bluuebunny/crossref_metadata_2025 huggingface dataset:
Medical Education Adaptations Post COVID-19 - An Egyptian Reflection
Authors: Hany Shehata Mohamed , Abouzeid Enjy , Wasfy Nourhan , Abdelaziz Adel , L. Wells Ray , A. Ahmed Samar
Published: June 2020

Coronavirus (COVID19) appears to be an inflection point that is forcing a disruption in medical education. However, it is not clear what the responses of the institutions are to this pandemic and how the adaptation of new methods may impact medical education in the post COVID-19 era. Objective: The study aims to explore how medical schools in Egypt responded to COVID-19 pandemic regarding the teaching and learning/assessment for undergraduate students. Design: A mixed method exploratory two-phase study was conducted. A survey was prepared and disseminated to a convenient non-probability sample of the medical school faculty through various social platforms. Then, a focus group guide was conducted to explore in more depth the findings. Results: The staff level of preparedness for that unexpected shift was evaluated by 55.1% of the survey participants as optimum to high and a good leadership support was reported by 70 % of them. They reported conflicting views about the proper role of medical education units but reinforced the idea of Egyptian Knowledge Bank’s crucial role in this transition. Additionally, there is a communication problem with the students that leads to their detachment. Subsequently, 84.6 % of the participants reported that their schools used alternative teaching methods for small groups, large groups, pre-clinical and clinical clerkships. However, 64.1 % of the participants identified a clinical skills teaching challenge. Although, 68.4% reported that alternative methods were used for formative assessment but absence of alternative methods for summative assessment was declared by 76.3%. Conclusions: Individuals moved faster than bodies and relied on support existing outside the universities when catastrophe happened. However, institutes which have experience in adapting modern engaging learning methods should organize a better response for crisis. Online learning should be integrated in the curriculum with a fair percentage especially in the early years of medical study.
Volume determination of weights in the range from 1 g to 5 kg: a comparison of hydrostatic weighing and double-weighing in air using Monte-Carlo simulation
Authors: Su Yi , Marti Kilian , Wuethrich Christian
Published: June 2020

We have investigated the two methods, double-weighing in air and hydrostatic weighing, for the determination of the volume of weights in the range from 5 kg down to 1 g. We present the mathematical equations of both methods and show that Monte-Carlo simulation is a suitable way to determine the measurement uncertainties and overcome the difficulties in dealing with correlated variables. We found that the measurement uncertainties of the two methods are comparable and that double-weighing in air is an efficient method for determining the volume of weights below 1 kg.
Impact of the Voluntary Safety Standard for Liquid Laundry Packets on Child Injuries Treated in US Hospital Emergency Departments, 2012−2018
Authors: Hanway Stephen J. , Rodgers Gregory B.
Published: June 2020

Objectives. To evaluate the effect of the voluntary safety standard for liquid laundry packets on the rate of injury involving children younger than 5 years in the United States.

Methods. Semiannual national estimates of child injuries involving liquid laundry packets treated in US hospital emergency departments were developed for the July 2012 through December 2018 study period. We used a negative binomial regression model to estimate the effect of the voluntary standard on the injury rate following the standard’s publication at the end of 2015. The analysis controlled for the rapid growth of laundry packet use during the study period. Results are presented as relative risks and percentage changes in the injury rate.

Results. The voluntary standard was associated with a 49.4% to 61.6% reduction in the rate of child injury.

Conclusions. The results suggest that the requirements of the voluntary standard have effectively reduced the rate of child injury involving liquid laundry packets and may have prevented 9200 to 23 000 emergency department–treated injuries during the study period.
Recent Advances in the Application of Artificial Intelligence in Otorhinolaryngology-Head and Neck Surgery
Authors: Tama Bayu Adhi , Kim Do Hyun , Kim Gyuwon , Kim Soo Whan , Lee Seungchul
Published: June 2020

This study presents an up-to-date survey of the use of artificial intelligence (AI) in the field of otorhinolaryngology, considering opportunities, research challenges, and research directions. We searched PubMed, the Cochrane Central Register of Controlled Trials, Embase, and the Web of Science. We initially retrieved 458 articles. The exclusion of non-English publications and duplicates yielded a total of 90 remaining studies. These 90 studies were divided into those analyzing medical images, voice, medical devices, and clinical diagnoses and treatments. Most studies (42.2%, 38/90) used AI for image-based analysis, followed by clinical diagnoses and treatments (24 studies). Each of the remaining two subcategories included 14 studies. Machine learning and deep learning have been extensively applied in the field of otorhinolaryngology. However, the performance of AI models varies and research challenges remain.
Taxonomic scheme of the order Chaetophorales (Chlorophyceae, Chlorophyta) based on Chloroplast genomes
Authors: Liu Benwen , Hu Yu Xin , Hu Zheng Yu , Liu Guo Xiang , Zhu Huan
Published: June 2020

