bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring Tourist Behavior in a Reused Heritage Site
Authors: Lee Yi-Ju , Tsai I-Ying , Chang Te-Yi
Published: June 2021

This study investigated the relationship among tourists’ perceived sustainability, aesthetic experience, and behavioral intention toward reused heritage buildings by employing stimulus–organism–response theory. There were 354 valid questionnaires collected from the Sputnik Lab in Tainan, Taiwan. A positive correlation was found between tourists’ perception of sustainability and aesthetic experience. When tourists perceived higher aesthetic experience, they also had stronger behavioral intention. Structural equation modeling analysis verified that the aesthetic experience of tourists had mediating effects between perceived sustainability and behavioral intention in the reused heritage space. The reuse of space should be attached significantly to the aesthetic display of space and service so as to promote such scenic spots and increase tourists’ intention to revisit through word of mouth.
Dancing with and within the Digital Domain
Authors: Ravetto-Biagioli Kriss
Published: June 2021

Digital cameras and motion capture technologies that document and share creative practices have transformed the way we think about dance as an embodied knowledge as well as the way we experience it bodily. Computational media, which not only records and archives but also calculates, analyses and models dance, further complicates its ontological status. This move to document and inscribe dance in a tangible medium marks a shift from understanding dance as an ungraspable event towards conceiving of dance as a tangible process that can be collected, transmitted, repeated and packaged or archived as an object. I look at two dance works – Matthias Sperling’s Loop Atlas and Siobhan Davies and Anri Sala’s Solo in the Doldrums – that trouble conventional notions of embodiment and its relationship to both presence and absence, at the same time they challenge how computational media fixates on figures and gestures that can be traced, mapped and calibrated.
Predicting motor gains with home-based telerehabilitation after stroke
Authors: Paik Sang Min , Cramer Steven C
Published: June 2021

Introduction

Telerehabilitation (TR) may be useful for rehabilitation therapy after stroke. However, stroke is a heterogeneous condition, and not all patients can be expected to derive the same benefit from TR, underscoring the need to identify predictors of response to TR.

Methods

A prior trial provided patients with 6 weeks of intensive rehabilitation therapy targeting arm movement, randomly assigned to be provided in the home via TR (current focus) or in clinic. Eligible patients had moderate arm motor deficits and were in the subacute–chronic stage post stroke. Behavioral gains were measured as change in the arm motor Fugl-Meyer score from baseline to 30 days post therapy. To delineate predictors of TR response, multivariable linear regression was performed, advancing the most significant predictor from each of eight categories: patient demographics, stroke characteristics, medical history, rehabilitation therapy outside of study procedures, motivation, sensorimotor impairment, cognitive/affective deficits, and functional status.

Results

The primary focus was on patients starting TR >90 days post stroke onset ( n = 44), among whom female sex, less spasticity, and less visual field defects predicted greater motor gains. This model explained 39.3% of the variance in treatment-related gains. In secondary analysis that also included TR patients enrolled ≤90 days post stroke (total n = 59), only female sex was a predictor of treatment gains. A separate secondary analysis examined patients >90 days post stroke ( n = 34) randomized to in-clinic therapy, among whom starting therapy earlier post stroke and less ataxia predicted greater motor gains.

Discussion

Response to TR varies across patients, emphasizing the need to identify characteristics that predict treatment-related behavioral gain. The current study highlights factors that might be important to patient selection for home-based TR after stroke.
A nonrandomized trial of a behavioral parent training intervention for parents with children with challenging behaviors: In-person versus internet-HOT DOCS
Authors: Agazzi Heather , Hayford Holland , Thomas Nicholas , Ortiz Cristina , Salinas-Miranda Abraham
Published: June 2021

Behavioral parent training (BPT) programs are the first-line interventions for childhood disruptive behaviors. In light of the COVID-19 pandemic, adapting these programs to telehealth modalities is necessary to ensure continued services to children and families. This study evaluates the use of telehealth versus in-person modality to deliver the Helping Our Toddlers, Developing Our Children’s Skills (HOT DOCS) BPT. The study design was quasi-experimental with two nonequivalent groups: in-person HOT DOCS ( n = 152) and internet-HOT DOCS ( n = 46). Participants were caregivers of children ages 2–5 exhibiting disruptive behaviors. Pre- and post-intervention outcome measures were collected for child disruptive behavior and parenting stress and post-test only for consumer satisfaction. Multiple linear and Poisson regression models were performed to assess the effect of class modality on the outcomes. Child disruptive behavior and parenting stress post-test scores for in-person and telehealth groups were not significantly different, even after adjusting for baseline characteristics. Consumer satisfaction scores were significantly more positive for the in-person group. The results of this study provide preliminary evidence for the i-HOT DOCS modality as being as effective as the in-person program. Study findings may be beneficial to practitioners utilizing telehealth interventions during the COVID-19 pandemic and onward.
Self-reported parkinsonism features in older autistic adults: A descriptive study
Authors: Geurts Hilde M , McQuaid Goldie A , Begeer Sander , Wallace Gregory L
Published: June 2021

