bluuebunny/crossref_metadata_2025 huggingface dataset:
Optimization of the Appearance Quality in CO2 Processed Ready-to-Eat Carrots through Image Analysis
Authors: Barberi Gianmarco , González-Alonso Víctor , Spilimbergo Sara , Barolo Massimiliano , Zambon Alessandro , Facco Pierantonio
Published: December 2021

A high-pressure CO2 process applied to ready-to-eat food products guarantees an increase of both their microbial safety and shelf-life. However, the treatment often produces unwanted changes in the visual appearance of products depending on the adopted process conditions. Accordingly, the alteration of the visual appearance influences consumers’ perception and acceptability. This study aims at identifying the optimal treatment conditions in terms of visual appearance by using an artificial vision system. The developed methodology was applied to fresh-cut carrots (Daucus carota) as the test product. The results showed that carrots packaged in 100% CO2 and subsequently treated at 6 MPa and 40 °C for 15 min maintained an appearance similar to the fresh product for up to 7 days of storage at 4 °C. Mild appearance changes were identified at 7 and 14 days of storage in the processed products. Microbiological analysis performed on the optimal treatment condition showed the microbiological stability of the samples up to 14 days of storage at 4 °C. The artificial vision system, successfully applied to the CO2 pasteurization process, can easily be applied to any food process involving changes in the appearance of any food product.
Sensory Specific Desires. The Role of Sensory Taste Exposure in Desire for Food with a Similar or Different Taste Profile
Authors: Chaaban Nora , Andersen Barbara Vad
Published: December 2021

The present study investigated how the sensory taste profile of a meal altered the subjective desire, wanting and liking of foods with a sweet, salty, sour, bitter, fatty, and spicy sensory profile, respectively. Participants (n = 85) ate a meal with a pronounced sensory taste profile: (1) sweet, (2) salty, or (3) sweet and salty combined. Self-reports of appetite, pleasantness, and sensory specific desires (SSD) were evaluated over the course of the meal using VAS-scales. SSDs were further studied through alterations in liking and desire for food samples with the main sensory profile being sweet (peach), salty (pretzel), sour (green apple), bitter (dark chocolate), fatty (whipped cream), and spicy (chilli nut), respectively. Consumption of food with a pronounced sensory taste profile was found to suppress the desire for food with a similar sensory taste profile, while the desire for different sensory profiles were enhanced or not affected. Further, when exposed to two pronounced tastes within the same meal, suppression of sensory desires was not only specific for the exposure tastes but tended to go beyond the sensory exposure. The findings suggest that taste variation within a meal holds the potential to create more satisfying meals, which can hinder additional desires after a meal and thus, lower additional calorie intake.
Bioactivity of Essential Oils for Mitigation of Listeria monocytogenes Isolated from Fresh Retail Chicken Meat
Authors: Morshdy Alaa Eldin M. A. , Al-Mogbel Mohammed S. , Mohamed Mohamed E. M. , Elabbasy Mohamed Tharwat , Elshafee Azza K. , Hussein Mohamed A.
Published: December 2021

Listeria monocytogenes is one of the most severe foodborne pathogens found in several habitats. Therefore, this study aims to investigate the antilisterial activity of different essential oils (EOs) against multidrug-resistant (MDR) L. monocytogenes strains isolated from fresh chicken meat. Our results showed that the prevalence of L. monocytogenes in the examined samples was 48%. Seventy-eight isolates were identified as L. monocytogenes. Out of these, 64.1% were categorized as MDR and were categorized in 18 patterns with 50 MDR isolates. One isolate was selected randomly from each pattern to investigate their biofilm-forming ability, resistance, and virulence genes incidence. Out of 18 MDR isolates, 88.9% showed biofilm-forming ability. Moreover, the most prevalent resistance genes were ermB (72%), aadA (67%), penA (61%), and floR genes (61%). However, the most prevalent virulence genes were inlA (94.4%), prfA (88.9%), plcB (83.3%), and actaA (83.3%). The antilisterial activity of EOs showed that cinnamon bark oil (CBO) was the most effective antilisterial agent. CBO activity could be attributed to the bioactivity of cinnamaldehyde which effects cell viability by increasing the bacterial cell electrical conductivity, ion leakage, and salt tolerance capacity loss. Therefore, CBO could be an effective alternative natural agent for food safety applications.
Composition of Brazil Nut (Bertholletia excels HBK), Its Beverage and By-Products: A Healthy Food and Potential Source of Ingredients
Authors: Vasquez-Rojas Wilson V. , Martín Diana , Miralles Beatriz , Recio Isidra , Fornari Tiziana , Cano M. Pilar
Published: December 2021

