bluuebunny/crossref_metadata_2025 huggingface dataset:
How Loud Do the Alarm Bells Toll? Execution of ‘Article 18 Judgments’ of the European Court of Human Rights
Authors: Çalı Başak
Published: August 2021

This article investigates whether Article 18 judgments of the European Court of Human Rights, indicating that the state authorities pursued ulterior and illegitimate motives when violating the Convention, receive the seriousness and the urgency that they call for at the execution phase. By way of an analysis of the responses of the Committee of Ministers and states on the receiving end of Article 18 judgments between 2004 and June 2021, this article finds that the collective responsiveness of the Committee of Ministers to Article 18 judgments has increased over time, especially with respect to individual measures required to implement Article 18 judgments. So far, the responsiveness of individual states to their Article 18 judgments does, however, vary significantly, ranging from taking concrete steps to implement the judgments to outright resistance and no response, posing a significant risk to the Convention system’s ability to respond to the decay of rule of law.
A reexamination of Monstera oreophila (Araceae: Monsteroideae) and description of two new pinkish-spathed species of Monstera from Costa Rica and Panama
Authors: CEDEÑO-FONSECA MARCO , ORTIZ ORLANDO O. , ZULUAGA ALEJANDRO , CROAT THOMAS B. , BLANCO MARIO A.
Published: August 2021

Monstera gentryi from Panama and M. mittermeieri from Costa Rica are newly described, illustrated and compared with M. oreophila. The differences between the novelties and similar species are presented and an amended description of M. oreophila is provided.
Amanita annulata, a new species of Amanita section Vaginatae with an annulus from southwestern China
Authors: ZHANG WEN-HAO , HUANG TING , HUANG HONG-YAN , TANG LI-PING
Published: August 2021

A species with an annulus is rare within Amanita section Vaginatae. In this study, A. annulata is proposed as a new species based on morphological and molecular evidence. It is the second annulate species of the section in China, the first being A. cingulata. The new species is found in forests dominated by Fagaceae in Yunnan Province of China. It is characterized by its large basidioma, white pileus covered with large, white, dingy yellow-tipped pyramidal warts that break off easily, a stipe with a mealy, evanescent, white annulus, the base of the stipe covered with concolorous pyramidal warts, and broadly ellipsoid to ellipsoid basidiospores measuring 11−15 × 9−12 μm. Moreover, it is compared with similar species, especially the annulate taxa of Amanita section Vaginatae.
Description of the first species of Nemeritis Holmgren (Hymenoptera: Ichneumonidae: Campopleginae) from the Southern Hemisphere, with a key to the New World species
Authors: ARAUJO RODRIGO O. , GIOVANNI FILIPPO DI
Published: August 2021

Nemeritis Holmgren, 1860 is a moderately species-rich genus of Campopleginae (Hymenoptera: Ichneumonidae) which includes 42 valid species, occurring in the Western Palearctic, Eastern Palearctic, Nearctic, and Oriental regions. Herein, a new species from Chile, Nemeritis scaramozzinoi sp. nov., is described. This is the first description of a species of Nemeritis for the Southern Hemisphere. The key for the New World species of the genus and biogeographical remarks on the Chilean fauna of Darwin wasps are also provided.
Causal Mechanisms of Sea-level and Freshwater Content Change in the Beaufort Sea
Authors: Fukumori Ichiro , Wang Ou , Fenty Ian
Published: August 2021

In the Arctic’s Beaufort Sea, the rate of sea-level rise over the last two decades has been an order of magnitude greater than that of its global mean. This rapid regional sea-level rise is mainly a halosteric change, reflecting an increase in Beaufort Sea’s freshwater content comparable to that associated with the Great Salinity Anomaly of the 1970s in the North Atlantic Ocean. Here we provide a new perspective of these Beaufort Sea variations by quantifying their causal mechanisms from 1992 to 2017 using a global, data-constrained ocean and sea-ice estimate of the Estimating the Circulation and Climate of the Ocean (ECCO) consortium. Our analysis reveals wind and sea-ice jointly driving the variations. Seasonal variation mainly reflects near-surface change due to annual melting and freezing of sea-ice, while interannual change extends deeper and mostly relates to wind-driven Ekman transport. Increasing wind stress and sea-ice melt are, however, equally important for decadal change that dominates the overall variation. Strengthening anticyclonic wind stress surrounding the Beaufort Sea intensifies the ocean’s lateral Ekman convergence of relatively fresh near-surface waters. The strengthening stress also enhances convergence of sea-ice and ocean heat that increase the amount of Beaufort Sea’s net sea-ice melt. The enhanced significance at longer time-scales of sea-ice melt relative to direct wind forcing can be attributed to ocean’s advection and mixing of melt-water being slower than its dynamic adjustment to mechanical perturbations. The adjustments’ difference implies that the sea-ice-melt-driven diabatic change will persist longer than the direct wind-driven kinematic anomaly.
Self-determined Occupational Performance Model for Children From Economically Disadvantaged Backgrounds
Authors: Bray Laura M.P. , Capilouto Gilson
Published: August 2021

