bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence and factors associated with covert contraceptive use in Kenya: a cross-sectional study
Authors: Akoth Catherine , Oguta James Odhiambo , Gatimu Samwel Maina
Published: July 2021

Background

Family planning (FP) is a key intervention for preventing unplanned pregnancies, unsafe abortions, and maternal death. Involvement of both women and their partners promotes contraceptive acceptance, uptake and continuation, couple communication and gender-equitable attitude. Partner involvement is a key strategy for addressing about 17.5% of the unmet needs in FP in Kenya. This study assessed the prevalence and factors associated with covert contraceptive use (CCU) in Kenya.

Methods

We used data from the sixth and seventh rounds of the performance monitoring for accountability surveys. We defined CCU as “the use of contraceptives without a partner’s knowledge”. We used frequencies and percentages to describe the sample characteristics and the prevalence of CCU and assessed the associated factors using bivariate and multivariable logistic regressions.

Results

The prevalence of CCU was 12.2% (95% CI: 10.4–14.2%); highest among uneducated (22.3%) poorest (18.2%) and 35–49 years-old (12.8%) women. Injectables (53.3%) and implants (34.6%) were the commonest methods among women who practice CCU. In the bivariate analysis, Siaya county, rural residence, education, wealth, and age at sexual debut were associated with CCU. On adjusting for covariates, the odds of CCU were increased among uneducated women (aOR 3.79, 95% CI 1.73–8.31), women with primary education (aOR 1.86, 95% CI 1.06–3.29) and those from the poorest (aOR 2.67, 95% CI 1.61–4.45), poorer (aOR 1.79, 95% CI 1.05–3.04), and middle (aOR 2.40, 95% CI 1.52–3.78) household wealth quintiles and were reduced among those with 2–3 (aOR 0.49, 95% CI 0.33–0.72) and ≥ 4 children (aOR 0.62, 95% CI 0.40–0.96). Age at sexual debut (aOR 0.94, 95% CI 0.89–0.99) reduced the odds of CCU.

Conclusion

About one in 10 married women in Kenya use contraceptives covertly, with injectables and implants being the preferred methods. Our study highlights a gap in partner involvement in FP and calls for efforts to strengthen their involvement to increase contraceptive use in Kenya while acknowledging women’s right to make independent choices.
Reach, engagement and effectiveness of in-person and online lifestyle change programs to prevent diabetes
Authors: Golovaty Ilya , Wadhwa Sandeep , Fisher Lois , Lobach Iryna , Crowe Byron , Levi Ronli , Seligman Hilary
Published: July 2021

Background

COVID-19 has accelerated interest in and need for online delivery of healthcare. We examined the reach, engagement and effectiveness of online delivery of lifestyle change programs (LCP) modelled after the Diabetes Prevention Program (DPP) in a multistate, real-world setting.

Methods

Longitudinal, non-randomized study comparing online and in-person LCP in a large multistate sample delivered over 1 year. Sample included at-risk adults (n = 26,743) referred to online (n = 9) and in-person (n = 11) CDC-recognized LCP from a multi-state registry (California, Florida and Colorado) between 2015 and 2018. The main outcome was effectiveness (proportion achieving > 5% weight loss) at one-year. Our secondary outcomes included reach (proportion enrolled among referred) and engagement (proportion ≥ 9 sessions by week 26). We used logistic regression modelling to assess the association between participant- and setting -level characteristics with meaningful weight loss.

Results

Online LCP effectiveness was lower, with 23% of online participants achieving > 5% weight loss, compared with 35% of in-person participants (p < 0.001). More adults referred to online programs enrolled (56% vs 51%, p < 0.001), but fewer engaged at 6-months (attendance at ≥9 sessions 46% vs 66%, p < 0.001) compared to in-person participants.

Conclusions

Compared to adults referred to in-person LCP, those referred to online LCP were more likely to enroll and less likely to engage. Online participants achieved modest meaningful weight loss. Online delivery of LCP is an attractive strategy to deliver and scale DPP, particularly with social distancing measures currently in place. However, it is unclear how to optimize delivery models for maximal impact given trade-offs in reach and effectiveness.
Amino terminal recognition by a CCR6 chemokine receptor antibody blocks CCL20 signaling and IL-17 expression via β-arrestin
Authors: Gómez-Melero Sara , García-Maceira Fé Isabel , García-Maceira Tania , Luna-Guerrero Verónica , Montero-Peñalvo Gracia , Túnez-Fiñana Isaac , Paz-Rojas Elier
Published: July 2021

Background

CCR6 chemokine receptor is an important target in inflammatory diseases. Th17 cells express CCR6 and a number of inflammatory cytokines, including IL-17 and IL-22, which are involved in the propagation of inflammatory immune responses. CCR6 antagonist would be a potential treatment for inflammatory diseases such as psoriasis or rheumatoid arthritis. The aim of this study is to develop an antagonistic monoclonal antibody (mAb) against human CCR6 receptor (hCCR6).

Results

We generate monoclonal antibodies against hCCR6 immunizing Balb/c mice with hCCR6 overexpressing cells. The antibodies were tested by flow cytometry for specific binding to hCCR6, cloned by limiting dilution and resulted in the isolation and purification monoclonal antibody 1C6. By ELISA and flow cytometry, was determined that the antibody obtained binds to hCCR6 N-terminal domain. The ability of 1C6 to neutralize hCCR6 signaling was tested and we determined that 1C6 antibody were able to block response in β-arrestin recruitment assay with IC50 10.23 nM, but did not inhibit calcium mobilization. In addition, we found in a chemotaxis assay that 1C6 reduces the migration of hCCR6 cells to their ligand CCL20. Finally, we determined by RT-qPCR that the expression of IL-17A in Th17 cells treated with 1C6 was inhibited.