The consumption of plant-based beverages is a growing trend and, consequently, the search for alternative plant sources, the improvement of beverage quality and the use of their by-products, acquire great interest. Thus, the purpose of this work was to characterize the composition (nutrients, phytochemicals and antioxidant activity) of the Brazil nut (BN), its whole beverage (WBM), water-soluble beverage (BM-S), and its by-products of the beverage production: cake, sediment fraction (BM-D), and fat fraction (BM-F). In this study, advanced methodologies for the analysis of the components were employed to assess HPLC-ESI-QTOF (phenolic compounds), GC (fatty acids), and MALDI-TOF/TOF (proteins and peptides). The production of WBM was based on a hot water extraction process, and the production of BM-S includes an additional centrifugation step. The BN showed an interesting nutritional quality and outstanding content of unsaturated fatty acids. The investigation found the following in the composition of the BN: phenolic compounds (mainly flavan-3-ols as Catechin (and glycosides or derivatives), Epicatechin (and glycosides or derivatives), Quercetin and Myricetin-3-O-rhamnoside, hydroxybenzoic acids as Gallic acid (and derivatives), 4-hydroxybenzoic acid, ellagic acid, Vanillic acid, p-Coumaric acid and Ferulic acid, bioactive minor lipid components (β-Sitosterol, γ-Tocopherol, α-Tocopherol and squalene), and a high level of selenium. In beverages, WBM had a higher lipid content than BM-S, a factor that influenced the energy characteristics and the content of bioactive minor lipid components. The level of phenolic compounds and selenium were outstanding in both beverages. Hydrothermal processing can promote some lipolysis, with an increase in free fatty acids and monoglycerides content. In by-products, the BM-F stood out due to its bioactive minor lipid components, the BM-D showed a highlight in protein and mineral contents, and the cake retained important nutrients and phytochemicals from the BN. In general, the BN and its beverages are healthy foods, and its by-products could be used to obtain healthy ingredients with appreciable biological activities (such as antioxidant activity).
A Rapid Detection Method for Tomato Gray Mold Spores in Greenhouse Based on Microfluidic Chip Enrichment and Lens-Less Diffraction Image Processing
Authors: Wang Yafei , Mao Hanping , Zhang Xiaodong , Liu Yong , Du Xiaoxue
Published: December 2021

It is of great significance to find tomato gray mold in time and take corresponding control measures to ensure the production of tomato crops. This study proposed a rapid detection method for spores of Botrytis cinerea in green-house based on microfluidic chip enrichment and lens-free diffraction image processing. Microfluidic chip with a regular triangular inner rib structure was designed to achieve the enrichment of Botrytis cinerea spores. In order to obtain the diffraction image of the diseased spores, a lens-less diffraction imaging system was built. Furthermore, the collected spore diffraction images were processed and counted. The simulation results showed that the collection efficiency of 16 μm particles was 79%, 100%, and 89% at the inlet flow rate of 12, 14 and 16 mL/min, respectively. The experimental verification results were observed under a microscope. The results showed that when the flow rate of the microfluidic chip was 12, 14 and 16 mL/min, the collection efficiency of Botrytis cinerea spores was 70.65%, 87.52% and 77.96%, respectively. The Botrytis cinerea spores collected in the experiment were placed under a microscope for manual counting and compared with the automatic counting results based on diffraction image processing. A total of 10 sets of experiments were carried out, with an error range of the experiment was 5.13~8.57%, and the average error of the experiment was 6.42%. The Bland–Altman method was used to analyze two methods based on diffraction image processing and manual counting under a microscope. All points are within the 95% consistency interval. Therefore, this study can provide a basis for the research on the real-time monitoring technology of tomato gray mold spores in the greenhouse.
Impact of Trade Openness on Food Security: Evidence from Panel Data for Central Asian Countries
Authors: Sun Zhilu , Zhang Defeng
Published: December 2021

The problem of food insecurity has become increasingly critical across the world since 2015, which threatens the lives and livelihoods of people around the world and has historically been a challenge confined primarily to developing countries, to which the countries of Central Asia, as typical transition countries, cannot be immune either. Under this context, many countries including Central Asian countries have recognized the importance of trade openness to ensure adequate levels of food security and are increasingly reliant on international trade for food security. Using the 2001–2018 panel data of Central Asian countries, based on food security’s four pillars (including availability, access, stability, and utilization), this study empirically estimates the impact of trade openness and other factors on food security and traces a U-shaped (or inverted U-shaped) relationship between trade openness and food security by adopting a panel data fixed effect model as the baseline model, and then conducts the robustness test by using the least-squares (LS) procedure for the pooled data and a dynamic panel data (DPD) analysis with the generalized method of moments (GMM) approach, simultaneously. The results show that: (1) a U-shaped relationship between trade openness and the four pillars of food security was found, which means that beyond a certain threshold of trade openness, food security status tends to improve in Central Asian countries; (2) gross domestic product (GDP) per capita, GDP growth, and agricultural productivity have contributed to the improvement of food security. Employment in agriculture, arable land, freshwater withdrawals in agriculture, population growth, natural disasters, and inflation rate have negative impacts on food security; and (3) this study confirms that trade policy reforms can finally be conducive to improving food security in Central Asian countries. However, considering the effects of other factors, potential negative effects of trade openness, and vulnerability of global food trade network, ensuring reasonable levels of food self-sufficiency is still very important for Central Asian countries to achieve food security. Our research findings can provide scientific support for sustainable food system strategies in Central Asian countries.
Composite Flour from Indonesian Local Food Resources to Develop Cereal/Tuber Nut/Bean-Based Ready-to-Use Supplementary Foods for Prevention and Rehabilitation of Moderate Acute Malnutrition in Children
Authors: Fetriyuna Fetriyuna , Purwestri Ratna Chrismiari , Susandy May , Köhler Realm , Jati Ignasius Radix A. P. , Wirawan Nia Novita , Biesalski Hans-Konrad
Published: December 2021