Background. Children from low-income backgrounds have a higher incidence of handwriting challenges due to the unique social and environmental stressors associated with poverty. Additionally, children from economically disadvantaged households are at risk for motor, cognitive, and social deficits, which further impact their handwriting performance. Purpose. The purpose of this paper is to propose a theoretical model that provides a holistic perspective for addressing the handwriting needs of children from low-socioeconomic backgrounds. Key Issues. The presented conceptual model is derived from the person–environment–occupation model for occupational performance and self-determination theory. These theories reciprocally complement and enhance each other, providing a foundation from which clinicians can guide evaluation and intervention. Implications. Through the use of the proposed model, evaluation and intervention focus on intrinsic motivation while considering the physical, social, and cultural impacts on a child's occupational performance. The provider connects with the child's basic psychological needs, thus improving handwriting outcomes and facilitating improved academic performance.
Does the Fear of Missing Out Moderate the Relationship Between Social Networking Use and Affect? A Daily Diary Study
Authors: Riordan Benjamin C. , Winter Taylor , Flett Jayde A. M. , Mason Andre , Scarf Damian , Jose Paul E. , Conner Tamlin S.
Published: August 2021

Social networking site (SNS) use is common and speculation about the negative impact of SNS use on mental health and psychological well-being is a recurring theme in scientific debates. The evidence for this link, however, is inconclusive. The Fear of Missing Out (FoMO) may assist in understanding the mixed evidence, as individuals who experience FoMO are more driven to keep up with what is happening to avoid missing out. We used a 2-week daily diary study of 408 university students to measure the daily associations between SNS use and negative and positive affect and whether FoMO moderated these associations. Multi-level Bayesian regression analyses revealed that 1) greater SNS use was associated with reductions in successive positive affect, but not increases in negative affect and 2) FoMO moderated the influence of SNS use such that increases in successive negative affect occurred only in those individuals high in trait FoMO.
A fish keeper’s life lessons: Implications for resilience promotion
Authors: Ayres Jennifer L
Published: August 2021

A self-care crisis follows a predictable, four-step pattern: Tension-building, flood zone, recovery, equilibrium. When we learn to identify our tension-building signals and intervene quickly by using tailored coping strategies, we often are able to alleviate emotional distress and regain equilibrium. This article identifies three self-reflective exercises that could be used to increase insight, identify early signals of self-care tension-building, and encourage intentional selection of coping strategies.
Impact of Preoperative Risk Factors on Inpatient Stay and Facility Discharge After Free Flap Reconstruction
Authors: Freeman Michael Hartley , Shinn Justin R. , Fernando Shanik J. , Totten Douglas , Lee Jaclyn , Malenke Jordan A. , Wood C. Burton , Langerman Alexander J. , Mannion Kyle , Sinard Robert J. , Rohde Sarah L.
Published: August 2021

Objective

To determine the preoperative risk factors most predictive of prolonged length of stay (LOS) or admission to a skilled nursing facility (SNF) or inpatient rehabilitation center (IPR) after free flap reconstruction of the head and neck.

Study Design

Retrospective cohort study.

Setting

Tertiary academic medical center.

Methods

Retrospective review of 1008 patients who underwent tumor resection and free flap reconstruction of the head and neck at a tertiary referral center from 2002 to 2019.

Results

Of 1008 patients (65.7% male; mean age of 61.4 years, SD 14.0 years), 161 (15.6%) were discharged to SNF/IPR, and the median LOS was 7 days. In multiple linear regression analysis, Charlson Comorbidity Index (CCI; P <. 001), American Society of Anesthesiologists (ASA) classification (P =. 021), female gender (P =. 023), and inability to tolerate oral diet preoperatively (P =. 006) were statistically significantly related to increased LOS, whereas age, body mass index (BMI), modified frailty index (MFI), a history of prior radiation or chemotherapy, and home oxygen use were not. Multiple logistic regression analysis demonstrated that CCI (odds ratio [OR] = 1.119, confidence interval [CI] 1.023‐1.223), age (OR = 1.082, CI 1.056‐1.108), and BMI <19.0 (OR = 2.141, CI 1.159‐3.807) were the only variables statistically significantly related to posthospital placement in an SNF or IPR.

Conclusion

Common tools for assessing frailty and need for additional care may be inadequate in a head and neck reconstructive population. CCI appears to be the best of the aggregate metrics assessed, with significant relationships to both LOS and placement in SNF/IPR.
Timing of Pegfilgrastim: Association with Febrile Neutropenia in a Pediatric Solid and CNS Tumor Population
Authors: Schlenker Laura , Manworren Renee C.B.
Published: August 2021

