leadership role, and a lack of coordination between nurses and medical doctors were barriers to the implementation of the resuscitation package.

Conclusion

The introduction of the resuscitation package, as well as the continuous capacity building of local multidisciplinary healthcare staff, is important to continue the accelerated efforts of improving newborn care. To secure sustainable change, facilitation during implementation should focus on exploring local resources to implement the resuscitation package sustainably.

Trial Registration

Not applicable.
Establishment of a new prognostic risk model of GNG7 pathway-related molecules in clear cell renal cell carcinoma based on immunomodulators
Authors: Zheng Jun , Zhang Weili , Zhang Junyong
Published: September 2023

Clear cell renal cell carcinoma (CCRCC) is a common tumor of the urological system for which surgery is the preferred treatment, but there is a lack of therapeutic options after surgery. This study aims to explore the biological role of GNG7 on CCRCC from a genetic perspective. Differences in mRNA expression and patient survival of GNG7 in patients with CCRCC and healthy patients were analyzed using the TCGA database. It was observed that GNG7 gene expression was downregulated in CCRCC tissue compared with healthy tissue, and high GNG7 predicted better prognosis for patients, and GNG7 also showed strong variability in clinical and TMN staging. The immune relevance of GNG7 and related genes was explored using renal cancer data from CCLE and TISIDB database. It was verified that the risk score constructed by 7 GNG7-related regulators might be used as an independent prognostic risk factor for CCRCC. A CCRCC prognostic model that involved 7 immune genes was further established to predict the survival probabilities of patients. At last, the GEO database and immunochemical tissue staining were used to validate GNG7 expression in CCRCC. Our study proposed a novel panel of genes to predict CCRCC OS based on GNG7-related immune genes, which may help to accurately predict the prognosis of CCRCC patients and make better clinical decisions for individual treatment.
Diagnosis and treatment challenges of autism spectrum disorder at a reference hospital in Douala, Cameroon
Authors: Koum Daniele Christiane Kedy , Enyama Dominique , Foko Loick Pradel Kojom , Noukeu Diomede , Nguedia Belviane , Mbono Rhita , Eposse Charlotte , Eboumbou Patricia Epee , Engome Cathy Bebey , Mapoure Yacouba Njankouo
Published: September 2023

Background

Autism spectrum disorder (ASD) is a neurodevelopmental disability associated with deficiency in social interaction, unusual development of social communication, and restricted or repetitive behaviors, interests and activities. This study aimed to describe management of pediatric ASD in Cameroon, a resource-constrained Central Africa country.

Methods

A retrospective study was conducted between December 2021 and May 2022 at the Pediatrics department of a reference hospital in the town of Douala. Data of interest of children with ASD were collected through eligible medical records and telephone discussions with their parents/guardians.

Results

Medical records of 145 children with ASD aged 2–15 years were included in the study, giving a hospital ASD prevalence of 3.7%. Time delay between parental concerns and hospital management was specified in 69 (47.58%) children, and among them 38 (55.07%) had a mean delay ± SD was less than five months. Children were mainly males (76%) and aged 4–5 years (37.93%), with mean age ± SD of 44.4 ± 22.2 months old. The main consultation reason was delayed language development (100%). Mean time delay between parental concerns and the first medical consultation was 18 months (range 1–60 month). Attention deficit hyperactivity disorder were found in 68.18% of children aged ≥ 6 years old. Neuropsychology (66.2%) was the most frequently used intervention. Some children were treated using traditional medicine.

Conclusions

Management of pediatric ASD is strongly influenced by socioeconomic and cultural context. It is crucial to implement behavioral change campaigns in community, organize training sessions to medical staff on diagnosis and treatment of ASD, and provide specialized centers with skilled staff and equipped material.
Initial experience of thoracoscopic segmentectomy of basal segment through the inferior pulmonary ligament approach in treating congenital lung malformations in children
Authors: Guo Rui , Liu Jike , Zhai Yunpeng , Zhao Huashan , Xu Hongxiu , Lv Longfei , Zhang Shisong
Published: September 2023

Purpose

This study aimed to evaluate the feasibility and limitations of thoracoscopic segmentectomy of the basal segment (S10).