Undernourishment is a threat to human health. The prevalence of undernourishment remains alarming, especially among children under five years old in many countries, including Indonesia. Nowadays, the handling of undernourishment has shifted to treatment outside the hospital, utilizing local nutrient-rich foods. At the national level, the utilization of local food resources is a part of the promotion of dietary diversification and the bioeconomy. Ready-to-use supplementary food (RUSF) refers to supplementary foods aimed at improving the nutrition of moderate acute malnutrition (MAM) children under five years old. RUSF biscuit recipes were made using local food resources available in Banten province, Indonesia. To optimize the nutritional profile of the developed RUSF, taro/talas banten were mixed with ground-nut/peanut (Arachis hypogaea L.) and mungbean (Vigna radiata) as protein and lipid sources and red rice (Oryza longistaminata) and maize (Zea mays) as carbohydrate sources, and enriched by the local banana Nangka (Musa textilia). Two formulations were selected for the pilot testing, namely the taro-peanut and taro-peanut/mungbean RUSF biscuits, made from taro Banten, cereal, peanut and/or mungbean, and local banana. The RUSF biscuit showed promising results, presenting a high level of acceptance and a macronutrient composition that meets the standards for MAM children. However, the RUSF biscuits should be fortified with micronutrient premix to fulfill the dietary requirement for the MAM children. The results of this study provide further development opportunities.
Effect of Die Configuration on the Physico-Chemical Properties, Anti-Nutritional Compounds, and Sensory Features of Legume-Based Extruded Snacks
Authors: Costantini Michela , Sabovics Martins , Galoburda Ruta , Kince Tatjana , Straumite Evita , Summo Carmine , Pasqualone Antonella
Published: December 2021

Legumes are not valued by all consumers, mostly due to the prolonged soaking and cooking process they require. This problem could be solved by preparing legume-based ready-to-eat snacks. In this study, the effect of two different dies (circular and star-shaped, with cross-sections of 19.6 and 35.9 mm2, respectively) on the physico-chemical properties, anti-nutritional compounds, and sensory features of extruded breakfast snacks was determined. Extruded products were obtained from 100% legume flours of red lentil, faba bean, brown pea, and common bean. The extrusion-cooking conditions were 2.5 g/s feed rate; 160 ± 1 °C die temperature; 16 ± 1 g/100 g feed moisture, and 230 rpm screw speed. Star-shaped extrudates showed a lower expansion ratio, degree of starch gelatinization, and water solubility index, as well as higher bulk density, hardness, crunchiness, and lightness (L*) values. The oligosaccharides showed non univocal variations by changing the die, whereas phytates did not vary at all. The extrudates from lentil flour (richer in fiber) were the least preferred by sensory panelists, due to their hard texture. However, the spherical extrudates were preferred over the star-shaped product. These results emphasize the possibility of improving the physico-chemical and sensory properties of legume extrudates by selecting a proper die.
Use of Microalgae Biomass for Fortification of Food Products from Grain
Authors: Bazarnova Julia , Nilova Liudmila , Trukhina Elena , Bernavskaya Maya , Smyatskaya Yulia , Aktar Tugba
Published: December 2021

This article describes the use of Chlorella sorokiniana biomass additives in pasta recipes to enrich the product with biologically active phytonutrients, as well as to achieve the desired color range without the use of synthetic dyes. Samples of dry biomass were obtained by the cultivation of microalgae C. sorokiniana (strain), its quality indicators and nutritional value were determined for use as a food additive. A method of using dry biomass of microalgae C. sorokiniana as a phytoadditive to replace 5% of flour mixture for effective enrichment of pasta with biologically active phytonutrients was proposed. The choice of the optimal amount of addition of microalgae biomass was proved since it turned out that the replacement of flour should be no more than 5% due to the distinct fish flavor of the final product. The present study was conducted to evaluate the effect of adding dry biomass of Chlorella microalgae on total protein, lipid, chlorophyll, and carotenoid content. Substitution of 5% of pasta flour led to an increase in the content of proteins and lipids to 15.7 ± 0.50% and 4.1 ± 0.06%, respectively. Meanwhile, the addition of microalgae Chlorella to pasta has helped to increase the content of polyunsaturated fatty acids, chlorophyll, and carotenoids which are necessary for the prevention of foodborne diseases. The aim of this study is to develop pasta recipe with additives of microalgae biomass C. sorokiniana and study their quality indicators.
Landslide Susceptibility Mapping in the Vrancea-Buzău Seismic Region, Southeast Romania
Authors: Harmouzi Hasnaa , Schlögel Romy , Jurchescu Marta , Havenith Hans-Balder
Published: December 2021