Prior research suggests that autistic adults are at increased risk for developing the core motor components of Parkinson’s disease (i.e. parkinsonism) although knowledge is limited to date. Therefore, we explore: (1) the prevalence of both continuous self-reported motor features typical of parkinsonism and the screen positivity rate for parkinsonism in two samples of older autistic adults without a suspected intellectual disability: the Netherlands-Sample ( N = 296, 50–81 years; 183 males; 113 females) and the United States of America-Sample ( N = 209, 50–83 years; 100 males; 109 females), and (2) whether there are differences between those who Screen+ versus Screen− for parkinsonism. Within the Netherlands-Sample only, the age of onset of the motor features was investigated. Self-reported parkinsonism features were prevalent in both samples (the Netherlands-Sample ~17% screened positive, mean age of onset ranging from 35.9 to 50.4 years; the United States of America-Sample ~33% screened positive). Autistic adults (the Netherlands-Sample) screening positive encountered more health problems than those who screened negative. In both samples, autistic adults who screened positive did not differ on current antipsychotic medication use relative to those who screened negative. The next step is to determine whether a positive screen for parkinsonism on this self-report questionnaire also implies that there is a higher risk for idiopathic Parkinson’s disease.

Lay abstract

Autistic adults without a suspected intellectual disability reported several motor features such as having tremors, and stiffness in one’s legs which are considered to be part of a complex of motor features called parkinsonism. This so-called parkinsonism was remarkably prevalent in middle-aged and older autistic adults in two independent studies (Dutch study: 50–81 years, 183 males, 113 females, all adulthood diagnoses; the USA study: 50–83 years, 110 females, 109 males, majority adulthood diagnosis). Parkinsonism can be part of the progressive motor disease—Parkinson’s disease. Therefore, it is important that future studies, including in-person neurological assessment, determine if (and if so, why) autistic adults who report these motor features are at increased risk for developing Parkinson’s disease.
A method for the experimental estimation of direct and cross-coupled dynamic coefficients of tilting-pad journal bearings of vertical hydro-generators
Authors: Brito Geraldo C , Machado Roberto D , Neto Anselmo C , Kimura Leonardo Y
Published: June 2021

This article presents a method to experimentally estimate the direct and cross-coupled dynamic coefficients of tilting-pad journal bearings of vertical hydro-generators and other similar rotating machinery for damage detection purposes. Based on a simplified second-order model of a journal bearing in the state-space, the method employs only the usually monitored vibrations, the shaft radial relative, and the bearing radial absolute vibrations originated by the hydro-generator residual unbalance or by hydraulic excitations in the turbine rotor. This article shows that the method was successfully tested using the shaft and bearing vibration signals synthesized by a mathematical model of a 700 MW hydro-generator, even when these signals are contaminated with random noise. This article also shows the method’s performance when applied to real vibration signals acquired from the modeled hydro-generator. Finally, it discusses the possible measures to improve the method’s efficiency.
Patient functional independence and occupational therapist time-use in inpatient services: Patient demographic and clinical correlates
Authors: Summers Bianca E , Laver Kate E , Nicks Rebecca J , Andrew Nadine E , Barr Christopher J , Jolliffe Laura , Lannin Natasha A
Published: June 2021

Introduction

Health care expenditure has rapidly increased in Australia. Effective management of occupational therapy services is required to meet clinical demand. Improving our understanding of factors which influence occupational therapy service delivery is a vital step to manage workload distribution and optimise service efficiency. This study aims to examine the influence of patient sociodemographic characteristics, diagnosis and functional independence on the utilisation of occupational therapy resources in hospital inpatients over 18 years old.

Methods

Prospective, cross-sectional, observational cohort study of 4549 inpatients from three hospital sites in Melbourne, Australia. Data extracted from organisational databases and included in this study were: patient demographics, diagnosis, functional level assessed using the SMAF (Functional Autonomy Measurement System) and occupational therapy time-use. Data were analysed using univariable and multivariable modelling.

Results

Occupational therapy time-use was significantly associated with all variables included in analysis ( p < 0.05). For each variable the amount and direction of effect differed between hospital sites. The SMAF was the only variable consistently associated with occupational therapy time-use. Higher occupational therapy time-use was associated with lower functional independence (leading to a 3.5 min increase in median occupational therapy time for every unit decrease in SMAF score).

Conclusions

Management of resources within busy hospitals require knowledge of factors associated with occupational therapist time-use. This study identified that time-use could in part be predicted by functional independence, diagnosis and sociodemographic characteristics. Occupational therapy managers can use this information to support decision making while acknowledging other patient and therapist level factors also influence time-use.
Turtlegoose Sazerac
Authors: Rao Naveen
Published: June 2021

A short story exploring the unthought futures of public health in America, Turtlegoose Sazerac introduces a young trans protagonist, Cayce, who has arrived at a career crossroads following a deadly massacre of a homeless encampment near their home in Oakland, California. Seeking advice from a past mentor, Victor, Cayce faces an uncertain path filled with digital, physical, and metaphysical challenges on their quest toward a career with impact.
Vertebral Compression Fractures—The First Manifestations in the Elderly Acute Lymphoblastic Leukemia
Authors: Liu Cheng , Shu Cuili
Published: June 2021

Background:

Acute lymphoblastic leukemia (ALL) is reported to be the most common malignancy in children, but is less common in adults. Though vertebral compression fractures have been reported as initial signs of ALL in children, to the best of our knowledge, there have not been any previous reports of vertebral compression fractures as an initial manifestation of ALL in elderly people.