Methods

Clinical data of 15 children with congenital lung malformations (CLM) who underwent thoracoscopic segmentectomy of S10 via the inferior pulmonary ligament approach from January to October 2022 were retrospectively analyzed. The demographics, clinical presentation, intraoperative time, blood loss, postoperative events, and follow-up duration were assessed.

Results

There were 15 patients in this group (nine males and six females). Age ranges from 4.3 to 96.0 months (median, 7.7 months). Fourteen patients underwent S10 segmentectomy, with one undergoing right S10 segmentectomy and right S6 partial wedge resection. The surgical time was 57–125 min (median, 80 min), intraoperative bleeding volume (5–20 ml; median, 10 ml), postoperative drainage tube indwelling (2–4 d; median, 3 d), and postoperative hospitalization time (4–7 d; median, 5 d). No intraoperative conversions, surgical mortalities, or major complications were observed among these patients. Subcutaneous emphysema appeared in three patients; however, it disappeared following conservative observation without pneumothorax or bronchopleural fistula occurrence.

Conclusions

Thoracoscopic segmentectomy of S10 via the inferior pulmonary ligament approach is technically feasible for treating CLM; however, this surgical approach may have certain limitations for CLM with large cysts.
The relationship in early childhood body composition and physical activity levels regarding fundamental motor skill development
Authors: Spring Katherine E. , Carroll Alexandra V. , Wadsworth Danielle D.
Published: September 2023

Background

Fundamental motor skills (FMS) are considered essential for sport participation and might be deficit in obese children. While evidence indicates that physical activity (PA) levels impact motor skill development, the relationship between body composition, PA, and motor competence, particularly in early childhood, is not thoroughly understood. We aimed to determine if PA, fat mass (FM), and fat-free mass (FFM) are predictors of FMS.

Methods

Preschoolers (n = 47) from two preschools were assessed for FMS, PA, and body composition. Peabody Developmental Motor Scales (PDMS-2) subscale scores were used to assess FMS. PA was assessed with a wrist-worn accelerometer for five days during school. FM and FFM were measured with foot-to-foot bioelectrical impedance.

Results

Linear regressions indicate significant models for stationary skills (SS) (F = 4.57, p = .004) and object manipulation skills (OMS) (F = 4.66, p = .003). FFM was the only significant predictor of SS (t = 3.98, p < .001) and OMS (t = 3.50, p = .001). FM and all intensities of PA were nonsignificant predictors in all models.

Conclusions

These results indicate that interventions that target improving or maintaining FFM may improve FMS.
Barriers and facilitators for sustainable weight loss in the pre-conception period among Danish women with overweight or obesity – a qualitative study
Authors: Pico Majken Lillholm , Grunnet Louise Groth , Vinter Christina Anne , Aagaard-Hansen Jens , Kragelund Nielsen Karoline
Published: September 2023

Background

The prevalence of overweight or obesity in women of reproductive age continues to increase. A high pre-pregnancy body mass index (BMI) has been shown to increase the risk of pregnancy complications and predispose offspring to childhood obesity. However, little is known about factors affecting women’s ability to achieve sustainable weight management and very few studies have applied behavior change theory to qualitative data.

Aim

This study aimed to explore barriers and facilitators for weight management among women with overweight or obesity, who wanted to lose weight before pregnancy.

Methods

We conducted semi-structured interviews with 17 women with a BMI ≥ 27 kg/m2, who planned to become pregnant in the near future. Data were analyzed using an abductive approach and the Capability, Opportunity, Motivation, and Behavior model was applied as a conceptual framework.

Results

The women’s strongest motivator for pre-conception weight loss was their ability to become pregnant. Barriers to successful weight management included their partners’ unhealthy behaviors, mental health challenges, competing priorities, and internalized weight stigmatization. The women described careful planning, partners’ health behaviors, social support, and good mental health as facilitators for sustainable weight management.

Conclusion

Our study provides insights into factors affecting weight management among women with overweight or obesity in the pre-conception period. Future interventions on weight management require a holistic approach, including a focus on social support, especially from the partner, and mental health, as well as an effort to limit internalized weight stigma.