bluuebunny/crossref_metadata_2025 huggingface dataset:
Performing well: Male prisoner experiences of drama, dance, singing and puppetry in England
Authors: Page Sarah , Chamberlain Victoria , Gratton Nicola
Published: July 2022

This paper outlines art form impacts used within Staging Time at an adult male sex offender prison in England by drawing on the voices of prisoners (aged 21–75 years), including those with undiagnosed autistic traits. We qualitatively investigate prisoner experiences from drama (n = 11), dance (n = 12), puppetry (n = 7) and singing (n = 15) projects using a theory of change approach. Based on a themed analysis of self-report data from 4 world cafés and 44 follow-up questionnaires, we conclude arts projects positively contribute to health and well-being, forming healthy relationships and prison culture. By applying a desistance theory lens, we argue arts projects provide building blocks towards crime abstinence. Whilst all arts projects improved prisoner well-being, dance had a greater propensity for increasing physical fitness. With a focus on dance impacts, our research widened to stakeholder and practitioner interviews (n = 4), alongside analysis of secondary data from dance performance audience feedback sheets (n = 48) collected by Staging Time. Audience members included prison staff, prisoners, prisoner family members and close friends and a small group of invited stakeholders. Arts projects have wider impacts on staff, other prisoners and family members.
Knowledge demands placed on mathematics teachers by textbooks: Case of decimal fractions
Authors: Takker Shikha , Pournara Craig
Published: July 2022

Textbooks remain an important and sometimes the only resource for teachers in developing nations. The participative relation between the teachers and the textbooks can be studied through an analysis of how the object of learning is mediated through a careful selection and sequencing of examples, tasks, and representations. In this paper, we use the Mathematical Discourse in Instruction framework to abstract the knowledge demands placed on the teachers by textbooks. We compare the textbooks of two countries, India and South Africa, for the topic of introduction to decimal operations. Findings indicate that these textbooks promote reliance on whole number thinking while deemphasising the use of fractional notation in generalizing the algorithm for decimal addition using a variety of examples, tasks and multiple representations. The demands on teacher knowledge include examining the affordances of using mediational tools while making connections between learners’ prior and emerging knowledge. The study offers an approach for unpacking the relational transparency of textbooks and can therefore be usefully extended to analyze and inform the design of educative materials for teachers.
Gamma-aminobutyric acid and glutamate/glutamine levels in the dentate nucleus and periaqueductal gray with episodic and chronic migraine: a proton magnetic resonance spectroscopy study
Authors: Wang Wei , Zhang Xueyan , Bai Xiaoyan , Zhang Yingkui , Yuan Ziyu , Tang Hefei , Li Zhiye , Hu Zhangxuan , Zhang Yaqing , Yu Xueying , Sui Binbin , Wang Yonggang
Published: July 2022

Background

The pathogenesis of migraine chronification remains unclear. Functional and structural magnetic resonance imaging studies have shown impaired functional and structural alterations in the brains of patients with chronic migraine. The cerebellum and periaqueductal gray (PAG) play pivotal roles in the neural circuits of pain conduction and analgesia in migraine. However, few neurotransmitter metabolism studies of these migraine-associated regions have been performed. To explore the pathogenesis of migraine chronification, we measured gamma-aminobutyric acid (GABA) and glutamate/glutamine (Glx) levels in the dentate nucleus (DN) and PAG of patients with episodic and chronic migraine and healthy subjects.

Methods

Using the MEGA-PRESS sequence and a 3-Tesla magnetic resonance scanner (Signa Premier; GE Healthcare, Chicago, IL, USA), we obtained DN and PAG metabolite concentrations from patients with episodic migraine (n = 25), those with chronic migraine (n = 24), and age-matched and sex-matched healthy subjects (n = 16). Patients with chronic migraine were further divided into those with (n = 12) and without (n = 12) medication overuse headache. All scans were performed at the Beijing Tiantan Hospital, Capital Medical University.

Results

We found that patients with chronic migraine had significantly lower levels of GABA/water (p = 0.011) and GABA/creatine (Cr) (p = 0.026) in the DN and higher levels of Glx/water (p = 0.049) in the PAG than healthy controls. In all patients with migraine, higher GABA levels in the PAG were significantly associated with poorer sleep quality (GABA/water:r = 0.515,p = 0.017,n = 21; GABA/Cr:r = 0.522,p = 0.015,n = 21). Additionally, a lower Glx/Cr ratio in the DN may be associated with more severe migraine disability (r = -0.425,p = 0.055,n = 20), and lower GABA/water (r = -0.424,p = 0.062,n = 20) and Glx/Water (r = -0.452,p = 0.045,n = 20) may be associated with poorer sleep quality.