Case Presentation:

Here we reported a 65-year-old man who was admitted with a 1-month history of progressive chest and back pain and worsening pain after heavy lifting. Considering the histories of osteoporosis, minor trauma and normal peripheral blood counts, it was firstly misdiagnosed as spinal osteoporotic compression fractures which were caused by low-energy injuries. The patient was definitely diagnosed as ALL after bone marrow biopsy.

Conclusion:

ALL must be considered in the differential diagnosis with acute vertebral compression fracture. Considering that bony lesions may precede clinical findings, knowledge of radiographic and orthopedic appearances of leukemia are important in order to initiate earlier treatment to avoid the progressive damage and improve their survival rates. we recommend bone marrow biopsy in vertebroplasty to avoid misdiagnosis.
Pediatric Mandibular Distraction Osteogenesis and Long-Term Dental Morbidity: A Clinical Evaluation and Review of the Literature
Authors: Chen Wendy , Brooker Jack , Barnett Joshua , Kim Justine , Bruce Madeleine K. , Pfaff Miles J. , Goldstein Jesse A. , Losee Joseph , Schuster Lindsay A.
Published: June 2021

Objectives: Pediatric mandibular distraction osteogenesis (MDO) is an increasingly common surgical procedure used to lengthen the mandible. Little is known about the long-term effects of MDO on dental development. This retrospective study sought to identify dental abnormalities at mixed dentition and early permanent dentition stages in patients who had undergone MDO. Methods: All pediatric patients who underwent MDO with imaging and clinical exams at mixed dentition and early permanent dentition stages were evaluated identify pathology. Data included demographic information, medical and surgical history, complications, and dental exam information. Descriptive statistics were reported. Results: Twenty-two hemimandibles at mixed dentition stage and 24 at early permanent stage were included. Mean age at initial MDO was 7.95 years with a mean follow-up time of 15.1 years. Nine patients required more than 1 distraction. At the mixed dentition stage, all patients showed abnormalities. The most common abnormalities were absent, dysplastic, or ectopic molars. At early permanent dentition stage, 87.5% of patients had dental abnormalities. The most common abnormality was missing molars (third, second, and first), but dysplastic, impacted, and ectopic teeth were also noted. At both mixed and early permanent dentition stages, some patients were noted to have abnormal V-shaped sigmoid notching of the mandibular ramus of undetermined clinical significance. Buccal mucosal scarring that interfered with orthodontic treatment was observed in a subset of patients. Conclusions: This study provides long-term dental analyses of patients undergoing MDO for mandibular hypoplasia. Dental abnormalities were seen at both mixed and early permanent dentition stages. Molars were the most commonly affected with absence the most commonly seen abnormality. Dysplastic, ectopic, and impacted teeth were also seen in posterior and anterior dentition, and abnormalities in buccal soft tissue and the mandibular ramus were also seen. MDO remains a crucial tool for functional and aesthetic improvement in children with hypoplastic mandibles. Dental abnormalities as a consequence of MDO should be considered as part of surgical planning process.
Cohesin mutations in myeloid malignancies
Authors: Jann Johann-Christoph , Tothova Zuzana
Published: June 2021

Cohesin is a multisubunit protein complex that forms a ring-like structure around DNA. It is essential for sister chromatid cohesion, chromatin organization, transcriptional regulation, and DNA damage repair and plays a major role in dynamically shaping the genome architecture and maintaining DNA integrity. The core complex subunits STAG2, RAD21, SMC1, and SMC3, as well as its modulators PDS5A/B, WAPL, and NIPBL, have been found to be recurrently mutated in hematologic and solid malignancies. These mutations are found across the full spectrum of myeloid neoplasia, including pediatric Down syndrome–associated acute megakaryoblastic leukemia, myelodysplastic syndromes, chronic myelomonocytic leukemia, and de novo and secondary acute myeloid leukemias. The mechanisms by which cohesin mutations act as drivers of clonal expansion and disease progression are still poorly understood. Recent studies have described the impact of cohesin alterations on self-renewal and differentiation of hematopoietic stem and progenitor cells, which are associated with changes in chromatin and epigenetic state directing lineage commitment, as well as genomic integrity. Herein, we review the role of the cohesin complex in healthy and malignant hematopoiesis. We discuss clinical implications of cohesin mutations in myeloid malignancies and discuss opportunities for therapeutic targeting.
Omidubicel vs standard myeloablative umbilical cord blood transplantation: results of a phase 3 randomized study
Authors: Horwitz Mitchell E. , Stiff Patrick J. , Cutler Corey , Brunstein Claudio , Hanna Rabi , Maziarz Richard T. , Rezvani Andrew R. , Karris Nicole A. , McGuirk Joseph , Valcarcel David , Schiller Gary J. , Lindemans Caroline A. , Hwang William Y. K. , Koh Liang Piu , Keating Amy , Khaled Yasser , Hamerschlak Nelson , Frankfurt Olga , Peled Tony , Segalovich Irit , Blackwell Beth , Wease Stephen , Freedman Laurence S. , Galamidi-Cohen Einat , Sanz Guillermo
Published: June 2021