Conclusions

In the present study, we applied whole cell immunization for successfully obtain an antibody that is capable to neutralize hCCR6 signaling and to reduce hCCR6 cells migration and IL-17 expression. These results provide an efficient approach to obtain therapeutic potential antibodies in the treatment of CCR6-mediated inflammatory diseases.
Premenstrual dysphoric disorder is associated with the longer length from clitoris to urethra
Authors: Li Zheng , Xu Meng-jiao , Jin Ying , Zhu Bing-gen
Published: July 2021

Background

Premenstrual dysphoric disorder (PMDD) is a common, recently recognized, psychiatric condition among reproductive women, reflecting abnormal responsivity to ovarian steroids. Moreover, the potential organizational effect of prenatal sex hormones during PMDD has got attentions, but there have been considerably less of researches on this topic. The aim of this research was to investigate the possible role of prenatal androgen in the PMDD.

Methods

Anogenital distance (AGD), the distance between a woman’s clitoris and her urethral meatus (CUMD), left and right 2D:4D ratios were measured in 77 subjects (25 patients with PMDD), as these anthropometric indicators are considered to indirectly reflect prenatal androgen exposures in utero.

Results

Patients with PMDD had a longer CUMD than controls (25.03 ± 4.73 vs. 22.07 ± 4.30, P = 0.008), while there were no significant difference between PMDD group and control group in the AGD and right and left 2D:4D ratios.

Conclusion

Atypical high prenatal androgen exposure might predispose individuals to be susceptible to PMDD.
Patient experiences of waiting times in standardised cancer patient pathways in Norway – a qualitative interview study
Authors: Solbjør Marit , Sand Kari , Ervik Bente , Melby Line
Published: July 2021

Objective

Standardised cancer patient pathways (CPP) are implemented within cancer care with an aim to ensure standardised waiting times for diagnosis and treatment. This article investigates how patients in Norway experience waiting times within a CPP.

Methods

Qualitative semi-structured interviews with 19 patients who had been through CPP for breast cancer, prostate cancer or malignant melanoma in Norway.

Results

Few patients knew about the term CPP but trusted that waiting times were standardised to decrease mortality. Their experiences of waiting depended on their expectations as much as the period they waited. Patients generally felt safe about the timing of treatment, but not all expectations of a rapid response from health services were met. Short waiting times were interpreted as a sign of urgency, and a change of pace between urgent action and prolonged periods of waiting were disturbing.

Conclusions

Patients are comforted by knowing they are within a structured CPP that ensures rapid diagnosis and start of treatment. CPPs still need to be improved to avoid delays, allow for adaptions to patient needs, and include more information to avoid stress.
Health system gaps in cardiovascular disease prevention and management in Nepal
Authors: Shrestha Archana , Maharjan Rashmi , Karmacharya Biraj Man , Bajracharya Swornim , Jha Niharika , Shrestha Soniya , Aryal Anu , Baral Phanindra Prasad , Bhatt Rajendra Dev , Bhattarai Sanju , Bista Durga , Citrin David , Dhimal Meghnath , Fitzpatrick Annette L. , Jha Anjani Kumar , Karmacharya Robin Man , Mali Sushmita , Neupane Tamanna , Oli Natalia , Pandit Rajan , Parajuli Surya Bahadur , Pradhan Pranil Man Singh , Prajapati Dipanker , Pyakurel Manita , Pyakurel Prajjwal , Rai Binuka Kulung , Sapkota Bhim Prasad , Sapkota Sujata , Shrestha Abha , Shrestha Anmol Purna , Shrestha Rajeev , Sharma Guna Nidhi , Sharma Sumitra , Spiegelman Donna , Suwal Punya Shori , Thapa Bobby , Vaidya Abhinav , Xu Dong , Yan Lijing L. , Koju Rajendra
Published: July 2021

Background

Cardiovascular diseases (CVDs) are the leading cause of deaths and disability in Nepal. Health systems can improve CVD health outcomes even in resource-limited settings by directing efforts to meet critical system gaps. This study aimed to identify Nepal’s health systems gaps to prevent and manage CVDs.

Methods

We formed a task force composed of the government and non-government representatives and assessed health system performance across six building blocks: governance, service delivery, human resources, medical products, information system, and financing in terms of equity, access, coverage, efficiency, quality, safety and sustainability. We reviewed 125 national health policies, plans, strategies, guidelines, reports and websites and conducted 52 key informant interviews. We grouped notes from desk review and transcripts’ codes into equity, access, coverage, efficiency, quality, safety and sustainability of the health system.

Results

National health insurance covers less than 10% of the population; and more than 50% of the health spending is out of pocket. The efficiency of CVDs prevention and management programs in Nepal is affected by the shortage of human resources, weak monitoring and supervision, and inadequate engagement of stakeholders. There are policies and strategies in place to ensure quality of care, however their implementation and supervision is weak. The total budget on health has been increasing over the past five years. However, the funding on CVDs is negligible.

Conclusion

Governments at the federal, provincial and local levels should prioritize CVDs care and partner with non-government organizations to improve preventive and curative CVDs services.
The impacts of family physician plan and health transformation plan on hospitalization rates in Iran: an interrupted time series
Authors: Rouhani Samad , Esmaeili Reza , Yazdani Charati Jamshid , Khandehroo Masoud
Published: July 2021

Background

Low and middle income countries has recently implemented various reforms toward Universal Health Coverage (UHC). This study aims to assess the impact of Family Physician Plan (FPP) and Health Transformation Plan (HTP) on hospitalization rate in Iran.