Conclusions

Neurochemical levels in the DN and PAG may provide evidence of the pathological mechanisms of migraine chronification. Correlations between migraine characteristics and neurochemical levels revealed the pathological mechanisms of the relevant characteristics.
Controversies in ACL revision surgery: Italian expert group consensus and state of the art
Authors: Matassi Fabrizio , Giabbani Niccolò , Arnaldi Enrico , Tripodo Alessandro , Bonaspetti Giovanni , Bait Corrado , Ronga Mario , Di Benedetto Paolo , Zaffagnini Stefano , Jannelli Eugenio , Schiavone Panni Alfredo , Berruto Massimo
Published: July 2022

Background

Revision ACL reconstruction is a complex topic with many controversies and not-easy-to-make decisions. The authors’ aim is to provide some feasible advice that can be applied in daily clinical practice with the goal of facilitating the decision-making process and improving the outcomes of patients subjected to revision ACL reconstruction.

Methods

A national survey with seven questions about the most controversial topics in revision ACL reconstruction was emailed to members of two societies: SIOT and SIAGASCOT. The participants’ answers were collected, the most recent literature was analyzed, and a consensus was created by the authors, according to their long-term surgical experience.

Conclusions

The decision-making process in revision ACL reconstruction starts with a standardized imaging protocol (weight-bearing radiographs, CT scan, and MRI). One-stage surgery is indicated in almost all cases (exceptions are severe tunnel enlargement and infection), while the choice of graft depends on the previously used graft and the dimensions of the tunnels, with better clinical outcomes obtained for autografts. Additional procedures such as lateral extra-articular tenodesis in high-grade pivot-shift knees, biplanar HTO in the case of severe coronal malalignment, and meniscal suture improve the clinical outcome and should be considered case by case.

Level of evidence

V (Expert opinion).
Barriers to change in urban freight systems: a systematic literature review
Authors: Kervall Mikael , Pålsson Henrik
Published: July 2022

Purpose

The purpose of this systematic literature review is to contribute to the knowledge about barriers to change in urban freight systems and to support managed changes toward more sustainable urban freight systems.

Method

This paper is based on a systematic review covering 93 peer-reviewed journal articles. The study was designed to advance earlier research in this area by providing a system perspective on barriers to development in urban freight systems. The theoretical knowledge about these barriers was analyzed and synthesized, the relationships between barriers explored, and the insights developed into a model of understanding of managed change processes in urban freight systems.

Findings

From a system perspective 11 categories of barriers to change in urban freight systems were identified and characterized. The barriers are, in different ways, related both to each other and to a managed change process for sustainable development of urban freight systems. A model for understanding categories of barriers and their connection to managed change processes in urban freight systems is proposed in this paper. The model consists of three groups of barriers within the process, and two groups in the system context, which should be addressed with different priorities in a managed change process. The study identifies several future research options. Future research could support the development of sustainable urban freight systems by providing insights into change process governance, potentially by combining theory from areas like organization, systems, and networks with the system perspective on urban freight systems. Research on non-European urban freight systems could increase the scholarly insights about contextual impact on barriers and change processes. Future studies could also explore methods to mitigate identified barriers, especially in the areas of cooperation, organization, politics, knowledge, and the first mover disadvantage. Finally, future research should continue to develop the model of the managed change process for urban freight systems and its use in supporting sustainable development of these systems.
Accurate classification of white blood cells by coupling pre-trained ResNet and DenseNet with SCAM mechanism
Authors: Chen Hua , Liu Juan , Hua Chunbing , Feng Jing , Pang Baochuan , Cao Dehua , Li Cheng
Published: July 2022

Background

Via counting the different kinds of white blood cells (WBCs), a good quantitative description of a person’s health status is obtained, thus forming the critical aspects for the early treatment of several diseases. Thereby, correct classification of WBCs is crucial. Unfortunately, the manual microscopic evaluation is complicated, time-consuming, and subjective, so its statistical reliability becomes limited. Hence, the automatic and accurate identification of WBCs is of great benefit. However, the similarity between WBC samples and the imbalance and insufficiency of samples in the field of medical computer vision bring challenges to intelligent and accurate classification of WBCs. To tackle these challenges, this study proposes a deep learning framework by coupling the pre-trained ResNet and DenseNet with SCAM (spatial and channel attention module) for accurately classifying WBCs.

Results

In the proposed network, ResNet and DenseNet enables information reusage and new information exploration, respectively, which are both important and compatible for learning good representations. Meanwhile, the SCAM module sequentially infers attention maps from two separate dimensions of space and channel to emphasize important information or suppress unnecessary information, further enhancing the representation power of our model for WBCs to overcome the limitation of sample similarity. Moreover, the data augmentation and transfer learning techniques are used to handle the data of imbalance and insufficiency. In addition, the mixup approach is adopted for modeling the vicinity relation across training samples of different categories to increase the generalizability of the model. By comparing with five representative networks on our developed LDWBC dataset and the publicly available LISC, BCCD, and Raabin WBC datasets, our model achieves the best overall performance. We also implement the occlusion testing by the gradient-weighted class activation mapping (Grad-CAM) algorithm to improve the interpretability of our model.