Background: Order Chaetophorales currently includes six families, namely Schizomeridaceae, Aphanochaetaceae, Barrancaceae, Uronemataceae, Fritschiellaceae, and Chaetophoraceae. The phylogenetic relationships of Chaetophorales have been inferred primarily based on short and less informative rDNA sequences. This study aimed to phylogenetically reconstruct order Chaetophorales and determine the taxonomic scheme and to further the current understanding of the evolution of order Chaetophorales.Results: In the present study, seven complete and five fragmentary chloroplast genomes were harvested. Phylogenomic and comparative genomic analysis were performed to determine the taxonomic scheme within Chaetophorales. Consequently, Oedogoniales was found to be a sister to a clade linking Chaetophorales and Chaetopeltidales. Schizomeriaceae, and Aphanochaetaceae clustered into a well-resolved basal clade in Chaetophorales, inconsistent with the results of phylogenetic analysis based on rDNA sequences. Comparative genomic analyses revealed that the chloroplast genomes of Schizomeriaceae and Aphanochaetaceae were highly conserved and homologous, highlighting the closest relationship in this order. Germination types of zoospores precisely correlated with the phylogenetic relationships.Conclusions: chloroplast genome structure analyses, synteny analyses, and zoospore germination analyses were concurrent with phylogenetic analyses based on the chloroplast genome, and all of them robustly determined the unique taxonomic scheme of Chaetophorales and the relationships of Oedogoniales, Chaetophorales, and Chaetopeltidales.
Challenge for Diagnostic Assessment of Deep Learning Algorithm for Metastases Classification in Sentinel Lymph Nodes on Frozen Tissue Section Digital Slides in Women with Breast Cancer
Authors: Kim Young-Gon , Song In Hye , Lee Hyunna , Yang Dong Hyun , Kim Namkug , Shin Dongho , Yoo Yeonsoo , Lee Kyowoon , Kim Dahye , Jung Hwejin , Cho Hyunbin , Lee Hyungyu , Kim Taeu , Choi Jong Hyun , Seo Changwon , Han Seong il , Lee Young Je , Lee Young Seo , Yoo Hyung-Ryun , Lee Yongju , Park Jeong Hwan , Gong Gyungyub , Oh Sohee
Published: June 2020

The authors have withdrawn this preprint due to author disagreement.
Is Laminectomy and Fusion the Better Choice than Laminoplasty for Multilevel Cervical Myelopathy with Signal Changes on Magnetic Resonance Imaging ? A Comparison of Two Posterior Surgeries
Authors: He Xin , Zhang Jia Nan , Liu Tuan Jiang , Hao Ding Jun
Published: June 2020

Background This study aimed to compare the clinical outcomes and complications between laminectomy and fusion (LF) and laminoplasty (LP) for multi-level cervical spondylotic myelopathy (MCSM) with increased signal intensity (ISI) on T2-weighted images (T2WI).Methods In this retrospective cohort study, we analyzed 52 patients with MCSM with ISI on T2WI who underwent laminoplasty (LP group). The Japanese Orthopedic Association (JOA) score, the Visual Analogue Scale (VAS) score, the physical and mental component scores (PCS and MCS) of Short-Form 36 (SF-36), and the extension and flexion ranges of motion (ROMs) were recorded. As controls, propensity score matching identified 52 patients who underwent laminectomy and fusion (LF group) from January 2014 to June 2016 using 7 independent variables (preoperation): age, sex, JOA score, SF-36 PCS, SF-36 MCS, preoperative symptom duration and high signal intensity ratio (HSIR).Results The operative duration in the LF group was significantly higher than that in the LP group. At the last follow-up, the JOA score, VAS score, and SF-36 (PCS and MCS) scores were all significantly improved in both groups. The extension and flexion ROMs were decreased in both groups but significantly better in the LP group than in the LF group. Both groups demonstrated similar clinical improvements at the final follow-up. The complication rate was higher in the LF group.Conclusion The present study demonstrates that LP for MCSM with ISI on T2WI achieves similar clinical improvement as LF. However, longer operative durations, higher complication rates and lower extension and flexion ROMs were found in the LF group.
Fire needle plus cupping for acute herpes zoster: Study protocol for a randomised controlled trial
Authors: Zhang Ying , Liang Zuohui , Li Shihua , Yang Ling , Guo Taipin , Yan Xu , Yang Juanjuan , Xu Qiannan , Zhang Qing , Zhao Jian , Li Cailian , Liu Xiuhong
Published: June 2020