Methods

We conducted an Interrupted Time Series (ITS) design. The data was monthly hospitalization of Mazandaran province over a period of 7 years. Segmented regression analysis was applied in R version 3.6.1.

Results

A decreasing trend by − 0.056 for every month was found after implementation of Family Physician Plan, but this was not significant. Significant level change was appeared at the beginning of Health Transformation Plan and average of hospitalization rate increased by 1.04 (P < 0.001). Also hospitalization trend increased significantly nearly 0.09 every month in period after Health Transformation Plan (P < 0.001).

Conclusions

Family physician created a decreasing trend for hospitalization in urban area of Mazandaran province in Iran. HTP with lower user fee in governmental public hospitals and clinics as well as fee-for-service mechanisms, stimulated both level and trend changes in hospital admissions. Some integrated health policy is required to optimize the implementation of diverse simultaneous reforms in low and middle-income countries.
The prognostic outcome of ‘type 2 diabetes mellitus and breast cancer’ association pivots on hypoxia-hyperglycemia axis
Authors: Durrani Ilhaam Ayaz , Bhatti Attya , John Peter
Published: July 2021

Type 2 diabetes mellitus and breast cancer are complex, chronic, heterogeneous, and multi-factorial diseases; with common risk factors including but not limited to diet, obesity, and age. They also share mutually inclusive phenotypic features such as the metabolic deregulations resulting from hyperglycemia, hypoxic conditions and hormonal imbalances. Although, the association between diabetes and cancer has long been speculated; however, the exact molecular nature of this link remains to be fully elucidated. Both the diseases are leading causes of death worldwide and a causal relationship between the two if not addressed, may translate into a major global health concern. Previous studies have hypothesized hyperglycemia, hyperinsulinemia, hormonal imbalances and chronic inflammation, as some of the possible grounds for explaining how diabetes may lead to cancer initiation, yet further research still needs to be done to validate these proposed mechanisms. At the crux of this dilemma, hyperglycemia and hypoxia are two intimately related states involving an intricate level of crosstalk and hypoxia inducible factor 1, at the center of this, plays a key role in mediating an aggressive disease state, particularly in solid tumors such as breast cancer. Subsequently, elucidating the role of HIF1 in establishing the diabetes-breast cancer link on hypoxia-hyperglycemia axis may not only provide an insight into the molecular mechanisms underlying the association but also, illuminate on the prognostic outcome of the therapeutic targeting of HIF1 signaling in diabetic patients with breast cancer or vice versa. Hence, this review highlights the critical role of HIF1 signaling in patients with both T2DM and breast cancer, potentiates its significance as a prognostic marker in comorbid patients, and further discusses the potential prognostic outcome of targeting HIF1, subsequently establishing the pressing need for HIF1 molecular profiling-based patient selection leading to more effective therapeutic strategies emerging from personalized medicine.
Derivation and validation of a lipid-covered prognostic model for mature T-cell lymphomas
Authors: Lu Tiange , Shi Lei , Shi Guanggang , Cai Yiqing , Hu Shunfeng , Liu Jiarui , Ren Shuai , Zhou Xiangxiang , Wang Xin
Published: July 2021

Background

Mature T-cell lymphomas (MTCLs), a group of diseases with high aggressiveness and vulnerable prognosis, lack for the accurate prognostic stratification systems at present. Novel prognostic markers and models are urgently demanded. Aberrant lipid metabolism is closely related to the tumor progression but its prognostic significance in MTCLs remains unexplored. This study aims to investigate the relationship between dysregulated lipid metabolism and survival prognosis of MTCLs and establish a novel and well-performed prognostic scoring system for MTCL patients.

Methods

A total of 173 treatment-naive patients were enrolled in this study. Univariate and multivariate Cox regression analysis were performed to assess the prognostic significance of serum lipid profiles and screen out independent prognostic factors, which constituted a novel prognostic model for MTCLs. The performance of the novel model was assessed in the training and validation cohort, respectively, by examining its calibration, discrimination and clinical utility.

Results

Among the 173 included patients, 115 patients (01/2006–12/2016) constituted the training cohort and 58 patients (01/2017–06/2020) formed the validation cohort. Univariate analysis revealed declined total cholesterol (TC, P = 0.000), high-density lipoprotein cholesterol (HDL-C, P = 0.000) and increased triglycerides (TG, P = 0.000) correlated to inferior survival outcomes. Multivariate analysis revealed extranodal involved sites ≥ 2 (hazard ratio [HR]: 2.439; P = 0.036), β2-MG ≥ 3 mg/L (HR: 4.165; P = 0.003) and TC < 3.58 mmol/L (HR: 3.338; P = 0.000) were independent predictors. Subsequently, a novel prognostic model, EnBC score, was constructed with these three factors. Harrell’s C-index of the model in the training and validation cohort was 0.840 (95% CI 0.810–0.870) and 0.882 (95% CI 0.822–0.942), respectively, with well-fitted calibration curves. The model divided patients into four risk groups with distinct OS [median OS: not available (NA) vs. NA vs. 14.0 vs. 4.0 months, P < 0.0001] and PFS (median PFS: 84.0 vs. 19.0 vs. 8.0 vs. 1.5 months, P < 0.0001). Time-dependent receiver operating characteristic curve and decision curve analysis  further revealed that EnBC score provided higher diagnostic capacity and clinical benefit, compared with International Prognostic Index (IPI).

