bluuebunny/crossref_metadata_2025 huggingface dataset:
Knowledge, attitudes and perceptions of radiology healthcare workers during the COVID-19 pandemic
Authors: Ooi Jolene Wei Ling , Er Amanda Tse Wern , Chong Choon Ming , Tsai Koh Tzan , Chong Mei Choo
Published: May 2021

Background:

Medical imaging is vital in the diagnostic workup and evaluation of patients suspected or confirmed to have COVID-19; hence, radiology healthcare workers (HCWs) were an essential part of the early containment response to the pandemic. Radiology services are facing rising demands to introduce stricter infection control measures, and staff are expected to adhere to the new protocols while coping with a surge in patients.

Objectives:

This study aims to identify the knowledge, attitudes and perceptions (KAPs) of radiology HCWs at a single site with regard to workplace preparedness during the COVID-19 pandemic.

Methods:

A 26-item questionnaire was conducted with radiographers, radiology nurses, and support staff who had direct patient contact. Questions were concerned with involvement in managing suspected or positive COVID-19 patients, knowledge of infection control measures, and attitudes and perceptions in relation to working during the pandemic. Results were analysed using t-tests, chi-square tests, and Spearman’s rank-order correlation, with statistical difference set at p<0.05.

Results:

Radiology HCWs self-reported significantly better knowledge of infection control measures and positive work attitudes. Those who had received the flu vaccine had significantly better perceptions of working during the pandemic. Suggested improvements included better organisational structure and more resources, better staff compliance and vigilance, better education, and a clearer focus on staff wellbeing.

Conclusion:

The findings indicate favourable KAPs among radiology HCWs in Singapore with regard to workplace preparedness during the pandemic, but efforts towards sustainability must be considered. Formulating policies to nurture motivated and resilient HCWs during a pandemic is advocated to foster a resilient workforce that is prepared for the next pandemic.
Still a long journey to decentralize geopolitics
Authors: An Ning , Sharp Jo , Shaw Ian
Published: May 2021

In this brief response paper, we respond to the insightful commentaries that critically engage with our original article in this forum. First, we discuss whether Confucian culture is fundamental to Chinese geopolitics, emphasizing how and why culture is part of a wider epistemic resource. We also note that our model is not normative, but an analytic framework for understanding complex non-western situations. Second, we discuss the geographies and scales of our model, noting a core tension between geopolitics at the state level and in everyday life. Third, we address the ‘gap’ between theory and practice under our Confucian model, noting that there is often a strategic inclusion (or exclusion) of Confucianism in practice. We finish by emphasizing that our paper is part a longer journey to further decentralize the western hold upon geopolitics.
Long-term outcome of sexual function in sickle cell disease men with ischemic priapism: A systematic review
Authors: Attar Firas S , Mohammad Majed A , Almoamin Haithem HA
Published: May 2021

Purpose:

The purpose of this study was to have an accurate estimate about the sexual function of sickle cell disease adult men with previous history of recurrent attacks of ischemic priapism in childhood. We assessed the studies for their precise documentation for the erectile function in this group of patients.

Materials and methods:

We performed a systematic review of the literature by querying PubMed, Medline, and Cochrane. We included original studies on adult patients with sickle cell disease and history of ischemic priapism.

Results:

We identified 15,057 publications, of which 10 met the study inclusion criteria. The incidence of erectile dysfunction was reported up to 69.20% in one study.

Conclusion:

More extended prospective studies are required as multicenter studies to find the exact incidence of erectile dysfunction in men with sickle cell disease and priapism.

Level of evidence:

Level of evidence is not applicable for this systematic review.
Chest CT versus RT-PCR for the detection of COVID-19: systematic review and meta-analysis of comparative studies
Authors: Karam Mohammad , Althuwaikh Sulaiman , Alazemi Mohammad , Abul Ahmad , Hayre Amrit , Alsaif Abdulmalik , Barlow Gavin
Published: May 2021

Objectives

To compare the performance of chest computed tomography (CT) scan versus reverse transcription polymerase chain reaction (RT-PCR) as the reference standard in the initial diagnostic assessment of coronavirus disease 2019 (COVID-19) patients.

Design

A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. A search of electronic information was conducted using the following databases: MEDLINE, EMBASE, EMCARE, CINAHL and the Cochrane Central Register of Controlled Trials.

Setting

Studies that compared the diagnostic performance within the same patient cohort of chest CT scan versus RT-PCR in COVID-19 suspected patients.

Participants

Thirteen non-randomised studies enrolling 4092 patients were identified.

Main outcome measures

Sensitivity, specificity and accuracy were primary outcome measures. Secondary outcomes included other test performance characteristics and discrepant findings between both investigations.

Results

Chest CT had a median sensitivity, specificity and accuracy of 0.91 (range 0.82–0.98), 0.775 (0.25–1.00) and 0.87 (0.68–0.99), respectively, with RT-PCR as the reference. Importantly, early small, China-based studies tended to favour chest CT versus later larger, non-China studies.

