bluuebunny/crossref_metadata_2025 huggingface dataset:
Video-interpreting for cognitive assessments: An intervention study and micro-costing analysis
Authors: Hwang Kerry , De Silva Anurika , Simpson Julie A , LoGiudice Dina , Engel Lidia , Gilbert Andrew S , Croy Samantha , Haralambous Betty
Published: March 2020

Introduction

Evidence in the literature demonstrates the reliability of cognitive screening assessments using video technology in English-speaking older populations. However, this has not been tested in older culturally and linguistically diverse (CALD) populations who require an interpreter, and what the associated costs would be. The aim was to determine if the Rowland Universal Dementia Assessment Scale (RUDAS) and the Geriatric Depression Scale (GDS) could be reliably administered over video-interpreting methods compared with face-to-face interpreting. In addition, the study aims to compare the costs of video-interpreting with the costs of face-to-face interpreting.

Methods

We compared similarity of the RUDAS and GDS scores when administered face-to-face and via video-interpreting. The similarity of scores between methods was analysed using paired t-tests and Bland–Altman plots. A costing analysis was done using a micro-costing approach to estimate the costs of video-interpreting compared with face-to-face, extrapolated to a national level.

Results

Analysis found no significant differences in the mean assessment scores between video-interpreting and face-to-face (RUDAS mean difference: −0.36; 95% confidence interval (CI): −1.09, 0.38, GDS mean difference: 0.22; 95% CI: −0.38, 0.83). Bland–Altman plots demonstrated that 71% of RUDAS scores and 82% of GDS scores were within the maximum allowed difference of ±2 units. Costing analysis showed a A$7 saving per assessment when using video-interpreting compared with face-to-face, with a total national saving of A$247,350.

Discussion

Video-interpreting was found to be as reliable as face-to-face interpreting for both RUDAS and GDS assessments. Cost analysis indicates that video-interpreting is cheaper than face-to-face interpreting.
Racism-related stress and psychological distress: Black Women’s Experiences Living with Lupus study
Authors: Hunter Evelyn A , Spears Erica C , Martz Connor D , Chung Kara , Fuller-Rowell Thomas E , Lim S Sam , Drenkard Cristina , Chae David H
Published: March 2020

Disparate health consequences in African American women with systemic lupus erythematosus include greater severity of physical and psychological distress. Racism-related stress is also related to psychological distress correlates in this population. This study examined the relationships between racism-related experiences, psychological distress, and systemic lupus erythematosus activity in 430 African American women from the Black Women’s Experiences Living with Lupus study. The structural equation model suggests that psychological distress mediates the relationship between racism-related stress and systemic lupus erythematosus disease activity. The impact of racism-related stress on systemic lupus erythematosus disease activity may occur primarily through their impact on psychological health variables. Implications for clinical care and future directions are explored.
The relationship between vocabulary knowledge and L2 reading/listening comprehension: A meta-analysis
Authors: Zhang Songshan , Zhang Xian
Published: March 2020

This study set out to investigate the relationship between L2 vocabulary knowledge (VK) and second-language (L2) reading/listening comprehension. More than 100 individual studies were included in this meta-analysis, which generated 276 effect sizes from a sample of almost 21,000 learners. The current meta-analysis had several major findings. First, the overall correlation between VK and L2 reading comprehension was .57 ( p < .01) and that between VK and L2 listening was .56 ( p < .01). If the attenuation effect due to reliability of measures was taken into consideration, the ‘true’ correlation between VK and L2 reading/listening comprehension may likely fall within the range of .56–.67, accounting for 31%–45% variance in L2 comprehension. Second, all three mastery levels of form–meaning knowledge (meaning recognition, meaning recall, form recall) had moderate to high correlations with L2 reading and L2 listening. However, meaning recall knowledge had the strongest correlation with L2 reading comprehension and form recall had the strongest correlation with L2 listening comprehension, suggesting that different mastery levels of VK may contribute differently to L2 comprehension in different modalities. Third, both word association knowledge and morphological awareness (two aspects of vocabulary depth knowledge) had significant correlations with L2 reading and L2 listening. Fourth, the modality of VK measure was found to have a significant moderating effect on the correlation between VK and L2 text comprehension: orthographical VK measures had stronger correlations with L2 reading comprehension as compared to auditory VK measures. Auditory VK measures, however, were better predictors of L2 listening comprehension. Fifth, studies with a shorter script distance between L1 and L2 yielded higher correlations between VK and L2 reading. Sixth, the number of items in vocabulary depth measures had a positive predictive power on the correlation between VK and L2 comprehension. Finally, correlations between VK and L2 reading/listening comprehension was found to be associated with two types of publication factors: year-of-publication and publication type. Implications of the findings were discussed.
Prison same-sex sexualities in the context of politicized homophobia in Malawi
Authors: Currier Ashley
Published: March 2020