This study presents the results of a landslide susceptibility analysis applied to the Vrancea-Buzău seismogenic region in the Carpathian Mountains, Romania. The target area is affected by a large diversity of landslide processes. Slopes are made-up of various types of rocks, climatic conditions can be classified as wet, and the area is a seismically active one. All this contributes to the observed high landslide hazard. The paper analyses the spatial component of the landslide hazard affecting the target area, the regional landslide susceptibility. First, an existing landslide inventory was completed to cover a wider area for the landslide susceptibility analysis. Second, two types of methods are applied, a purely statistical technique, based on correlations between landslide occurrence and local conditions, as well as the simplified spatial process-based Newmark Displacement analysis. Landslide susceptibility maps have been produced by applying both methods, the second one also allowing us to simulate different scenarios, based on various soil saturation rates and seismic inputs. Furthermore, landslide susceptibility was computed both for the landslide source and runout zones—the first providing information about areas where landslides are preferentially triggered and the second indicating where landslides preferentially move along the slope and accumulate. The analysis showed that any of the different methods applied produces reliable maps of landslide susceptibility. However, uncertainties were also outlined as validation is insufficient, especially in the northern area, where only a few landslides could be mapped due to the intense vegetation cover.
Levels of Moral Distress among Health Care Professionals Working in Hospital and Community Settings: A Cross Sectional Study
Authors: Giannetta Noemi , Sergi Rebecca , Villa Giulia , Pennestrì Federico , Sala Roberta , Mordacci Roberto , Manara Duilio Fiorenzo
Published: December 2021

Moral distress is a concern for all healthcare professionals working in all care settings. Based on our knowledge, no studies explore the differences in levels of moral distress in hospital and community settings. This study aims to examine the level of moral distress among healthcare professional working in community or hospital settings and compare it by demographic and workplace characteristics. This is a cross-sectional study. All the professionals working in the hospitals or community settings involved received personal e-mail invitations to participate in the study. The Moral Distress Thermometer was used to measure moral distress among healthcare professionals. Before data collection, ethical approval was obtained from each setting where the participants were enrolled. The sample of this study is made up of 397 healthcare professionals: 53.65% of the sample works in hospital setting while 46.35% of the sample works in community setting. Moral distress was present in all professional groups. Findings have shown that nurses experienced level of moral distress higher than other healthcare professionals (mean: 4.91). There was a significant differences between moral distress among different professional categories (H(6) = 14.407; p < 0.05). The ETA Coefficient test showed significant variation between healthcare professionals working in community and in hospital settings. Specifically, healthcare professionals who work in hospital experienced a higher level of moral distress than those who work in community settings (means 4.92 vs. means 3.80). The results of this study confirm that it is imperative to develop educational programs to reduce moral distress even in those settings where the level perceived is low, in order to mitigate the moral residue and the crescendo effect.
The Experiences of People with Dementia and Informal Carers Related to the Closure of Social and Medical Services in Poland during the COVID-19 Pandemic—A Qualitative Study
Authors: Maćkowiak Maria , Senczyszyn Adrianna , Lion Katarzyna , Trypka Elżbieta , Małecka Monika , Ciułkowicz Marta , Mazurek Justyna , Świderska Roksana , Giebel Clarissa , Gabbay Mark , Rymaszewska Joanna , Szcześniak Dorota
Published: December 2021

Older people with dementia are particularly at risk of COVID-19; however, relatively little is known about the indirect impact of the pandemic on the lives of those living with, and/or caring for someone with, dementia. The aim of this study was to investigate the experiences of people with dementia and informal carers during the closure of available social and medical services in Poland during the COVID-19 pandemic. A qualitative thematic analysis of semi-structured interviews with people with dementia (n = 5) and informal carers (n = 21) was performed between June and August 2020 after the first wave of COVID-19 in Poland. Three overarching themes were identified: (1) care re-organization; (2) psychological responses; (3) emerging needs. The factor underlying all these elements was reliance on other people. Social support and engagement are vital to the ongoing health and well-being of people living with dementia and their informal carers. Services need to be strengthened to provide ongoing provision to those living with dementia to reach pre-pandemic levels, if not better. Within the post-pandemic environment, people with dementia and their informal carers need reassurance that they can rely on external institutional and social support able to meet their needs.
Exploring Global Research Trends in Burnout among Nursing Professionals: A Bibliometric Analysis
Authors: de Oliveira Delana Galdino , da Cunha Reis Augusto , de Melo Franco Isabela , Braga Ayala Liberato
Published: December 2021

Nursing professionals are constantly exposed to several risk factors and high levels of stress that can affect their mental, emotional, and physical health, which can trigger burnout syndrome. This article aims to use bibliometric analysis to investigate burnout research trends among nursing professionals worldwide and to compare the contributions of different countries/institutions, scientific journals, authors, keywords, and citations. A bibliometric study was performed using the Scopus and Web of Science databases, in the period up to November 2021, aiming to search original and review articles in the English language regarding burnout in nursing professionals. The analysis was performed with a sample of 1406 articles. The most cited article indicated that 43% of nurses had high burnout scores, and a similar percentage were dissatisfied with their work. The most productive and most cited country in the world was the United States of America. Regarding the 10 most cited documents, there were no studies that could provide interventions to reduce burnout in nursing professionals, which can result in a need to develop studies on prevention capable of mitigating the problem, in view of the impacts generated on their mental, emotional, and physical health.
Association between Serum Uric Acid Levels and Bone Mineral Density in Postmenopausal Women: A Cross-Sectional and Longitudinal Study
Authors: Kang Soyeon , Kwon Dongjin , Lee Jiwoo , Chung Youn-Jee , Kim Mee-Ran , Namkung Jeong , Jeung In Cheul
Published: December 2021