Omidubicel is an ex vivo expanded hematopoietic progenitor cell and nonexpanded myeloid and lymphoid cell product derived from a single umbilical cord blood unit. We report results of a phase 3 trial to evaluate the efficacy of omidubicel compared with standard umbilical cord blood transplantation (UCBT). Between January 2017 and January 2020, 125 patients age 13 to 65 years with hematologic malignancies were randomly assigned to omidubicel vs standard UCBT. Patients received myeloablative conditioning and prophylaxis with a calcineurin inhibitor and mycophenolate mofetil for graft-versus-host disease (GVHD). The primary end point was time to neutrophil engraftment. The treatment arms were well balanced and racially diverse. Median time to neutrophil engraftment was 12 days (95% confidence interval [CI], 10-14 days) for the omidubicel arm and 22 days (95% CI, 19-25 days) for the control arm (P < .001). The cumulative incidence of neutrophil engraftment was 96% for patients receiving omidubicel and 89% for patients receiving control transplants. The omidubicel arm had faster platelet recovery (55% vs 35% recovery by 42 days; P = .028), had a lower incidence of first grade 2 to 3 bacterial or invasive fungal infection (37% vs 57%; P = .027), and spent more time out of hospital during the first 100 days after transplant (median, 61 vs 48 days; P = .005) than controls. Differences in GVHD and survival between the 2 arms were not statistically significant. Transplantation with omidubicel results in faster hematopoietic recovery and reduces early transplant-related complications compared with standard UCBT. The results suggest that omidubicel may be considered as a new standard of care for adult patients eligible for UCBT. The trial was registered at www.clinicaltrials.gov as #NCT02730299.
Primary headaches during the COVID-19 lockdown in Germany: analysis of data from 2325 patients using an electronic headache diary
Authors: Raffaelli Bianca , Mecklenburg Jasper , Scholler Simon , Overeem Lucas Hendrik , Oliveira Gonçalves Ana Sofia , Reuter Uwe , Neeb Lars
Published: June 2021

Background

Lockdown measures due to the COVID-19 pandemic have led to lifestyle changes, which in turn may have an impact on the course of headache disorders. We aimed to assess changes in primary headache characteristics and lifestyle factors during the COVID-19 lockdown in Germany using digital documentation in the mobile application (app) M-sense.

Main body

We analyzed data of smartphone users, who entered daily data in the app in the 28-day period before lockdown (baseline) and in the first 28 days of lockdown (observation period). This analysis included the change of monthly headache days (MHD) in the observation period compared to baseline. We also assessed changes in monthly migraine days (MMD), the use of acute medication, and pain intensity. In addition, we looked into the changes in sleep duration, sleep quality, energy level, mood, stress, and activity level. Outcomes were compared using paired t-tests.

The analysis included data from 2325 app users. They reported 7.01 ± SD 5.64 MHD during baseline and 6.89 ± 5.47 MHD during lockdown without significant changes (p > 0.999). MMD, headache and migraine intensity neither showed any significant changes. Days with acute medication use were reduced from 4.50 ± 3.88 in the baseline to 4.27 ± 3.81 in the observation period (p < 0.001). The app users reported reduced stress levels, longer sleep duration, reduced activity levels, along with a better mood, and an improved energy level during the first lockdown month (p ≤ 0.001).

In an extension analysis of users who continued to use M-sense every day for 3 months after initiation of lockdown, we compared the baseline and the subsequent months using repeated-measures ANOVA. In these 539 users, headache frequency did not change significantly neither (6.11 ± 5.10 MHD before lockdown vs. 6.07 ± 5.17 MHD in the third lockdown month, p = 0.688 in the ANOVA). Migraine frequency, headache and migraine intensity, and acute medication use were also not different during the entire observation period.

Conclusion

Despite slight changes in factors that contribute to the generation of headache, COVID-19-related lockdown measures did not seem to be associated with primary headache frequency and intensity over the course of 3 months.
Niche partitioning between sympatric wild canids: the case of the golden jackal (Canis aureus) and the red fox (Vulpes vulpes) in north-eastern Italy
Authors: Torretta Elisa , Riboldi Luca , Costa Elena , Delfoco Claudio , Frignani Erica , Meriggi Alberto
Published: June 2021

Background

Two coexisting species with similar ecological requirements avoid or reduce competition by changing the extent of their use of a given resource. Numerous coexistence mechanisms have been proposed, but species interactions can also be aggressive; thus, generally a subordinate species modifies its realized niche to limit the probability of direct encounters with the dominant species. We studied niche partitioning between two sympatric wild canids in north-eastern Italy: the golden jackal and the red fox, which, based on competition theories, have a high potential for competition. We considered four main niche dimensions: space, habitat, time, and diet.