Conclusion

The proposed method has great potential for application in intelligent and accurate classification of WBCs.
Genome-wide identification of resistance genes and transcriptome regulation in yeast to accommodate ammonium toxicity
Authors: Fu Wenhao , Cao Xiuling , An Tingting , Zhao Huihui , Zhang Jie , Li Danqi , Jin Xuejiao , Liu Beidong
Published: July 2022

Background

Ammonium is an important raw material for biomolecules and life activities, and the toxicity of ammonium is also an important ecological and agricultural issue. Ammonium toxicity in yeast has only recently been discovered, and information on its mechanism is limited. In recent years, environmental pollution caused by nitrogen-containing wastewater has been increasing. In addition, the use of yeast in bioreactors to produce nitrogen-containing compounds has been developed. Therefore, research on resistance mechanisms that allow yeast to grow under conditions of high concentrations of ammonium has become more and more important.

Results

To further understand the resistance mechanism of yeast to grow under high concentration of ammonium, we used NH4Cl to screen a yeast non-essential gene-deletion library. We identified 61 NH4Cl-sensitive deletion mutants from approximately 4200 mutants in the library, then 34 of them were confirmed by drop test analysis. Enrichment analysis of these 34 genes showed that biosynthesis metabolism, mitophagy, MAPK signaling, and other pathways may play important roles in NH4Cl resistance. Transcriptome analysis under NH4Cl stress revealed 451 significantly upregulated genes and 835 significantly downregulated genes. The genes are mainly enriched in: nitrogen compound metabolic process, cell wall, MAPK signaling pathway, mitophagy, and glycine, serine and threonine metabolism.

Conclusions

Our results present a broad view of biological pathways involved in the response to NH4Cl stress, and thereby advance our understanding of the resistance genes and cellular transcriptional regulation under high concentration of ammonium.
Genomic surveillance of SARS-CoV-2 in US military compounds in Afghanistan reveals multiple introductions and outbreaks of Alpha and Delta variants
Authors: Maljkovic Berry Irina , Hang Jun , Fung Christian , Yang Yu , Chibucos Marcus , Pollio Adam , Gandhi Jay , Li Tao , Conte Matthew A. , Lidl Grace M. , Johannigman Jay A. , Friberg Heather
Published: July 2022

Background

With the emergence and spread of SARS-CoV-2 variants, genomic epidemiology and surveillance have proven invaluable tools for variant tracking. Here, we analyzed SARS-CoV-2 samples collected from personnel located at the US/NATO bases across Afghanistan.

Results

Sequencing and phylogenetic analyses revealed at least 16 independent introductions of SARS-CoV-2 into four of these relatively isolated compounds during April and May 2021, including multiple introductions of Alpha and Delta variants. Four of the introductions resulted in sustained spread of the virus within, and in two cases between, the compounds. Three of these outbreaks, one Delta and two Alpha, occurred simultaneously.

Conclusions

Even in rigorously controlled and segregated environments, SARS-CoV-2 introduction and spread may occur frequently.
Strategies to rare primary cardiac lipomas in the left ventricle in a patient: case report
Authors: Liu Wei , Bu Haisong
Published: July 2022

Background

Primary cardiac tumors are rare in all age groups and are usually benign. Symptoms are usually related to tumor size, location, invasiveness, number, and growth rate. While histologically benign, cardiac arrest may be caused by blocked inflow or outflow or malignant ventricular arrhythmia. Surgical resection of left ventricular tumors, especially those involving the outflow tract, is challenging.

Case presentation

Herein, we present a rare case of an asymptomatic, 39-year-old woman who was referred to our cardiovascular department for a huge left ventricular cardiac mass incidentally discovered during the physical examination. Images showed a huge mass that quasi-circular low-density focus with a clear boundary and regular shape in the left ventricular cavity and fortunately had no significant effect on the peripheral valves and hemodynamics.

Conclusions

This illustrative report highlights the exact surgical management of a cardiac tumor depends largely on the site and extent of the mass. Mechanical compromise and not the neoplastic potential should be considered. A conservative approach and follow-up regularly are advocated to ensure that the patient gets the best diagnosis and treatment, however, surgery is indicated only for severely symptomatic patients with hemodynamic compromise.
Therapy options for those affected by a long lie after a fall: a scoping review
Authors: Kubitza Jenny , Haas Margit , Keppeler Lena , Reuschenbach Bernd
Published: July 2022

Background

After a fall, more than half of older people living alone are unable to get up or get help independently. Fall-related recumbency makes affected individuals aware of functional status limitations and increased vulnerability. Patient-centered therapy is needed to manage physical, psychological, and social needs. This review summarizes the current evidence on care options for the special patient population.

Methods

The scoping review used the six-step framework proposed by Arksey and O´Malley and was conducted in accordance with the modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework for scoping reviews. The literature searches were conducted in five databases and ten online archives. Articles were screened, assessed and selected using defined inclusion and exclusion criteria. Articles were included if they were published in either German or English and related to the care of long lies. Thematic synthesis was based on the literature review.

Results

The search yielded 1047 hits, of which 19 research papers were included. Two themes were identified: (1) acute therapy, focused on prolonged recumbency and pronounced physical effects; and (2) preventive therapy, which examined standing up training, technical aids, and social control systems in the context of fall management.