Conclusions

A relatively high false positive rate can be expected with chest CT. It is possible it may still be useful to provide circumstantial evidence, however, in some patients with a suspicious clinical presentation of COVID-19 and negative initial Severe Acute Respiratory Syndrome Coronavirus 2 RT-PCR tests, but more evidence is required in this context. In acute cardiorespiratory presentations, negative CT scan and RT-PCR tests is likely to be reassuring.
Applying the Uses and Gratifications Model to Examine Consequences of Social Media Addiction
Authors: Ferris Amber L. , Hollenbaugh Erin E. , Sommer Paul A.
Published: May 2021

The purpose of this research is to test the uses and gratifications model (U&G) with respect to addictive outcomes for young adult social media users. Two cross-sectional survey studies were completed with college students aged 18–25 years. Study 1 applied path analysis with regression to determine how individual traits, motives, and dependency related to intrusive and emotional consequences of addiction ( N = 373). Results indicated that, among other predictor variables, being dependent on social media for personal understanding was associated with increased emotional consequences of addiction. In Study 2, the functional alternative of interpersonal interaction and frequency of social media use were included to more fully test the U&G model with structural equation modeling ( N = 446). Interpersonal interaction was a significant predictor in the intrusive consequences model. Participants who reported engaging in more offline interpersonal interactions that engaged in heavy use of social media found it to be more intrusive in their lives. In addition, being dependent on social media to understand oneself mediated the relationships between various motives and emotional consequences of addiction. Taken together, results of these studies supported U&G. Contextual age variables were found to be related to motives, dependency, and addictive consequences. In addition, motives in both studies were important variables in explaining addictive consequences.
Consanguinity: A Form of Social Capital Among the Muslims of Char Areas in Barpeta District, Assam
Authors: Begum Gulrukh
Published: May 2021

Information on the dynamics of consanguinity is always important for public health strategy. It provides a direct roadmap for healthcare providers and health policymakers to make people aware of the consequences of consanguinity. The present study aims to investigate the attitude of the Muslim people practising consanguinity in the char (river island) areas of Barpeta district in Assam. It intends to seek a cultural explanation behind the practice of consanguinity.

The study was conducted cross-sectionally among the Muslims living in different villages of the temporary, semi-permanent and permanent river islands of Barpeta district in Assam. A total of 556 married couples were included in the study. Of these, 103 couples are consanguineous and the rest 453 are non-consanguineous. To study the prevalence of congenital disorders, a sample of 153 males and 121 female inbred children of the consanguineous couples and 701 male and 571 female children of the non-consanguineous parents have been included in the study.

The prevalence of consanguineous marriage in the chars was found to be 18.53% and the average coefficient of inbreeding was 0.05996796. Of the consanguineous marriages, the most favoured type was between the first cousins (63.11%), followed by half first-cousin marriages (12.62%). Altogether 14.60% of inbred were found to have some type of congenital disorder against 0.31% non-inbred. In the chars of Barpeta, it is not only ignorance but poor economic condition is also a reason behind the practise of consanguinity. Consanguineous marriage provides means of escaping the expenditure incurred in dowry or bridewealth payment. With seasonal floods, river erodes their village and crops completely every year. Family remains the sole source of stability and security. Consanguineous marriage therefore forms a sort of social capital as they are a source of secured and stable married life in the most hostile ecological settings where these people are living. Social security is of utmost priority behind these marriages in the char.
Using Trust as a Resource for Social Value Creation: A Case of JanaJal
Authors: Kulshrestha Reeti , Sahay Arunaditya , Sengupta Subhanjan
Published: May 2021

Research question:

With the help of an instrumental research case on a social enterprise in India that provides a solution to those with none or limited access to fresh drinking water, this study aims to explore how trust helps create social value.

Links to theory:

At the theoretical level, the study draws upon ‘trust’ and ‘social value’ literature to examine how a social entrepreneur utilized trust as an enabler to creating social value.

Phenomenon studied:

The case developed deeper understanding of the phenomena of ‘trust helps creating social value’.

Type of the case:

It is an instrumental research case study that helps explore the phenomenon and draws connections between trust and social value creation if any.

Case context:

The case context is making affordable drinking water available to all, especially the community of people who are deprived of it.

Findings:

Conducting a series of in-depth interviews with the founder, we developed a better understanding of how the social entrepreneur used trust as a resource to create social value in the context of affordable drinking water. The findings showed how the protagonist (founder) worked on gaining trust of his beneficiaries and stakeholders to create social value. Findings also revealed the enablers and deterrents of trust in social value creation.

Discussions:

Our study shows how trust as a resource creates social value. In the context of our study, it contributes on how a social entrepreneur is creating social value not only by making affordable drinking water accessible to all but also deliver other social value creation benefits. The study brings out legitimacy, technology and social network as its enablers. The study also intends to fill the knowledge gap on how firms create social value by building trust with stakeholders and beneficiaries. Since little is known about trust even at the level of beneficiaries and stakeholders, our study aims to develop a better understanding of the phenomenon.
Consistency and Reliability of Ankle Stress Radiography in Patients With Chronic Lateral Ankle Instability
Authors: Choi Ji Hye , Choi Kug Jin , Chung Chin Youb , Park Moon Seok , Sung Ki Hyuk , Lee Kyoung Min
Published: May 2021

Background:

Ankle stress radiographs are important tools for evaluating chronic lateral ankle instability. The consistency of a patient’s ankle condition as it affects the reliability of ankle stress radiographs has never been evaluated.

