bluuebunny/crossref_metadata_2025 huggingface dataset:
Home Care Delivery and Remote Patient Monitoring of Kidney Transplant Recipients During COVID-19 Pandemic
Authors: Chang Jae-Hyung , Sritharan Sharlinee , Schmitt Kevin , Patel Shefali , Crew R. John , Tsapepas Demetra S.
Published: October 2021

Telehealth plays a critical role in the response of healthcare organizations during the COVID-19 pandemic. While telemedicine offers a real-time patient-provider encounter, the inability to obtain vital signs during virtual visits is a potential limitation. Remote patient monitoring (RPM) uses portable devices in the patient‘s home to collect and electronically transmit physiological data to clinicians. Two kidney transplant recipients were enrolled in RPM in their immediate post-transplant period. Real-time monitoring of their physiological data at home through the RPM in combination with the ability to titrate medications resulted in normalization of the blood pressure and blood glucose measurements by six weeks. Our initial experience demonstrates that RPM is feasible and effective in the post-transplant period and can expand care opportunities on the remote care model. This is more relevant than ever as remote monitoring can facilitate the care of COVID-19-positive transplant patients who require close monitoring while isolated at home.
The Association of Hospital Magnet® Status and Pay-for-Performance Penalties
Authors: Dierkes Andrew M. , Riman Kathryn , Daus Marguerite , Germack Hayley D. , Lasater Karen B.
Published: October 2021

The Centers for Medicare and Medicaid Services’ Pay-for-Performance (P4P) programs aim to improve hospital care through financial incentives for care quality and patient outcomes. Magnet® recognition—a potential pathway for improving nurse work environments—is associated with better patient outcomes and P4P program scores, but whether these indicators of higher quality are substantial enough to avoid penalties and thereby impact hospital reimbursements is unknown. This cross-sectional study used a national sample of 2,860 hospitals to examine the relationship between hospital Magnet® status and P4P penalties under P4P programs: Hospital Readmission Reduction Program, Hospital-Acquired Conditions (HAC) Reduction Program, Hospital Value-Based Purchasing (VBP) Program. Magnet® hospitals were matched 1:1 with non-Magnet hospitals accounting for 13 organizational characteristics including hospital size and location. Post-match logistic regression models were used to compute a hospital's odds of penalties. In a national sample of hospitals, 77% of hospitals experienced P4P penalties. Magnet® hospitals were less likely to be penalized in the VBP program compared to their matched non-Magnet counterparts (40% vs. 48%). Magnet® status was associated with 30% lower odds of VBP penalties relative to non-Magnet hospitals. Lower P4P program penalties is one benefit associated with achieving Magnet® status or otherwise maintaining high-quality nurse work environments.
A terrain segmentation method based on pyramid scene parsing-mobile network for outdoor robots
Authors: Zhang Botao , Hong Tao , Xiong Rong , Chepinskiy Sergey A
Published: October 2021

Terrain segmentation is of great significance to robot navigation, cognition, and map building. However, the existing vision-based methods are challenging to meet the high-accuracy and real-time performance. A terrain segmentation method with a novel lightweight pyramid scene parsing mobile network is proposed for terrain segmentation in robot navigation. It combines the feature extraction structure of MobileNet and the encoding path of pyramid scene parsing network. The depthwise separable convolution, the spatial pyramid pooling, and the feature fusion are employed to reduce the onboard computing time of pyramid scene parsing mobile network. A unique data set called Hangzhou Dianzi University Terrain Dataset is constructed for terrain segmentation, which contains more than 4000 images from 10 different scenes. The data set was collected from a robot’s perspective to make it more suitable for robotic applications. Experimental results show that the proposed method has high-accuracy and real-time performance on the onboard computer. Moreover, its real-time performance is better than most state-of-the-art methods for terrain segmentation.
Understanding how the Support Needs Approach for Patients (SNAP) enables identification, expression and discussion of patient support needs: A qualitative study
Authors: Gardener A Carole , Ewing Gail , Deaton Christi , Farquhar Morag
Published: October 2021

Objectives

To identify whether and how the support needs approach for patients enables patients with chronic progressive conditions to identify, express and discuss their unmet support needs.

Methods

Thirteen healthcare professionals trained in the Support Needs Approach for Patients (SNAP), recruited from three pilot sites in the East of England (across primary, community and secondary care) delivered SNAP to 56 patients with the exemplar condition chronic obstructive pulmonary disease over a 4-month period. Healthcare professionals participated in a mid-pilot semi-structured interview (pilot site representatives) and end-of pilot focus group (all healthcare professionals). Twenty patients who received SNAP were interviewed about their experiences (topic-guided). Transcripts analysed using a framework approach.

Results

There were differences in how healthcare professionals delivered SNAP and how patients engaged with it; analysing the interaction of these identified a continuum of care (from person-centred to healthcare professional-led) which impacted patient identification and expression of need and resulting responses. When delivered as intended, SNAP operationalised person-centred care enabling patient-led identification, expression and discussion of support needs.