BackgroundAcute herpes zoster (AHZ) is a common skin disease caused by invasion of the varicella-zoster virus into the ganglia and skin, and the severe pain is the most complaint, which can seriously disturb the normal life of patients. Fire needle plus cupping is a special acupuncture treatment, which is widely used to treat AHZ for its better analgesic effect in China although it has not been fully verified by rigorous randomized controlled trial (RCT). Methods/ Design To test the effect, a three-arm randomized parallel controlled trial protocol has been designed. 105 AHZ patients suffering pain will be randomly divided into three groups in an equal proportion. The interventions are fire needle plus cupping (FC) in group A , famciclovir plus gabapentin (FG) in group B and fire needle plus cupping plus famciclovir (FCF) in Group C. The length for the trial is set for a week time frame. Precisely speaking, the A group (FC ) is to carry out 1 treatment per day for the total of 7 treatment sessions within 1 week period, On the other hand, the B group (FG) will take drugs orally three times a day within the trial 1 week . Meanwhile, with its combination element, the C group (FCF) is due to undertake both treatments and drugs as prescribed for A and B groups within the trial week. As an intra-trial arrangement, analgesics medication will be carefully administered for temporary pain release if the sudden intolerable pain appeared. For the primary outcome, this study is due to apply visual analogue scale to identify pain intensity relief. As the secondary outcomes are concerned, this study is aiming to focus on the issues related to changes in substance P and beta-endorphin concentrations in peripheral plasma, as well as those issues of analgesic needs, side effects, symptoms and physical signs including pain classification, local itching, burning sensation, fever, local lymphadenopathy, skin lesion area, blisters, herpes clusters, vesicular traits, ulcers, and pimples; and all these are taking into account for evaluation. For the final stage, the participants are due to be followed up for postherpetic neuralgia. Discussion: The results of this trial aim to provide sufficient evidence on FC treatment over both FG and FCF treatments. It will then give a credible alternative treatment to cut down acute pain and to cure AHZ infection. Trial registration: The registration number is ChiCTR1800015372. Registered on 28 March 2018.
Serum concentration of asprosin in new-onset type 2 diabetes
Authors: Naiemian Shakiba , naeemipour Mohsen , Zarei Mehdi , Najafi Moslem Lari , Gohari Ali , Behroozikhah Mohammad Reza , Heydari Hafez , Miri Mohammad
Published: June 2020

Background: Asprosin, a newly identified adipokine, is pathologically increased in individuals with insulin resistance. However, the available evidence on the association of asprosin and type 2 diabetes mellitus (T2DM) status is still scarce. Therefore, this study aimed to determine the relationship between serum concentrations of asprosin and T2DM status. Methods: This observational study was performed based on 194 adults (97 newly diagnosed T2DM and 97 healthy individuals). Anthropometric and biochemical variables were determined in all participants. Serum concentrations of asprosin were measured using enzyme-linked immunosorbent assay (ELISA). Results: In patients with T2DM, the serum concentrations of asprosin were significantly higher than the healthy controls (4.18 [IQR: 4.4] vs. 3.5 [IQR: 1.85], P< 0.001). The concentrations of asprosin were significantly correlated with body mass index (BMI) and fasting blood glucose (FBG) in healthy subjects and with BMI, FBG, hemoglobin A1c (HbA1c), homeostatic model assessment of insulin resistance (HOMA-IR), and quantitative insulin check index (QUICKI), triacylglycerol (TAG) and total cholesterol/ high-density lipoprotein cholesterol (TC/HDL-C) ratio in the T2DM group. In fully adjusted model, the odds ratio (OR) of T2DM with serum concentrations of asprosin was approximately 1.547 (95% CI 1.293-1.850, P< 0.001) compared to the control group. Multiple stepwise regression analysis indicated that FBG and HOMA-IR were independently associated with asprosin in T2DM. Conclusion: Our findings indicated that serum concentrations of asprosin are increased in patients with T2DM. Also, asprosin is correlated with insulin resistance and TC/HDL-C ratio (atherosclerotic risk factor of cardiovascular diseases) in patients with T2DM.
Association between wasting and food insecurity among children under five years: Findings from Nepal demographic health survey 2016
Authors: Nepali Sajama , Simkhada Padam , Davies Ian Glyyn
Published: June 2020

Background: Wasting is a consequence of food insecurity, inappropriate dietary practices, and inadequate caring and feeding practices. The present study assessed association between wasting and household food insecurity among under five years old children, along with other socio-demographic characteristics.Methods: This study is a secondary analysis of the Nepal Demographic and Health Survey 2016. The survey is cross-sectional in design with use of standardized tools. The sampling frame used is an updated version of the frame from the 2011 National Population and Housing Census. The participants were children under five years of age (n= 2414). Logistic regression was carried out to identify the odds of being wasted for children belonging to different levels of food insecure households using odds ratio and 95 percent confidence intervals. Results: The prevalence of wasting increased with the level of food insecurity, from mild (9.4%) to moderate (10.8%) and to severe (11.3%). The highest proportions of wasted children were in Province 2 (14.3%), from rural areas (10.1%), born to mothers with no education (12.4%) and from a richer quintile (11.3%). Children belonging to severe food insecure households had 1.36 (95%CI 0.72-2.57) adjusted odds of being wasted and those belonging to mild food insecure and moderately food insecure households had 1.13 (95%CI 0.65-1.97) and 1.36 (95%CI 0.72-2.57) odds of being wasted respectively. Province 1 (AOR 2.06, 95%CI 1.01-4.19) and Province 2 (AOR 2.45, 95%CI 1.22-4.95) were significantly associated with wasting.Conclusion: Considering the increment in childhood wasting as per level of food insecurity, an integrated intervention should be developed in Nepal that, 1. addresses improving knowledge and behavior of community people with respect to diet and nutrition; 2. reduce the problem of food insecurity through agricultural interventions.
CARTA Fellows’ Scientific Contribution to the African Public and Population Health Research Agenda (2011 to 2018)
Authors: Igumbor Jude , Bosire Edna N , Basera Tariro , Dieudonn Uwizeye , Fayehun Funke , Wao Hesborn , Ajuwon Ademola , Otukpa Emmanuel , Karimi Florah , Conco Daphney , Gitau Evelyn , Fonn Sharon
Published: June 2020