Purpose:

To investigate the consistency and reliability of ankle stress radiographs in patients with chronic lateral ankle instability without an ankle injury during the study period.

Study Design:

Cohort study (diagnosis); Level of evidence, 3.

Methods:

Included were patients with chronic lateral ankle instability who underwent 2 repeated ankle stress radiographs between January 2014 and July 2019; those with an ankle injury during the study period were excluded. The tibiotalar tilt angle on varus stress radiographs and anterior translation of the talus on anterior drawer stress radiographs were measured at initial presentation and final follow-up examination. Interobserver reliability and consistency of ankle stress radiographs were analyzed using the intraclass correlation coefficient (ICC).

Results:

A total of 45 patients (mean ± standard deviation age, 36.4 ± 13.4 years; 18 men and 27 women; follow-up duration, 9.1 ± 3.2 months) were included. The mean ± standard deviation tibiotalar tilt angle and anterior talar translation at initial presentation were 10.8° ± 5.2° and 6.9 ± 2.7 mm, respectively. The interobserver reliabilities of the tibiotalar tilt angle and anterior talar translation were excellent (ICC = 0.926 [95% CI, 0.874-0.959] and 0.911 [95% CI, 0.766-0.961], respectively). The consistency between the initial and final radiographs was good for tibiotalar tilt angle (ICC = 0.763 [95% CI, 0.607-0.862]) and poor for anterior talar translation (ICC = 0.456 [95% CI, 0.187-0.660]).

Conclusion:

Although the interobserver reliability of the radiographic measurements was excellent, the consistency of the ankle stress radiographs was not as acceptable. Surgeons need to be cautious when deciding whether to operate on a patient with chronic lateral ankle instability based on a single ankle stress radiograph.
Commentary—Space is Hard: Using Social Media for Selective Investigative Disclosure as a Multi-faceted Crisis Communication Strategy to Achieve Technical Transparency
Authors: Waters Eric D. , D’Urso Scott C.
Published: May 2021

In this commentary, we note that situational crisis communication theory (SCCT) provides useful guidelines for an organization to protect its reputation during a crisis. However, when a high reliability organization (HRO) faces a crisis, openness often supersedes reputation management as a priority as maintaining the public’s trust is paramount. Unfortunately, SCCT in its present form does not account for this distinction. With the present research, we seek to extend SCCT by offering additional crisis response options for HROs which further explicate the evolving role of social media in providing an effective crisis response. A content analysis of 18 tweets and eight website updates, released by a private spaceflight corporation, allows us to offer investigative disclosure as a new crisis response category and technical transparency as a new crisis response objective. We propose a nuanced view that situates investigative disclosure as an antecedent to corrective action.
Pulmonary Embolism Associated with COVID-19 Occurs in Predominantly Elderly Patients with Comorbidities: A Single Center Retrospective Study
Authors: Budimir Mršić Danijela , Perković-Tabak Lara , Ćavar Marija , Luetić Ante , Petričević Mate , Dolić Krešimir
Published: May 2021

Introduction: Complications of COVID-19 infection have been greatly investigated. The most recent studies found strong association of COVID-19 pneumonia with thromboembolism. The aim of research was to describe clinical and computed tomography pulmonary angiograms (CTPA) characteristics of COVID-19 related pulmonary artery thromboembolism (PE). Methods: All consecutive CTPA with positive PE in COVID-19 patients from University Hospital Split, from March 23, 2020 to January 31, 2021 were analyzed. Baseline data were collected from patient’s electronic records. CTPA scan analysis identified PE anatomical location (i.e., main, lobar, segmental, or subsegmental). Results: A total number of 78 positive CTPA in COVID-19 patients was mainly in elderly with several co-morbidities, high D-dimer levels, at median of 14 days. CTPAs showed involvement of the entire pulmonary artery tree, mainly of the small-to medium diameter pulmonary artery branches, unilaterally ( n = 31, 39,74%), and bilaterally ( n = 33, 42.31%). The large-diameter branches were the most rarely affected as a single location ( n = 14, 17.95%). Conclusion: PE occurred in predominantly elderly people, having several comorbidities, and high D-dimer levels. Embolic involvement of pulmonary branches of all sizes were found, the most frequent of small to medium diameter branches. Further investigation is needed to better understand mechanisms and course of the COVID-19 related PE.
Magnitude and Determinants of Adverse Perinatal Outcomes in Tefera Hailu Memorial Hospital, Sekota Town, Northern Ethiopia
Authors: Seyoum Eshetu , Bekele Alemayehu , Tsegaye Adino Tesfahun , Birhanu Simon
Published: May 2021

Background

Of 133 million births globally, 3.7 million died in the neonatal period and 3 million are stillborn. The perinatal mortality rate in Ethiopia is 46 per 1000 pregnancies. However, area-specific information is limited in this regard. Therefore, this study aimed to determine the magnitude and determinants of adverse perinatal outcomes in Northern Ethiopia.