Discussion

SNAP addresses the rhetoric within policy, good practice guidance and the person-centred care literature espousing the need to involve patients in identifying their needs and preferences by providing healthcare professionals with a mechanism for achieving holistic person-centred care in everyday practice.
Medical professionalism: Navigating modern challenges
Authors: Cooper-Moss Nicola , Hooper Helen , Choong Kartina A. , Chauhan Umesh
Published: October 2021

Medical professionalism is an evolving entity, requiring continual development according to shifting societal priorities. The public trust that underpins the medical profession is imperative for maintaining effective partnerships with patients, their families and the wider community. This article provides an overview of what constitutes medical professionalism, including the current protocols and assessments for general practice training. The aim is to improve understanding of the current issues surrounding professionalism in primary care. Fictional case scenarios are used to illustrate modern professional dilemmas and to promote reflection on the complex interacting factors that influence professional practice and clinical decision-making.
Urethritis in men
Authors: Cooke-Jones Rob , Humphries Katie
Published: October 2021

Urethritis is simply defined as inflammation of the urethra. In the majority of cases, urethritis is caused by a sexually transmitted infection. Urethritis is the most common condition diagnosed and treated among men attending genito-urinary medicine (GUM) clinics in the UK. This article aims to outline the assessment and management of urethritis in both primary care and GUM clinics.
Murine models of sickle cell disease and beta‐thalassemia demonstrate pulmonary hypertension with distinctive features
Authors: Buehler Paul W. , Swindle Delaney , Pak David I. , Fini Mehdi A. , Hassell Kathryn , Nuss Rachelle , Wilkerson Rebecca B. , D’Alessandro Angelo , Irwin David C.
Published: October 2021

Sickle cell anemia and β‐thalassemia intermedia are very different genetically determined hemoglobinopathies predisposing to pulmonary hypertension. The etiologies responsible for the associated development of pulmonary hypertension in both diseases are multi‐factorial with extensive mechanistic contributors described. Both sickle cell anemia and β‐thalassemia intermedia present with intra and extravascular hemolysis. And because sickle cell anemia and β‐thalassemia intermedia share features of extravascular hemolysis, macrophage iron excess and anemia we sought to characterize the common features of the pulmonary hypertension phenotype, cardiac mechanics, and function as well as lung and right ventricular metabolism. Within the concept of iron, we have defined a unique pulmonary vascular iron accumulation in lungs of sickle cell anemia pulmonary hypertension patients at autopsy. This observation is unlike findings in idiopathic or other forms of pulmonary arterial hypertension. In this study, we hypothesized that a common pathophysiology would characterize the pulmonary hypertension phenotype in sickle cell anemia and β‐thalassemia intermedia murine models. However, unlike sickle cell anemia, β‐thalassemia is also a disease of dyserythropoiesis, with increased iron absorption and cellular iron extrusion. This process is mediated by high erythroferrone and low hepcidin levels as well as dysregulated iron transport due transferrin saturation, so there may be differences as well. Herein we describe common and divergent features of pulmonary hypertension in aged Berk‐ss (sickle cell anemia) and Hbbth/3+ (intermediate β‐thalassemia) mice and suggest translational utility as proof‐of‐concept models to study pulmonary hypertension therapeutics specific to genetic anemias.
How Does Individual-Level Envy Affect Team Creativity? Effects of Knowledge Seeking and Moral Reflection
Authors: Chu Fengdi , Zhang Wei , Wu Shaobo , Liu Guolei
Published: October 2021

Where there is a team, there is envy emotion among team members. Prior studies argue that two opposite types of envy—benign envy and malicious envy differently influence team members’ interactions, thus impact team creativity differently. However, little literature has discussed whether envy has a direct influence on team creativity. This research is conducted to narrow this literature gap. Moreover, if their relationship was verified, the mechanism needs to be further explored. Previous studies have shown negative public perception of envy and strong behavioral motivation function of it. Therefore, a morality-related variable—moral reflection, and a competition-related variable—knowledge seeking are introduced as mediating variables. To test the relationships among the above variables, an experiment with 74 MBA students’ participation was conducted. The results show the positive relationship between benign envy and team creativity, while malicious envy gets the opposite result. Besides, knowledge seeking and moral reflection are proven to be bridges connecting envy and team creativity. Envy is more complicated than what previous studies have found. It has positive sides to team creativity.
The BRICS Countries’ Bilateral Economic Relations, 2009 to 2019: Between Rhetoric and Reality
Authors: Hooijmaaijers Bas
Published: October 2021

After Brazil, Russia, India, and China (BRIC) started meeting in the BRIC countries format, and since 2011 with South Africa in the BRICS format, these countries’ leaders made several pledges for strengthening intra-BRICS economic cooperation. This article examines the degree this is reflected in the increase of Chinese Outward Foreign Direct Investment (COFDI) in the other four BRICS countries, the value of Chinese construction contracts, and bilateral trade between China and Brazil, India, Russia South Africa in 2009 to 2019. Focusing on these aspects contributes to the ongoing debate about the institutionalization of the BRICS political grouping. This article demonstrates that, thus far, despite the various pledges, the intensification of intra-BRICS economic cooperation is very limited. With some exemptions due to mega investment deals, COFDI in the other BRICS partners is still reasonably modest and shows no clear trend of increase over time in both absolute and relative figures. There is no significant increase in total trade, and various imbalances and asymmetries remain. Thus, the reality does not mirror the BRICS rhetoric on the intensification of economic cooperation.
Caribbean Economic Thought: Advances, Retreat, Current Challenges
Authors: Witter Michael
Published: October 2021