Background: While recommended timing of pegfilgrastim administration is ≥24 h after chemotherapy, patient barriers to next day administration, available adult evidence, and pharmacokinetic data have led to earlier administration in some pediatric patients with solid and central nervous system tumors. The purpose of this study was to compare patient outcomes by timing of pegfilgrastim after chemotherapy. Methods: A retrospective chart review examined timing of 932 pegfilgrastim administrations to 182 patients, 0–29 years of age. The primary outcome was febrile neutropenia (FN); the secondary outcome was neutropenic delays (ND) ≥7 days to next chemotherapy cycle. To account for multiple pegfilgrastim administrations per patient, a generalized mixed model was used with a logit link for the dichotomous outcomes (FN & ND), timing as the dichotomous independent variable, and random effect for patient. Results: FN occurred in 196 of 916 cycles (21.4%); and ND in 19 of 805 cycles (2.4%). The fixed effect of pegfilgrastim administration < or ≥24 h after chemotherapy was not significant, p = .50; however, earlier or later than 20 h was significant, p = .005. FN odds were significantly higher when pegfilgrastim was given <20 h (OR 1.78, 95% CI: 1.19–2.65) after chemotherapy, which may be attributable to differences in chemotherapy toxicity regardless of pegfilgrastim timing. Discussion: While attempts should be made to administer pegfilgrastim ≥24 h after chemotherapy, if barriers exist, modified timing based on individual patient characteristics should be considered. Prospective randomized trials are needed to identify lower risk patients for early pegfilgrastim administration.
Adolescents’ Perceptions About Cancer and Preferences for Cancer Education
Authors: Abraham Olufunmilola , Rosenberger Claire A. , LeMay Sarah M. , Bittner Sarah J.
Published: August 2021

Background

Cancer is one of the leading causes of death within the United States. Adolescence remains a critical stage of development in which new cognitive skills and lifestyle factors related to cancer are acquired. It is critical to understand adolescents’ knowledge of cancer and preferences for receiving clear and easy-to-comprehend information about cancer and cancer prevention. The purpose of this study was to explore adolescents’ perceptions of cancer and cancer risk factors and identify their preferences for receiving cancer prevention education.

Methods

The survey used in this study was based on the Health Belief Model framework, the Youth Risk Behavior Survey, and the Cancer, Clear & Simple (CC&S) Curriculum. The survey evaluated adolescents’ knowledge, attitudes, and health-related behaviors regarding cancer and cancer prevention among adolescents. Three Midwestern middle and high schools were recruited, and 235 students completed the survey. Survey responses were analyzed using descriptive statistics.

Results

Study participants had some basic knowledge of cancer; however, only 66% recognized that individuals have control over their risk of developing cancer. Participants (95%) reported that cancer prevention was important, yet only 37.3% stated they knew how to lower their risk of getting cancer and 50% indicated that they currently try to make decisions that lower their chances of getting cancer. About 82% stated that an educational game would be a useful tool to learn about cancer and prevention.

Conclusion

Study findings indicate the need for an increase in adolescent knowledge of cancer, specifically how they can control their cancer risk, and prevention strategies through development of game-based education to teach adolescents about cancer-related topics.
Water Infrastructure: Does the US Need a National Policy?
Authors: Grigg Neil S.
Published: August 2021

Although its investment needs lag the dominant transportation category, water infrastructure addresses human needs at a foundational level because it plays public health and economic roles. Much of it is old and not likely to be replaced soon, so federal policy must focus on intergovernmental leadership to sustain vital dams, urban water systems, and natural systems. Fixing the federal responsibility requires attention to intergovernmental relations and the conflicting goals of investment and regulation. Regulatory reform is ongoing, and normally not amenable to political initiatives. Federal water policies for both investment and regulatory controls seem to be on a flat trajectory, which is expected because they have evolved over decades. These can be summarized as: maintain federal dams and levees, invest in small grants and leveraging funds for state and local governments, address water justice issues, and operate essential programs like flood insurance. Public health and safety concerns will continue to dominate, more than in other infrastructure sectors. The future of water investments will be to hold the course with occasional shifts to respond to emergencies and new opportunities, such as greater private sector involvement.
Secondary malposition of a PICC-port due to heavy physical exercise: A case report
Authors: D’Arrigo Sonia , Annetta Maria Giuseppina , Musarò Andrea , Distefano Mariagrazia , Pittiruti Mauro
Published: August 2021

Physical exercise is often encouraged in cancer patients, mainly for the purpose of rehabilitation and for its psychological benefit. Some authors also suggest that exercise—specially in patient with peripherally inserted central venous access devices—may contribute to reduce the risk of catheter-related thrombosis. Still, the impact of physical exercise on the risk of device-related complications is not yet defined.

We report a case of secondary migration of the tip of an arm port, caused by high-intensity exercise in a woman undergoing chemotherapy because of ovarian cancer. Tip migration was suspected because of malfunction (persistent withdrawal occlusion) and diagnosis established after ultrasound examination and chest x-ray.

Even if exercise may yield benefit in the cancer patient on chemotherapy, the risk of mechanical complication of the venous access device—such as tip migration—should be considered in the case of high-intensity exercise.
How fiduciary duty law incentivises investors to manage sustainability risks
Authors: Strakodonskaya Liudmila
Published: August 2021