Method

An institution-based cross-sectional study was conducted by reviewing the medical records of mothers who gave birth between September 2015 and August 2016. The completeness and consistency of data were checked. Descriptive statistics were computed. A multinomial logistic regression model was fitted to identify determinants of adverse perinatal outcomes. Odds ratio with 95%CI was used and variables that had a P-value of < 0.05 in the final model were considered statistically significant.

Result

The magnitude of adverse perinatal outcomes was 214/799(27.47 %). Out of that, 10.8% had a perinatal mortality outcome, and 16.7% had a perinatal morbidity. Not using modern contraceptives(AOR = 1.7, 95% CI: 1.1-2.7), labor induction or augmentation(AOR = 3.0, 95% CI: 1.2-7.8), obstetric complications(AOR = 2.2, 95% CI: 1.1-4.5), attending antenatal care(AOR = 0.4, 95% CI: 0.2-0.8), primigravida (AOR = 0.5, 95% CI: 0.3-0.9), had no history of medical illness(AOR = 0.5, 95% CI: 0.3-0.8), and urban residency(AOR = 1.9, 95% CI, 1.1-2.9) were the significant determinants of perinatal outcome.

Conclusion

The magnitude of adverse perinatal outcomes was considerable and 1 in 5 neonates either had morbidity conditions or died. Improving family planning utilization, ANC, referral linkage, and management of obstetric complications could help to reduce the undesirable consequences of perinatal outcomes.
Contested mobilities in the maritory: Implications of boundary formation in a nomadic space
Authors: Barrena José , Harambour Alberto , Lamers Machiel , Bush Simon R
Published: May 2021

The mobility of nomadic Indigenous people has been systematically constrained over time by states seeking control over peripheral spaces and people. This is evident in the case of the Kawésqar nomadic ‘people of the sea’ who have been subject to a century of attempts by the Chilean state to spatially fix their movements over both their terrestrial territories and marine ‘maritories’. In this paper, we show how Indigenous groups like the Kawésqar can challenge and even regain partial control over their maritory by using spatial instruments of the state. We argue that by using these instruments to remobilise, the Kawésqar have been empowered to demobilise other groups and marine related sectors, such as aquaculture. These findings can reorient public policy to be more sensitive to Indigenous space and mobility. Instead of focusing exclusively on the establishment of spatial boundaries to exclude Indigenous communities, they can be used as a means of empowering these communities to exert control over actors and sectors seeking to limit their mobility.
A Bibliometric Analysis of the Top 100 Cited Papers in Retinal Detachment
Authors: Asahi Masumi George , Pakhchanian Haig , Doepker Christine , Raiker Rahul , Gallemore Ron P.
Published: May 2021

Purpose:

This work aimed to identify and analyze the most frequently cited articles in retinal detachment (RD).

Methods:

Institute for Scientific Information’s Web of Science index (Thomas Scientific) was used to identify the top 100 most cited articles on RD between 1900 and 2019. Data from the top 100 most cited articles that met inclusion criteria were analyzed based on title, citation frequency, authorship, institution, journal, year of publication, and country of origin.

Results:

The top 100 articles in RD were cited 88 to 480 times. Steven K. Fisher was the most cited individual, with the University of California system being the most cited organization. Sixty-four percent of the top 100 articles originated from the United States and were published in the American Journal of Ophthalmology, Ophthalmology, and Archives of Ophthalmology at frequencies of 36%, 24%, and 11%, respectively. The top funding agencies included the US Department of Health and Human Services, the National Institutes of Health, and the National Eye Institute at 29%, 28%, and 27%, respectively. The top-cited article, which assessed the role of the retinal pigment epithelium by histologic and electron microscopic analysis of RDs in eyes of owl monkeys, was by Machemer and Laqua in the American Journal of Ophthalmology.

Conclusions:

This bibliometric analysis provides researchers and clinicians with a detailed overview of the most cited manuscripts in RD. Such analyses may guide researchers and funding agencies on important research areas in the field.
The Effect of Obstructive Sleep Apnea Treatment and Severity on Choroidal Thickness in Patients With Central Serous Chorioretinopathy
Authors: Azad Amee D. , Davila Jose R. , Rayess Nadim , Cao Michelle , Mruthyunjaya Prithvi , Pan Carolyn K.
Published: May 2021

Purpose:

This work aimed to analyze the association of obstructive sleep apnea (OSA) with choroidal thickness (CT) in patients with central serous chorioretinopathy (CSC).

Methods:

We identified patients in the Stanford Research Repository with a diagnosis of CSC and OSA. Age- and sex-matched controls with either CSC or OSA only were also identified. CT was measured at 5 points (subfoveal, and 1500 and 3000 µm nasal and temporal) by 2 graders. In addition to OSA treatment and severity, we also investigated the association of Oxygen Desaturation Index and nocturnal oxygen saturation nadir with subfoveal CT (SFCT).

Results:

A total of 57 patients and 72 eyes met the study inclusion criteria. The mean SFCT was significantly different across the 3 groups: OSA-only was the thinnest, followed by CSC with OSA, and CSC-only was the thickest (194.2 μm, 295.1 μm, and 357.8 μm, respectively, P < .001). SFCT was thicker in CSC with OSA compared with those with only OSA ( P < .05). OSA treatment status and OSA severity did not show a significant difference in SFCT in multivariable modeling. Nocturnal oxygen saturation nadir was positively associated with SFCT, but this did not reach significance..