The reflections provided in this article were presented in the 4th Sam Moyo Memorial Lecture, delivered at the SMAIAS/ASN Summer School in January 2021. The article focuses on the critical tradition of economic knowledge and thought about the socio-economic development of the Caribbean, which began in the last decades of the colonial era. The advances made through the early Independence period were concerned with the problems of individual countries and the region as a whole. The objective was to improve the material economic welfare of the broad masses of Caribbean people while generating the requisite economic growth to sustain an improvement in the general conditions of life. From the thought of W. Arthur Lewis to the Plantation Economy theorists and subsequent critiques, a rich critical tradition emerged, only to be displaced by the onset of the debt crisis and neoliberalism. This article reviews the main elements of this critical tradition, its advances, and retreats, as well as the new challenges presented to it today.
Predictors of Mortality in Patients With Necrotizing Fasciitis: A Literature Review and Multivariate Analysis
Authors: Kjaldgaard Lindsey , Cristall Nora , Gawaziuk Justin P. , Kohja Zeenib , Logsetty Sarvesh
Published: October 2021

Background:

Necrotizing fasciitis (NF) is a life-threatening infectious disease that can result in significant morbidity and mortality. Previously identified factors have not been verified in a large population. The objective of this study is to further examine the relationship of patient factors in NF mortality.

Methods:

This study is a retrospective review on patients ≥18 years old diagnosed with NF at the provincial referral centres from 2004 to 2016. The following data were examined: demographics, comorbidities, laboratory values, length of stay, and inhospital mortality.

Results:

Three hundred forty patients satisfied the inclusion criteria: 297 survived and were discharged, 43 died in hospital. In multivariate analysis, a prognostic model for NF mortality identified age >60 years, elevated creatinine, abnormal blood platelets, and group A β-hemolytic Streptococcus (GABS) infection.

Conclusions:

Multiple factors were associated with mortality in NF. The strongest univariate association with mortality was age >60 years. In addition, a history of hypertension and/or dyslipidemia, renal disease, and the presence of GABS contributed to a predictive model for inhospital NF mortality.
Acetabular Morphology and Spinopelvic Characteristics: What Predominantly Determines Functional Acetabular Version?
Authors: DeVries Zachary , Speirs Andrew D. , Salih Saif , Beaulé Paul E. , Witt Johan , Grammatopoulos George
Published: October 2021

Background:

In addition to the relative size of the acetabular rim and how the pelvis is positioned in space, the plane in which the acetabular version is calculated also affects its measurement.

Purpose:

To determine the relative contribution of pelvic and acetabular characteristics on morphological version (measured relative to the anterior pelvic plane angle [APPA]) and functional version (measured relative to the horizontal table).

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

Included were 50 acetabular dysplasia patients and 109 asymptomatic controls. Using image analysis software, morphological parameters of the pelvis and acetabulum were determined from 2-dimensional computed topography: pelvic incidence, pelvic tilt angle, sacral slope, APPA, morphological and functional acetabular versions, and subtended angles (measure of acetabular rim prominence relative to the femoral head center) around the acetabular clockface in 30° increments. Correlation and multivariable regression analyses were performed with morphological and functional version as dependent variables and spinopelvic and acetabular parameters as independent variables.

Results:

Morphological version was moderately associated with differences between anterior and posterior subtended angles ( R = 0.68 [ P < .001] and R = 0.57 [ P < .001] for differences at 165° and 15° and 135° and 45°, respectively). Functional version was moderately associated with pelvic tilt angle ( R = 0.56; P <.001) and the difference in subtended angles between anterior and posterior rims ( R = 0.61 [ P < .001] and R = 0.50 [ P < .001] for differences at 165° and 15° and 135° and 45°, respectively). Multivariate analysis revealed a good model for predicting morphological version ( R 2 = 0.44; P < .01) and functional version ( R 2 = 0.58; P < .01). Subtended angle difference between 165° and 15° ( B = 0.36 [95% CI, 0.24-0.49]; P < .001) was most strongly related to morphological version, and pelvic tilt angle ( B = 0.57 [95% CI, 0.46-0.68]; P < .001) was most strongly related to functional version.

Conclusion:

Functional acetabular version was influenced most strongly by pelvic tilt angle rather than the relative prominence of the acetabular rims. Before determining surgical management for version abnormalities, it would be prudent to assess pelvic mobility and characteristics in different functional positions. In patients with minimal pelvic tilt change dynamically, corrective osteotomy would be the treatment of choice to improve functional version.
Second-Look Arthroscopic Evaluation of Healing Rates After Arthroscopic Repair of Meniscal Tears: A Systematic Review and Meta-analysis
Authors: Dai Wenli , Leng Xi , Wang Jian , Hu Xiaoqing , Ao Yingfang
Published: October 2021

Background:

Evaluation of meniscal healing status after repair is important, as it allows the surgeon to inform patients whether they can increase their activities or return to sports.