The compatibility of Environmental, Social and Governance (ESG) risk management with the investment management requirements under the investors’ fiduciary duties (FD) figures among the key questions in today’s context of a rapid growth of sustainable investment strategies. Despite some legal developments, namely, in Europe, investors still have no clear answer to this question, which leaves them inert in the face of these new, unconventional types of risk. In our research, we explore the recent advancements in the EU and the US legal practice with the objective to establish to what extent the FD actually requires investors to consider ESG risks in their investment management decisions. Through analysis, we define a theoretical decision-making pattern for ESG risk management set by the current FD law as applied to investors and identify: 1) ESG risk materiality and 2) the effectiveness of ESG risk hedging as its fundamental elements. Then, we design a theoretical representation of ESG risk materiality under the FD legal constraints and identify that the current FD law binds investors to assimilate ESG risks to financial risks; thus, their management is required only if they are financially material for investments. We show that this principle equally applies to long-term ESG risks (like climate change); investors are incentivised to manage only those that are sufficiently financially material considering the applied hypothetical discount rate. Also, through the case study of a recent US ERISA ESOP lawsuit, we reveal that risk aversion towards probability to successfully hedge material ESG risks could impede efficient risk management by incentivising investors not to hedge a material ESG risk, i.e. to breach their FD.
Numerical solution of a class of space fractional nonlinear vibration equations with periodic boundary conditions by the Fourier spectral method
Authors: Zhu Zhixin , Han Che , Liu Haitao , Cao Li , Yulan Wang
Published: August 2021

Nonlinear vibration arises everywhere in engineering. So far there is no method to track the exact trajectory of a space fractional nonlinear oscillator; therefore, a sophisticated numerical method is much needed to elucidate its basic properties. For this purpose, a numerical method that combines the Fourier spectral method with the Runge–Kutta method is proposed. Its accuracy and efficiency have been demonstrated numerically. This approach has full physical understanding and numerical access; thus, it can be used to solve many types of nonlinear space fractional partial differential equations with periodic boundary conditions.
Free diving-inspired breathing techniques for COPD patients: A pilot study
Authors: Borg Morten , Thastrup Tue , Larsen Kurt L , Overgaard Kristian , Hilberg Ole , Løkke Anders
Published: August 2021

Objectives: Pulmonary rehabilitation (PR) is a key factor in enhancing self-management and exercise capacity in patients with chronic obstructive pulmonary disease (COPD). The content and length of PR varies between countries and authorities responsible for rehabilitation. After completion of rehabilitation, it is often difficult for patients to stay motivated and perform regular exercise. Methods: In this pilot study, nine patients with moderate to severe COPD completed a 6-week training programme consisting of free diving-inspired breathing techniques, designed to be incorporated into daily activities. Results: Participants significantly increased the distance walked in 6 min by 48 m ( p < 0.05) and a significant reduction was seen on the COPD self-efficacy scale ( p < 0.05). Furthermore, adherence to the programme sessions was very high at 96.3% and no adverse events occurred. Discussion: This pilot study tested the feasibility of introducing breathing techniques used by COPD patients to enhance their walking capacity. The techniques were well tolerated and participant’s adherence to the weekly group sessions was high.
Marine seismic signal denoising using VMD with Hausdorff distance and wavelet transform
Authors: Kesharwani Abhishek , Aggarwal Vaibhav , Singh Shubham , B R Rahul , Kumar Arvind
Published: August 2021

In marine seismic acquisitions, signal interference remains a major menace. In this paper, a denoising approach based on the Variational Mode Decomposition (VMD) combined with the Hausdorff distance (HD) and Wavelet transform (WT) is proposed. There has been substantial research in this field over the years. However, traditional denoising methods fall short of achieving satisfactory results in an extremely low signal to noise ratio (SNR) environment. The feasibility, and stability of the proposed method was validated by performing simulations in MATLAB on both a synthetic signal and a seismic signal generated using real dataset. It was found that the proposed method does well in preserving marine signals in low SNR environments, and has a superior output SNR.
Theoretical study of an unsteady ciliary hemodynamic fluid flow subject to the Newton’s boundary conditions
Authors: Nazeer Mubbashar , Hussain Farooq , Ahmad Fayyaz , Iftikhar Sadia , Subia Gener S
Published: August 2021

This article addresses the hemodynamic flow of biological fluid through a symmetric channel. Methachronal waves induced by the ciliary motion of motile structures are the main source of Couple stress nanofluid flow. Darcy’s law is incorporated in Navier-Stokes equations to highlight the influence of the porous medium. Thermal transport by the microscopic collision of particles is governed by Fourier’s law while a separate expression is obtained for net diffusion of nanoparticles by using Fick’s law. A closed-form solution is achieved of nonlinear differential equations subject to Newton’s boundary conditions. Moreover, the current findings are compared with previous outcomes for the limiting case and found a complete coherence. Parametric study reveals that nanoflow is resisted by employing Newton’s boundary conditions. Thermal profile enhancement is contributed by the viscous dissipation parameter. Finally, one infers that hemodynamic flow of non-Newtonian fluid is an effective mode of heat and mass transfer especially, in medical sciences for the rapid transport of medicines in drug therapy.
The brinker repressor system regulates injury-induced nociceptive sensitization in Drosophila melanogaster
Authors: McParland Aidan , Moulton Julie , Brann Courtney , Hale Christine , Otis Yvonne , Ganter Geoffrey
Published: August 2021