Background: Uric acid is one of natural antioxidants in human body. There have been several studies on the correlation between uric acid with oxidative stress and osteoporosis. However, the data are insufficient and results are controversial. In this regard, we determined the association between uric acid levels and bone mineral density (BMD) during the postmenopausal period. Methods: We analyzed data from 328 postmenopausal women (mean age, 57.3 ± 6.5 years; mean serum uric acid level, 4.6 ± 1.0 mg/dL). The participants were divided into three groups based on tertiles of the serum uric acid level. The participants receiving hormone replacement therapy (HRT), bisphosphonates, or lipid-lowering agents were included. Results: Blood urea nitrogen, serum creatinine, and serum triglyceride levels were significantly higher in the upper tertiles of uric acid levels. No significant difference was found in the mean uric acid levels between medication users and non-users. Each HRT regimen had a different mean serum uric acid level. A cross-sectional analysis showed no significant correlation between the serum uric acid levels and BMD in the spine and femoral neck (spine BMD: 1.050 ± 0.131, 1.060 ± 0.160, 1.084 ± 0.140, p = 0.22; femoral neck BMD: 0.837 ± 0.110, 0.849 ± 0.096, 0.863 ± 0.115, p = 0.28 for each tertile of uric acid). Longitudinal analysis of data from 186 women with follow-up examinations at a mean interval of 14.6 months also revealed no difference in reduction in both spine and femoral neck BMD between tertile groups of serum uric acid (the median BMD reduction for spine: −0.02, 0.01, −0.04, p = 0.95; the median BMD reduction for femoral neck: 0.008, 0.005, −0.003, p = 0.34). Conclusions: Serum uric acid level is not associated with BMD in postmenopausal women.
Macroelements and Microelements in the Soil and Their Relationship with the Content of Steviol Glucosides in Stevia rebaudiana Bert from Five Regions of Colombia
Authors: Combatt Caballero Enrique , Hernández Burgos Jaime , Jarma-Orozco Alfredo , Jaraba Navas Juan , Rodríguez Páez Luis
Published: December 2021

This study was conducted to determine the effect of edaphic environmental conditions in the concentration of principal steviol glycosides and Stevia rebaudiana Bert yield, utilizing leaves from five Colombian regions. The structure of the experiment was a randomized complete block design with two treatments in a 5 × 2 factorial arrangement (5 locations × 2 radiation levels). In each experimental unit (UE), five healthy plants of similar physiological growth age were selected for the extraction of total glycosides (GT), stevioside (Stv), rebaudioside A (Rb-A),and leaf yield. Results were analyzed with the SAS statistical package (version 9.1). Concentrations of total glycosides and rebaudioside A showed a positive effect with the increase of nitrogen (N), phosphorus (P), magnesium (Mg), and copper (Cu). Therefore, they are important in the available phase of the soil to obtain an increase in these glycosides. Meanwhile, boron (B) presented a negative correlation under these conditions. For the production of stevioside, N, Mg, manganese (Mn) had a positive correlation, and calcium (Ca) and sodium (Na) had a negative correlation. Similarly, for leaf yields by locality, it was found that N, Ca, Mg, and B have a positive correlation with leaf production, while Mg, Mn, and iron (Fe) negatively correlate with biomass gain.The cultivation of stevia can be established in different soil conditions, precipitation and solar radiation in Colombia. Therefore, it is necessary to advance fertilization plans with these nutrients, considering the response of these metabolites to their application.
Grapevine Red Blotch Disease Etiology and Its Impact on Grapevine Physiology and Berry and Wine Composition
Authors: Rumbaugh Arran C. , Sudarshana Mysore R. , Oberholster Anita
Published: December 2021

Grapevine red blotch virus (GRBV) has become widespread in the United States since its identification in 2012. GRBV is the causative agent of grapevine red blotch disease (GRBD), which has caused detrimental economic impacts to the grape and wine industry. Understanding viral function, plant–pathogen interactions, and the effects of GRBV on grapevine performance remains essential to developing potential mitigation strategies. This comprehensive review examines the current body of knowledge regarding GRBV, to highlight gaps in the knowledge and potential mitigation strategies for grape growers and winemakers.
Robotic Surgery: Rediscovering Human Anatomy
Authors: Gangemi Antonio , Chang Betty , Bernante Paolo , Poggioli Gilberto
Published: December 2021