Conclusions

There are a limited number of interventions that relate to the patient population. The interventions are predominantly presented independently, so there is a lack of structuring of the interventions in the form of a treatment pathway. In addition to pooling professional expertise and an interprofessional approach, it is important to continue inpatient treatment in the home setting, even though the effectiveness of interventions in a home setting has hardly been verified thus far. The solution for a missing treatment process is first of all a planned, interprofessional and intersectoral approach in therapy.
Influence of intergenerational relationships on depressive symptoms in ageing Chinese adults in Hong Kong: Mediating effects of sense of loneliness
Authors: Zhou Jia-Jia , Bai Xue
Published: July 2022

Background

Mental health of older adults could be positively predicted by harmonious parent–adult children relationships, although the mechanism has not been sufficiently demonstrated. This study employed sense of loneliness as mediator to examine the influence of multiple domains of intergenerational relationships on depressive symptoms in ageing Chinese adults.

Methods

Data was extracted from a representative survey in Hong Kong among Chinese adults aged over 50 with at least one adult child (n = 801). Four key domains (structural–associational, consensual–normative, affectual closeness, and intergenerational conflict) were adopted to measure the intergenerational relationship quality. Depressive symptoms were assessed using the five-item Geriatric Depression Scale. The mediating role of sense of loneliness in the association between intergenerational relationships and depressive symptoms were tested by the PROCESS macro in SPSS.

Results

The influence of overall intergenerational relationship quality and its four subdomains on depressive symptoms were significantly mediated by sense of loneliness. Among the four domains, affectual closeness presented the strongest association with older people’s depressive symptoms. The effect of intergenerational conflict on depressive symptoms was completely mediated by sense of loneliness, and the effects of remaining three domains were partially mediated. The domain of consensual–normative solidarity received the lowest rating by Chinese older adults.

Conclusion

The psychological pathway that loneliness links intergenerational relationships and depressive symptoms was supported in this study. With respect to improving intergenerational relationships, enhancing affectual connection between older parents and adult children was essential to prevent mental problems. This study calls for more attention to the protective role of diverse social relationships in improving mental health through multiple pathways.
Performance of the APOP-screener for predicting in-hospital mortality in older COVID-19 patients: a retrospective study
Authors: van der Velde Marleen G. A. M. , van der Aa Merel J. , van Daal Merel H. C. , Kremers Marjolein N. T. , Keijsers Carolina J. P. W. , van Kuijk Sander M. J. , Haak Harm R.
Published: July 2022

Background

A variety of prediction models concerning COVID-19 have been proposed since onset of the pandemic, but to this date no gold standard exists. Mortality rates show a sharp increase with advancing age but with the large heterogeneity of this population in terms of comorbidities, vulnerability and disabilities, identifying risk factors is difficult. Therefore, we aimed to research the multidimensional concept of frailty, measured by the Acute Presenting Older Patient (APOP)-screener, as a risk factor for in-hospital mortality in older COVID-19 patients.

Methods

All consecutive patients of 70 years or older, with a PCR confirmed COVID-19 infection and a completed APOP-score, presenting at the Emergency Department (ED) of the Jeroen Bosch Hospital, the Netherlands, between February 27th 2020 and February 1st 2021 were retrospectively included. We gathered baseline characteristics and scored the CCI and CFS from patient records. The primary outcome was in-hospital mortality.

Results

A total of 292 patients met the inclusion criteria. Approximately half of the patients were considered frail by the APOP or CFS. 127 patients (43.5%) scored frail on the CFS, 158 (54.1%) scored high risk on the APOP-screener. 79 patients (27.1%) died during their hospital admission. The APOP-screener showed a significantly elevated risk of in-hospital mortality when patients scored both high risk of functional and evidence of cognitive impairment (OR 2.24, 95% 1.18–4.25). Significant elevation of in-hospital mortality was found for the high CCI-scores (≥ 5)(OR 1.78, 95% 1.02–3.11), but not for the highest CFS category (5–9, frail) (OR 1.35, 95% 0.75–2.47). The discriminatory performance of the APOP, CFS and CCI were comparable (AUC resp. 0.59 (0.52–0.66), 0.54 (0.46–0.62) and 0.58 (0.51–0.65)).

Conclusion

Although the elevated risk for in-hospital mortality found for the most frail patients as scored by the APOP, this instrument has poor discriminatory value. Additionally, the CFS did not show significance in predicting in-hospital mortality and had a poor discriminatory value as well. Therefore, treatment decisions based on frailty or comorbidities alone should be made with caution. Approaching the heterogeneity of the older population by adding frailty as assessed by the APOP-score to existing prediction models may enhance the predictive value of these models.
Phase 1 trial of apatinib combined with intensity-modulated radiotherapy in unresectable hepatocellular carcinoma
Authors: Wang Hongzhi , Zhu Xianggao , Zhao Yuting , Dong Dezuo , Li Lijuan , Cai Yong , Li Yongheng , Wang Weihu
Published: July 2022

Background

To investigate the maximum tolerated dose (MTD) of apatinib delivered during and after intensity-modulated radiotherapy (IMRT) for unresectable hepatocellular carcinoma (HCC).