Prison same-sex sexualities have largely gone unnoticed in Malawi, an African nation associated with politicized homophobia. The term ‘politicized homophobia’ refers to political elites’ public hostility toward same-sex sexualities, gender variance, and gender and sexual diversity activism. In a context typified by scrutiny of same-sex sexualities, it is surprising that certain same-sex sexual practices, specifically prison same-sex sexualities, escaped rebuke and attention in news media, which play an important role in circulating discourses of politicized homophobia in contemporary African nations. Using the case of prison sex in Malawi, this article asserts that politicized homophobia has verifiable limits because not all negative discourses about same-sex sexualities agglomerate into politicized homophobia. The essay draws on an analysis of 109 Malawian newspaper articles published between 1995 and 2016 that mention prison sex.
Being unneeded in post-Soviet Russia: Lessons for an anthropology of loneliness
Authors: Parsons Michelle Anne
Published: March 2020

The problem of loneliness is receiving increasing attention in the popular media and among social scientists. Despite anthropology's rich engagement with emotions and experience, the anthropology of loneliness is still scant. In psychology, loneliness has been defined as relational lack. In this article, I reconsider one culturally specific form of relational lack—being unneeded among post-Soviet Muscovites. I draw on the anthropological literature on emotion, exchange, and morality to suggest that being unneeded is an ethical commentary on a lack of recognition. During Soviet times, recognition was secured through informal social exchange practices. Being unneeded among middle-aged and elderly post-Soviet Muscovites is therefore connected to a constricted ability to give and experience recognition. One avenue of analysis for an anthropology of loneliness is to consider social exchange practices and how these connect with societal and moral dimensions of loneliness.
Legionella species: A potential problem associated with rain water harvesting systems?
Authors: Taylor Judith A. , McLoughlin Rory , Sandford John , Bevan Ruth , Aldred David
Published: March 2020

The risk of Legionella transmission from rain water harvesting (RWH)-fed water toilet flushing was investigated. Experiments monitored RWH tanks to determine Legionella spp. presence which was successfully isolated from three of four of RWH tanks (site 1: 3600 CFU/dm3 in February and 3600 CFU/dm3 in May; site 2: not detected; site 3: <940 GU/dm3; site 4: 44,000 GU/dm3), and to determine whether toilets could generate aerosol droplets capable of harbouring bacteria. The concentrations of particles measuring 10 µm or less in diameter (PM10, capable of reaching the alveolar region of the lungs and causing disease) were monitored following flushes. Aerosols were detectable in an enclosed toilet cubicle (PM10 concentration increased in one experiment from 0.038 mg/m3 when t = 1–600 s to 0.057 mg/m3 when t = 600–800 s). Recovery of Lactobacillus plantarum (surrogate for Legionella) from a seeded toilet cistern (108 CFU ml/dm3) indicated that bacteria were expelled, as demonstrated by recovery on MRS plates placed around the toilet unit. Legionella could be dispersed via aerosols from a toilet flushed with water from an RWH system and the effect would be more pronounced in smaller, enclosed areas, but this is unlikely to pose a risk to human health.
Voices of displacement: a methodology of sound portraits exploring identity and belonging
Authors: Baker Alison M , Sonn Christopher C , Meyer Kirsten
Published: March 2020

Sound portraiture blends audio-documentary techniques and qualitative arts-based and narrative methods, privileging participants’ voices and conveying the complexity of their stories through the layering of sound. We created sound portraits that negotiated the multiple and often conflicting voices, histories and subject positions for South African migrants who psychologically straddle home and host lands. Sound portraits speak to the history of colonialism, Apartheid, displacement, and the continuities of power and privilege in people’s lives. We argue for the use of sound portraits as an aesthetic representation of lived experience and as a medium through which research knowledge becomes democratised.
Reach Out Emergency Department: Partnering With an Economically Disadvantaged Community in the Development of a Text-Messaging Intervention to Address High Blood Pressure
Authors: Champoux Emily , Price Rory , Cowdery Joan E. , Dinh Mackenzie , Meurer William J. , Rehman Narmeen , Schille Caitlin , Oliver Alina , Brown Devin L. , Killingsworth Jordan , Skolarus Lesli E.
Published: March 2020