Since its advent, robotic surgery has redefined the operating room experience. It directly addressed and resolved many of the shortcomings of laparoscopic methods while maintaining a minimally invasive approach that brought benefits in cosmesis and healing for patients but also benefits in ergonomics and precision for surgeons. This new platform has brought with it changes in surgical training and education, principally through the utilization of virtual reality. Accurate depictions of human anatomy seen through augmented reality allow the surgeon-in-training to learn, practice and perfect their skills before they operate on their first patient. However, the anatomical knowledge required for minimally invasive surgery (MIS) is distinct from current methods of dissection and prosection that inherently cater towards open surgery with large cuts and unobstructed field. It is integral that robotic surgeons are also equipped with accurate anatomical information, heralding a new era in which anatomists can work alongside those developing virtual reality technology to create anatomical training curricula for MIS. As the field of surgery and medicine in general moves to include more and more technology, it is only fitting that the building blocks of medical education follow suit and rediscover human anatomy in a modern context.
Coping Strategies as a Mental Health Protection Factor of Spanish Nurses during COVID-19
Authors: Molero-Jurado María del Mar , Pérez-Fuentes María del Carmen , Gázquez-Linares José Jesús , Santillán García Azucena
Published: December 2021

Background: Due to the healthcare crisis caused by COVID-19, nurses have been exposed to stressful, uncertain situations. In such situations, emotional coping strategies are especially important due to their repercussion on health. The purpose of this study is analyze the relationships between nurses’ coping strategies and health, with attention to factors related to perceived threat and/or someone close to them is COVID-19 positive. Methods: This descriptive cross-sectional study was done with a sample of 351 nurses in Spain. In addition to the questionnaire on perception of threat from COVID-19, the Cognitive Emotion Regulation Questionnaire and the General Health Questionnaire, an ad hoc question asked them whether someone close to them was COVID-19 positive. Results: Perceived threat and use of negative coping strategies were related, and these strategies were related to a greater presence of somatic symptoms, anxiety, social dysfunction, and depression. Conclusions: Given the work and personal influence of coping on nurses, interventions must be designed to promote adaptive strategies.
Stress and Bio-Ethical Issues Perceived by Romanian Healthcare Practitioners in the COVID-19 Era
Authors: Reisz Daniela , Crișan Iulia , Reisz Andrea , Tudor Raluca , Georgescu Doina
Published: December 2021

Objective: The COVID-19 pandemic had a major impact on different areas of life, especially in the medical system. Because of the pandemic outbreak, the medical system was remodeled to treat COVID-19 patients in secure conditions. Those changes and restrictive measures have put pressure on individual adaptability. The present study investigated the stress of Romanian healthcare practitioners (HCP) and the capacity to deal with new bio-ethical issues that emerged during the COVID-19 pandemic in 2020. Methods: We analyzed results from a survey on 97 Romanian HCP in several areas: personal experience with COVID-19, perceived emotional distress, and appraisal of bio-ethical principles respected or infringed during the pandemic in 2020. Results: Unlike previous studies, our respondents reported low to moderate stress levels. In addition, few bio-ethical principles were infringed on a personal level. Tendencies to sacrifice individual autonomy and make decisions affecting patients and co-workers were more prevalent among HCP with over 30 years of experience. Conclusions: Retrospectively, Romanian HCP in our sample appeared to share an embellished view of the COVID-19 pandemic in 2020. Potentially related factors and coping mechanisms with stress are discussed.
Self-Management Nursing Intervention for Controlling Glucose among Diabetes: A Systematic Review and Meta-Analysis
Authors: Cho Mi-Kyoung , Kim Mi Young
Published: December 2021

As the diabetic population increases, self-management of diabetes, a chronic disease, is important. Given that self-management nursing interventions using various techniques have been developed, an analysis of their importance is crucial. This study aimed to identify the overall effects of self-management nursing interventions on primary (HbA1c) and secondary (self-care, self-efficacy, fasting blood sugar level blood pressure, lipid, body mass index, waist circumference, distress, anxiety, depression, and quality of life) outcomes in diabetes. Systematic review and meta-analysis were used. The meta-analysis involved the synthesis of effect size; tests of homogeneity and heterogeneity; trim and fill plot; Egger’s regression test; and Begg’s test for assessing publication bias. The overall effect on HbA1c was −0.55, suggesting a moderate effect size, with HbA1c decreasing significantly after nursing interventions. Among the nursing interventions, the overall effect on HbA1c of nurse management programs, home visiting, and customized programs was −0.25, −0.61, and −0.65, respectively, a small or medium effect size, and was statistically significant. Healthcare professionals may encourage people with diabetes to engage in self-management of their glucose levels, such as patient-centered customized intervention. Interventions that reflect the individual’s characteristics and circumstances are effective in enabling self-management.
Addressing Depression Symptoms among University Students under COVID-19 Restrictions—The Mediating Role of Stress and the Moderating Role of Resilience
Authors: Liu Chang , McCabe Melinda , Kellett-Renzella Sebastian , Shankar Shruthi , Gerges Nardin , Cornish Kim
Published: December 2021