Conclusion

Firstly, abnormal serum lipid metabolism was demonstrated significantly related to the survival of MTCL patients. Furthermore, a lipid-covered prognostic scoring system was established and performed well in stratifying patients with MTCLs.
Malaria prevalence and long-lasting insecticidal net use in rural western Uganda: results of a cross-sectional survey conducted in an area of highly variable malaria transmission intensity
Authors: Cote Claire M. , Goel Varun , Muhindo Rabbison , Baguma Emmanuel , Ntaro Moses , Shook-Sa Bonnie E. , Reyes Raquel , Staedke Sarah G. , Mulogo Edgar M. , Boyce Ross M.
Published: July 2021

Background

Long-lasting insecticidal nets (LLINs) remain a cornerstone of malaria control, but strategies to sustain universal coverage and high rates of use are not well-defined. A more complete understanding of context-specific factors, including transmission intensity and access to health facilities, may inform sub-district distribution approaches and tailored messaging campaigns.

Methods

A cross-sectional survey of 2190 households was conducted in a single sub-county of western Uganda that experiences highly variable malaria transmission intensity. The survey was carried out approximately 3 years after the most recent mass distribution campaign. At each household, study staff documented reported LLIN use and source among children 2 to 10 years of age and performed a malaria rapid diagnostic test. Elevation and distance to the nearest health facility was estimated for each household. Associations between parasite prevalence and LLIN use were estimated from log binomial regression models with elevation and distance to clinic being the primary variables of interest.

Results

Overall, 6.8% (148 of 2170) of children age 2–10 years of age had a positive RDT result, yielding a weighted estimate of 5.8% (95% confidence interval [CI] 5.4–6.2%). There was substantial variability in the positivity rates among villages, with the highest elevation villages having lower prevalence than lowest-elevation villages (p < .001). Only 64.7% (95% CI 64.0–65.5%) of children were reported to have slept under a LLIN the previous night. Compared to those living < 1 km from a health centre, households at ≥ 2 km were less likely to report the child sleeping under a LLIN (RR 0.86, 95% CI 0.83–0.89, p < .001). Households located farther from a health centre received a higher proportion of LLINs from government distributions compared to households living closer to health centres.

Conclusions

LLIN use and sourcing was correlated with household elevation and estimated distance to the nearest health facility. The findings suggest that current facility-based distribution strategies are limited in their reach. More frequent mass distribution campaigns and complementary approaches are likely required to maintain universal LLIN coverage and high rates of use among children in rural Uganda.
Portable HEPA filter air cleaner use during pregnancy and children’s behavior problem scores: a secondary analysis of the UGAAR randomized controlled trial
Authors: Enkhbat Undarmaa , Gombojav Enkhjargal , Banzrai Chimeglkham , Batsukh Sarangerel , Boldbaatar Buyantushig , Enkhtuya Enkhtuul , Ochir Chimedsuren , Bellinger David C. , Lanphear Bruce P. , McCandless Lawrence C. , Allen Ryan W.
Published: July 2021

Background

Developmental exposure to particulate matter (PM) air pollution may impair children’s behaviors. Our objectives were to quantify the impact of reducing indoor PM using portable HEPA filter air cleaners during pregnancy on behavioral problems in children and to assess associations between indoor fine PM (PM2.5) concentrations during pregnancy and children’s behavior.

Methods

This is a secondary analysis of a single-blind parallel-group randomized controlled trial in which we randomly assigned 540 non-smoking pregnant women to receive 1 or 2 HEPA filter air cleaners or no air cleaners. We administered the Behavior Assessment System for Children (BASC-3) to caregivers when children were a mean age of 23 months, and again at a mean age of 48 months. Primary outcomes were the four BASC-3 composite scales: externalizing problems, internalizing problems, adaptive skills, and the behavioral symptoms index. We imputed missing data using multiple imputation with chained equations. The primary analysis was by intention-to-treat. In a secondary analysis, we evaluated associations between BASC-3 composite indices and modeled trimester-specific PM2.5 concentrations inside residences.

Results

We enrolled participants at a median of 11 weeks gestation. After excluding miscarriages, still births and neonatal deaths, our analysis included 478 children (233 control and 245 intervention). We observed no differences in the mean BASC-3 scores between treatment groups. An interquartile increase (20.1 µg/m3) in first trimester PM2.5 concentration was associated with higher externalizing problem scores (2.4 units, 95% CI: 0.7, 4.1), higher internalizing problem scores (2.4 units, 95% CI: 0.7, 4.0), lower adaptive skills scores (-1.5 units, 95% CI: -3.0, 0.0), and higher behavior symptoms index scores (2.3 units, 95% CI: 0.7, 3.9). Third trimester PM2.5 concentrations were also associated with some behavioral indices at age 4, but effect estimates were smaller. No significant associations were observed with PM2.5 concentrations during the second trimester or for any of the BASC indices when children were 2 years old.

Conclusion

We found no benefit of reducing indoor particulate air pollution during pregnancy on parent-reported behaviors in children. Associations between indoor PM2.5 concentrations in the first trimester and behavioral scores among 4-year old children suggest that it may be necessary to intervene early in pregnancy to protect children, but these exploratory findings should be interpreted cautiously.