Results

We investigated three study areas monitoring target species populations from March 2017 to November 2018 using non-invasive monitoring techniques. Red fox presence was ascertained in every study area, while golden jackal presence was not ascertained in one study area, where we collected data regarding wolf presence. Considering the two target species, we observed partial diet partitioning based on prey size, with the golden jackal mainly feeding on wild ungulates and the red fox mainly feeding on small mammals. The two canids had an extensive temporal overlap along the diel cycle, having both predominant crepuscular and nocturnal activity patterns, but marked spatial partitioning and differential use of habitats. The golden jackal proved to be specialist concerning the habitat dimension, while the red fox resulted completely generalist: the former selected less human-modified habitats and avoided intensively cultivated lands, while the latter was present in all habitats, including intensively cultivated lands.

Conclusions

The observed partitioning might be due partially to some ecological adaptations (e.g. specialist vs. generalist use of resources) and specific behaviours (e.g. cooperative vs. solitary hunting) and partially to the avoidance response of the red fox aimed at reducing the probability of direct encounters with the golden jackal.
Phenotypic overlap between atopic dermatitis and autism
Authors: Shin Kyong-Oh , Crumrine Debra A. , Kim Sungeun , Lee Yerin , Kim Bogyeong , Abuabara Katrina , Park Chaehyeong , Uchida Yoshikazu , Wakefield Joan S. , Meyer Jason M. , Jeong Sekyoo , Park Byeong Deog , Park Kyungho , Elias Peter M.
Published: June 2021

Background

Autism, a childhood behavioral disorder, belongs to a large suite of diseases, collectively referred to as autism spectrum disorders (ASD). Though multifactorial in etiology, approximately 10% of ASD are associated with atopic dermatitis (AD). Moreover, ASD prevalence increases further as AD severity worsens, though these disorders share no common causative mutations. We assessed here the link between these two disorders in the standard, valproic acid mouse model of ASD. In prior studies, there was no evidence of skin involvement, but we hypothesized that cutaneous involvement could be detected in experiments conducted in BALB/c mice. BALB/c is an albino, laboratory-bred strain of the house mouse and is among the most widely used inbred strains used in animal experimentation.

Methods

We performed our studies in valproic acid (VPA)-treated BALB/c hairless mice, a standard mouse model of ASD. Mid-trimester pregnant mice received a single intraperitoneal injection of either valproic acid sodium salt dissolved in saline or saline alone on embryonic day 12.5 and were housed individually until postnatal day 21. Only the brain and epidermis appeared to be affected, while other tissues remain unchanged. At various postnatal time points, brain, skin and blood samples were obtained for histology and for quantitation of tissue sphingolipid content and cytokine levels.

Results

AD-like changes in ceramide content occurred by day one postpartum in both VPA-treated mouse skin and brain. The temporal co-emergence of AD and ASD, and the AD phenotype-dependent increase in ASD prevalence correlated with early appearance of cytokine markers (i.e., interleukin [IL]-4, 5, and 13), as well as mast cells in skin and brain. The high levels of interferon (IFN)γ not only in skin, but also in brain likely account for a significant decline in esterified very-long-chain N-acyl fatty acids in brain ceramides, again mimicking known IFNγ-induced changes in AD.

Conclusion

Baseline involvement of both AD and ASD could reflect concurrent neuro- and epidermal toxicity, possibly because both epidermis and neural tissues originate from the embryonic neuroectoderm. These studies illuminate the shared susceptibility of the brain and epidermis to a known neurotoxin, suggesting that the atopic diathesis could be extended to include ASD.
Genome-wide association study and its applications in the non-model crop Sesamum indicum
Authors: Berhe Muez , Dossa Komivi , You Jun , Mboup Pape Adama , Diallo Idrissa Navel , Diouf Diaga , Zhang Xiurong , Wang Linhai
Published: June 2021

Background

Sesame is a rare example of non-model and minor crop for which numerous genetic loci and candidate genes underlying features of interest have been disclosed at relatively high resolution. These progresses have been achieved thanks to the applications of the genome-wide association study (GWAS) approach. GWAS has benefited from the availability of high-quality genomes, re-sequencing data from thousands of genotypes, extensive transcriptome sequencing, development of haplotype map and web-based functional databases in sesame.

Results

In this paper, we reviewed the GWAS methods, the underlying statistical models and the applications for genetic discovery of important traits in sesame. A novel online database SiGeDiD (http://sigedid.ucad.sn/) has been developed to provide access to all genetic and genomic discoveries through GWAS in sesame. We also tested for the first time, applications of various new GWAS multi-locus models in sesame.

Conclusions

Collectively, this work portrays steps and provides guidelines for efficient GWAS implementation in sesame, a non-model crop.
Ultraviolet C lamps for disinfection of surfaces potentially contaminated with SARS-CoV-2 in critical hospital settings: examples of their use and some practical advice
Authors: Lualdi Manuela , Cavalleri Adalberto , Bianco Andrea , Biasin Mara , Cavatorta Claudia , Clerici Mario , Galli Paola , Pareschi Giovanni , Pignoli Emanuele
Published: June 2021

Background

UltraViolet-C (UV-C) lamps may be used to supplement current hospital cleaning and disinfection of surfaces contaminated by SARS-CoV-2. Our aim is to provide some practical indications for the correct use of UV-C lamps.