Background. Hypertension affects nearly 30% of the U.S. adult population. Due to the ubiquitous nature of mobile phone usage, text messaging offers a promising platform for interventions to assist in the management of chronic diseases including hypertension, including among populations that are historically underserved. We present the intervention development of Reach Out, a health behavior theory–based, mobile health intervention to reduce blood pressure among hypertensive patients evaluated in a safety net emergency department primarily caring for African Americans. Aims. To describe the process of designing and refining text messages currently being implemented in the Reach Out randomized controlled trial. Method. We used a five-step framework to develop the text messages used in Reach Out. These steps included literature review and community formative research, conception of a community-centered behavioral theoretical framework, draft of evidence-based text messages, community review, and revision based on community feedback and finalization. Results. The Reach Out development process drew from pertinent evidence that, combined with community feedback, guided the development of a community-centered health behavior theory framework that led to development of text messages. A total of 333 generic and segmented messages were created. Messages address dietary choices, physical activity, hypertension medication adherence, and blood pressure monitoring. Discussion. Our five-step framework is intended to inform future text-messaging-based health promotion efforts to address health issues in vulnerable populations. Conclusion. Text message–based health promotion programs should be developed in partnership with the local community to ensure acceptability and relevance.
The Risk of Acute Pancreatitis and Selective Serotonin Reuptake Inhibitors Use: A Meta-Analysis of Case–Control Studies
Authors: Lai Shih-Wei , Yu Cheng-Chan , Lin Cheng-Li , Liao Kuan-Fu
Published: March 2020

Background/Objective:

Some case series and case report have shown the association between the risk of acute pancreatitis and use of selective serotonin reuptake inhibitors. The results of systematic studies were not consistent.

Methods:

A meta-analysis was performed to investigate the risk of acute pancreatitis associated with use of selective serotonin reuptake inhibitors.

Results:

There was no statistical association between the risk of acute pancreatitis and selective serotonin reuptake inhibitors use (odds ratio: 1.19, 95% confidence interval: 0.93-1.51).

Conclusions:

Despite reaching no statistical significance, the possibility of the association between the risk of acute pancreatitis and selective serotonin reuptake inhibitors use cannot be totally excluded.
Using Visual Timelines in Telephone Interviews: Reflections and Lessons Learned From the Star Family Study
Authors: Pell Bethan , Williams Denitza , Phillips Rhiannon , Sanders Julia , Edwards Adrian , Choy Ernest , Grant Aimee
Published: March 2020

Visual timeline methods have been used as part of face-to-face qualitative interviewing with vulnerable populations to uncover the intricacies of lived experiences, but little is known about whether visual timelines can be effectively used in telephone interviews. In this article, we reflect on the process of using visual timelines in 16 telephone interviews with women as part of the “STarting a family when you have an Autoimmune Rheumatic disease” study (STAR Family Study). The visual timeline method was used to empower women to organize and share their narratives about the sensitive and complex topic of starting a family. We conducted a thematic analysis of the audio-recorded interview data, using researchers’ field notes and reflections to provide context for our understanding of the benefits of using timelines and to understand the process of using visual timelines during telephone interviews. Resource packs were sent to women before study participation; 11 of the 16 women completed a version of the timeline activity. Six themes were identified in the methodological data analysis: (1) use and adaptation of the timeline tool, (2) timeline exchange, (3) framing the interview: emphasizing that women are in control, (4) jumping straight in, (5) taking a lead, and (6) disclosing personal and sensitive experiences. The use of visual timelines facilitated interviewee control and elicited rich narratives of participants’ experiences in telephone interviews. Women created their visual timelines autonomously and retained ownership of their timeline data; these features of the data generation process need to be considered when using visual timelines in telephone rather than face-to-face interviews. Use of visual methods within telephone interviews is feasible, can generate rich data, and should be further explored in a wider range of settings.
The relationship between elevated serum uric acid and arterial stiffness in a healthy population
Authors: Jiang Ye , Ge Ji-Yong , Zhang Yu-Yan , Wang Fang-Fang , Ji Yuan , Li Hai-Yan
Published: March 2020

Objective

This study aims to investigate the relationship between serum uric acid and arterial stiffness in a healthy population.

Methods

Among the 979 participants, baPWV was non-invasively measured, the circulating levels of uric acid were tested, and the uric acid polymorphisms (rs2231142 and rs11722228) were genotyped. Then, the Mendelian randomization method was employed to test the relationship between serum uric acid and arterial stiffness in a healthy population.