Chronic pain is a debilitating condition affecting millions of people worldwide, and an improved understanding of the pathophysiology of chronic pain is urgently needed. Nociceptors are the sensory neurons that alert the nervous system to potentially harmful stimuli such as mechanical pressure or noxious thermal temperature. When an injury occurs, the nociceptive threshold for pain is reduced and an increased pain signal is produced. This process is called nociceptive sensitization. This sensitization normally subsides after the injury is healed. However, dysregulation can occur which results in sensitization that persists after the injury has healed. This process is thought to perpetuate chronic pain. The Hedgehog (Hh) signaling pathway has been previously implicated in nociceptive sensitization in response to injury in Drosophila melanogaster. Downstream of Hh signaling, the Bone Morphogenetic Protein (BMP) pathway has also been shown to be necessary for this process. Here, we describe a role for nuclear components of BMP’s signaling pathway in the formation of injury-induced nociceptive sensitization. Brinker (Brk), and Schnurri (Shn) were suppressed in nociceptors using an RNA-interference (RNAi) “knockdown” approach. Knockdown of Brk resulted in hypersensitivity in the absence of injury, indicating that it normally acts to suppress nociceptive sensitivity. Animals in which transcriptional activator Shn was knocked down in nociceptors failed to develop normal allodynia after ultraviolet irradiation injury, indicating that Shn normally acts to promote hypersensitivity after injury. These results indicate that Brk-related transcription regulators play a crucial role in the formation of nociceptive sensitization and may therefore represent valuable new targets for pain-relieving medications.
Designing a Preliminary Model of Coaching Pedagogy for Synchronous Collaborative Online Learning
Authors: Timonen Päivi , Ruokamo Heli
Published: August 2021

In recent years, webinar platforms have been broadly utilized in online learning where students meet one another synchronously online. This research’s underlying value is its recognition of the utmost importance of the awareness that online learning is a social process, as is all learning. This study aims to find out what kinds of synchronous collaborative online coaching pedagogy models have been used in previous research and proceeds to construct a preliminary pedagogical model for a coaching pedagogy for synchronous collaborative online learning (CPSCOL). The methods comprise a systematic literature review and qualitative-data and theory-driven content analysis. Through the systematic literature review, peer-reviewed articles spanning 2014–2018 are carefully examined. The results identify the following pedagogical framework, theory, and model combinations for synchronous collaborative online learning: the Community of Inquiry framework, including social, cognitive, and teaching presence; social presence in conjunction with the media synchronicity theory or the broaden-and-build theory, or the 4E Learning Cycle (engagement, exploration, explanation, and extension); no specific pedagogy; problem-based learning with Community of Inquiry framework or FISh (focus, investigate, and share); collaborative learning and collaborative learning connected to social presence; Carpe Diem with the Five-Step Model; and coaching pedagogy. The preliminary results indicate a scarcity of research on synchronous coaching pedagogy in online education. Consequently, the CPSCOL model for collaborative online learning, including cognitive, social, and teaching presence, is introduced to formulate a new perspective regarding webinar pedagogy. The process of learners, skills, and competences should factor in the pedagogical methods designed by a coach (teacher), and the results show that webinar pedagogy enables and enhances active collaborative learning and knowledge construction in groups. In addition, 18 CPSCOL principles of practice have been developed to support the practical implementation of the CPSCOL model.
Sensing freedom: Insights into long-term prisoners’ perceptions of the outside world
Authors: Marti Irene
Published: August 2021

In recent years, scholars have come to agree that ‘total institutions’ are in general more permeable than as outlined in prior studies. The idea of the ‘totality’ of prisons has been challenged, for example, by acknowledging the penetration of the outside world through media or external visitors. However, prison surroundings are often a topic that is not granted a lot of attention. Using ethnographic data on the everyday lives of prisoners sentenced to indefinite incarceration in Switzerland, this article explores long-term prisoners’ sensory perceptions of the outside world, in particular through hearing, seeing and smelling. It is argued that this affects not only the prisoners’ understanding of ‘the prison’ but also their experience of time and their sense of self. A closer look at their diverse ways of dealing with these (potential) connections to the outside world reveals their individual approaches to the indefinite nature of their incarceration.
Anaesthetic management using remimazolam in a patient with severe aortic stenosis: a case report
Authors: Furuta Minako , Ito Hisakatsu , Yamazaki Mitsuaki
Published: August 2021

Background

The administration of general anaesthesia in patients with aortic stenosis (AS) requires careful attention to haemodynamics. We used remimazolam for the induction and maintenance of anaesthesia in a woman with severe AS undergoing a total mastectomy.

Case presentation

An 81-year-old woman with severe AS was scheduled to undergo a total mastectomy. We decided to administer total intravenous anaesthesia with remimazolam to minimize haemodynamic changes. Although the patient showed transient hypotension after anaesthesia induction, the cardiac index was preserved with a low dose of continuous noradrenaline. The anaesthesia was then safely maintained without a decrease in the patient’s cardiac index.

Conclusions

General anaesthesia using remimazolam preserved cardiac output in this patient; therefore, remimazolam can be safely used to avoid the risk of cardiac suppression in patients with severe AS.
Spatio-temporal distribution characteristics of COVID-19 in China: a city-level modeling study
Authors: Ma Qianqian , Gao Jinghong , Zhang Wenjie , Wang Linlin , Li Mingyuan , Shi Jinming , Zhai Yunkai , Sun Dongxu , Wang Lin , Chen Baozhan , Jiang Shuai , Zhao Jie
Published: August 2021

Background

The coronavirus disease 2019 (COVID-19) has become a pandemic. Few studies have been conducted to investigate the spatio-temporal distribution of COVID-19 on nationwide city-level in China.