Methods

Patients with unresectable HCC who were not eligible for radiofrequency ablation (RFA), transcatheter arterial chemoembolization (TACE), or residual/ recurrent after the prior local treatment were enrolled. Patients were scheduled to be treated with IMRT at 50–60 Gy/25–30 fractions. Oral apatinib tablets were administered concurrently with IMRT and continued thereafter. We used a 3 + 3 dose-escalation design, with three dose levels of apatinib (250, 500, and 750 mg). Grade 3 or more severe adverse events (AEs) were defined as dose-limiting toxicities (DLTs). The treatment response was calculated using the Modified Response Evaluation Criteria in Solid Tumours.

Results

Nine patients with Barcelona Clinic Liver Cancer Stage C were included. One patient withdrew from the apatinib 250 mg group and another patient was added. No DLTs occurred in the apatinib 250 mg group. Five patients were included in the apatinib 500 mg group, and 2 cases of DLT (grade 3 leukopenia) were found among them. Dose escalation was terminated and the MTD was determined to be 250 mg. Common grade 1–2 AEs included fatigue, hypertension, dizziness, bone marrow suppression, and hyperbilirubinemia. The median follow-up time for all patients was 16.0 months. Three patients achieved complete response and another three achieved partial response. The objective response rate was 6/9 (66.7%), and the disease control rate was 9/9 (100%). Three patients relapsed out of the radiation field. The median progression-free survival was 17.0 months, and the median overall survival was 16.7 months.

Conclusions

When combined with IMRT, apatinib 250 mg daily was recommended for a phase 2 study of unresectable HCC. The antitumor activity of the combination treatment was encouraging. The safety and efficacy of apatinib combined with IMRT for unresectable HCC should be further investigated in future studies.

Trial registration

Registration No. ChiCTR1800018309. Registered 11 September 2018. Retrospectively registered, https://www.chictr.org.cn/showproj.aspx?proj=30461.
Public procurement of antineoplastic agents used for treating breast cancer in Brazil between 2013 and 2019
Authors: dos Santos Ranailla Lima Bandeira , Pepe Vera Lúcia Edais , Osorio-de-Castro Claudia Garcia Serpa
Published: July 2022

Background

Breast cancer is the most common cancer among women in Brazil and the country’s public health care system is the main care provider. Timely treatment can increase the chance of cure, prevent metastasis and improve quality of life. Effective public procurement of antineoplastic agents can therefore improve access to drug therapy. This study investigates patterns in the procurement of selected antineoplastic agents used for treating breast cancer by public bodies and avoidable expenditure on these drugs between January 2013 and December 2019.

Methods

We selected antineoplastic agents used for adjuvant or preoperative chemotherapy listed in the 2018 Breast Cancer Diagnosis and Treatment Guidelines and included in category L of the WHO Anatomical Therapeutic Chemical classification system. We analyzed regular purchases of antineoplastic agents registered in the Integrated General Services Administration System (SIASG), considering purchased quantity, unit price, date of purchase and procuring entity. Prices were inflation-adjusted to July 2019 based on the National Consumer Price Index.

Results

A total of 10 antineoplastic agents were selected. Trastuzumab and tamoxifen accounted for the largest share of total spending and largest volume of purchases, respectively. The Ministry of Education was the largest purchaser in volume terms of all the drugs studied, except trastuzumab 440 mg, where the category “Other Institutions” accounted for most purchases, and vinorelbine 20 mg, where the Ministry of Health made most purchases. The category “Other Institutions” accounted for the largest share of total spending. Total avoidable expenditure was R$99,130,645. Prices paid for medicines and avoidable expenditure were highest in the Ministry of Defense.

Conclusions

The differences observed in the performance of different categories of buyers as to amounts purchased and prices practiced for antineoplastic agents could be reduced by employing strategies to expand the centralization of purchases, resulting in expanded access to breast cancer medicines in the public sector.
The effect of Orem-based self-care education on improving self-care ability of patients undergoing chemotherapy: a randomized clinical trial
Authors: Rakhshani Tayebeh , Najafi Siamak , Javady Fakhry , Taghian dasht bozorg Alireza , Mohammadkhah Fatemeh , Khani Jeihooni Ali
Published: July 2022

Background

Cancer is a frightening disease. Therefore, the care of cancer patients is very complex. This study aimed to investigate the effect of the education based on Orem’s self-care model on self-care abilities of the patients undergoing chemotherapy in Shafa Hospital in Ahvaz city, Iran.

Methods

This randomized clinical trial was carried out in 2018 on 100 cancer patients undergoing chemotherapy, who referred to Shafa Hospital in Ahvaz city, Iran. The sampling method was simple and the subjects were randomly divided into two experimental and control groups (50 in the experimental and 50 in the control group). The study outcome was the self-care ability of the patients measured before and 2 months after the intervention by the control and experimental groups. The educational intervention consisted of five 60-minute sessions (one session per week) held as educational and counseling ones through group, face-to-face and individual training based on the identified needs of the patients in the experimental group at Shafa Hospital Chemotherapy Department. To collect data, two questionnaires [the assess and identify the conceptual pattern of Orem questionnaire and the Self-care capacity assessment (ESCI)]were used. Statistical data were entered into SPSS software version 20 and analyzed by chi-square, independent t-test and paired t-test.