Results

After adjusting for age, gender, antihypertensive medication, body mass index, waist-to-hip ratio, urea nitrogen, creatinine and diabetic mellitus, there was a significant allelic difference in uric acid levels for each genotype ( P <  0.0001 for rs2231142; P =  0.007 for rs11722228). However, there were no differences on the potential confounders between the genotypes of rs2231142 and rs11722228 ( P >  0.05). The baPWV was significantly associated with circulating levels of uric acid after adjusting for cardiovascular risk factors and other potential confounders ( P =  0.002). However, neither the single polymorphism, nor the accumulation of culprit alleles was associated with baPWV ( P =  0.92 for rs2231142; P =  0.60 for rs11722228; P for trend = 0.77 for the combined analysis of culprit alleles).

Conclusion

These results do not support the causal role of circulating levels of uric acid in the development of arterial stiffness.
Therapeutic Effects of Total Saponins From Dioscorea nipponica Makino on Gouty Arthritis Based on the MAPK-PPARγ Signaling Pathway: An In Vitro Study
Authors: Zhou Qi , Yu Dong H. , Zhang Na , Wang Xiao Y. , Zhang Ning , Lin Fang F. , Liu Shu M.
Published: March 2020

Gouty arthritis (GA) is an inflammatory disease caused by the deposition of monosodium urate in the synovial membrane and cartilage due to a high concentration of uric acid in the blood. Dioscorea nipponica Makino is widely used in the clinic to treat GA. Total saponins are its main components and showed an anti-inflammatory effect on GA in a previous study. The mitogen-activated protein kinase (MAPK)-peroxisome proliferator-activated receptor γ (PPARγ) signaling pathway plays a key role during the onset of GA; however, little is known about its potential mechanism. Based on in vitro experiments, this study aims to determine the mechanism of total saponins from Dioscorea nipponica Makino (TDN) in treating GA by regulating the MAPK-PPARγ signaling pathway. Fibroblast-like synoviocytes were divided into 3 groups: the model group, which was given 10 µg/L IL-1β to induce proliferation; TDN group (10 µg/L IL-1β + 100 µg/L TDN); and indomethacin group (10 µg/L IL-1β + 100 µg/L indomethacin). Seventy-two hours after treatment, the real-time PCR method was used to detect the mRNA expression levels of extracellular signal regulated kinase 1/2 (ERK1/2), p-38, c-Jun N-terminal kinase (JNK), IKKα, c-Jun, MAPK phosphatase (MKP), vascular cell adhesion molecule 1 (VCAM1), intercellular adhesion molecule 1 (ICAM1), C-X-C motif chemokine ligand 1 (CXCL1), PPARγ, and Adipor2. The Western blot method was used to detect the protein expression of ERK1/2, p-ERK1/2, p-38, p-P38, JNK, p-JNK, IKKα, p-IKKα, c-Jun, p-c-Jun, MKP, p-MKP, VCAM1, ICAM1, CXCL1, PPARγ, and Adipor2. Compared with the model group, the TDN group displayed significantly increased mRNA expression of c-Jun, MKP, CXCL1, PPARγ, and Adipor2 and significantly decreased mRNA expression of ICAM1. Compared with the model group, the TDN group exhibited significantly increased protein expression of MKP and significantly decreased protein expression of p-ERK1/2, p-38, p-JNK, p-IKKα, p-c-Jun, VCAM1, ICAM1, and PPARγ. Our results indicated that TDN could treat GA by influencing the MAPK-PPARγ signaling pathway.
The Influence of Media on Students’ Views Regarding Refugeehood in Turkey: A Phenomenological Study of Seventh-Grade Students
Authors: Keskin Yusuf , Keskin Sevgi Coşkun , Yüceer Deniz
Published: March 2020

In Turkey today, one of the most frequently mentioned issues in the media is the influx of refugees, mostly from Syria. While most refugees are attempting to reach Europe by crossing through Turkey illegally, some consider Turkey an asylum center. This study used a phenomenological approach and qualitative experiment to determine how the phenomenon of refugeehood discussed in the media in Turkey affects children’s views on the issue. The sample was determined using the convenience sampling method, and 31 seventh-grade students (18 girls and 13 boys, all aged 14 years old) were selected. “Having previously met refugees” was used as a basic criterion in the selection of students, while classroom activities, letters, and semi-structured interviews were used to collect data. Descriptive and content analyses revealed that there were both positive and negative changes in students’ views regarding refugees, depending on the content of the news in the media, which was an important factor in influencing these changes.
Revisiting Green Supply Chain Management Practices: The Mediating Role of Emotional Intelligence
Authors: Khan Adnan , Tao Meng , Ahmad Hassan , Shafique Muhammad Nouman , Nawaz Muhammad Zahid
Published: March 2020