Trial registration

ClinicalTrials.gov: NCT01741051
Amplified antitumor efficacy by a targeted drug retention and chemosensitization strategy-based “combo” nanoagent together with PD-L1 blockade in reversing multidrug resistance
Authors: Jiang Weixi , Su Lei , Ao Meng , Guo Xun , Cheng Chen , Luo Yuanli , Xie Zhuoyan , Wang Xingyue , Wang Junrui , Liu Shuling , Cao Yang , Li Pan , Wang Zhigang , Ran Haitao , Zhou Zhiyi , Ren Jianli
Published: July 2021

Background

Recent studies have demonstrated that multidrug resistance (MDR) is a critical factor in the low efficacy of cancer chemotherapy. The main mechanism of MDR arises from the overexpression of P-glycoprotein (P-gp), which actively enhances drug efflux and limits the effectiveness of chemotherapeutic agents.

Results

In this study, we fabricated a “combo” nanoagent equipping with triple synergistic strategies for enhancing antitumor efficacy against MDR cells. Tumor homing-penetrating peptide endows the nanosystem with targeting and penetrating capabilities in the first stage of tumor internalization. The abundant amine groups of polyethylenimine (PEI)-modified nanoparticles then trigger a proton sponge effect to promote endo/lysosomal escape, which enhances the intracellular accumulation and retention of anticancer drugs. Furthermore, copper tetrakis(4-carboxyphenyl)porphyrin (CuTCPP) encapsulated in the nanosystem, effectively scavenges endogenous glutathione (GSH) to reduce the detoxification mediated by GSH and sensitize the cancer cells to drugs, while simultaneously serving as a photoacoustic imaging (PAI) contrast agent for image visualization. Moreover, we also verify that these versatile nanoparticles in combination with PD-1/PD-L1 blockade therapy can not only activate immunological responses but also inhibit P-gp expression to obliterate primary and metastatic tumors.

Conclusion

This work shows a significant enhancement in therapeutic efficacy against MDR cells and syngeneic tumors by using multiple MDR reversing strategies compared to an equivalent dose of free paclitaxel.

Graphic Abstract
Community-based surveillance in internally displaced people’s camps and urban settings during a complex emergency in Yemen in 2020
Authors: Baaees Manal Salem Omar , Naiene Jeremias D. , Al-Waleedi Ali Ahmed , Bin-Azoon Nasreen Salem , Khan Muhammad Fawad , Mahmoud Nuha , Musani Altaf
Published: July 2021

Background

The need for early identification of coronavirus disease (COVID-19) cases in communities was high in Yemen during the first wave of the COVID-19 epidemic because most cases presenting to health facilities were severe. Early detection of cases would allow early interventions to interrupt the transmission chains. This study aimed to describe the implementation of community-based surveillance (CBS) in in internally displaced people (IDP) camps and urban settings in Yemen from 15 April 2020 to 30 September 2020.

Methods

Following the Centers for Disease Control and Prevention guidance for evaluation of surveillance systems, we assessed the usefulness and acceptability of CBS. For acceptability, we calculated the proportion of trained volunteers who reported disease alerts. To assess the usefulness, we compared the alerts reported through the electronic diseases early warning system (eDEWS) with the alerts reported through CBS and described the response activities implemented.

Results

In Al-Mukalla City, 18% (14/78) of the volunteers reported at least one alert. In IDP camps, 58% (18/31) of volunteers reported at least one alert. In Al-Mukalla City, CBS detected 49 alerts of influenza-like illness, whereas health facilities detected 561 cases of COVID-19. In IDP camps, CBS detected 91 alerts of influenza-like illness, compared to 10 alerts detected through eDEWS. In IDP camps, CBS detected three other syndromes besides influenza-like illness (febrile illness outbreak suspicion, acute diarrhoea, and skin disease). In IDP camps, public health actions were implemented for each disease detected and no further cases were reported.

Conclusions

In Yemen, CBS was useful for detecting suspected outbreaks in IDP camps. CBS implementation did not yield expected results in general communities in urban areas in the early stage of the COVID-19 pandemic when little was known about the disease. In the urban setting, the system failed to detect suspected COVID-19 cases and other diseases despite the ongoing outbreaks reported through eDEWS. In Yemen, as in other countries, feasibility and acceptability studies should be conducted few months before CBS expansion in urban communities. The project should be expanded in IDP camps, by creating COVID-19 and other disease outbreak reporting sites.
Coordinated changes in gene expression kinetics underlie both mouse and human erythroid maturation
Authors: Barile Melania , Imaz-Rosshandler Ivan , Inzani Isabella , Ghazanfar Shila , Nichols Jennifer , Marioni John C. , Guibentif Carolina , Göttgens Berthold
Published: July 2021

Background

Single-cell technologies are transforming biomedical research, including the recent demonstration that unspliced pre-mRNA present in single-cell RNA-Seq permits prediction of future expression states. Here we apply this RNA velocity concept to an extended timecourse dataset covering mouse gastrulation and early organogenesis.

Results

Intriguingly, RNA velocity correctly identifies epiblast cells as the starting point, but several trajectory predictions at later stages are inconsistent with both real-time ordering and existing knowledge. The most striking discrepancy concerns red blood cell maturation, with velocity-inferred trajectories opposing the true differentiation path. Investigating the underlying causes reveals a group of genes with a coordinated step-change in transcription, thus violating the assumptions behind current velocity analysis suites, which do not accommodate time-dependent changes in expression dynamics. Using scRNA-Seq analysis of chimeric mouse embryos lacking the major erythroid regulator Gata1, we show that genes with the step-changes in expression dynamics during erythroid differentiation fail to be upregulated in the mutant cells, thus underscoring the coordination of modulating transcription rate along a differentiation trajectory. In addition to the expected block in erythroid maturation, the Gata1-chimera dataset reveals induction of PU.1 and expansion of megakaryocyte progenitors. Finally, we show that erythropoiesis in human fetal liver is similarly characterized by a coordinated step-change in gene expression.