Conclusions:

SFCT is significantly different in patients with OSA alone, CSC with OSA, and CSC alone. While OSA treatment status did not demonstrate a significant difference in SFCT in this study, future studies should evaluate patients for OSA in patients known to have CSC and atypically thin CT to further investigate the novel metrics leveraged in this study.
Sulcus-Deepening Trochleoplasty for Trochlear Dysplasia
Authors: Ignozzi Anthony J. , Hyde Zane , Dart Scott E. , Diduch David R.
Published: May 2021

Background:

Patients who are refractory to initial management of trochlear dysplasia, which consists of bracing and physical therapy, may be candidates for trochleoplasty.

Indications:

Indications for trochleoplasty include Dejour classification type B or D trochlear dysplasia, supratrochlear spur height ≥7 mm, and a positive J sign on examination.

Technique Description:

The thick shell sulcus-deepening trochleoplasty technique involves removing the supratrochlear spur by creating a 5-mm–thick osteochondral shell with underlying cavity, dividing the thick shell into medial and lateral leaflets, and securing the leaflets with absorbable sutures. This establishes a new trochlear groove that is flush with the anterior cortex of the femur.

Results:

A review of 21 studies with length of follow-up from 8.8 months to 15 years found postoperative dislocation was present in 0% to 15% of patients and the patient satisfaction ranged from 81.0% to 94.4%. A prospective study with a minimum 2-year follow-up found no cases of recurrent dislocation, no progression of radiographic arthritis, 84.8% of patients returned to sport, and the patient satisfaction was a 9.1/10.

Discussion/Conclusion:

Sulcus-deepening trochleoplasty for trochlear dysplasia provides patellar stability and excellent patient satisfaction.
Gene expression and alternative splicing dynamics are perturbed in female head transcriptomes following heterospecific copulation
Authors: Diaz Fernando , Allan Carson W. , Markow Therese Ann , Bono Jeremy M. , Matzkin Luciano M.
Published: May 2021

Background

Despite the growing interest in the female side of copulatory interactions, the roles played by differential expression and alternative splicing mechanisms ofpre-RNAon tissues outside of the reproductive tract have remained largely unknown. Here we addressed these questions in the context of con- vs heterospecific matings betweenDrosophila mojavensisand its sister species,D. arizonae. We analyzed transcriptional responses in female heads using an integrated investigation of genome-wide patterns of gene expression, including differential expression (DE), alternative splicing (AS) and intron retention (IR).

Results

Our results indicated that early transcriptional responses were largely congruent between con- and heterospecific matings but are substantially perturbed over time. Conspecific matings induced functional pathways related to amino acid balance previously associated with the brain’s physiology and female postmating behavior. Heterospecific matings often failed to activate regulation of some of these genes and induced expression of additional genes when compared with those of conspecifically-mated females. These mechanisms showed functional specializations withDEgenes mostly linked to pathways of proteolysis and nutrient homeostasis, whileASgenes were more related to photoreception and muscle assembly pathways.IRseems to play a more general role inDEregulation during the female postmating response.

Conclusions

We provide evidence showing thatASgenes substantially perturbed by heterospecific matings in female heads evolve at slower evolutionary rates than the genome background. However,DEgenes evolve at evolutionary rates similar, or even higher, than those of male reproductive genes, which highlights their potential role in sexual selection and the evolution of reproductive barriers.
Identification of cell wall-associated kinases as important regulators involved in Gossypium hirsutum resistance to Verticillium dahliae
Authors: Yang Jun , Xie Meixia , Wang Xingfen , Wang Guoning , Zhang Yan , Li Zhikun , Ma Zhiying
Published: May 2021

Background

Verticillium wilt, caused by the soil borne fungus Verticillium dahliae, is a major threat to cotton production worldwide. An increasing number of findings indicate that WAK genes participate in plant−pathogen interactions, but their roles in cotton resistance to V. dahliae remain largely unclear.

Results

Here, we carried out a genome-wide analysis of WAK gene family in Gossypium hirsutum that resulted in the identification of 81 putative GhWAKs, which were all predicated to be localized on plasma membrane. In which, GhWAK77 as a representative was further located in tobacco epidermal cells using transient expression of fluorescent fusion proteins. All GhWAKs could be classified into seven groups according to their diverse protein domains, indicating that they might sense different outside signals to trigger intracellular signaling pathways that were response to various environmental stresses. A lot of cis-regulatory elements were predicted in the upstream region of GhWAKs and classified into four main groups including hormones, biotic, abiotic and light. As many as 28 GhWAKs, playing a potential role in the interaction between cotton and V. dahliae, were screened out by RNA-seq and qRT-PCR. To further study the function of GhWAKs in cotton resistance to V. dahliae, VIGS technology was used to silence GhWAKs. At 20 dpi, VIGSed plants exhibited more chlorosis and wilting than the control plants. The disease indices of VIGSed plants were also significantly higher than those of the control. Furthermore, silencing of GhWAKs significantly affected the expression of JA- and SA-related marker genes, increased the spread of V. dahliae in the cotton stems, dramatically compromised V. dahliae-induced accumulation of lignin, H2O2 and NO, but enhanced POD activity.