Background: The COVID-19 pandemic has contributed to a decline in mental health globally. Compared to the general population, university students have been identified as a group vulnerable to developing depression symptoms during the pandemic. Social isolation, a signature mental health consequence under physical-distancing regulations, is a known predictor of depression symptoms during the pandemic. Yet, more research is required to understand the mechanism that underpins the isolation–depression association and identify psychological factors that may attenuate the association. The current study aimed to understand the role of stress and resilience in the isolation–depression association among university students. Methods: Data were collected from 1718 university students between 28 and 31 May 2020. Partial least squares structural equation modelling (PLS-SEM) was used to examine the mediating role of perceived stress and the moderating role of resilience in the isolation–depression association. Results: We found that perceived stress partially mediated the association between social isolation and depression symptoms. Both the direct and indirect effects were moderated by participants’ resilience levels. Conclusions: Social isolation during the pandemic may contribute to depression symptoms both directly and through elevated stress levels. As an internal strength, resilience may buffer the adverse effects of isolation and stress on depression symptoms. Targeted interventions including mindfulness and physical exercise training may provide promising results in reducing depression symptoms among university students and should be considered by university administrators particularly during times of imposed physical-distancing measures.
Health Literacy in the Canton of Zurich: First Results of a Representative Study
Authors: Guggiari Elena , Jaks Rebecca , Berger Fabian Marc Pascal , Nicca Dunja , De Gani Saskia Maria
Published: December 2021

Managing health information and services is difficult for nearly half of the population in Switzerland. Low health literacy has been shown to result in poorer health and health outcomes as well as a higher utilization of health services. To date, studies on health literacy in Switzerland have focused on a national level. However, Switzerland is a federal state with 26 cantons and a strongly decentralized health system. Therefore, the aim of this study is to understand how health literacy is distributed within the population of the canton of Zurich specifically, and to develop methods to determine whether an individual has a higher or lower level of health literacy. There were a total of 1000 participants in this representative study. Data was collected by an adapted version of the HLS-EU-Q47 and additional sociodemographic questions. The majority (56%) of the reported difficulties concerned accessing, understanding, appraising, and applying health information. The findings confirm that health literacy follows a social gradient, whereby financially deprived individuals and those with a low educational level report lower health literacy. The need for action to strengthen the health literacy of these population groups is therefore urgent. Interventions should pay particular attention to these vulnerable groups and tailor resolutions to their needs and preferences.
Complex Lifestyle and Psychological Intervention in Knee Osteoarthritis: Scoping Review of Randomized Controlled Trials
Authors: Tan Bryan Yijia , Thach Tivona , Munro Yasmin Lynda , Skou Soren Thorgaard , Thumboo Julian , Car Josip , Car Lorainne Tudor
Published: December 2021

Knee osteoarthritis (OA) causes pain, disability and poor quality of life in the elderly. The primary aim was to identify and map out the current evidence for randomised controlled trials (RCTs) on complex lifestyle and psychosocial interventions for knee OA. The secondary aim was to outline different components of complex lifestyle and psychosocial interventions. Our scoping review searched five databases from 2000 to 2021 where complex lifestyle or psychosocial interventions for patients with knee OA were compared to other interventions. Screening and data extraction were performed by two review authors independently and discrepancies resolved through consensus and in parallel with a third reviewer. A total of 38 articles were selected: 9 studied the effectiveness of psychological interventions; 11 were on self-management and lifestyle interventions; 18 looked at multifaceted interventions. This review highlights the substantial variation in knee OA interventions and the overall lack of quality in the current literature. Potential areas of future research, including identifying prognostic social factors, stratified care models, transdisciplinary care delivery and technology augmented interventions, have been identified. Further high-quality RCTs utilizing process evaluations and economic evaluation in accordance with the MRC guidelines are critical for the development of evidence-based knee OA programs globally.
Emotional Labor and Burnout among Teachers: A Systematic Review
Authors: Kariou Anna , Koutsimani Panagiota , Montgomery Anthony , Lainidi Olga
Published: December 2021

A significant amount of emotional labor takes place during teaching. Teaching is a multitasking profession that consists of both cognitive and emotional components, with teachers engaging in emotional labor on a daily basis as an instrumental part of achieving teaching goals and positive learning outcomes. The purpose of the present review was to explore the relationship between emotional labor and burnout in school settings. The review focused specifically on teachers from elementary and high schools, between January 2006 and August 2021, and 21 studies fit the inclusion criteria. Overall, the review of the literature supports the significant associations between burnout and emotional labor with the majority of results pointing to the consistent relationship between surface acting and burnout. However, the results regarding the association of deep acting and naturally felt emotions with burnout were mixed. There is considerable scope for improvement in our study of emotional labor in terms of the study designs we employ, the variables we study and our appreciation of the historical and cultural factors that moderate and mediate the relationship between emotional labor and burnout.
Multi-Material 3D Printing of a Customized Sports Mouth Guard: Proof-of-Concept Clinical Case
Authors: Unkovskiy Alexey , Huettig Fabian , Kraemer-Fernandez Pablo , Spintzyk Sebastian
Published: December 2021

A multilayer mouth guard is known to have the best protective performance. However, its manufacturing in a digital workflow may be challenging with regards to virtual design and materialization. The present case demonstrates a pathway to fabricate a multilayer individualized mouth guard in a fully digital workflow, which starts with intraoral scanning. A free-form CAD software was used for the virtual design. Two various CAM techniques were used, including Polyjet 3D printing of rubber-like soft material and silicone printing using Drop-on-Demand technique. For both methods the outer layer was manufactured from more rigid materials to facilitate its protective function; the inner layer was printed from a softer material to aid a better adaptation to mucosa and teeth. Both 3D printed multilayer mouth guards showed a clinically acceptable fit and were met with patient appraisal. Their protective capacities must be evaluated in further clinical studies.
Between Restrictive and Supportive Devices in the Context of Physical Restraints: Findings from a Large Mixed-Method Study Design
Authors: Palese Alvisa , Longhini Jessica , Businarolo Angela , Piccin Tiziana , Pitacco Giuliana , Bicego Livia
Published: December 2021