Background: Since its inception in 2009, the Consortium for Advanced Research Training in Africa (CARTA) program has focused on strengthening the capacity of nine African universities and four research centres to produce skilled researchers and scholars able to improve public and population health on the continent. This study describes the alignment between CARTA-supported doctoral topics and publications with the priorities articulated by the African public and population health research agenda. Methods: We reviewed the output from CARTA PhD fellows between 2011 and 2018 to establish the volume and scope of the publications, and the degree to which the research focus coincided with the SDGs, World Bank, and African Development Bank research priority areas. We identified nine key priority areas into which the topics were classified.Results: In total, 140 CARTA fellows published 806 articles in peer-reviewed journals over the 8 years up to 2018. All the publications considered in this paper had authors affiliated with African universities, 90% of the publications had an African university first author and 41% of the papers have CARTA fellows as the first author. The publications are available in over 6300 online versions and have been cited in over 5500 other publications. About 69% of the published papers addressed the nine African public and population health research agenda and SDG priority areas. Infectious diseases topped the list of publications (26.8%), followed by the health system and policy research (17.6%), maternal and child health (14.7%), sexual and reproductive health (14.3%). Conclusions: Investments by CARTA in supporting doctoral studies provides fellows with sufficient training and skills to publish their research in fields of public and population health. The number of publications is understandably uneven across Africa’s public and population priority areas. Even while low in number, fellows are publishing in areas such as non-communicable disease, health financing, neglected tropical diseases and environmental health. Violence and injury is perhaps underrepresented. There is need to keep developing research capacity in partner institutions with low research output by training more PhDs in such institutions and by facilitating enabling environments for research.
A Multilevel Mixed Effects Analysis of Informal Carers Health in Australia: The role of Community Participation, Social Support and Trust at Small Area level.
Authors: Mohanty Itismita , Niyonsenga Theo , Cochrane Tom , Rickwood Debra
Published: June 2020

Background: Informal carers suffer from worse health outcomes than non-carers due to their caregiving role. Yet, in a society carers health is as important as that of their care recipients. This study investigated the self-assessed mental and general health outcomes of informal carers in Australia. It evaluated the influence of carers’ personal social capital- a logically linked sequence of their social behaviour such as community participation, social support and trust in others- on their health outcomes. The study estimated the magnitude of small local area (SA1) level variation along with individual level variation in carers’ health outcomes.Methods: The study used a multilevel mixed effects cross-sectional design using data from the Household Income and Labour Dynamics of Australia survey, wave 14. It included Australians aged 15 years and older that were surveyed in the year 2014. The sample consisted of 12,767 individuals and 5004 SA1s. The outcome measures included- mental health, general health and physical functioning, domains of the Short Form 36 Questionnaire, a widely used multi-dimensional measure of health-related quality of life.Results: Informal carers suffered from poor mental (Beta = -0.587, p=0.003) and general health (Beta = -0.670, p=0.001) outcomes compared to non-carers in Australia. These health outcomes exhibited significant variation across small areas (SA1s) in Australia, with 12-13% variation in general and mental health. However, within small local areas, differences at the individual level, accounted for most of the variation in outcomes. Moreover, levels of community participation, personal social connection and trust, as perceived by individuals in the communities, had a positive influence on both mental and general health of carers and non-carers, and were more beneficial for carers compared to non-carers. Conclusion: It seems that the positive influence of social capital for carers helps them in coping with the negative impact of their caregiving duty on health outcomes. Findings suggested that some targeted community support programs for carers to build on their personal social cohesion and trust in their community could help in improving their poor health profiles. Moreover, improved informal carers’ health may help the health system in better managing their resources.
SUV39H1-DNMT3A-mediated epigenetic regulation of Tim-3 and galectin-9 in the cervical cancer
Authors: Zhang Li , Tian Sijuan , Zhao Minyi , Yang Ting , Quan Shimin , Yang Qing , Song Lihua , Yang Xiaofeng
Published: June 2020