Conclusion

Our study presents a comprehensive analysis on cotton WAK gene family for the first time. Expression analysis and VIGS assay provided direct evidences on GhWAKs participation in the cotton resistance to V. dahliae.
Dynamic prediction based on variability of a longitudinal biomarker
Authors: Campbell Kristen R. , Martins Rui , Davis Scott , Juarez-Colunga Elizabeth
Published: May 2021

Background

Tacrolimus is given post-kidney transplant to suppress the immune system, and the amount of drug in the body is measured frequently. Higher variability over time may be indicative of poor drug adherence, leading to more adverse events. It is important to account for the variation in Tacrolimus, not just the average change over time.

Methods

Using data from the University of Colorado, we compare methods of assessing how the variability in Tacrolimus influences the hazard of de novo Donor Specific Antibodies (dnDSA), an early warning sign of graft failure. We compare multiple joint models in terms of fit and predictive ability. We explain that the models that account for the individual-specific variability over time have the best predictive performance. These models allowed each patient to have an individual-specific random error term in the longitudinal Tacrolimus model, and linked this to the hazard of dnDSA model.

Results

The hazard for the variance and coefficient of variation (CV) loading parameter were greater than 1, indicating that higher variability of Tacrolimus had a higher hazard of dnDSA. Introducing the individual-specific variability improved the fit, leading to more accurate predictions about the individual-specific time-to-dnDSA.

Conclusions

We showed that the individual’s variability in Tacrolimus is an important metric in predicting long-term adverse events in kidney transplantation. This is an important step in personalizing the dosage of TAC post-transplant to improve outcomes post-transplant.
Shared decision making and patient-centeredness for patients with poorly controlled type 2 diabetes mellitus in primary care—results of the cluster-randomised controlled DEBATE trial
Authors: Wollny Anja , Löffler Christin , Drewelow Eva , Altiner Attila , Helbig Christian , Daubmann Anne , Wegscheider Karl , Löscher Susanne , Pentzek Michael , Wilm Stefan , Feldmeier Gregor , Santos Sara
Published: May 2021

Background

We investigate whether an educational intervention of GPs increases patient-centeredness and perceived shared decision making in the treatment of patients with poorly controlled type 2 diabetes mellitus?

Methods

We performed a cluster-randomized controlled trial in German primary care. Patients with type 2 diabetes mellitus defined as HbA1c levels ≥ 8.0% (64 mmol/mol) at the time of recruitment (n = 833) from general practitioners (n = 108) were included. Outcome measures included subjective shared decision making (SDM-Q-9; scale from 0 to 45 (high)) and patient-centeredness (PACIC-D; scale from 1 to 5 (high)) as secondary outcomes. Data collection was performed before intervention (baseline, T0), at 6 months (T1), at 12 months (T2), at 18 months (T3), and at 24 months (T4) after baseline.

Results

Subjective shared decision making decreased in both groups during the course of the study (intervention group: -3.17 between T0 and T4 (95% CI: -4.66, -1.69; p < 0.0001) control group: -2.80 (95% CI: -4.30, -1.30; p = 0.0003)). There were no significant differences between the two groups (-0.37; 95% CI: -2.20, 1.45; p = 0.6847). The intervention's impact on patient-centeredness was minor. Values increased in both groups, but the increase was not statistically significant, nor was the difference between the groups.

Conclusions

The intervention did not increase patient perceived subjective shared decision making and patient-centeredness in the intervention group as compared to the control group. Effects in both groups might be partially attributed to the Hawthorne-effect. Future trials should focus on patient-based intervention elements to investigate effects on shared decision making and patient-centeredness.

Trial registration

The trial was registered on March 10th, 2011 at ISRCTN registry under the reference ISRCTN70713571.
Examining primary care physician rationale for not following geriatric choosing wisely recommendations
Authors: Rowe Theresa A. , Brown Tiffany , Doctor Jason N. , Linder Jeffrey A. , Persell Stephen D.
Published: May 2021

Background

The objective is to understand why physicians order tests or treatments in older adults contrary to published recommendations.

Methods

Participants: Physicians above the median for ≥ 1 measures of overuse representing 3 Choosing Wisely topics. Measurements: Participants evaluated decisions in a semi-structured interview regarding: 1) Screening men aged ≥ 76 with prostate specific antigen 2) Ordering urine studies in women ≥ 65 without symptoms 3) Overtreating adults aged ≥ 75 with insulin or oral hypoglycemic medications. Two investigators independently coded transcripts using qualitative analysis.

Results

Nineteen interviews were conducted across the three topics resulting in four themes. First, physicians were aware and knowledgeable of guidelines. Second, perceived patient preference towards overuse influenced physician action even when physicians felt strongly that testing was not indicated. Third, physicians overestimated benefits of a test and underemphasized potential harms. Fourth, physicians were resistant to change when patients appeared to be doing well.