Objective

To analyze and visualize the spatiotemporal distribution characteristics and clustering pattern of COVID-19 cases from 362 cities of 31 provinces, municipalities and autonomous regions in mainland China.

Methods

A spatiotemporal statistical analysis of COVID-19 cases was carried out by collecting the confirmed COVID-19 cases in mainland China from January 10, 2020 to October 5, 2020. Methods including statistical charts, hotspot analysis, spatial autocorrelation, and Poisson space–time scan statistic were conducted.

Results

The high incidence stage of China’s COVID-19 epidemic was from January 17 to February 9, 2020 with daily increase rate greater than 7.5%. The hot spot analysis suggested that the cities including Wuhan, Huangshi, Ezhou, Xiaogan, Jingzhou, Huanggang, Xianning, and Xiantao, were the hot spots with statistical significance. Spatial autocorrelation analysis indicated a moderately correlated pattern of spatial clustering of COVID-19 cases across China in the early phase, with Moran’s I statistic reaching maximum value on January 31, at 0.235 (Z = 12.344, P = 0.001), but the spatial correlation gradually decreased later and showed a discrete trend to a random distribution. Considering both space and time, 19 statistically significant clusters were identified. 63.16% of the clusters occurred from January to February. Larger clusters were located in central and southern China. The most likely cluster (RR = 845.01, P < 0.01) included 6 cities in Hubei province with Wuhan as the centre. Overall, the clusters with larger coverage were in the early stage of the epidemic, while it changed to only gather in a specific city in the later period. The pattern and scope of clusters changed and reduced over time in China.

Conclusions

Spatio-temporal cluster detection plays a vital role in the exploration of epidemic evolution and early warning of disease outbreaks and recurrences. This study can provide scientific reference for the allocation of medical resources and monitoring potential rebound of the COVID-19 epidemic in China.
Identification of PLA2G7 as a novel biomarker of diffuse large B cell lymphoma
Authors: Zheng Weili , Lin Qiaochu , Issah Mohammed Awal , Liao Ziyuan , Shen Jianzhen
Published: August 2021

Background

Diffuse large B-cell lymphoma is the most common form of non-Hodgkin lymphoma globally, and patients with relapsed or refractory DLBCL typically experience poor long-term outcomes.

Methods

Differentially expressed genes associated with DLBCL were identified using two GEO datasets in an effort to detect novel diagnostic or prognostic biomarkers of this cancer type, after which receiver operating characteristic curve analyses were conducted. Genes associated with DLBCL patient prognosis were additionally identified via WCGNA analyses of the TCGA database. The expression of PLA2G7 in DLBCL patient clinical samples was further assessed, and the functional role of this gene in DLBCL was assessed through in vitro and bioinformatics analyses.

Results

DLBCL-related DEGs were found to be most closely associated with immune responses, cell proliferation, and angiogenesis. WCGNA analyses revealed that PLA2G7 exhibited prognostic value in DLBCL patients, and the upregulation of this gene in DLBCL patient samples was subsequently validated. PLA2G7 was also found to be closely linked to tumor microenvironmental composition such that DLBCL patients expressing higher levels of this gene exhibited high local monocyte and gamma delta T cell levels. In vitro experiments also revealed that knocking down PLA2G7 expression was sufficient to impair the migration and proliferation of DLBCL cells while promoting their apoptotic death. Furthmore, the specific inhibitor of PLA2G7, darapladib, could noticeably restrained the DLBCL cell viability and induced apoptosis.

Conclusions

PLA2G7 may represent an important diagnostic, prognostic, or therapeutic biomarker in patients with DLBCL.
Barriers to the uptake of community-based curative child health services in Ethiopia
Authors: Mengistu Birkety , Paulos Meron , Agonafir Nesibu , Ameha Agazi , Legesse Hailemariam , Dankenbring Elizabeth , Sylla Mariame , Miller Nathan P.
Published: August 2021

Background

Uptake of services to treat newborns and children has been persistently low in Ethiopia, despite being provided free-of-charge by Health Extension Workers (HEWs). In order to increase the uptake of these services, the Optimizing the Health Extension Project was designed to be implemented in four regions in Ethiopia. This study was carried out to identify barriers to the uptake of these services and potential solutions to inform the project.

Methods

Qualitative data were collected in October and November 2015 in 15 purposely selected districts in four regions. We conducted 90 focus group discussions and 60 in-depth interviews reaching a total of 664 participants. Thematic analysis was used to identify key barriers and potential solutions.

Results

Five demand-side barriers to utilization of health services were identified. Misconceptions about illness causation, compounded with preference for traditional healers has affected service uptake. Limited awareness of the availability of free curative services for children at health posts; along with the prevailing perception that HEWs were providing preventive services only had constrained uptake. Geographic challenge that made access to the health post difficult was the other barrier.

Four supply-side barriers were identified. Health post closure and drug stock-out led to inconsistent availability of services. Limited confidence and skill among HEWs and under-resourced physical facilities affected the service delivery.

Study participants suggested demand creation solutions such as increasing community awareness on curative service availability and educating them on childhood illness causation. Maintaining consistent supplies and ensuring service availability; along with regular support to build HEWs’ confidence were the suggested supply-side solutions. Creating community feedback mechanisms was suggested as a way of addressing community concerns on the health services.