Results

The mean and standard deviation of age was 35.06 ± 14.51 in the control group and 31.72 ± 15.01 in the experimental group. The results of the independent t-test showed that before the educational intervention, there was no significant difference between the two groups in terms of the mean self-care (P = 0.38). But after the intervention, a significant difference was found between the mean self-care scores of the experimental and control groups (P = 0.001).

Conclusion

Application of Orem’s self-care model led to increased self-care ability of the cancer patients undergoing chemotherapy. Therefore, it is recommended that this model be included in the routine programs of chemotherapy departments.

Trial registration

IRCT registration number: IRCT20160418027449N6.

Registration date: 01/05/2019.
The repeatability of corneal topography measurements in severe Dry Eye disease
Authors: Guven Soner
Published: July 2022

Background

To determine the repeatability of corneal topography measurements in severe dry eye disease (DED). A comparison of corneal topography parameters between severe DED and healthy subjects was a secondary goal of this study.

Methods

Sixty-nine patients with severe DED and 46 healthy subjects were enrolled in the study. All participants underwent repeated corneal topography measurements with Pentacam (Oculus, Germany) within a half hour time. Both eyes of the participants were used in statistical analysis. A further subcategorization of severe DED patients was performed according to Ocular Surface Disease Index (OSDI) scores: 32–50, 51–70 and 71–100. The repeatability of corneal parameters was assessed with correlation coefficients (CC).

Results

The mean age of dry eye patients and healthy subjects were 40.8 ± 13.2 (17–66) and 39.8 ± 8.2 (18–61) years (p:0.604) respectively. No significant differences were found between severe DED and control groups according to analysed corneal parameters in both eyes (p:>0.05). All CCs were greater than 0.9 in severe DED group (p:<0.001). All CCs were also greater than 0.9 in severe DED patients among different OSDI groups (p:<0.001).

Conclusions

Corneal topography measurements are highly repeatable in severe DED with Pentacam. This is the first report about this topic. Nonetheless, further studies are needed with different topography devices for validation.
The effects of seasonal variations on household water security and burden of diarrheal diseases among under 5 children in an urban community, Southwest Nigeria
Authors: Akinyemi Patrick A. , Afolabi Olusegun T. , Aluko Olufemi O.
Published: July 2022

Background

Household water security encompasses water-related factors that pose threats to public health at the household level. It presents a reliable access to water in sufficient quantity and quality towards meeting basic human needs. This study assessed the dynamics of seasonal variations in household water security and the association between household water security and diarrheal disease across dry and wet seasons in an urban settlement in Southwest Nigeria.

Methods

A panel study design was employed to study 180 households selected using a multistage sampling technique. The selected households were studied during dry and rainy seasons. Household water security was assessed through the application of the all or none principle to 9 indicators associated with household water security. The intensity of water insecurity was also assessed using the nine indicators. The higher the number of indicators a household failed, the higher the intensity of household water insecurity. The association between the intensity of household water insecurity and the burden of diarrheal disease across the seasons was assessed using the Mantel-Haenszel test.

Results

No household was water-secure in both dry and rainy seasons; however, the intensity of insecurity was more pronounced during the dry season compared with the rainy season. Ninety households (52.0%), had water insecurity intensity scores above fifty percentiles during the dry season while 21 (12.1%) households had a water insecurity score above the 50th percentile during raining season, p < 0.001. The burden of diarrheal disease was significantly higher among households with a water insecurity intensity score above the 50th percentile, 9 (8.1%) compared to households with a water insecurity intensity score below the 50th percentile 7 (3.0%), p = 0.034.

There was no statistically significant association between the intensity of water insecurity and diarrheal disease burden across the dry and rainy seasons, p = 0.218.

Conclusion

The high burden of household water insecurity deserves concerted efforts from all concerned stakeholders, a panacea to an important health threat in the developing world.
covidscreen: a web app and R Package for assessing asymptomatic COVID-19 testing strategies
Authors: Smith Jesse , Sun Yilun , Hijano Diego R. , Hoffman James M. , Hakim Hana , Webby Richard J. , Hayden Randall T , Gaur Aditya H. , Armstrong Gregory T. , Mori Motomi , Tang Li
Published: July 2022

Background

COVID-19 has caused over 305 million infections and nearly 5.5 million deaths globally. With complete eradication unlikely, organizations will need to evaluate their risk and the benefits of mitigation strategies, including the effects of regular asymptomatic testing. We developed a web application and R package that provides estimates and visualizations to aid the assessment of organizational infection risk and testing benefits to facilitate decision-making, which combines internal and community information with malleable assumptions.