Purpose:

To identify the healing rates after arthroscopic repair of meniscal tears via second-look arthroscopic evaluation.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

Searches of PubMed, Embase, Scopus, and the Cochrane databases were conducted to identify relevant studies published before June 1, 2020. Studies were eligible for this meta-analysis if they provided data regarding healing status of the meniscus at second-look arthroscopy. Random-effects meta-analyses were generated to provide pooled meniscal healing estimates. We further performed subgroup analysis to investigate the healing rates of the meniscus under different situations.

Results:

A total of 41 studies with 1908 individuals were included in the study. The pooled analysis showed the complete healing rate was 74% (95% confidence interval [CI], 67%-80%), the partial healing rate was 10% (95% CI, 6%-16%), and the failure rate was 12% (95% CI, 10%-15%) for arthroscopic repair of meniscal tears via second-look arthroscopic evaluation. Sensitivity analysis demonstrated that no individual study affected the overall healing rate by >1%. Subgroup analysis found higher meniscal healing rates in patients with the following characteristics: age <40 years, male, body mass index <26, red-red tear location, tear in posterior horn, vertical tear, outside-in technique, repair concomitant with anterior cruciate ligament reconstruction, weight-restricted rehabilitation, and time interval from meniscal repair to second-look arthroscopy >12 months.

Conclusion:

In this systematic review, the complete healing rate was 74%, the partial healing rate was 10%, and the failure rate was 12% for arthroscopic repair of meniscal tears via second-look arthroscopic evaluation.
Bilateral Ischemic Retinopathy Associated With Upshaw-Schulman Syndrome: A Case Report
Authors: Cernichiaro-Espinosa Mariam , Meizner-Grezemkovsky Daniela , López-Santiago Norma , Borbolla-Pertierra Ana M. , Morales-Cantón Virgilio , Cernichiaro-Espinosa Linda A.
Published: October 2021

Purpose:

This is the first report to our knowledge of ischemic retinopathy in a pediatric patient with Upshaw-Schulman syndrome (USS).

Methods:

A 6-year-old girl previously diagnosed with USS was referred to our clinic with exodeviation of the left eye and a 2-month-long decrease in vision of both eyes. A dilated fundus examination showed a total vitreous hemorrhage in both eyes. The first course of action was conservative treatment, with the patient experiencing visual-acuity improvement in her right eye.

Results:

An ischemic retina and optic nerve atrophy was found once the left eye was cleared of the hemorrhage.

Conclusions:

We present a case of a vitreous hemorrhage, possibly secondary to an episode of severe thrombocytopenia. Following USS diagnosis, providers should perform dilated ophthalmologic examinations as part of initial and follow-up general evaluations. This case exemplifies that, in understudied and underdescribed pediatric retinal diseases, extreme therapeutic decisions—such as surgery—should not be rushed.
From wave to wave: a Dutch national study on the long-term impact of COVID-19 on well-being and family visitation in nursing homes
Authors: Backhaus Ramona , Verbeek Hilde , de Boer Bram , Urlings Judith H. J. , Gerritsen Debby L. , Koopmans Raymond T. C. M. , Hamers Jan P. H.
Published: October 2021

Background

To protect nursing home residents, many governments around the world implemented blanket visitor bans in March and April 2020. As a consequence, family caregivers, friends, and volunteers were not allowed to enter nursing homes, while residents were not allowed to go out. Up until now, little is known on the long-term consequences and effects of visiting bans and re-opening of nursing homes. The aim of the study was to assess the long-term effects of the pandemic on residents, family members, and staff, and their preparedness for the next coronavirus wave.

Methods

A mixed-methods approach was used, consisting of a questionnaire and analyses of documentation (local visiting protocols). Of the 76 nursing home locations that participated in a Dutch national pilot on welcoming visitors back into nursing homes, 64 participated in this follow-up study. Data were collected in September/October 2020. For each nursing home, one contact person completed the questionnaire. Descriptive statistics were calculated for quantitative questionnaire data. Data on open-ended questions, as well as data from the documentation, were analyzed thematically.

Results

The study demonstrated that the consequences of strict visiting bans do not disappear at the moment the visiting ban is lifted. Although in October 2020, daily life in nursing homes was more “back to normal,” more than one-third of the respondents indicated that they still applied restrictions. Compared to the situation before the pandemic, fewer volunteers were working in the nursing homes, grandchildren visited their relative less often, and visits differed.

Conclusions

Five months after the visiting ban in Dutch nursing homes had been lifted, it still had an impact on residents, family members, and staff. It is questionable whether nursing homes feel prepared for welcoming visitors in the case of new COVID-19 infections. Nursing homes indicated that they felt prepared for the next wave, while at the same time, they were particularly concerned about staff well-being and vitality. It seems wise to invest in staff well-being. In addition, it seems desirable to think about how to support nursing homes in seeking a balance between infection prevention and well-being of residents, family members, and staff.
The relationship between bone density and the oral function in older adults: a cross-sectional observational study
Authors: Hasegawa Yoko , Tsuji Shotaro , Nagai Koutatsu , Sakuramoto-Sadakane Ayumi , Tamaoka Joji , Oshitani Masayuki , Ono Takahiro , Sawada Takashi , Shinmura Ken , Kishimoto Hiromitsu
Published: October 2021

Background

Falls among older adults with a low bone density can lead to a bedridden state. Declining bone density increases the risk of falls resulting fractures in older adults. A person’s physical performance is known to be closely related to bone density, and a relationship between the physical performance and the oral function is also known to exist. However, there currently is a lack of evidence regarding the relationship between bone density and the oral function. We assessed the relationship between the bone density and the both the oral function and physical performance among older adults.