Conclusion

This study explored nine demand- and supply-side barriers that decreased the uptake of community-based services. It indicated the importance of increasing awareness of new services and addressing prevailing barriers that deprioritize health services. At the same time, supply-side barriers would have to be tackled by strengthening the health system to uphold newly introduced services and harness sustainable impact.
Perceptions among diabetic patients in the ultra-orthodox Jewish community regarding medication adherence: a qualitative study
Authors: Levkovich Inbar , Rodin David , Shinan-Altman Shiri , Alperin Mordechai , Stein Hodaya
Published: August 2021

Background

Promoting a healthy lifestyle and achieving strict adherence to medical treatment among patients with diabetes are key objectives in public health. Yet health behaviors are often culturally driven, especially in closed religious communities. This study seeks to reveal key cultural-religious factors, attitudes and behaviors characterizing the lifestyle in one such closed community—the ultra-Orthodox Jewish community—by understanding the attitudes of ultra-Orthodox patients with diabetes toward coping with their illness and the factors impacting their adherence to medicinal treatment.

Method

Qualitative interviews were conducted with 16 ultra-Orthodox patients with diabetes using a semi-structured, in-depth questionnaire.

Results

Three main themes emerged: 1) “The disease as a secret”: Hiding the disease among patients with diabetes in ultra-Orthodox society; 2) “Distinguishing between sacred and secular occasions”: ultra-Orthodox diabetes patients distinguish between treatment adherence on weekdays and treatment adherence on holidays or special occasions; 3) “Ask the rabbi”: In cases of dilemmas that involved conflicts between halakhic rulings and doctors’ instructions, the rabbi’s decision was usually the final one.

Conclusions

The findings of this study may help provide an in-depth understanding of the obstacles and motives of ultra-Orthodox patients in adhering to medicinal treatment of diabetes in particular and to medicinal treatment in general, thus helping family physicians who treat this population provide optimal and appropriate treatment.
Fundamental movement skill proficiency and objectively measured physical activity in children with bronchiectasis: a cross-sectional study
Authors: Joschtel Barbara , Gomersall Sjaan R. , Tweedy Sean , Petsky Helen , Chang Anne B. , Trost Stewart G.
Published: August 2021

Background

Bronchiectasis is a major contributor to respiratory morbidity and healthcare utilization in children. Children with bronchiectasis exhibit low levels of physical activity (PA) and poor fundamental movement skills (FMS) may be a contributing factor. However, there are no data on FMS’s in this population. The current study assessed FMS proficiency in children with bronchiectasis and examined associations with objectively measured PA.

Methods

Forty-six children with bronchiectasis (mean age 7.5 ± 2.6 year, 63% Male) were recruited from the Queensland Children’s Hospital, Brisbane. PA was measured using the ActiGraph GT3X + accelerometer. Raw accelerometer data were processed into daily time spent in sedentary activities, light-intensity activities and games, walking, running, and moderate-to-vigorous activities and games using a random forest (RF) PA classification algorithm specifically developed for children. Daily MVPA was calculated by summing time spent in walking, running, and moderate-to-vigorous activities and games. FMS were assessed using the Test of Gross Motor Development 2nd Edition (TGMD-2).

Results

Fewer than 5% of children demonstrated mastery in the run, gallop, hop, and leap; while fewer than 10% demonstrated mastery for the two-handed strike, overarm throw, and underarm throw. Only eight of the 46 children (17.4%) achieved their age equivalency for locomotor skills, while just four (8.7%) achieved their age equivalency for object control skills. One-way ANCOVA revealed that children achieving their age equivalency for FMS had significantly higher levels of MVPA than children not achieving their age equivalency (51.7 vs 36.7 min/day). When examined by the five activity classes predicted by the RF algorithm, children achieving their age equivalency exhibited significantly greater participation moderate-to-vigorous intensity activities and games (22.1 vs 10.7 min/day). No significant differences were observed for sedentary activities, light-intensity activities and games, walking, and running.

Conclusion

Children with bronchiectasis exhibit significant delays in their FMS development. However, those who meet their age equivalency for FMS proficiency participate in significantly more daily MVPA than children who do not meet their age-equivalency. Therapeutic exercise programs designed to improve FMS proficiency are thus likely to be beneficial in this population.
Translation, cross-cultural adaptation, reliability and construct validity of the Dutch Oxford Knee Score – Activity and Participation Questionnaire
Authors: te Molder Malou E. M. , Vriezekolk Johanna E. , Bénard Menno R. , Heesterbeek Petra J. C.
Published: August 2021

Background

Patients undergoing total knee arthroplasty (TKA) tend to be younger and tend to receive TKA at an earlier stage compared to 20 years ago. The Oxford Knee Score – Activity and Participation (OKS-APQ) questionnaire evaluates higher levels of activity and participation, reflecting activity patterns of younger or more active people. The purpose of this study was to translate the OKS-APQ questionnaire into Dutch, and to evaluate its measurement properties in pre- and postoperative TKA patients.