Physical restraints are still a common problem across healthcare settings: they are triggered by patient-related factors, nurses, and context-related factors. However, the role of some devices (e.g., bed rails), and those applied according to relatives’/patients’ requests have been little investigated to date. A mixed-method study in 2018, according to the Good Reporting of a Mixed Methods Study criteria was performed. In the quantitative phase, patients with one or more physical restraint(s) as detected through observation of a single index day in 37 Italian facilities (27 long-term, 10 hospital units, =4562 patients) were identified. Then, for each patient with one or more restraint(s), the nurse responsible was interviewed to gather purposes and reasons for physical restraints use. A thematic analysis of the narratives was conducted to (a) clarify the decision-making framework that had been used and (b) to assess the differences, if any, between hospital and long-term settings. The categories ‘Restrictive’ and ‘Supportive’ devices aimed at ‘Preventing risks’ and at ‘Promoting support’, respectively, have emerged. Reasons triggering ‘restrictive devices’ involved patients’ risks, the health professionals’ and/or the relatives’ concerns. In contrast, the ‘supportive’ ones were triggered by patients’ problems/needs. ‘Restrictive’ and ‘Supportive’ devices were applied based on the decision of the team or through a process of shared decision-making involving relatives and patients. According to the framework that emerged, long-term care patients are at increased risk of being treated with ‘restrictive devices’ (Odds Ratio 1.87, Confidence Interval 95% 1.44; 2.43; p < 0.001) as compared to those hospitalized. This study contributes to the improvement in knowledge of the definition, classification and measurement of physical devices across settings.
The Impacts of COVID-19 on China’s Economy and Energy in the Context of Trade Protectionism
Authors: Wang Feng , Wu Min
Published: December 2021

In the current context of rising trade protectionism, deeply understanding the impacts of COVID-19 on economy and energy has important practical significance for China to cope with external shocks in an uncertain environment and enhance economic resilience. By constructing an integrated economic and energy input-output model including the COVID-19 shock, this paper assesses the impacts of COVID-19 on China’s macro-economy and energy consumption in the context of trade protectionism. The results are shown as follows. First, in the context of protectionism, the outbreak of COVID-19 in China would cause a 2.2–3.09% drop in China’s GDP and a 1.56–2.48% drop in energy consumption, while adverse spillovers from global spread of COVID-19 would reduce its GDP by 2.27–3.28% and energy consumption by 2.48–3.49%. Second, the negative impacts of domestic outbreak on China’s construction, non-metallic mineral products, and services would be on average 1.29% higher than those on other industries, while the impacts of global spread of COVID-19 on export-oriented industries such as textiles and wearing apparel would be on average 1.23% higher than other industries. Third, the effects of two wave of the pandemic on China’s fossil energy consumption would be on average 1.44% and 0.93% higher than non-fossil energy consumption, respectively.
Association of Nights and Weekends with Survival of Traumatic Out-of-Hospital Cardiac Arrest following Traffic Collisions: Japanese Registry-Based Study
Authors: Fukuda Tatsuma , Ohashi-Fukuda Naoko , Sekiguchi Hiroshi , Inokuchi Ryota , Kukita Ichiro
Published: December 2021

Background: The process of care for traumatic out-of-hospital cardiac arrest (OHCA) may be different at night and on the weekend. However, little is known about whether the rate of survival after OHCA is affected by the time of day and day of the week. Methods: This observational study analyzed the Japanese government-led nationwide population-based registry data of OHCA patients. Patients who experienced traumatic OHCA following traffic collisions from 2013 to 2017 were included in the study. A multivariable logistic regression model was used to examine the association of both time of day (day/evening vs. night) and day of the week (weekday vs. weekend) with outcomes after traumatic OHCA. Night was defined as 23:00 p.m. to 6:59 a.m., and weekends were defined as Saturday and Sunday. The primary outcome was one-month survival. Results: A total of 8500 patients (mean [SD] age, 57.7 [22.3] years; 68.6% male) were included. 2267 events (26.7%) occurred at night, and 2482 events (29.2%) occurred on weekends. Overall, 173 patients (2.0%) survived one month after OHCA. After adjusting for potential confounders, one-month survival during the day/evening (148/6233 [2.4%]) was significantly higher than during the night (25/2267 [1.1%]) (adjusted OR, 1.95 [95%CI, 1.24–3.07]), whereas there was no significant difference in one-month survival between weekdays (121/6018 [2.0%]) and weekends (52/2482 [2.1%]) (adjusted OR, 0.97 [95%CI, 0.69–1.38]). Conclusions: One-month survival after traumatic OHCA was significantly lower during the night than during the day/evening, although there was no difference in one-month survival between weekdays and weekends. Further studies are warranted to investigate the underlying mechanisms of decreased survival at night.