Background: Methylation of histone 3 at lysine 9 (H3K9) and DNA methylation are epigenetic marks correlated with genes silencing. The tumor microenvironment significantly influences therapeutic responses and clinical outcomes. The epigenetic-regulation mechanism of the costimulatory factors Tim-3 and galectin-9 in cervical cancer remains unknown. Methods: The methylation status of HAVCR2 and LGALS9 were detected by MS-PCR in cervical cancer tissues and cell lines. The underlying molecular mechanism of SUV39H1-DNMT3A-Tim-3/galectin-9 regulation was elucidated using cervical cancer cell lines containing siRNA or/and over-expression system. Confirmation of the regulation of DNMT3A by SUV39H1 used ChIP-qPCR.Results: SUV39H1 up-regulates H3K9me3 expression at the DNMT3A promoter region, which in turn induced expression of DNMT3A in cervical cancer. In addition, the mechanistic studies indicate that DNMT3A mediates the epigenetic modulation of the HAVCR2 and LGALS9 genes by directly binding to their promoter regions in vitro. Moreover, in an in vivo assay, the expression profile of SUV39H1 up-regulates the level of H3K9me3 at the DNMT3A promoter region was found to correlate with Tim-3 and galectin-9 cellular expression level. Conclusion: These results indicate that SUV39H1-DNMT3A is a crucial Tim-3 and galectin-9 regulatory axis in cervical cancer.
Prognostic value of an autophagy-related gene expression signature for endometrial cancer patients
Authors: Wang Hui , Ma Xiaoling , Liu Jinhui , Wan Yicong , Jiang Yi , Xia Yankai , cheng wenjun
Published: June 2020

Background: Autophagy is associated with cancer development. Autophagy-related genes play significant roles in endometrial cancer (EC), a major gynecological malignancy worldwide, but little was known about their value as prognostic markers. Here we evaluated the value of a prognostic signature based on autophagy-related genes for EC. Methods: First, various autophagy-related genes were obtained via the Human Autophagy Database and their expression profiles were downloaded from The Cancer Genome Atlas. Second, key prognostic autophagy-related genes were identified via univariat, LASSO and multivariate Cox regression analyses. Finally, a risk score to predict the prognosis of EC was calculated and validated by using the test and the entire data sets. Besides, the key genes mRNA expression were validated using quantitative real-time PCR in clinical tissue samples. Results: A total of 40 differentially expressed autophagy-related genes in EC were screened and five of them were prognosis-related (CDKN1B, DLC1, EIF4EBP1, ERBB2 and GRID1). A prognostic signature was constructed based on these five genes using the train set, which stratified EC patients into high-risk and low-risk groups (P<0.05). In terms of overall survival, the analyses of the test set and the entire set yielded consistent results (test set: p < 0.05; entire set: p < 0.05). Time-dependent ROC analysis suggested that the risk score predicted EC prognosis accurately and independently (0.674 at 1 year, 0.712 at 3 years and 0.659 at 5 years). A nomogram with clinical utility was built. Patients in the high-risk group displayed distinct mutation signatures compared with those in the low-risk group. For clinical sample validation, we found that EIF4EBP1and ERBB2 had higher level in EC than that in normal tissues while CDKN1B, DLC1 and GRID1 had lower level, which was consistent with the results predicted. Conclusions: Based on five autophagy-related genes (CDKN1B, DLC1, EIF4EBP1, ERBB2 and GRID1), our model can independently predict the OS of EC patients by combining molecular signature and clinical characteristics.
The association between family cohesion and disability following blunt trauma: Findings from a level-I trauma center in Saudi Arabia
Authors: Almarwani Sarah , Hijazi Leen , Alamer Modhi , Alnwaiser Jury , Aldakheel Reem , Alsheikh Khalid , Albabtin Ibrahim , Alghnam Suliman
Published: June 2020

Background: Injuries pose a significant burden on population health of Saudi Arabia. Even in nonfatal injuries, the burden varies from temporary to permanent disabilities. Health outcomes following injuries can vary, and predictors of recovery from disability are not well understood. In the Kingdom, family values and cohesion can differ from other countries due to several factors, including religious beliefs and cultural traditions. Learning about predictors of injury recovery can improve prevention as well as planning for rehabilitation programs. Therefore, the study aims to evaluate the association between family cohesion and recovery following blunt injuries. Methods: This prospective study included 249 patients who were hospitalized for at least one day following blunt trauma in King Abdulaziz Medical City, Riyadh. Adult patients were interviewed twice: initially during admission, and a second interview via the phone three months after discharge. Baseline information included: demographics, injury characteristics, the five dimensions EQ-5D and family support scale. The follow-up interview captured only EQ-5D. Suboptimal family cohesion was defined as any issue with the relationship with parents, spouse, or siblings. Any disability was defined as a reported limitation in one or more domains of the EQ-5D scale. Logistic regression was used to assess the association between family cohesion and recovery at three months. Results: Of the overall sample, 169 (67.8%) responded to the second interview, and three patients passed away. About 95.2% of patients reported disabilities at baseline, while 88.1% continued to report disabilities after three months. Forty patients (16.1%) reported suboptimal family cohesion. Of these patients, 37(94.87%) were in pain, 33(82.5%) reported problems with usual activities, 32(80%) faced problems with self-care, 32 (80%) patients had difficulty in mobility, and 23(57.5%) were depressed. Multivariable regression suggested that patients with suboptimal family cohesion were less likely to recover from disabilities.Conclusion: The prevalence of any disability three months after discharge is striking. This study suggests that health outcomes after blunt trauma are affected by the strength of the patient’s family cohesion. More research is needed to identify effective ways through which the provision of social support can reduce short term disability after trauma.
Analysis on mental health status and needs of health care workers in designated medical institutions of tuberculosis during the epidemic period of COVID-19
Authors: Fang Xue-Hui , Wu Li , Lu Lun-Shan , Kan Xiao-Hong , Wang Hua , Xiong Yan-Jun , Ma Dong-Chun , Wu Guo-Cui
Published: June 2020