Methods

We studied three UV-C lamps, measuring their spatial irradiance and emission over time. We quantify the error that is committed by calculating the irradiation time based exclusively on the technical data of the lamps or by making direct irradiance measurements. Finally, we tested specific dosimeters for UV-C.

Results

Our results show that the spatial emission of UV-C lamps is strongly dependent on the power of the lamps and on the design of their reflectors. Only by optimizing the positioning and calculating the exposure time correctly, is it possible to dispense the dose necessary to obtain SARS-CoV-2 inactivation. In the absence of suitable equipment for measuring irradiance, the calculated irradiation time can be underestimated. We therefore consider it precautionary to increase the calculated times by at least 20%.

Conclusion

To use UV-C lamps effectively, it is necessary to follow a few simple precepts when choosing, positioning and verifying the lamps. In the absence of instruments dedicated to direct verification of irradiance, photochromic UV-C dosimeters may represent a useful tool for easily verifying that a proper UV-C dose has been delivered.
Detecting neonatal acute bilirubin encephalopathy based on T1-weighted MRI images and learning-based approaches
Authors: Wu Miao , Shen Xiaoxia , Lai Can , Zheng Weihao , Li Yingqun , Shangguan Zhongli , Yan Chuanbo , Liu Tingting , Wu Dan
Published: June 2021

Background

Neonatal hyperbilirubinemia is a common clinical condition that requires medical attention in newborns, which may develop into acute bilirubin encephalopathy with a significant risk of long-term neurological deficits. The current clinical challenge lies in the separation of acute bilirubin encephalopathy and non-acute bilirubin encephalopathy neonates both with hyperbilirubinemia condition since both of them demonstrated similar T1 hyperintensity and lead to difficulties in clinical diagnosis based on the conventional radiological reading. This study aims to investigate the utility of T1-weighted MRI images for differentiating acute bilirubin encephalopathy and non-acute bilirubin encephalopathy neonates with hyperbilirubinemia.

Methods

3 diagnostic approaches, including a visual inspection, a semi-quantitative method based on normalized the T1-weighted intensities of the globus pallidus and subthalamic nuclei, and a deep learning method with ResNet18 framework were applied to classify 47 acute bilirubin encephalopathy neonates and 32 non-acute bilirubin encephalopathy neonates with hyperbilirubinemia based on T1-weighted images. Chi-squared test and t-test were used to test the significant difference of clinical features between the 2 groups.

Results

The visual inspection got a poor diagnostic accuracy of 53.58 ± 5.71% indicating the difficulty of the challenge in real clinical practice. However, the semi-quantitative approach and ResNet18 achieved a classification accuracy of 62.11 ± 8.03% and 72.15%, respectively, which outperformed visual inspection significantly.

Conclusion

Our study indicates that it is not sufficient to only use T1-weighted MRI images to detect neonates with acute bilirubin encephalopathy. Other more MRI multimodal images combined with T1-weighted MRI images are expected to use to improve the accuracy in future work. However, this study demonstrates that the semi-quantitative measurement based on T1-weighted MRI images is a simple and compromised way to discriminate acute bilirubin encephalopathy and non-acute bilirubin encephalopathy neonates with hyperbilirubinemia, which may be helpful in improving the current manual diagnosis.
Limited recurrence distance of glioblastoma under modern radiotherapy era
Authors: Tu Ziwei , Xiong Huifen , Qiu Yang , Li Guoqing , Wang Li , Peng Shiyi
Published: June 2021

Background

The optimal treatment volume for Glioblastoma multiforme (GBM) is still a subject of debate worldwide. The current study was aimed to determine the distances between recurring tumors and the edge of primary lesions, and thereby provide evidence for accurate target area delineation.

Methods

Between October 2007 and March 2019, 68 recurrent patients with GBM were included in our study. We measured the distance from the initial tumor to the recurrent lesion of GBM patients by expanding the initial gross tumor volume (GTV) to overlap the center of recurrent lesion, with the help of the Pinnacle Treatment Planning System.

Results

Recurrences were local in 47(69.1%) patients, distant in 12(17.7%) patients, and both in 9(13.2%) patients. Factors significantly influencing local recurrence were age (P = 0.049), sex (P = 0.049), and the size of peritumoral edema (P = 0.00). A total number of 91 recurrent tumors were analyzed. All local recurrences occurred within 2 cm and 94.8% (55/58) occurred within 1 cm of the original GTV based on T1 enhanced imaging. All local recurrences occurred within 1.5 cm and 98.3%(57/58) occurred within 0.5 cm of the original GTV based on T2-FLAIR imaging. 90.9% (30/33) and 81.8% (27/33) distant recurrences occurred >3 cm of T1 enhanced and T2-Flair primary tumor margins, respectively.