Results

Our web application, covidscreen, presents estimated values of risk metrics in an intuitive graphical format. It shows the current expected number of active, primarily community-acquired infections among employees in an organization. It calculates and explains the absolute and relative risk reduction of an intervention, relative to the baseline scenario, and shows the value of testing vaccinated and unvaccinated employees. In addition, the web interface allows users to profile risk over a chosen range of input values. The performance and output are illustrated using simulations and a real-world example from the employee testing program of a pediatric oncology specialty hospital.

Conclusions

As the COVID-19 pandemic continues to evolve, covidscreen can assist organizations in making informed decisions about whether to incorporate covid test based screening as part of their on-campus risk-mitigation strategy. The web application, R package, and source code are freely available online (see “Availability of data and materials”).
Use data augmentation for a deep learning classification model with chest X-ray clinical imaging featuring coal workers' pneumoconiosis
Authors: Dong Hantian , Zhu Biaokai , Zhang Xinri , Kong Xiaomei
Published: July 2022

Purpose

This paper aims to develop a successful deep learning model with data augmentation technique to discover the clinical uniqueness of chest X-ray imaging features of coal workers' pneumoconiosis (CWP).

Patients and methods

We enrolled 149 CWP patients and 68 dust-exposure workers for a prospective cohort observational study between August 2021 and December 2021 at First Hospital of Shanxi Medical University. Two hundred seventeen chest X-ray images were collected for this study, obtaining reliable diagnostic results through the radiologists' team, and confirming clinical imaging features. We segmented regions of interest with diagnosis reports, then classified them into three categories. To identify these clinical features, we developed a deep learning model (ShuffleNet V2-ECA Net) with data augmentation through performances of different deep learning models by assessment with Receiver Operation Characteristics (ROC) curve and area under the curve (AUC), accuracy (ACC), and Loss curves.

Results

We selected the ShuffleNet V2-ECA Net as the optimal model. The average AUC of this model was 0.98, and all classifications of clinical imaging features had an AUC above 0.95.

Conclusion

We performed a study on a small dataset to classify the chest X-ray clinical imaging features of pneumoconiosis using a deep learning technique. A deep learning model of ShuffleNet V2 and ECA-Net was successfully constructed using data augmentation, which achieved an average accuracy of 98%. This method uncovered the uniqueness of the chest X-ray imaging features of CWP, thus supplying additional reference material for clinical application.
Effect of body mass index on symptomatic venous thromboembolism and prosthesis revision risk after total knee arthroplasty: a long-term study from China
Authors: Shao Changjie , Xu Kuishuai , Zhang Liang , Yu Tengbo , Yu Ning
Published: July 2022

Objective

To investigate the effect of body mass index (BMI) on the risk of symptomatic VTE and prosthesis revision after total knee arthroplasty (TKA).

Methods

Seven thousand one hundred eighty-two patients with primary unilateral TKA treated in our hospital from 2011 to 2020 were divided into four groups according to BMI: BMI < 25 kg/m2, BMI 25 kg/m2–29.9 kg/m2, BMI 30 kg/m2–34.9 kg/m2 and BMI ≥ 35 kg/m2. Incidence, Odds ratio and Kaplan-Meier survival analysis were used to evaluate the effects of BMI on symptomatic VTE and prosthesis revision risk after TKA.

Results

The incidence of VTE after TKA was 8.9‰(64/7182). There was no significant difference in the incidence of VTE among different BMI groups(P = 0.452). Deep vein thrombosis mainly occurred in the distal lower extremities, especially in intermuscular veins. Revision rate of prosthesis after TKA was 6.4‰(46/7182). There was no significant difference in revision rate among different BMI groups(P = 0.718). In the univariate analysis of TKA, compared with patients with normal BMI, the risk of postoperative VTE and prosthesis revision in patients with overweight, obesity class I and obesity class II did not increase. Higher prosthesis revision rate and lower prosthesis survival rate were observed in BMI ≥ 35 kg/m2 group, although the difference was not statistically significant.

Conclusions

Through such a retrospective large sample data of long-term follow-up, we believe that the higher BMI was not associated with the increased risk of symptomatic VTE and prosthesis revision after TKA. When TKA was used for appropriate indications, high BMI should not be considered as a contraindication.
Interdisciplinary staff perceptions of advance care planning in long-term care homes: a qualitative study
Authors: Vellani Shirin , Green Elizabeth , Kulasegaram Pereya , Sussman Tamara , Wickson-Griffiths Abby , Kaasalainen Sharon
Published: July 2022

Background

Residents living in long-term care homes (LTCH) have complex care needs, multiple chronic conditions, increasing frailty and cognitive impairment. A palliative approach that incorporates advance care planning (ACP) should be integrated with chronic disease management, yet it is not a norm in most LTCHs. Despite its growing need, there remains a lack of staff engagement in the ACP process.

Objectives

The aim of this study was to explore the perceptions and experiences of interdisciplinary staff related to the practice of ACP in LTCHs.

Methods

This study is part of a larger Canadian project, iCAN ACP, that aims to increase uptake, and access to ACP for older Canadians living with frailty. An exploratory qualitative design using an interpretive descriptive approach was employed utilizing focus groups and semi-structured interviews with staff from four LTCHs in Ontario, Canada.