Conclusions

Though physicians expressed awareness to avoid overuse, deference to patient preferences and the tendency to distort the chance of benefit over harm influenced decisions to order testing. Approaches for decreasing unnecessary testing must account for perceived patient preferences, make the potential harms of overtesting salient, and address clinical inertia among patients who appear to be doing well.
The mental health crises of the families of COVID-19 victims: a qualitative study
Authors: Mohammadi Fateme , Oshvandi Khodayar , Shamsaei Farshid , Cheraghi Fateme , Khodaveisi Masoud , Bijani Mostafa
Published: May 2021

Background

The bereaved families of COVID-19 victims are among the most vulnerable social groups in the COVID-19 pandemic. This highly infectious and contagious disease has afflicted these families with numerous psychological crises which have not been studied much yet. The present study is an attempt at investigating the psychological challenges and issues which the families of COVID-19 victims are faced with. The present study aims to identify the Mental Health crises which the families of COVID-19 deceased victims are going through.

Methods

A qualitative research, the present study uses a conventional content analysis design. The participants were 16 members of the families of COVID-19 victims selected from medical centers in Iran from February to May 2020 via purposeful sampling. Sampling continued to the point of data saturation Data were collected via semi-structured individual interviews conducted online. The collected data were analyzed according to the conventional qualitative content analysis approach.

Results

Analyses of the data yielded two main themes and seven categories. Emotional shock included (feelings of guilt and rumination, bitter farewell, strange burial and concern about unreligious burial), and fear of the future included (instability in the family, lack of job security and difficult financial conditions, Stigmatization and complications in social interactions).

Conclusion

The families of COVID-19 deceased victims are affected by various psychological crises which have exposed them to a deep sense of loss and emotional shock. Therefore, there is an urgent need for a cultural context which recognizes and supports all the various aspects of the mental health of these families.
The period from prodromal fever onset to rash onset in laboratory-confirmed rubella cases: a cross-sectional study
Authors: Ogata Tsuyoshi , Murooka Maki , Akashi Makoto , Ishitsuka Akemi , Miyazaki Akari , Osawa Shuuichi , Ishikawa Kanako , Tanaka-Taya Keiko , Uehara Ritei
Published: May 2021

Background

In resource-limited settings, where rubella is endemic, it is difficult to determine which sporadic case should be tested for rubella. The study aimed to provide useful evidence to help screen rubella cases for real-time reverse transcriptase-polymerase chain reaction (RT-PCR) examination for rubella in resource-limited settings.

Method

Suspected rubella patients identified by a physician and brought to the notice of the Ryugasaki public health center or the Tsuchiura public health center were enrolled from April 2018 through December 2019. The inclusion criterion was a confirmed rubella diagnosis based on laboratory tests. We studied the distribution of the time from the onset of fever until the onset of rash.

Results

The study included 86 cases with simultaneous presentation of fever and rash. Twenty-nine cases had confirmed rubella based on the laboratory diagnosis. Among these, the time from the onset of fever until the onset of rash was limited to − 1 day to 2 days. The number of rubella cases was the highest when the onset of rash was on the following day of the onset of fever. Of the 78 patients who underwent the RT-PCR test, 48% tested positive for rubella among those with a time from the onset of fever to the onset of rash between − 1 day and 2 days (22 out of 46, 95% confidence interval 34–62%); no positive results (0 out of 30, 95% confidence interval - 14%) were seen in patients with a time from fever to rash onset ≥3 days.

Conclusion

The period from the onset of fever to the onset of rash was limited to − 1 day to 2 days among confirmed rubella patients. If the period from onset of fever to the onset of rash was ≥3 days for a patient, the likelihood of rubella was low.
Reduction in massive postpartum haemorrhage and red blood cell transfusion during a national quality improvement project, Obstetric Bleeding Strategy for Wales, OBS Cymru: an observational study
Authors: Bell Sarah F. , Collis Rachel E. , Pallmann Philip , Bailey Christopher , James Kathryn , John Miriam , Kelly Kevin , Kitchen Thomas , Scarr Cerys , Watkins Adam , Edey Tracey , Macgillivray Elinore , Greaves Kathryn , Volikas Ingrid , Tozer James , Sengupta Niladri , Roberts Iolo , Francis Claire , Collins Peter W.
Published: May 2021

Background

Postpartum haemorrhage (PPH) is a major cause of maternal morbidity and mortality and its incidence is increasing in many countries despite management guidelines. A national quality improvement programme called the Obstetric Bleeding Strategy for Wales (OBS Cymru) was introduced in all obstetric units in Wales. The aim was to reduce moderate PPH (1000 mL) progressing to massive PPH (> 2500 mL) and the need for red cell transfusion.

Methods

A PPH care bundle was introduced into all 12 obstetric units in Wales included all women giving birth in 2017 and 2018 (n = 61,094). The care bundle prompted: universal risk assessment, quantitative measurement of blood loss after all deliveries (as opposed to visual estimation), structured escalation to senior clinicians and point-of-care viscoelastometric-guided early fibrinogen replacement. Data were submitted by each obstetric unit to a national database. Outcome measures were incidence of massive PPH (> 2500 mL) and red cell transfusion. Analysis was performed using linear regression of the all Wales monthly data.