Conclusions

The 1 cm margin from T1 enhanced lesions and 0.5 cm margin from T2-Flair abnormal lesions could cover 94.8 and 98.3% local recurrences respectively, which deserves further prospective study as a limited but effective target area.
Pyruvate carboxylase promotes thyroid cancer aggressiveness through fatty acid synthesis
Authors: Liu Chang , Zhou Xiang , Pan Yu , Liu Yang , Zhang Yifan
Published: June 2021

Background

Pyruvate carboxylase (PC) is an important anaplerotic enzyme in the tricarboxylic acid cycle (TCA) in cancer cells. Although PC overexpression has been observed in thyroid cancer (TC), the mechanisms involved in the carcinogenic effects of PC are still unclear.

Methods

Bioinformatics analysis and clinical specimens were used to analyze the relationship of PC expression with clinicopathological variables in TC. Fatty acid synthesis was monitored by LC/MS, Nile red staining, and triglyceride analysis. Mitochondrial oxygen consumption was evaluated by the Seahorse XF Mito Cell Stress Test. The correlation of PC with FASN and SREBP1c was assessed by qRT-PCR and IHC in 38 human TC tissues. Western blotting was used to evaluate the protein expression of PC, FASN, and SREBP1c and members of the AKT/mTOR and EMT pathways in TC cell lines. Wound-healing, CCK-8, and Transwell assays and a nude mouse xenograft model were used to verify the regulatory effects of PC and SREBP1c on thyroid tumor cell proliferation, migration and invasion.

Results

We demonstrated that PC increased fatty acid synthesis, which then promoted TC progression and metastasis. Analysis of GEO data showed that the overexpression of PC in papillary thyroid cancer (PTC) was associated with PTC invasion and the fatty acid synthesis pathway. Analysis of clinical tissue specimens from PTC patients revealed that PC was more highly expressed in specimens from PTC patients with lymph node metastasis than in those from patients without metastasis. Multiple genes in the fatty acid synthesis signaling pathway, including FASN and SREBP1c, were downregulated in PC-knockdown TC cells compared to control cells. Lipid levels were also decreased in the PC-knockdown TC cells. Moreover, the ability of cells to grow, invade, and metastasize was also suppressed upon PC knockdown, suggesting that PC-mediated lipogenesis activation increases the aggressiveness of TC cells. In addition, PC was found to activate the AKT/mTOR pathway, thus improving FASN-mediated de novo lipogenesis in TC cells by upregulating SREBP1c expression. Studies in a nude mouse xenograft model showed that PC knockdown decreased tumor weight, but this effect was attenuated by forced expression of SREBP1c.

Conclusions

Our results demonstrate that PC is strongly involved in the tumor aggressiveness of TC via its stimulation of fatty acid synthesis.
Usability and acceptability of self-testing for hepatitis C virus infection among the general population in the Nile Delta region of Egypt
Authors: Reipold Elena Ivanova , Farahat Ahmed , Elbeeh Amira , Soliman Reham , Aza Elkin Bermudez , Jamil Muhammad S. , Johnson Cheryl Case , Shiha Gamal , Easterbrook Philippa
Published: June 2021

Background

Self-testing for hepatitis C virus antibodies (HCVST) may be an additional strategy to expand access to hepatitis C virus (HCV) testing and support elimination efforts. We conducted a study to assess the usability and acceptability of HCVST among the general population in a semi-rural, high-HCV prevalence region in Egypt.

Methods

An observational study was conducted in two hospitals in the Nile Delta region. A trained provider gave an in-person demonstration on how to use the oral fluid HCVST followed by observation of the participant performing the test. Usability was assessed by observing errors made and difficulties faced by participants. Acceptability of HCV self-testing was assessed using an interviewer-administered semi-structured questionnaire.

Results

Of 116 participants enrolled, 17 (14.6%) had received no formal education. The majority (72%) of participants completed all testing steps without any assistance and interpreted the test results correctly. Agreement between participant-reported HCVST results and interpretation by a trained user was 86%, with a Cohen’s kappa of 0.6. Agreement between participant-reported HCVST results and provider-administered oral fluid HCV rapid test results was 97.2%, with a Cohen’s kappa of 0.75. The majority of participants rated the HCVST process as easy (53%) or very easy (44%), and 96% indicated they would be willing to use HCVST again and recommend it to their family and friends.

Conclusion

Our study demonstrates the high usability and acceptability of oral fluid HCVST in a general population. Further studies are needed to establish the optimal positioning of self-testing alongside facility-based testing to expand access to HCV diagnosis in both general and high-risk populations.
Health literacy levels and its determinants among people with asthma in Malaysian primary healthcare settings: a cross-sectional study
Authors: Salim H. , Shariff Ghazali S. , Lee P. Y. , Cheong A. T. , Harrun N. H. , Mohamed Isa S. , Pinnock H.
Published: June 2021

Background

Limited health literacy among people with asthma is associated with poor adherence to self-management activities, thus poor clinical outcomes. This study aimed to determine the prevalence of health literacy level and its determinants among people with asthma in the Malaysian primary healthcare settings.