Patients and methods

754 older adults aged 65 years or older who independently lived in rural regions and who were not taking any medications for osteoporosis participated. We checked all participants for osteoporosis using an ultrasonic bone density measuring device. Regarding the oral function, we evaluated the following factors: remaining teeth, occlusal support, masticatory performance, occlusal force, and tongue pressure. We also evaluated body mass index (BMI) and skeletal muscle mass Index as clinical characteristics. The normal walking speed, knee extension force and one-leg standing test were evaluated as physical performance. For the statistical analyses, we used the Mann–Whitney U test, chi-square test, the Kruskal-Wallis, and a multiple regression analysis.

Results

Eighty-one percent of the females and 58% of the males had osteoporosis or a decreased bone mass. The occlusal force, masticatory performance and the tongue pressure showed significant association with the bone density. The participants physical performance showed a significant association with their bone states except for walking speed. According to a multiple regression analysis, clinical characteristics (sex, age, BMI), one-leg standing and occlusal force showed independent associations with the bone density. It was suggested that the bone density tends to increase if the occlusal force is high and/or the one-leg standing test results are good.

Conclusions

The bone density in the older adults showed a significant relationship not only with clinical characteristics or physical performance, but also with occlusal force. It may also be effective to confirm a good oral function in order to maintain healthy living for older adults.
Loneliness in older parents: marital transitions, family and social connections, and separate bedrooms for sleep
Authors: Chiao Chi , Lin Wen-Hsu , Chen Yu-Hua , Yi Chin-Chun
Published: October 2021

Objectives

This research innovatively analyzed the marital transitions (i.e., divorce and widowhood) of older Taiwanese parents, their sleep problems and spousal specific characteristics (i.e., separate bedrooms for sleep and marital relationships) as well as their social and family connections, all of which were simultaneously reflected in emotional and social domains of loneliness.

Methods

Data are from 1645 older parents from Northern Taiwan. Loneliness was assessed by a De Jong-Gierveld short scale with emotional and social domains. We conducted multivariate logistic regression to examine the associations of marital transitions and family/social connections regarding sleep problems and psychological well-being with loneliness in social and emotional domains. Besides sleep problems and individual socioeconomic status, we included data on couples’ sleeping arrangements and marital relationships.

Results

Social loneliness was significantly associated with being divorced (AOR = 1.80, 95% CI 1.13–2.86) and living alone (AOR = 1.50, 95% CI 1.02–2.23). In contrast, strong family cohesion and frequent weekly contact with friends were associated with lower social loneliness. Married parents who slept in separate bedrooms were more likely than bed-sharing couples to feel emotional and social loneliness, despite adjusting for their sleep problems. Furthermore, satisfactory spousal relationships significantly decreased the magnitude of associations in the social domain.

Discussion

Our findings support significant associations between loneliness in later life and major marital transitions, family and social connections and sleep problems which differ in social and emotional domains. Independent of relationship satisfaction, separate bedrooms relate to higher risks of emotional loneliness in older adults.
Langerhans cell histiocytosis misdiagnosed as cow protein allergy: a case report
Authors: Lv Xintong , Wang Libo , Pi Zhuang , Zhang Chunyan
Published: October 2021

Background

Langerhans cell histiocytosis (LCH) is a heterogeneous disease with diverse clinical manifestations. Abdominal organ involvement is rare. Early diagnosis and active treatment are needed. The purpose of this article is to enable readers to have a better knowledge of LCH and prevent misdiagnosis.

Case presentation

A 2-month-old boy had diarrhea, hematochezia, and a rash, and was diagnosed as having a cow milk protein allergy (CMPA). He was given an amino acid-based formula, but there was no sign of improvement in his condition.

The patient then had a skin biopsy and was diagnosed as having multisystem Langerhans cell histiocytosis (MS-LCH). The general condition of the child deteriorated after the first two doses of chemotherapy, and the child died.

Conclusions

MS-LCH is a protracted and progressive condition with poor prognosis. Early diagnosis and treatment are essential for survival. If a child has chronic diarrhea and hematochezia in the presence of a characteristic rash, the pediatrician should consider the possibility of this disease to avoid misdiagnosis.
Subtypes of nurses’ mental workload and interaction patterns with fatigue and work engagement during coronavirus disease 2019 (COVID-19) outbreak: A latent class analysis
Authors: Wu Jing , Li Husheng , Geng Zhaohui , Wang Yanmei , Wang Xian , Zhang Jie
Published: October 2021

Background

Nurses play critical roles when providing health care in high-risk situations, such as during the COVID-19 outbreak. However, no previous study had systematically assessed nurses’ mental workloads and its interaction patterns with fatigue, work engagement and COVID-19 exposure risk.