Conclusions

By identifying a limitation of the current velocity framework coupled with in vivo analysis of mutant cells, we reveal a coordinated step-change in gene expression kinetics during erythropoiesis, with likely implications for many other differentiation processes.
MRI-based radiomics models to assess prostate cancer, extracapsular extension and positive surgical margins
Authors: He Dong , Wang Ximing , Fu Chenchao , Wei Xuedong , Bao Jie , Ji Xuefu , Bai Honglin , Xia Wei , Gao Xin , Huang Yuhua , Hou Jianquan
Published: July 2021

Purpose

To investigate the performance of magnetic resonance imaging (MRI)-based radiomics models for benign and malignant prostate lesion discrimination and extracapsular extension (ECE) and positive surgical margins (PSM) prediction.

Methods and materials

In total, 459 patients who underwent multiparametric MRI (mpMRI) before prostate biopsy were included. Radiomic features were extracted from both T2-weighted imaging (T2WI) and the apparent diffusion coefficient (ADC). Patients were divided into different training sets and testing sets for different targets according to a ratio of 7:3. Radiomics signatures were built using radiomic features on the training set, and integrated models were built by adding clinical characteristics. The areas under the receiver operating characteristic curves (AUCs) were calculated to assess the classification performance on the testing sets.

Results

The radiomics signatures for benign and malignant lesion discrimination achieved AUCs of 0.775 (T2WI), 0.863 (ADC) and 0.855 (ADC + T2WI). The corresponding integrated models improved the AUC to 0.851/0.912/0.905, respectively. The radiomics signatures for ECE achieved the highest AUC of 0.625 (ADC), and the corresponding integrated model achieved the highest AUC (0.728). The radiomics signatures for PSM prediction achieved AUCs of 0.614 (T2WI) and 0.733 (ADC). The corresponding integrated models reached AUCs of 0.680 and 0.766, respectively.

Conclusions

The MRI-based radiomics models, which took advantage of radiomic features on ADC and T2WI scans, showed good performance in discriminating benign and malignant prostate lesions and predicting ECE and PSM. Combining radiomics signatures and clinical factors enhanced the performance of the models, which may contribute to clinical diagnosis and treatment.
Presence of dogs and proximity to a wildlife reserve increase household level risk of tungiasis in Kwale, Kenya
Authors: Larson Peter S , Ono Masanobu , Changoma Mwatasa , Goto Kensuke , Kaneko Satoshi , Moji Kazuhiko , Minakawa Noboru
Published: July 2021

Introduction

Tungiasis is a ectopic skin disease caused by some species of fleas in the Tunga genus, most notably T. penetrans. The disease afflicts poor and marginalized communities in developing countries. Transmission of tungiasis comprises a complex web of factors including domesticated animals and wildlife. This research explores animal and environmental risk factors for tungiasis in an area adjacent to a wildlife reserve in Kwale, Kenya.

Methods

A two-stage complex sampling strategy was used. Households were selected from three areas in and around Kwale Town, Kenya, an area close to the Kenyan Coast. Households were listed as positive if at least one member had tungiasis. Each household was administered a questionnaire regarding tungiasis behaviors, domesticated animal assets, and wild animal species that frequent the peridomiciliary area. Associations of household tungiasis were tests with household and environmental variables using regression methods.

Results

The study included 319 households. Of these, 41 (12.85%) were found to have at least one person who had signs of tungiasis. There were 295 (92.48%) households that possessed at least one species of domesticated animal. It was reported that wildlife regularly come into the vicinity of the home 90.59% of households. Presence of dogs around the home (OR 3.85; 95% CI 1.84; 8.11) and proximity to the park were associated with increased risk for tungiasis infestation in humans in a multivariate regression model.

Conclusions

Human tungiasis is a complex disease associated with domesticated and wild animals. Canines in particular appear to be important determinants of household level risk.
Can politically oriented interventions in built heritage contribute to its authenticity? Erbil Citadel’s Babylonian Gate as a case study
Authors: Jasim Mohammed Awadh , Hanks Laura , Borsi Katharina
Published: July 2021

Today, the concept of built heritage authenticity is aprojection screen for conflicting demandsand thus a ‘contested field’. Short-sighted readings started to drag the concept behind different ill-considered treatises, in which some heritage aspects loosely outweighed other aspects. Archaeological perspectives that tend to freeze heritage structures in time, such as those that are privileged upon other contemporary socio-cultural issues, while political takes also overshadowed other epistemological prospects, and vice versa. Repercussions have made inclusion of what is regarded as ‘inevitable changes’ within the built context problematic as to the re-interpretation and thus assessment of its authenticity. Despite their possible momentary threat to the latter, these changes may add to the cultural value of the context over time, granting new potential that may instead boost its authenticity. This paper investigates the potential continuity of Erbil Citadel’s Babylonian Gate as an inevitable change within the site’s built context by studying the Gate’s controversial political impacts on the context’s authenticity. This study affirms that authenticity is a transcendental value of an open-ended progressive nature, which cannot be reduced to a specific period or properties within the historical chronology of built heritage. Hence, authenticity should be approached as a meaningful existential issue, while revelation of its essence and thus its dimension entails precise scrutiny of both the tangibles and intangibles of the context. However, to be part of its authenticity, any change in the context should be adaptable and possibly incorporated as a new value within its cultural strata, thus enabling progressive support for site authenticity.
Adapting the Trauma History Questionnaire for use in a population of homeless people with severe mental illness in Tamil Nadu, India: qualitative study
Authors: Gilmoor Andrew R. , Vallath Smriti , Peters Ruth M. H. , van der Ben Denise , Ng Lauren
Published: July 2021

Background

The Trauma History Questionnaire (THQ) is one of the most widely used traumatic event inventories, but its lack of validation makes it unsuitable for the millions of homeless people with severe mental illness in India, who are particularly vulnerable to trauma exposure.