Method

A cross-sectional study was conducted among participants aged > 18 years with asthma who attended five primary health clinics in Malaysia. Systematic random sampling was employed with a final sample of 550 participants. The questionnaires included the validated Malay version of Health Literacy Scale (HLS) and asthma control questionnaire (ACQ). Statistical analysis was done using SPSS version 25. Multiple logistic regression was performed to determine the determinants for limited health literacy.

Results

The participants mean age of the participants was 48 (SD15.4) years. Most of the participants were women (64%) and of Malay ethnicity (51.1%). Nearly half had a secondary level of education, n = 112, (45.8%). Mean duration of asthma diagnosis is 20.6 (SD 15.9) years. More than half (62.5%) had a family history of asthma. About half (50.9%) had uncontrolled asthma, with 87.3% self-rated themselves as having controlled asthma. About a third (29.1%) received education on of asthma action plan, but only 7.1% of these owned a written version an asthma action plan. Limited health literacy accounts for 60.5% of the participants. The significant determinants for limited health literacy included lower educational attainment (p < 0.001), family history of asthma (p = 0.034), < 20 years duration of asthma diagnosis (p = 0.031) and not receiving asthma action plan education (p < 0.001).

Conclusion

In this study population, more than half of the people living with asthma were found to have limited health literacy, which was associated with not having received self-management education supported by an asthma action plan. Future interventions should include strategies that ensure they meet the needs of people with limited health literacy.
Knowledge of palliative care and preference of end of life care: a cross-sectional survey of residents in the Chinese socio-cultural background of Macao
Authors: Tam Kuai In , Che Sok Leng , Zhu Mingxia , Leong Sok Man
Published: June 2021

Background

Since the establishment of a hospice in the year 2000 and the development of a palliative care ward in 2019, there is no study examining public’s knowledge of palliative care, nor preference of end of life care in Macao.

Aim

Targeting Chinese residents of Macao, the current study has 3 goals: i) to understand the level of knowledge of palliative care, ii) to explore the preference of end of life treatments, and iii) to identify the associated factors of the preference of end of life treatments.

Methods

A cross-sectional questionnaire survey was conducted using a structured questionnaire. The study employed non-probability quota sampling through which Macao residents aged 18 and above were recruited between July and September 2020.

Results

A total of 737 responses were valid. The average correct rate of palliative care knowledge ranged from 40.4% to 85.5%. Pertaining to end of life treatments, 62.0% of the respondents chose comfort care. However, almost half of the respondents agreed that life-sustaining treatments should not be stopped under any circumstances. Respondents who scored higher in palliative care knowledge and those with secondary and tertiary education were associated factors of choosing comfort care rather than life-sustaining treatments. In addition, respondents who agreed that futile life-sustaining treatments should be stopped were also associated with preference for comfort care.

Conclusion

The understanding of palliative care amongst Macao residents is inadequate. Despite the public’s inclination towards comfort care, it is generally believed that life-sustaining treatments should not be stopped at the end of life. The study results suggest that not only the knowledge of palliative care should be enhanced amongst the general public in Macao, but information about life-sustaining treatments should also be offered to patients and families by healthcare professionals, in aiding end of life treatment decision making.
Association between knowledge and attitudes towards advance directives in emergency services
Authors: Poveda-Moral Silvia , de la Casa Pilar José-Maria , Sánchez-Valero Pere , Pomares-Quintana Núria , Vicente-García Mireia , Falcó-Pegueroles Anna
Published: June 2021

Background

Implementing the routine consultation of patient advance directives in hospital emergency departments and emergency medical services has become essential, given that advance directives constitute the frame of reference for care personalisation and respect for patients’ values and preferences related to healthcare. The aim of this study was to assess the levels and relationship of knowledge and attitudes of nursing and medical professionals towards advance directives in hospital emergency departments and emergency medical services, and to determine the correlated and predictor variables of favourable attitudes towards advance directives.

Methods

Observational, descriptive, and cross-sectional study. The study was conducted in the emergency department of a second-level hospital and in the emergency medical service. Data collection was performed from January 2019 to February 2020. The STROBE guidelines were followed for the preparation of the study.

Results

A total of 173 healthcare professionals responded to the questionnaire. Among them, 91.3% considered that they were not sufficiently informed about advance directives, and 74% acknowledged not having incorporated them into their usual practice. Multinomial analysis indicated a statistically significant relationship between the variable emergency medical service and having more favourable attitudes towards consulting the advance directives in their practical application (OR 2.49 [95% CI 1.06–5.88]; p = 0.037) and compliance in complex scenarios (OR 3.65 [95% CI 1.58 − 8.41]; p = 0.002). Working the afternoon and night shift was a predictor variable for obtaining a higher score with respect to attitudes in complex scenarios.

Conclusion

There is an association between the level of knowledge that nursing and medical professionals have about advance directives and the scores obtained on the attitude scales at the time of practical implementation and in complex scenarios. This shows that the more knowledge professionals have, the more likely they are to consult patients' advance directives and to respect their wishes and preferences for care and/or treatment.