Findings

There were 98 participants, including nurses (n = 36), physicians (n = 4), personal support workers (n = 34), support staff (n = 23), and a public guardian (n = 1). Three common themes and nine subthemes were derived: a) ongoing nature of ACP; b) complexities around ACP conversations; and c) aspirations for ACP becoming a standard of care in LTCHs.

Discussion

The findings of this study provide important contributions to our understanding of the complexities surrounding ACP implementation as a standard of practice in LTCHs. One of the critical findings relates to a lack of ACP conversations prior to admission in the LTCHs, by which time many residents may have already lost cognitive abilities to engage in these discussions. The hierarchical nature of LTCH staffing also serves as a barrier to the interdisciplinary collaboration required for a successful implementation of ACP initiatives. Participants within our study expressed support for ACP communication and the need for open lines of formal and informal interdisciplinary communication. There is a need for revitalizing care in LTCHs through interdisciplinary care practices, clarification of role descriptions, optimized staffing, capacity building of each category of staff and commitment from the LTCH leadership for such care.

Conclusion

The findings build on a growing body of research illustrating the need to improve staff engagement in ACP communication in LTCHs.
The association between Healthy Beverage Index and psychological disorders among overweight and obese women: a cross-sectional study
Authors: Rasaei Niloufar , Ghaffarian-Ensaf Rasool , Shiraseb Farideh , Abaj Faezeh , Gholami Fatemeh , Clark Cain C. T. , Mirzaei Khadijeh
Published: July 2022

Background and aims

The Healthy Beverage Index (HBI) is a valuable technique to estimate the synergistic effects of overall beverage consumption. Several studies have evaluated the associations between HBI and beneficial changes in the health status. however, there is no study on the association between patterns of beverage consumption and mental health status. Therefore, this study sought to examine the association between HBI and psychological disorders among overweight and obese women.

Methods

199 overweight and obese women, between the ages of 18 and 55 y, were enrolled in this cross-sectional study in Tehran, Iran. To collect beverage dietary data, a validated semi-quantitative food-frequency questionnaire (FFQ) was used. Furthermore, the DASS-21 questionnaire was used to assess psychological profile states.

Results

The association of total depression anxiety stress (DASS) score with healthy beverage index (HBI) tertiles in models was marginally significant (OR =: 0.78; 95% CI 0.30–2.02; P-value = 0.074; (OR = 0.77; 95% CI 0.28–2.16; P-value = 0.062), respectively. In terms of stress, anxiety, and depression, after adjusting for confounders, participants with higher HBI in the third tertile had lower odds of depression vs. the first tertile (OR = 0.99; 95% CI 0.35–2.81; P-trend = 0.040).

Conclusion

We demonstrate that the total DASS score was associated with HBI tertiles. We also found that participants with higher HBI had lower odds of depression. However, additional well-designed studies are needed to confirm the veracity of these findings.
Chlamydia infection, PID, and infertility: further evidence from a case–control study in China
Authors: Liu Lijun , Li Changchang , Sun Xuewan , Liu Jie , Zheng Hepeng , Yang Bin , Tang Weiming , Wang Cheng
Published: July 2022

Background

Chlamydia trachomatis infection and pelvic inflammatory disease (PID) are well-known risk factors for female infertility. But there is limited evidence from China. This study aimed to further explore the associations between previous/current chlamydial infection, PID, and infertility in China.

Methods

We performed a 1:2 matched case–control study with two control groups: pregnant controls and non-pregnant controls in China in 2019. Women diagnosed with infertility were selected as cases (n = 255). Controls were selected based on the following criteria: Pregnant women who were documented in the selected hospitals were chosen as Pregnant controls (n = 510), and people who sought health care in Obstetric/Gynecologic clinics, Family Planning clinics, Dermatology and STD Department or Urological department were selected as Non-pregnant controls (n = 510). Infertility induced by male factors and people who used antibiotics in the vagina within two weeks were excluded. The first-stream specimen of urine samples was tested for chlamydia by nucleic acid amplification testing (NAAT). Conditional logistic regression was used to estimate the association.

Results

The prevalence of previous chlamydial infection and PID were significantly higher in cases (2.4%, 17.3%) than in controls (Non-pregnancy: 0.4%, 3.0%; Pregnancy: 0.4%, 9.0%). The current chlamydial infection rates were 5.9%, 7.3%, and 7.1% in infertile, pregnant, and non-pregnant women, respectively. After adjusting for confounders, PID largely elevated the risk of infertility (using non-pregnant controls: adjusted OR = 2.57, 95% CI 1.51, 4.39; using pregnant controls: adjusted OR = 6.83, 95% CI 3.47, 13.43). And the positive association between PID and tubal infertility was more obvious for both groups. For current chlamydial infection, none of the odds ratios were significant at the 0.05 level, while small sample size limited the evaluation of an association between prior chlamydial infection with infertility.

Conclusions

Previous PID was indicated to largely increase the risk of infertility, especially tubal infertility. And there should be continuing emphasis on highly sensitive and specific biomarker for prior chlamydial infection.