Aims

To translate and culturally adapt the THQ for use in a population of homeless people with severe mental illness in Tamil Nadu, India.

Method

We used Herdman et al's model of cultural equivalence to conduct an in-depth qualitative assessment of the cultural validity of the THQ. Following several translations, conceptual, item, semantic and operational equivalence of the THQ was assessed through four focus groups with user-survivors (n = 20) and two focus groups with mental health professionals (n = 11).

Results

Several adaptations, including the addition of 18 items about relationships, homelessness and mental illness, were necessary to improve cultural validity. Three items, such as rape, were removed for reasons of irrelevance or cultural insensitivity. Items like ‘adultery’ and ‘mental illness’ were reworded to ‘extramarital affair’ and ‘mental health problem’, respectively, to capture the cultural nuances of the Tamil language. Findings revealed a divergence in views on tool acceptability between user-survivors, who felt empowered to voice their experiences, and mental health professionals, who were concerned for patient well-being. Providing a sense of pride and autonomy, user-survivors preferred self-administration, whereas mental health professionals preferred rater administration.

Conclusions

Culture significantly affects what types of events are considered traumatic, highlighting the importance of cultural validation of instruments for use in novel populations and settings.
Leptin Attenuates Cardiac Hypertrophy in Patients With Generalized Lipodystrophy
Authors: Nguyen My-Le , Sachdev Vandana , Burklow Thomas R , Li Wen , Startzell Megan , Auh Sungyoung , Brown Rebecca J
Published: July 2021

Context

Lipodystrophy syndromes are rare disorders of deficient adipose tissue, low leptin, and severe metabolic disease, affecting all adipose depots (generalized lipodystrophy, GLD) or only some (partial lipodystrophy, PLD). Left ventricular (LV) hypertrophy is common (especially in GLD); mechanisms may include hyperglycemia, dyslipidemia, or hyperinsulinemia.

Objective

Determine effects of recombinant leptin (metreleptin) on cardiac structure and function in lipodystrophy.

Methods

Open-label treatment study of 38 subjects (18 GLD, 20 PLD) at the National Institutes of Health before and after 1 (N = 27), and 3 to 5 years (N = 23) of metreleptin. Outcomes were echocardiograms, blood pressure (BP), triglycerides, A1c, and homeostasis model assessment of insulin resistance.

Results

In GLD, metreleptin lowered triglycerides (median [interquartile range] 740 [403-1239], 138 [88-196], 211 [136-558] mg/dL at baseline, 1 year, 3-5 years, P < .0001), A1c (9.5 ± 3.0, 6.5 ± 1.6, 6.5 ± 1.9%, P < .001), and HOMA-IR (34.1 [15.2-43.5], 8.7 [2.4-16.0], 8.9 [2.1-16.4], P < .001). Only HOMA-IR improved in PLD (P < .01). Systolic BP decreased in GLD but not PLD. Metreleptin improved cardiac parameters in patients with GLD, including reduced posterior wall thickness (9.8 ± 1.7, 9.1 ± 1.3, 8.3 ± 1.7 mm, P < .01), and LV mass (140.7 ± 45.9, 128.7 ± 37.9, 110.9 ± 29.1 g, P < .01), and increased septal e′ velocity (8.6 ± 1.7, 10.0 ± 2.1, 10.7 ± 2.4 cm/s, P < .01). Changes remained significant after adjustment for BP. In GLD, multivariate models suggested that reduced posterior wall thickness and LV mass index correlated with reduced triglycerides and increased septal e′ velocity correlated with reduced A1c. No changes in echocardiographic parameters were seen in PLD.

Conclusion

Metreleptin attenuated cardiac hypertrophy and improved septal e′ velocity in GLD, which may be mediated by reduced lipotoxicity and glucose toxicity. The applicability of these findings to leptin-sufficient populations remains to be determined.
The RNA helicase Ddx52 functions as a growth switch in juvenile zebrafish
Authors: Tseng Tzu-Lun , Wang Ying-Ting , Tsao Chang-Yu , Ke Yi-Teng , Lee Yi-Ching , Hsu Hwei-Jan , Poss Kenneth D. , Chen Chen-Hui
Published: July 2021

Vertebrate animals usually display robust growth trajectories during juvenile stages, and reversible suspension of this growth momentum by a single genetic determinant has not been reported. Here, we report a single genetic factor that is essential for juvenile growth in zebrafish. Using a forward genetic screen, we recovered a temperature-sensitive allele, pan (after Peter Pan), that suspends whole-organism growth at juvenile stages. Remarkably, even after growth is halted for a full 8-week period, pan mutants are able to resume a robust growth trajectory after release from the restrictive temperature, eventually growing into fertile adults without apparent adverse phenotypes. Positional cloning and complementation assays revealed that pan encodes a probable ATP-dependent RNA helicase (DEAD-Box Helicase 52; ddx52) that maintains the level of 47S precursor ribosomal RNA. Furthermore, genetic silencing of ddx52 and pharmacological inhibition of bulk RNA transcription similarly suspend the growth of flies, zebrafish and mice. Our findings reveal evidence that safe, reversible pauses of juvenile growth can be mediated by targeting the activity of a single gene, and that its pausing mechanism has high evolutionary conservation.
Ciencia y argumentos científicos en la controversia sobre la instalación del proyecto HidroAysén: normativa, debate y proceso
Authors: Broitman Claudio , Rocamora Villena Verónica
Published: July 2021