Background Coronavirus disease 2019 (COVID-19) has spread rapidly in China and other overseas areas, which has aroused widespread concern. The sharp increase in the number of patients has led to great psychological pressure on health care workers. The purpose of this study is to understand their mental health status and needs, so as to provide a scientific basis for alleviating the psychological pressure of health care workers.Methods Using a cross-sectional study design, 511 health care workers were randomly selected from two designated tuberculosis medical institutions in Anhui Province. The basic situation, perceived social support, depression level, loneliness and COVID-19 related knowledge were collected and analyzed by questionnaire.Results There were 139 people in epidemic prevention and control positions (27.20%). Depression level: female was higher than male; nurse was higher than doctor; middle and junior job titles were higher than senior titles; junior college degree or below were higher than bachelor's degree, master's degree and above; isolation ward, fever clinic and pre-check triage were significantly higher than those of non-prevention and control positions (P < 0.05). Loneliness scores: doctors were higher than that of medical technicians, and isolation ward, fever clinic and pre-check triage were higher than those of non-prevention and control positions (P < 0.05). Social support: doctors were lower than that of medical technicians, and isolation ward, fever clinic and pre-check triage were significantly lower than those of non-prevention and control positions (P < 0.05). The score of social support was negatively correlated with depression and loneliness (P < 0.001), while depression was positively correlated with loneliness (P < 0.001). Health care workers most want to receive one-to-one psychological counseling (29.75%), and provide crisis management (24.07%). The awareness rate of health care workers on COVID-19's knowledge was relatively high.Conclusions The psychological problems of health care workers, especially women, nurses with low educational background, low professional title, and staff in the epidemic prevention and control positions are relatively serious. We should focus on this population, and take targeted intervention measures.
Family Witnessed Resuscitation: Staff Opinion
Authors: de Mingo-Fernández Eva , Belzunegui-Eraso Ángel , Jiménez-Herrera María
Published: June 2020

BACKGROUNDSince the 1980s, the controversial issue of family presence during cardiopulmonary resuscitation has been studied, as well as to identify the perceptions, opinions and beliefs of health professionals, patients and family members, as well as to identify benefits, barriers and design training and protocols for its implementation. In 2008, Twibell et al. designed a questionnaire that measured nurses’ perceptions of Risks-Benefits and Self-Confidence in the face of Family Presence during Cardiopulmonary Resuscitation.MethodsThe objective is to adapt and validate into Spanish the Family Presence Risk-Benefit scale and Family Presence Self-Confidence scale (FPRB-FPSC) instrument by Twibell et al. For this purpose were used a questionnaire on paper and online self-administered, semi-structured, translated cross-culturally. Statistical tests were performed for the validity of the questionnaire. 541 health workers were invited to answer. The results were analysed by factor analysis with varimax rotation (maximum likelihood method), in addition to ANOVA, contingency tables and Student’s t-test to observe associations between different variables. The study was approved by the institutional review board of the Consorci Sanitari del Garraf, and by the Ethic Comitee clinical research of the Fundació Unió Catalana Hospitals.Results 237 health workers answered the survey (69% women), of whom 167 were nurses. Health care providers who have experienced CPR barely reach 13%, with the majority being men and the elderly. Regarding the invitation to the FPDR, it barely reaches 5% and regarding the willingness to include the FP in the advance directives, 66% of the health workers are in favour. Health personnel identify similar barriers and factors that favour Family Presence.The correlation between the two measured scales, FPRB-FPSC, is significant and has a moderate intensity of the relationship (r = 0.65 and α <0.001).ConclusionsThe Family Presence during Cardiopulmonary Resuscitation generates controversy in health personnel, observing a trend along with generational change, as younger professionals tend to accept the Family Presence more. The psychometric properties of the questionnaire indicate high validity and reliability. Risk-Benefit perception and trust are related to healthcare staff who consider the Family Presence beneficial.
Systematic Review of cost-effectiveness models in prostate cancer: exploring new developments in testing and diagnosis
Authors: Keeney Edna , Thom Howard , Turner Emma , Martin Richard M , Morley Josie , Sanghera Sabina
Published: June 2020