Methods

A cross-sectional study was conducted via online questionnaire. The NASA Task Load Index, Fatigue Scale-14, and Utrecht Work Engagement Scale were used to assess nurses’ mental workload, fatigue and work engagement, respectively. A total of 1337 valid questionnaires were received and analyzed. Nurses were categorized into different subgroups of mental workload via latent class analysis (LCA). Cross-sectional comparisons, analysis of covariance (ANCOVA), and multivariate (or logistic) regression were subsequently performed to examine how demographic variables, fatigue and work engagement differ among nurses belonging to different subgroups.

Results

Three latent classes were identified based on the responses to mental workload assessment: Class 1 – low workload perception & high self-evaluation group (n = 41, 3.1%); Class 2 – medium workload perception & medium self-evaluation group (n = 455, 34.0%); and Class 3 – high workload perception & low self-evaluation group (n = 841, `62.9%). Nurses belonging into class 3 were most likely to be older and have longer professional years, and displayed higher scores of fatigue and work engagement compared with the other latent classes (p < 0.05). Multivariate analysis showed that high cognitive workload increased subjective fatigue, and mental workload may be positively associated with work engagement. Group comparison results indicated that COVID-19 exposure contributed to significantly higher mental workload levels.

Conclusions

The complex scenario for the care of patients with infectious diseases, especially during an epidemic, raises the need for improved consideration of nurses’ perceived workload, as well as their physical fatigue, work engagement and personal safety when working in public health emergencies.
Long-acting antimuscarinic therapy in patients with chronic obstructive pulmonary disease receiving beta-blockers
Authors: Chapman Kenneth R. , Wise Robert A. , Scirica Benjamin M. , Bhatt Deepak L. , Daoud Sami Z. , Lythgoe Dan , Gil Esther Garcia
Published: October 2021

Background

Beta-blocker therapies for cardiovascular comorbidities are often withheld in patients with chronic obstructive pulmonary disease (COPD) due to potential adverse effects on airway obstruction. We carried out a post hoc analysis to determine the efficacy and safety of aclidinium in patients with moderate-to-very severe COPD and increased cardiovascular risk receiving beta-blockers at baseline versus non-users.

Methods

ASCENT-COPD was a Phase 4, multicenter, double-blind, randomized, placebo-controlled, parallel-group study. Patients were randomized 1:1 to aclidinium or placebo twice-daily for up to 3 years. Outcomes included risk of (time to first) major adverse cardiovascular events (MACE), all-cause mortality, and lung function over 3 years, and exacerbations over 1 year.

Results

Of 3589 patients, 1269 (35.4%) used beta-blockers and 2320 (64.6%) were non-users at baseline. Aclidinium did not statistically increase the risk of MACE (beta-blocker user: hazard ratio 1.01 [95% CI 0.62–1.64]; non-user: 0.80 [0.51–1.24]; interaction P = 0.48) or all-cause mortality (beta-blocker user: 1.13 [0.78–1.64]; non-user: 0.89 [0.62–1.26]; interaction P = 0.35), in patients using beta-blockers. Aclidinium reduced annualized rate of moderate-to-severe COPD exacerbation (beta-blocker user: rate ratio 0.75 [95% CI 0.60–0.94, P = 0.013]; non-user: 0.79 [0.67–0.93, P = 0.005]), delayed time to first exacerbation, and improved lung function versus placebo. There was greater trough FEV1 benefit in beta-blocker users versus non-users (least squares mean difference at 52 weeks: 111 mL [95% CI 74 mL–147 mL] versus 69 mL [42 mL–97 mL]; interaction P = 0.041).

Conclusions

This post hoc analysis supports long-acting anti-muscarinic use with concomitant beta-blockers in patients with moderate-to-very severe COPD and cardiovascular comorbidity.

Trial registration: ClinicalTrials.gov, NCT01966107, Registered 16 October 2013, https://clinicaltrials.gov/ct2/show/NCT01966107.
Diaphragmatic excursion is correlated with the improvement in exercise tolerance after pulmonary rehabilitation in patients with chronic obstructive pulmonary disease
Authors: Shiraishi Masashi , Higashimoto Yuji , Sugiya Ryuji , Mizusawa Hiroki , Takeda Yu , Fujita Shuhei , Nishiyama Osamu , Kudo Shintarou , Kimura Tamotsu , Chiba Yasutaka , Fukuda Kanji , Tohda Yuji , Matsumoto Hisako
Published: October 2021

Background

In patients with chronic obstructive pulmonary disease (COPD), the maximum level of diaphragm excursion (DEmax) is correlated with dynamic lung hyperinflation and exercise tolerance. This study aimed to elucidate the utility of DEmaxto predict the improvement in exercise tolerance after pulmonary rehabilitation (PR) in patients with COPD.

Methods

This was a prospective cohort study. Of the 62 patients with stable COPD who participated in the outpatient PR programme from April 2018 to February 2021, 50 completed the programme. Six-minute walk distance (6MWD) was performed to evaluate exercise tolerance, and ultrasonography was performed to measure DEmax. Responders to PR in exercise capacity were defined as patients who demonstrated an increase of > 30 m in 6MWD. The receiver operating characteristic (ROC) curve was used to determine the cut-off point of DEmaxto predict responses to PR.