Environmental problems are one of the major concerns in China due to booming industries and large-scale production. Manufacturing industries must change the traditional approaches of production and supply chain management practices to cope with environmental issues. For this purpose, a multidisciplinary and empirical study has been conducted in China. In the manufacturing industries around the world, there is a noticeable transition in human resource management approaches toward green human resource management (GHRM). However, green training could be considered as a critical element of GHRM and could be used as an instrument to trigger emotional intelligence (EI) of the employees, which could make them more responsible toward the external environment and result in improved green supply chain management (GSCM) practices. Similarly, regulatory pressures could also enforce manufacturing industries to contribute positively to GSCM practices. In addition, taking into account the two critical functions of GSCM practices, that is, green purchasing and eco-design, this research study attempted to bring under consideration that GSCM practices could be enhanced through EI as well. For this purpose, data were collected from 250 manufacturing industries of China through a convenient sampling technique, and structural equation modeling was applied through Smart-PLS version 3.2.7 to measure and validate the model of this study. The findings of the study revealed that GSCM practices could be improved through regulatory pressures, and EI could be used as a mediating factor to enhance the relationship between GHRM (green training) and GSCM practices.
A prospective observational study of the epidemiology and pathological profile of RCC in a South African referral centre
Authors: Du Plessis D. E. , Van Deventer H. , Fernandez P. , Van Der Merwe A.
Published: March 2020

Background

There are global differences in the incidence, stage, prognosis, pathological profile and presentation of renal cell carcinoma (RCC). We review and describe the risk factors, pathological profile, stage and epidemiology of RCC in a South African centre. Prospective data were collected from all patients undergoing partial or radical nephrectomy for suspected RCC from July 2016 to March 2018.

Results

We collected data from 35 patients and excluded four patients after histological examination showed benign disease. The most common mode of presentation was incidental finding in 48%; with only one case presenting with the classical triad of abdominal mass, flank pain and macroscopic haematuria. The pathological profile of RCC cases included: clear cell 23 (74%), papillary type II 5 (16%), papillary mixed type I and II 1 (3%) and chromophobe 2 (7%). The pathological stage of the patients varied, from pT1a to pT3b. The median stage of presentation was pT1b. There was a trend towards a more advanced stage with the presence of obesity, female gender, smoking and hypertension.

Conclusion

The pathological profile and presenting symptoms in our population mimics that seen in Europe and the USA, with the exception of an increased prevalence of papillary type II RCC. The stage and presenting symptoms differ from that seen in other African studies, whilst our population followed the trend of younger presentation seen elsewhere in Africa.
Dynamics of gene expression associated with arsenic uptake and transport in rice during the whole growth period
Authors: Pan Dandan , Yi Jicai , Li Fangbai , Li Xiaomin , Liu Chuanping , Wu Weijian , Tao Tingting
Published: March 2020

Background

Genes associated with arsenite uptake and transport in rice plants (i.e., OsLsi1, OsLsi2, OsLsi3, OsLsi6 and OsABCC1) have been identified to date. However, their expression over time during the whole growth period of rice under arsenite stress conditions is still poorly understood. In this study, the dynamics of gene expression associated with arsenite transport and arsenic concentrations in different organs of rice were investigated to determine the critical period(s) of arsenite uptake and translocation regulated by gene expression during the whole growth period.

Results

The relative expression of OsLsi2 and OsLsi1 in the roots was upregulated and reached its highest value (2-∆∆Ct = 4.04 and 1.19, respectively) at the jointing stage (9 weeks after transplantation), in which the arsenic concentration in roots also was the highest at 144 mg/kg. A range from 45.1 to 61.2% of total arsenic accumulated in the roots during seedling to heading stages (3–16 weeks), which was mainly associated with the relatively high expression of OsABCC1 (1.50–7.68), resulting in arsenic located in the vacuoles of roots. Subsequently, the As translocation factor from root to shoot increased over time from heading to milky ripe (16–20 weeks), and 74.3% of the arsenic accumulated in shoots at the milk stage. Such an increase in arsenic accumulation in shoots was likely related to the findings that (i) OsABCC1 expression in roots was suppressed to 0.14–0.75 in 18–20 weeks; (ii) OsLsi3 and OsABCC1 expression in nodes I, II, and III was upregulated to 4.01–25.8 and 1.59–2.36, respectively, in 16–20 weeks; and (iii) OsLsi6 and OsABCC1 expression in leaves and husks was significantly upregulated to 2.03–5.26 at 18 weeks.

Conclusions

The jointing stage is the key period for the expression of arsenite-transporting genes in roots, and the heading to milky ripe stages are the key period for the expression of arsenite-transporting genes in shoots, both of which should be considered for regulation during safe rice production in arsenic-contaminated paddy soil.