Methods

The OKS-APQ was translated and adapted according to the forward–backward translation multi step approach and tested for clinimetric quality. Floor and ceiling effects, structural validity, construct validity, internal consistency and test–retest reliability were evaluated using COSMIN quality criteria. The OKS-APQ, the Oxford Knee Score (OKS), the Short Form-36 (SF-36), a Visual Analogue Scale (VAS) for pain and the Forgotten Joint Score (FJS) were assessed in 131 patients (72 preoperative and 59 postoperative TKA patients), and the OKS-APQ was administered twice in 50 patients (12 preoperative and 38 postoperative TKA patients), after an interval of minimal 2 weeks.

Results

Floor effects were observed in preoperative patients. Confirmatory factor analyses (CFA) indicated a good fit of a 1-factor model by the following indices: (Comparative Fit Index (CFI): 0.97, Tucker-Lewis Index (TLI): 0.96 and Standardized Root Mean Square Residual (SRMR): 0.03). Construct validity was supported as > 75% of the hypotheses were confirmed. Internal consistency (Cronbach α’s from 0.81 to 0.95) was good in the pooled and separate pre- and postoperative samples and test–retest reliability (Intraclass Correlation Coefficients (ICCs) from 0.63 – 0.85) were good in postoperative patients and moderate in preoperative patients. The standard Error of Measurements (SEMs) ranged from 8.5 – 12.2 and the Smallest Detectable Changes in individuals (SDCind) ranged from 23.5 – 34.0 (on a scale from 0 to 100).

Conclusions

Preliminary findings suggest that the Dutch version of the OKS-APQ is reliable and valid for a Dutch postoperative TKA patient sample. However, in a preoperative TKA sample, the OKS-APQ seems less suitable, because of floor effects and lower test–retest reliability. The Dutch version of the OKS-APQ can be used alongside the OKS to discriminate among levels of activity and participation in postoperative patients.
Significantly reducing blood loss via a peri-articular injection of tranexamic acid during total knee arthroplasty: a retrospective study
Authors: Lin Yu-Kuan , Tsai Shang-Wen , Wu Po-Kuei , Chen Chao-Ming , Yang Jesse Chieh-Szu , Chen Cheng-Fong , Chen Wei-Ming
Published: August 2021

Background

The administration of an intra-articular injection (IAI) of tranexamic acid (TXA) has been demonstrated to be effective in reducing both blood loss and transfusion rate during total knee arthroplasty (TKA); however, few studies have reported the efficiency of a peri-articular injection (PAI) of TXA. We studied the efficiency of a PAI of TXA in reducing blood loss during TKA.

Methods

Fifty patients undergoing primary simultaneous bilateral TKA were enrolled in this retrospective study. The right knee received a PAI of 1 g of TXA (Group I), and the left knee received an IAI of 1 g of TXA (Group II). The clinical outcome measures were a change in blood loss from Hemovac drains and surgical time.

Results

The decrease in blood loss from the Hemovac was significantly lower in Group I (460.1 ± 36.79 vs. 576.0 ± 34.01, P < 0.001) than in Group II, and no significant difference in surgical times was observed. The blood transfusion rate in the present study was 16 %.

Conclusions

A PAI of TXA may reduce blood loss more efficiently than an IAI of TXA during TKA without increased complications such as surgical site infection, poor wound healing, skin necrosis, pulmonary embolism, and deep vein thrombosis.
The incidence and prevalence of upper tract urothelial carcinoma: a systematic review
Authors: Soualhi Ahmed , Rammant Elke , George Gincy , Russell Beth , Enting Deborah , Nair Rajesh , Van Hemelrijck Mieke , Bosco Cecilia
Published: August 2021

Background

Upper tract urothelial carcinoma (UTUC) is a rare urological cancer that is still an important public health concern in many areas around the world. Although UTUC has been linked to a number of risk factors, to our knowledge no systematic review has been published on the overall incidence and prevalence of de-novo UTUC. This review aimed to examine the global epidemiology of UTUC to provide clinicians and public health specialists a better understanding of UTUC.

Methods

A systematic search was conducted on MEDLINE, Embase, and the Web of Science using a detailed search strategy. Observational epidemiological studies describing the incidence and prevalence of de-novo UTUC in adults were included, and the Joanna Briggs Institute checklist was used for critical appraisal and data extraction of the studies selected.

Results

The systematic search identified 3506 papers, of which 59 papers were included for qualitative synthesis. The studies selected included data ranging from the years 1943 to 2018. A comprehensive qualitative synthesis of the data was performed. UTUC incidence generally varied according to age (higher with increasing age), sex (unclear), race (unclear), calendar time (increased, stable, or decreased according to region), geographical region (higher in Asian countries), occupation (higher in seamen and printers), and other population characteristics. Prevalence was only reported by one study, which showed UTUC to have the highest incidence of the rare urogenital cancers in Europe.

Conclusion

This systematic review highlights an increased incidence of UTUC in certain groups, including increasing age and certain occupations such as seamen. The incidence of UTUC also varies between certain geographical regions. The trend of UTUC incidence for sex, race, and calendar time is less clear due to a wide variety of metrics used by the studies identified. More studies are also required on the prevalence of UTUC to understand its disease burden.

Trial registration This review was registered on PROSPERO (registration number CRD42019134255).