Results

Baseline levels of forced expiratory volume in 1 s, 6MWD, maximum inspiratory pressure, DEmaxand quadriceps muscle strength were significantly higher, and peak dyspnoea of modified Borg (mBorg) scale score was lower in responders (n = 30) than in non-responders (n = 20) to PR (p < 0.01). In multivariate analysis, DEmaxwas significantly correlated with an increase of > 30 m in 6MWD. The area under the ROC curve of DEmaxto predict responders was 0.915, with a sensitivity and specificity of 83% and 95%, respectively, at a cut-off value of 44.9 mm of DEmax.

Conclusion

DEmaxcould adequately predict the improvement in exercise tolerance after PR in patients with COPD.
Molecular response to PARP1 inhibition in ovarian cancer cells as determined by mass spectrometry based proteomics
Authors: Franz Alexandra , Coscia Fabian , Shen Ciyue , Charaoui Lea , Mann Matthias , Sander Chris
Published: October 2021

Background

Poly (ADP)-ribose polymerase (PARP) inhibitors have entered routine clinical practice for the treatment of high-grade serous ovarian cancer (HGSOC), yet the molecular mechanisms underlying treatment response to PARP1 inhibition (PARP1i) are not fully understood.

Methods

Here, we used unbiased mass spectrometry based proteomics with data-driven protein network analysis to systematically characterize how HGSOC cells respond to PARP1i treatment.

Results

We found that PARP1i leads to pronounced proteomic changes in a diverse set of cellular processes in HGSOC cancer cells, consistent with transcript changes in an independent perturbation dataset. We interpret decreases in the levels of the pro-proliferative transcription factors SP1 and β-catenin and in growth factor signaling as reflecting the anti-proliferative effect of PARP1i; and the strong activation of pro-survival processes NF-κB signaling and lipid metabolism as PARPi-induced adaptive resistance mechanisms. Based on these observations, we nominate several protein targets for therapeutic inhibition in combination with PARP1i. When tested experimentally, the combination of PARPi with an inhibitor of fatty acid synthase (TVB-2640) has a 3-fold synergistic effect and is therefore of particular pre-clinical interest.

Conclusion

Our study improves the current understanding of PARP1 function, highlights the potential that the anti-tumor efficacy of PARP1i may not only rely on DNA damage repair mechanisms and informs on the rational design of PARP1i combination therapies in ovarian cancer.
Intracortical diffusion tensor imaging signature of microstructural changes in frontotemporal lobar degeneration
Authors: Torso Mario , Ridgway Gerard R. , Jenkinson Mark , Chance Steven ,   the Frontotemporal Lobar Degeneration Neuroimaging Initiative and the 4-Repeat Tau Neuroimaging Initiative (4RTNI)
Published: October 2021

Background

Frontotemporal lobar degeneration (FTLD) is a neuropathological construct with multiple clinical presentations, including the behavioural variant of frontotemporal dementia (bvFTD), primary progressive aphasia—both non-fluent variant (nfvPPA) and semantic variant (svPPA)—progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS), characterised by the deposition of abnormal tau protein in the brain. A major challenge for treating FTLD is early diagnosis and accurate discrimination among different syndromes. The main goal here was to investigate the cortical architecture of FTLD syndromes using cortical diffusion tensor imaging (DTI) analysis and to test its power to discriminate between different clinical presentations.

Methods

A total of 271 individuals were included in the study: 87 healthy subjects (HS), 31 semantic variant primary progressive aphasia (svPPA), 37 behavioural variant (bvFTD), 30 non-fluent/agrammatic variant primary progressive aphasia (nfvPPA), 47 PSP Richardson’s syndrome (PSP-RS) and 39 CBS cases. 3T MRI T1-weighted images and DTI scans were analysed to extract three cortical DTI derived measures (AngleR, PerpPD and ParlPD) and mean diffusivity (MD), as well as standard volumetric measurements. Whole brain and regional data were extracted. Linear discriminant analysis was used to assess the group discrimination capability of volumetric and DTI measures to differentiate the FTLD syndromes. In addition, in order to further investigate differential diagnosis in CBS and PSP-RS, a subgroup of subjects with autopsy confirmation in the training cohort was used to select features which were then tested in the test cohort.

Three different challenges were explored: a binary classification (controls vs all patients), a multiclass classification (HS vs bvFTD vs svPPA vs nfvPPA vs CBS vs PSP-RS) and an additional binary classification to differentiate CBS and PSP-RS using features selected in an autopsy confirmed subcohort.

Results

Linear discriminant analysis revealed that PerpPD was the best feature to distinguish between controls and all patients (ACC 86%). PerpPD regional values were able to classify correctly the different FTLD syndromes with an accuracy of 85.6%. The PerpPD and volumetric values selected to differentiate CBS and PSP-RS patients showed a classification accuracy of 85.2%.