Graphical abstract
Pembrolizumab-induced hypothyroidism caused reversible increased serum creatinine levels: a case report
Authors: Matsuoka Natsumi , Tsuji Kenji , Ichihara Eiki , Hara Takayuki , Fukushima Kazuhiko , Toma Kishio , Kitamura Shinji , Inagaki Kenichi , Sugiyama Hitoshi , Wada Jun
Published: March 2020

Background

The advent of immune checkpoint inhibitors (ICIs) has significantly improved the prognosis of patients with advanced malignancies. On the other hand, these drugs might cause immune-related adverse events (irAEs) including endocrinopathies and nephropathies. Thyroid dysfunction is one of the most common irAEs. For ICIs-induced nephropathies, most cases are due to tubulointerstitial nephritis, which might require steroid treatment. Here, we report a patient with non-small cell lung cancer treated with ICI who developed increased serum creatinine (s-Cr) levels due to ICIs-induced hypothyroidism.

Case presentation

A 57-year-old Asian man with refractory non-small cell lung cancer under ICIs therapy (pembrolizumab, an anti-programmed cell death-1 monoclonal antibody) developed increased s-Cr levels 5 months after the pembrolizumab initiation. His laboratory data, renal biopsy, and Gallium-67 scintigraphy findings denied pembrolizumab-induced tubulointerstitial nephritis. His renal function was correlated with thyroid function. Despite the increase of s-Cr levels, serum cystatin C levels were normal, which could be explained by the hypothyroidism. Levothyroxine treatment improved renal function as well as thyroid function. Then pembrolizumab was resumed, and both his thyroid and renal function remained normal level. Ultimately, we concluded that the increased s-Cr levels were caused by pembrolizumab-induced hypothyroidism.

Conclusion

All clinicians involved in ICI treatment need to recognize the possible increase in s-Cr levels caused by ICIs-induced hypothyroidism, and we propose monitoring serum cystatin C levels to differentiate ICIs-induced hypothyroidism from tubulointerstitial nephritis before invasive renal biopsies or steroid treatment, which are recommended by the prescribing information for pembrolizumab, are performed.
Enhancement of tendon-bone interface healing and graft maturation with cylindrical titanium-web (TW) in a miniature swine anterior cruciate ligament reconstruction model: histological and collagen-based analysis
Authors: Ryu Keisho , Saito Mitsuru , Kurosaka Daisaburo , Kitasato Seiichiro , Omori Toshiyuki , Hayashi Hiroteru , Kayama Tomohiro , Marumo Keishi
Published: March 2020

Background

Tendon-bone interface healing and ligamentization of the graft in anterior cruciate ligament (ACL) reconstruction with autografts are important factors affecting treatment outcome. This study aimed to investigate the effectiveness of a cylindrical titanium-web (TW) in tendon-bone interface healing and graft maturation in ACL reconstruction.

Methods

Fourteen mature female CLAWN miniature swine underwent bilateral ACL reconstructions with patellar tendon (PT) autografts. In one limb, the TW/tendon complex was placed into the proximal side of the tibial tunnel. Only the graft was transplanted into the tunnel in the control limb. The proximal side of the graft was sutured into the stump of the native ACL and the distal end was stapled to the tibia. The animals were euthanized at 4 and 15 weeks postoperatively, for histological and biochemical analyses.

Results

Microscopic images in TW limbs showed that ingrowth of tendon-like tissue and mineralized bone tissue into the TW connected the bone and the tendon directly. In contrast, fibrous tissue intervened between the bone and tendon in the control limbs. The total amount of collagen cross-links (which defines the strength of collagen fibers) and the maturation of collagen cross-links in TW tendons were significantly higher (p < 0.05) than those of control limbs. There was no significant difference in the ratio of dihydroxy-lysinonorleucine to hydroxy-lysinonorleucine (an indicator of tissue specific collagen maturation) between TW tendons and that of the native PT.

Conclusions

TW promoted the maturation and formation of collagen cross-links in the grafted tendon while maintaining the cross-links pattern of native tendon collagen, and enabled direct binding of tendon to bone.
Training in obstetric and neonatal emergencies in Mexico: effect on knowledge and self-efficacy by gender, age, shift, and profession
Authors: Fritz Jimena , Montoya Alejandra , Lamadrid-Figueroa Héctor , Flores-Pimentel Delia , Walker Dilys , Treviño-Siller Sandra , González-Hernández Dolores , Magaña-Valladares Laura
Published: March 2020

Background

Continuing education is essential for healthcare workers. Education interventions can help to maintain and improve competency and confidence in the technical skills necessary to address adverse events. However, characteristics of the health provider such as age (related to more critical and reflexive attitude); sex (relationship with gender socialization), profession and work conditions might have an influence on the effect of continuing education efforts.