Results

Uptake of the intervention was good: quantitative blood loss measurement and risk assessment increased to 98.1 and 64.5% of all PPH > 1000 mL, whilst ROTEM use for PPH > 1500 mL increased to 68.2%. Massive PPH decreased by 1.10 (95% CI 0.28 to 1.92) per 1000 maternities per year (P = 0.011). Fewer women progressed from moderate to massive PPH in the last 6 months, 74/1490 (5.0%), than in the first 6 months, 97/1386 (7.0%), (P = 0.021). Units of red cells transfused decreased by 7.4 (95% CI 1.6 to 13.2) per 1000 maternities per year (P = 0.015). Red cells were transfused to 350/15204 (2.3%) and 268/15150 (1.8%) (P = 0.001) in the first and last 6 months, respectively. There was no increase in the number of women with lowest haemoglobin below 80 g/L during this time period. Infusions of fresh frozen plasma fell and there was no increase in the number of women with haemostatic impairment.

Conclusions

The OBS Cymru care bundle was feasible to implement and associated with progressive, clinically significant improvements in outcomes for PPH across Wales. It is applicable across obstetric units of widely varying size, complexity and staff mixes.
A multicenter evaluation of viral bloodstream detections in children presenting to the Emergency Department with suspected systemic infection
Authors: Rostad Christina A. , Kanwar Neena , Yi Jumi , Morris Claudia R. , Bard Jennifer Dien , Leber Amy , Dunn James , Chapin Kimberle C. , Blaschke Anne J. , Daly Judy A. , Hueschen Leslie A. , Jones Matthew , Ott Elizabeth , Bastar Jeffrey , Bourzac Kevin M. , Selvarangan Rangaraj
Published: May 2021

Background

Fever is a common symptom in children presenting to the Emergency Department (ED). We aimed to describe the epidemiology of systemic viral infections and their predictive values for excluding serious bacterial infections (SBIs), including bacteremia, meningitis and urinary tract infections (UTIs) in children presenting to the ED with suspected systemic infections.

Methods

We enrolled children who presented to the ED with suspected systemic infections who had blood cultures obtained at seven healthcare facilities. Whole blood specimens were analyzed by an experimental multiplexed PCR test for 7 viruses. Demographic and laboratory results were abstracted.

Results

Of the 1114 subjects enrolled, 245 viruses were detected in 224 (20.1%) subjects. Bacteremia, meningitis and UTI frequency in viral bloodstream-positive patients was 1.3, 0 and 10.1% compared to 2.9, 1.3 and 9.7% in viral bloodstream-negative patients respectively. Although viral bloodstream detections had a high negative predictive value for bacteremia or meningitis (NPV = 98.7%), the frequency of UTIs among these subjects remained appreciable (9/89, 10.1%) (NPV = 89.9%). Screening urinalyses were positive for leukocyte esterase in 8/9 (88.9%) of these subjects, improving the ability to distinguish UTI.

Conclusions

Viral bloodstream detections were common in children presenting to the ED with suspected systemic infections. Although overall frequencies of SBIs among subjects with and without viral bloodstream detections did not differ significantly, combining whole blood viral testing with urinalysis provided high NPV for excluding SBI.
Social isolation, physical inactivity and inadequate diet among European middle-aged and older adults
Authors: Delerue Matos Alice , Barbosa Fátima , Cunha Cláudia , Voss Gina , Correia Filipa
Published: May 2021

Background

Social isolation is a growing public health concern for older adults, as it has been associated with poor health and premature mortality. On the other hand, physical inactivity and an inadequate diet are important health risk behaviours associated with physical and mental health problems. Considering that there is no research examining the possible relationship between social isolation and the above mentioned health risk behaviours of European middle-aged and older adults, this cross-sectional study aims to contribute to filling this gap.

Methods

We used data from the SHARE project (Survey of Health, Ageing and Retirement in Europe), wave 6 (2015), release 7.0.0 (N = 67,173 individuals from 17 European countries plus Israel). Statistical tests for a two-group comparison were carried out to assess the differences between highly socially isolated individuals and low/intermediate socially isolated ones. Logistic regressions by country were performed to examine whether social isolation is associated with physical inactivity and an inadequate diet in the population aged 50 + .

Results

Our results point out that, for the majority of the countries analysed, highly socially isolated individuals are more likely than low/intermediate isolated ones to be physically inactive and to consume less fruit or vegetables on a daily basis. In 9 European countries (Austria, Germany, Sweden, Denmark, Greece, Belgium, Poland, Luxembourg and Estonia) highly socially isolated individuals are more likely to be physically inactive. On the other hand, in 14 European countries (Austria, Germany, Sweden, Italy, France, Denmark, Greece, Switzerland, Belgium, Czech Republic, Luxembourg, Slovenia, Estonia and Croatia), high social isolation increases the likelihood of having an inadequate diet.

Conclusion

Highly socially isolated European middle-aged and older adults are more prone to be physically inactive and to have an inadequate diet in terms of daily consumption of fruit and vegetables. The reduced social integration, social support and companionship of the highly socially isolated individuals may explain this association. Our results reinforce the importance of social and health policies targeting highly socially isolated European individuals aged 50 + .