Background
There is currently no formal prostate cancer screening programme in the UK. Early detection using age-based prostate-specific antigen (PSA) testing is unlikely to be cost-effective due to limited mortality benefit and harms associated with overdetection. However, the discovery of new prostate cancer specific biomarkers and more accurate diagnostic strategies (e.g. magnetic resonance imaging (MRI)) could improve the outcomes of screening. A systematic review was conducted to assess the evidence base on cost-effectiveness of such innovations and areas for further development.
Methods
To identify model-based economic evaluations of screening and diagnostic tests for prostate cancer, a systematic review of the literature using the NHS Economic Evaluation Database, Medline, EMBASE, HTA databases, NICE guidelines, and UK National Screening Committee guidance was carried out, between 2009 and 2019. Relevant data were extracted on study type, model inputs, modelling methods and cost-effectiveness conclusions and the results narratively synthesized.
Results
Sixteen studies were included in the review. Seven studies compared the cost-effectiveness of new urinary or blood biomarkers compared to each other or the PSA test and found the biomarkers e.g. the Prostate Health Index (PHI) and SelectMDx, to be the most cost-effective. Seven studies compared newer prostate biopsy methods, including MRI-guided, to TRUS guided biopsy and found MRI-guided methods to be most cost-effective. The newer detection methods showed a reduction in unnecessary biopsies and overtreatment. However, there was uncertainty around the most cost-effective pathway of follow-up strategies (MRI/biomarkers) in men who have a negative initial biopsy. Many studies did not model stage or grade of cancer, cancer progression or the entire testing, screening and treatment pathway. Very few studies fully accounted for uncertainty in their analysis.
Conclusions
This review brings together the cost-effectiveness literature for novel screening and testing methods used in the diagnosis of prostate cancer. Several limitations of the published models were identified. The models generally either compared new biomarkers or new imaging techniques which highlights the importance of future work in this area, as biomarkers and imaging are likely to be used in combination.
Unleashing the Indirect Influence of FDI in Environmental Degradation via Financial Development and Economic Growth. New Evidence from Asian Countries
Authors: Qamri Ghulam Muhmmad , Sheng Bing , Khan Rana Ejaz Ali , Hanim Wasisfah
Published: June 2020

Background:Scholars in developed and emerging economies have widely tested the interactions between foreign direct investment, financial development, economic growth and environmental degradation. Despite a number of empirical and review studies, it is not yet wrap up either the associations are negative, positive, direct or indirect. Additionally, minor attention is given to the indirect role of foreign direct investment in environmental degradation; perhaps no study has yet demonstrated the mediating role of financial development and economic growth between foreign direct investment and environmental degradation in Asian economies. Referring to the fragmented outputs and consequences as well as lacking the indirect role, the present study examines the influence of foreign direct investment on environmental degradation with the mediating role of financial development and economic growth. Results:Secondary data of 21 Asian countries from 1980-2018 were gathered from World Bank Indicators and then performed STATA to test the paths. Our findings are slightly different from the studies conducted in developed economies. The results indicate that foreign direct investment significantly improves environmental quality by deteriorating environmental pollution. It also significantly improves economic growth in the selected regions. Surprisingly, our study shows that foreign direct investment has a significant negative influence on financial development in the Asian regions. Both financial development and economic growth significantly negatively influence environmental degradation in Asian regions. However, financial development partially mediates while economic growth does not play any mediating role between foreign direct investment and environmental degradation in the Asian countries. Trade openness and population growth as control factors do not show any significant role in the model. Conclusions:This research recommends policymakers to focus on the inflow of foreign direct investment in order to enhance economic growth and environmental quality. It is strongly suggested for policymakers to attenuate the political intervention (e.g. ensure the political stability) in the inflow of foreign direct investment, so financial resources can be impartially distributed in the industrial sector and thus the nations will have an effective financial development system. Other implications have described.
Association Between Obstetric and Medical Risk Factors With Stillbirths in 4 Tertiary Hospitals in a Low Income Country
Authors: Gwako George Nyakundi , Obimbo Moses Madadi , Gichangi Peter Bundi , Kinuthia John , Onesmus Gachuno W , Bosire Alex Nyakundi , Were Fredrick
Published: June 2020

Background

The burden of stillbirth in Africa is high. The burden of stillbirth in Kenya is unknown, and very few studies have investigated the association between medical and obstetric risk factors and the occurrence of stillbirth in a Kenyan setting. The aim of this study was to evaluate the association between obstetric and medical risk factors with stillbirths in Nairobi, Kenya. This information is key to the healthcare system while formulating policies and interventions to mitigate preventable stillbirths.
Methods

This was a case-control study conducted in four Kenyan hospitals between August 2018 and April 2019. Two hundred and fourteen women with stillbirths and 428 with livebirths > 28 weeks were enrolled and evaluated. Data was collected via interviews and data abstraction from medical records. The outcome variables were stillbirth and livebirth; the exposure variables were sociodemographic characteristics, medical and obstetric risk factors. Sociodemographic characteristics were compared using the two-sample t-test for continuous variables and Chi-square or Fisher's exact tests for categorical variables. The association between the medical and obstetric risk factors with stillbirth was assessed using univariate and multivariate analysis using logistic regression. Statistical significance was defined as a two-tailed p-value of ≤0.05.
Results