Conclusions

(I) PerpPD achieved the highest classification power for differentiating healthy controls and FTLD syndromes and FTLD syndromes among themselves. (II) PerpPD regional values could provide an additional marker to differentiate FTD, PSP-RS and CBS.
Investigating the COVID-19 related behaviors in the public transport system
Authors: Aghdam Fatemeh Bakhtari , Sadeghi-Bazargani Homayoun , Shahsavarinia Kavous , Jafari Fatemeh , Jahangiry Leila , Gilani Neda
Published: October 2021

Background

Determining people’s healthy behaviors related to COVID-19 could be effective in providing preventive measures. The present study aims to investigate preventive behaviors associated with COVID-19 including wearing masks and keeping physical distance among the passengers on buses and public taxis measures to evaluate the ventilation systems in these vehicles.

Methods

This cross-sectional study was performed on 753 passengers on buses and taxis in Tabriz, northwestern Iran, from 15 February to 1 March 2021. Multistage sampling method was used to select the participants. Tabriz was socioeconomically divided into three areas, including high, moderate, and low socioeconomic status. Three researchers were observed passengers behaviors standing at the selected stations and assessed their behaviors according to study checklist.

Results

In total, the data were gathered from 358 (47.5%) female and 395 (52.5%) male in public transport systems. The results of this study indicated that female passengers used masks significantly more than men (P < 0.001). About 40% of men and women did not keep a physical distance of at least one meter in the public transportation system. Failing to keep social distancing was mostly observed among people with low SES (N = 103, 54%) and those who were in city center (N = 88, 48.5%). According to the multivariate regression analysis, for not wearing mask: being male [OR 4.94; 95%CI (2.62–9.28)] and using bus [(OR 3.27, 95%CI (1.73,6.19)], and for not physical distancing: having age under 25 years [OR 2.58; 95%CI (1.53,4.36)] and low socioeconomic status (SES) [OR 5.19; 95%CI (3.25,8.30)], and for no ventilation: using bus [OR 1.57; 95%CI (1.05,2.34)] were significant predictors.

Conclusion

Our results suggest that gender, type of vehicle, age, and SES were significant predictors of non-adherence to COVID-19 preventive behaviors in public transport during the pandemic. Given that social distancing is less observed in the public transportation system in Tabriz, Iran, it is necessary for government to consider and monitor guidelines to protect the passengers from COVID-19 infections by providing measures to maintain physical distance in public transportation systems. It may be possible to force vehicle owners who do not comply with health protocols to keep some distance by imposing fines.
Recent advances in the microbial synthesis of lactate-based copolymer
Authors: Guo Pengye , Luo Yuanchan , Wu Ju , Wu Hui
Published: October 2021

Due to the increasing environmental pollution of un-degradable plastics and the consumption of non-renewable resources, more attention has been attracted by new bio-degradable/based polymers produced from renewable resources. Polylactic acid (PLA) is one of the most representative bio-based materials, with obvious advantages and disadvantages, and has a wide range of applications in industry, medicine, and research. By copolymerizing to make up for its deficiencies, the obtained copolymers have more excellent properties. The development of a one-step microbial metabolism production process of the lactate (LA)-based copolymers overcomes the inherent shortcomings in the traditional chemical synthesis process. The most common lactate-based copolymer is poly(lactate-co-3-hydroxybutyrate) [P(LA-co-3HB)], within which the difference of LA monomer fraction will cause the change in the material properties. It is necessary to regulate LA monomer fraction by appropriate methods. Based on synthetic biology and systems metabolic engineering, this review mainly focus on how did the different production strategies (such as enzyme engineering, fermentation engineering, etc.) of P(LA-co-3HB) optimize the chassis cells to efficiently produce it. In addition, the metabolic engineering strategies of some other lactate-based copolymers are also introduced in this article. These studies would facilitate to expand the application fields of the corresponding materials.
Teliospore mucilage of Puccinia miscanthi revealed through the axial imaging of secondary electrons
Authors: Kim Ki Woo
Published: October 2021

Puccinia miscanthi teliospores were observed on the leaf surface of Miscanthus sinensis using a field emission scanning electron microscope. Details of teliospore mucilage could be visualized through the axial imaging of secondary electrons for a better understanding of pathogen behavior in rust diseases.
Source-independent time-lapse full-waveform inversion for anisotropic media
Authors: Liu Yanhua , Tsvankin Ilya
Published: October 2021

Time-lapse full-waveform inversion can provide high-resolution information about changes in the reservoir properties during hydrocarbon production and CO2 injection. However, the accuracy of the estimated source wavelet, which is critically important for time-lapse FWI, is often insufficient for field-data applications. The so-called “source-independent” FWI is designed to reduce the influence of the source wavelet on the inversion results. We incorporate the convolution-based source-independent technique into a time-lapse FWI algorithm for VTI (transversely isotropic with a vertical symmetry axis) media. The gradient of the modified FWI objective function is obtained from the adjoint-state method. The algorithm is tested on a model with a graben structure and the modified VTI Marmousi model using three time-lapse strategies (the parallel-difference, sequential-difference, and double-difference methods). The results confirm the ability of the developed methodology to reconstruct the localized time-lapse parameter variations even for a strongly distorted source wavelet. The algorithm remains robust in the presence of moderate noise in the input data but the accuracy of the estimated time-lapse changes depends on the model complexity.