Methods

A training in the management of obstetric and neonatal emergencies (PRONTO, Spanish acronym forNeonatal and Obstetric Rescue Program: Optimal and Timely treatment) was implemented in 14 hospitals in six Mexican states between 2013 and 2014, with a before-after evaluation design. A total of 351 health providers including physicians, interns, nurses and midwives completed the training and were included in the analytic sample. Mixed-effects regression models were fitted to model changes in knowledge and self-efficacy scores after the training for each training topic. Interaction terms of training with age, gender, profession, and shift were included to evaluate possible heterogeneities of effect. All models considered the within-hospital clustering of participants.

Results

After training, all participants showed a significant knowledge gain by an average of 19 percentage points for hemorrhage, 23 for neonatal resuscitation, 19 for shoulder dystocia, and 15 for preeclampsia/eclampsia (p < 0.001). Participants who worked night shifts showed lower scores for overall knowledge, compared with morning shift workers. Interns perceived the lowest self-efficacy while they scored very high in knowledge. Self-efficacy in managing obstetric and neonatal emergencies increased significantly by 16 percentage points in average.

Conclusions

Our results show that PRONTO is generally successful in increasing knowledge and self-efficacy on all topics but knowledge and self efficacy levels vary greatly by factors such as work shift. Training should be particularly aimed at personnel working during weekends and night shifts, as well as interns and nurses.
Medical assessment in the age of digitalisation
Authors: Egarter Saskia , Mutschler Anna , Tekian Ara , Norcini John , Brass Konstantin
Published: March 2020

Background

Digital assessment is becoming more and more popular within medical education. To analyse the dimensions of this digital trend, we investigated how exam questions (items) are created and designed for use in digital medical assessments in Germany. Thus, we want to explore whether different types of media are used for item creation and if a digital trend in medical assessment can be observed.

Methods

In a cross-sectional descriptive study, we examined data of 30 German medical faculties stored within a common assessment platform. More precise, 23,008 exams which contained 847,137 items were analysed concerning the exam type (paper-, computer- or tablet-based) and their respective media content (picture, video and/or audio). Out of these, 5252 electronic exams with 12,214 questions were evaluated. The media types per individual question were quantified.

Results

The amount of computer- and tablet-based exams were rapidly increasing from 2012 until 2018. Computer- and tablet-based written exams showed with 45 and 66% a higher percentage of exams containing media in comparison to paper-based exams (33%). Analysis on the level of individual questions showed that 90.8% of questions had one single picture. The remaining questions contained either more than one picture (2.9%), video (2.7%), audio (0.2%) or 3.3% of questions had picture as well as video added. The main question types used for items with one picture are TypeA (54%) and Long_Menu (31%). In contrast, questions with video content contain only 11% TypeA questions, whereas Long_Menu is represented by 66%. Nearly all questions containing both picture and video are Long_Menu questions.

Conclusions

It can be stated that digital assessment formats are indeed on the raise. Moreover, our data indicates that electronic assessments formats have easier options to embed media items and thus show a higher frequency of media addition. We even identified the usage of different media types in the same question and this innovative item design could be a useful feature for the creation of medical assessments. Moreover, the choice of media type seems to depend on the respective question type.
Examining validity and reliability of objective structured clinical examination for evaluation of clinical skills of midwifery undergraduate students: a descriptive study
Authors: Kolivand Mitra , Esfandyari Marzie , Heydarpour Sousan
Published: March 2020

Background

Clinical evaluation is one of the main pillars of medical education. The Objective Structured Clinical Examination is one of the commonly adopted practical tools to evaluate clinical and practical skills of medical students. The purpose of the study is to determine validity and reliability of Objective Structured Clinical Examination for evaluation of clinical skills of midwifery undergraduate students.

Methods

Seven clinical skills were evaluated in this descriptive correlative study using a performance checklist. Census method was used for sampling. Thirty-two midwifery students performed the skills at seven stations each monitored by an observer using an evaluation checklist. Criterion validity was obtained through determining the correlation between the clinical and theoretical courses point and the Objective Structured Clinical Evaluation score. The collected data was analyzed in SPSS (v.20) and logistic regression test.

Results

The correlation score of Objective Structured Clinical Examination was significantly related to the mean score of clinical course “Normal and Abnormal delivery I” (0.399, p = 0.024) and the mean score of clinical course “gynaecology “(0.419, p = 0.017). There was no significant correlation between OSCE scores and the mean score of theoretical courses (0.23, p = 0. 200).