Mothers with obstetric complications had higher odds of stillbirth: pre-eclampsia (OR 9.1, 95% CI 2.6–32.5, P = 0.001), eclampsia (OR 9.2, 95% CI 2.6–32.5, P = 0.001), placenta previa (OR 8.6 95% CI 2.8–25.9, P = 0.001), abruptio placenta (OR 6.9 95% CI 2.2–21.3, P = 0.001), early preterm delivery 28-34weeks (OR 9.5, 95% CI 5.7–16), late preterm delivery between 34–37 weeks (OR 2.0 95% CI 1.3–3.3) and previous preterm birth (OR 4.7, 95% CI 1.2–18.7, P = 0.01). Women with gestational diabetes mellitus had a 11fold higher likelihood of a stillbirth, OR 11.5 95% CI 2.5–52, P = 0.001). There was no association between intrauterine growth restriction (IUGR), multiple gestation, congenital anomalies, previous stillbirth, previous abortion, HIV and anaemia with stillbirth.
Conclusion:

Our findings reiterate the significance of medical and obstetric complications in association with stillbirth in a Kenyan urban setting. Proper antepartum care and surveillance to identify and manage medical and obstetric conditions with a potential of causing stillbirth are recommended.
Measuring the Quality of Nursing Clinical Placements. Development of the Placement Evaluation Tool (PET): A Mixed Methods Co-design Project
Authors: Cooper Simon , Cant Robyn , Waters Donna , Luders Elise , Henderson Amanda , Willetts Georgina , Tower Marion , Searl Kerry Reid , Ryan Colleen , Hood Kerry
Published: June 2020

Background: The quality of nursing clinical placements has been found to vary. Placement evaluation tools for nursing students are available but lack contemporary reviews of clinical settings. Therefore, the aim of this study was to develop a feasible, valid and reliable clinical placement evaluation tool applicable to nursing student placements in Australia and beyond.Methods: An exploratory mixed methods co-design project. Phase 1 included a literature review; expert rating of potential question items and Nominal Group Technique meetings with a range of stakeholders for item development. Phase 2 included on-line pilot testing of the Placement Evaluation Tool (PET) with 1,263 nursing students, across all year levels at six Australian Universities and one further education college in 2019-20, to confirm validity, reliability and feasibility.Results: The PET included 19-items (rated on a 5-point agreement scale) and one global satisfaction rating (a 10-point scale). Placements were generally positively rated. The total scale score (19 items) revealed a median student rating of 81 points from a maximum of 95 and a median global satisfaction rating of 9/10. Criterion validity was confirmed by item correlation: Intra-class Correlation Co-efficient ICC = .709; scale total to global score r = .722; and items to total score ranging from .609 to .832. Strong concurrent validity was demonstrated with the Clinical Learning Environment and Supervision Scale (r= .834). Internal reliability was identified and confirmed in two subscale factors: Clinical Environment (Cronbach’s alpha = .94) and Learning Support (alpha = .96). Based on the short time taken to complete the survey (median 3.5 minutes) and students’ comments, the tool was deemed applicable and feasible.Conclusions: The PET was found to be valid, reliable and feasible. Use of the tool as a quality assurance measure is likely to improve education and practice in clinical environments. Further international evaluation of the instrument is required to fully determine its psychometric properties.
Responses of Forest Carbon and Water Coupling to Thinning Treatments Across Multiple Spatial Scales
Authors: Wang Yi , Campo Antonio D. del , Wei Xiaohua , Liu Wanyi , Li Qiang
Published: June 2020

BackgroundWater-use efficiency (WUE) represents the coupling of forest carbon and water. Little is known about the responses of WUE to thinning at multiple spatial scales. The objective of this research was to use field measurements to understand short-term effects of two thinning treatments (T1: 4,500 stems ha-1; and T2: 1,100 stems ha-1) and the control (C: 27,000 stems ha-1) on WUE (the ratio of leaf photosynthesis to leaf transpiration, or tree growth to tree transpiration, or net stand above-ground biomass (AGB) accumulation to stand transpiration) and the intrinsic WUE (WUEi, the ratio of leaf photosynthesis to stomatal conductance or the net stand AGB accumulation to canopy conductance) in a 16-year old natural lodgepole pine forest. Leaf-level measurements were conducted in 2017, while tree- and stand-level measurements were conducted in both 2016 (the normal year) and 2017 (the drought year).ResultsThere was no significant effect of thinning on the tree- and stand-level WUE in 2016, while in 2017, only T2 exhibited significantly higher tree-level WUE (0.63 mm2 kg-1) than the C (0.06 mm2 kg-1), and the stand-level WUE values were significantly higher in the thinned stands, with the means of 0.34, 0.61 and 0.7 kg m-3 for the control, T1 and T2, respectively. Stand-level WUEi was, however, significantly higher in the unthinned stands than in the thinned stands. In contrast, the leaf-level WUE values were not significantly different from each other, while the leaf-level WUEi was statistically higher in C than in the thinned stands. Thinning changed the WUE-VPD relationships at tree and stand levels, but not at the leaf level.Conclusions The effects of thinning on forest carbon and water coupling differed with the spatial scales and the metrics (WUE or WUEi) of water use efficiency. Lacking consistent reponses of WUE metrics to thinning treatments across the spatial scales suggests that caution must be exercised when transferring and modeling WUE from one spatial scale to others. Both tree-level and stand-level WUE values in the more heavily thinning stands were significantly promoted under the drough condition, demonstrating that thinning can improve WUE and consequently support forests to cope with the drought effects.