La construcción de un gran proyecto hidroeléctrico en la Patagonia chilena produjo un debate que enfrentó los argumentos de promotores y opositores. Este artículo analiza la estrategia comunicacional de los principales actores de esta emblemática controversia y devela la forma en que ambos se adaptaron a la coyuntura, con diferente grado de flexibilidad, movilizando el discurso científico-técnico como marca de legitimación. Sin embargo, a medida que se mediatizó el conflicto y se definieron claramente los posicionamientos, se observaron cambios en la manera como se desplegaron los argumentos. Mientras que en el caso de los opositores se destaca una participación permanente de los científicos durante toda la controversia, no fue así con los promotores. Si bien estas voces expertas, que fueron reclutadas tempranamente por la empresa HidroAysén, se diluyeron durante el conflicto, se puede señalar que sus ar gumentos pervivieron a lo largo del debate.
Girlguides' awareness of and attitudes towards sun risks and sun-protective behaviours
Authors: Griffiths Emily , Owen Alison , Taylor Jennifer
Published: July 2021

This study was designed to explore girlguiding members' awareness of and attitudes towards sun risks and sun-protection behaviours. Girlguides represent a particularly important group for exploring awareness and attitudes, not only because of their adolescent age range but also because of the time they spend participating in a variety of outdoor activities. Two focus groups were facilitated, with a total of 10 participants between the ages of 12 and 18 years. Four themes were identified following thematic analysis of the data, which capture the awareness and attitudes of the participants: 1) Uncertainty over the specifics; 2) The importance of the influence of others; 3) Tanned appearance is positive; 4) The importance of increased education. The implications of the research include a need for further education in schools and at home, as well as in groups such as girlguiding, so that young people, especially adolescent girls, understand the importance of protecting themselves from ultraviolet radiation.
How will you raise your school nursing roar?
Authors: White Sharon
Published: July 2021

In light of International Nurses Day 2021, Sharon White reflects on the importance of the school and public health nurse role, as well as the impact of the COVID-19 pandemic on the mental and physical health and wellbeing of children and young people.
Anaesthetic management of dogs with myxomatous mitral valve disease
Authors: Crosland Andrew , Love Brian , Trimble Toby
Published: July 2021

Myxomatous mitral valve disease is the most commonly acquired heart disease in the dog. Affected dogs have a reduced forward stroke volume as a result of the regurgitant flow back through the compromised mitral valve leaflets. Primary care practitioners will be all too familiar with the challenges of performing a general anaesthetic on these animals and unfortunately, there is no ideal protocol for every case. Having knowledge of the haemodynamic changes that occur with myxomatous mitral valve disease, compared to structurally normal hearts, as well as a good understanding of pharmacological effects of agents used in general anaesthesia, is essential in the safe management of these cases. This article will summarise disease pathophysiology, concurrent cardiac medications and commonly used pre-anaesthetic, induction and maintenance agents available in primary care practice for use in dogs with myxomatous mitral valve disease.
Non-Hermitian flat bands in rhombic microring resonator arrays
Authors: Ding Lu , Lin Zekun , Ke Shaolin , Wang Bing , Lu Peixiang
Published: July 2021

We investigate the flat bands in a quasi-one-dimensional rhombic array composed of evanescently coupled microring resonators (MRRs) with non-Hermitian coupling. By changing the relative position of non-Hermitian coupling in each cell, we construct topologically trivial and nontrivial flat bands, where both the real and imaginary parts of energy bands become flat and coalesce into a single band. We show the nontrivial systems are able to support topological boundary modes isolated from the flat bulk bands although there is no band gap. The elusive topology of flat bands can be geometrically visualized by plotting the trajectories of their eigenvectors on Bloch sphere based on Majorana’s stellar representation (MSR). Furthermore, we perform a full wave simulation and show the characteristics of flat bands, associated compact localized modes, and boundary modes are reflected from absorption spectra and field intensity profiles. The study may find potential applications in lasers, narrowband filters, and efficient light harvesting.
The Nordic noir brand
Authors: Nestingen Andrew
Published: July 2021

Editing the volume Nordic Noir, Adaptation, Appropriation with Linda Badley and Jaakko Seppälä made evident historical changes in the role of adaptation in Nordic audio-visual culture. An earlier generation of auteurs such as Aki Kaurismäki used adaptation to align themselves with aesthetic and philosophical bodies of texts, what we might call ‘networks of similarity’, following Luis M. García Mainar. In the rise of Nordic noir since the millennium, Nordic cinema and television’s networks of similarity change. The auteurs used adaptation to establish modernist originality of vision. In the current moment, this quality has diminished, and adaptation increasingly figures in broader, more densely cross-referential networks of similarity, of which Nordic noir is arguably an instantiation. These are defined by aesthetic and sociopolitical associations, more so than originality. These associations figure in practitioners’ and textual consumers’ use of response to and replication of the noir texts and their networks in a variety of media. This activity can be understood as a type of branding that aligns with attempts at national and regional branding.