The correlation between the total score and mean score of students at the stations showed that out of the seven stations, the correlations of the stations three (communication and collecting medical history) and four (childbirth) were not significant.

Conclusion

Although, it appeared that Objective Structured Clinical Examination was one of the effective and efficient ways to evaluate clinical competencies and practical skills of students, the tool could not evaluate all the aspects.
Measuring social capital of healthcare organizations reported by employees for creating positive workplaces - validation of the SOCAPO-E instrument
Authors: Ansmann Lena , Hower Kira Isabel , Wirtz Markus Antonius , Kowalski Christoph , Ernstmann Nicole , McKee Lorna , Pfaff Holger
Published: March 2020

Background

In highly segmented and complex healthcare organizations social capital is assumed to be of high relevance for the coordination of tasks in healthcare. So far, comprehensively validated instruments on social capital in healthcare organizations are lacking. The aim of this work is to validate an instrument measuring social capital in healthcare organizations.

Methods

This validation study is based on a cross-sectional survey of 1050 hospital employees from 49 German hospitals which specialize in breast cancer care. Social capital was assessed by a six-item scale. Reliability analyses and confirmatory factor analyses were conducted to determine the content validity of items within the theory-driven one-dimensional scale structure. The scale’s associations with measures of the social aspects of the work environment (identification, social support, open communication climate) were estimated to test convergent validity. Criterion-related validity was evaluated by conducting structural equation modelling to examine the predictive validity of the scale with measures of work engagement, well-being and burnout.

Results

A one-dimensional structure of the instrument could be identified (CFI = .99; RMSEA = .06). Convergent validity was shown by hypothesis-consistent correlations with social support offered by supervisors and colleagues, a climate of open communication, and employee commitment to the organization. Criterion-related validity of the social capital scale was proved by its prediction of employee work engagement (R2 = .10–.13 for the three subscales), well-being (R2 = .13), and burnout (R2 = .06–.11 for the three subscales).

Conclusions

The confirmed associations between social capital and work engagement, burnout as well as well-being stress the importance of social capital as a vital resource for employee health and performance in healthcare organizations. In healthcare organizations this short instrument can be used as an efficient instrument to measure the organizations’ social capital.
The effect of primary care on potentially avoidable hospitalizations in France: a cross-sectional study
Authors: Mercier Gregoire , Georgescu Vera , Plancque Elodie , Duflos Claire , Le Pape Annick , Quantin Catherine
Published: March 2020

Background

Potentially avoidable hospitalizations are an indirect measure of access to primary care. However, the role and quality of primary care might vary by geographical location. The main objective was to assess the impact of primary care on geographic variations of potentially avoidable hospitalizations in Occitanie, France.

Methods

We conducted a retrospective analysis of claims and socio-economic data for the French Occitanie region in 2014. In order to account for spatial heterogeneity, the region was split into two zones based on socio-economic traits: median pre-tax income and unemployment rate. Age- and sex-adjusted hospital discharge potentially avoidable hospitalization rates were calculated at the ZIP-code level. Demographic, socio-economic, and epidemiological determinants were retrieved, as well as data on supply of, access to and utilization of primary care.

Results

72% of PAH are attributable to two chronic conditions: chronic obstructive pulmonary disease and heart failure. In Zone 1, the potentially avoidable hospitalization rate was positively associated with premature mortality and with the number of specialist encounters by patients. It was negatively associated with the density of nurses. In Zone 2, the potentially avoidable hospitalization rate was positively associated with premature mortality, with access to general practitioners, and with the number of nurse encounters by patients. It was negatively associated with the proportion of the population having at least one general practitioner encounter and with the density of nurses.

Conclusions

This study suggests that the role of primary care in potentially avoidable hospitalizations might be geography dependent.
Mechanical ventilation and the daily cost of ICU care
Authors: Kaier Klaus , Heister Thomas , Wolff Jan , Wolkewitz Martin
Published: March 2020

Background

Intensive care units represent one of the largest clinical cost centers in hospitals. Mechanical ventilation accounts for a significant share of this cost. There is a relative dearth of information quantifying the impact of ventilation on daily ICU cost. We thus determine daily costs of ICU care, incremental cost of mechanical ventilation per ICU day, and further differentiate cost by underlying diseases.

Methods

Total ICU costs, length of ICU stay, and duration of mechanical ventilation of all 10,637 adult patients treated in ICUs at a German hospital in 2013 were analyzed for never-ventilated patients (N = 9181), patients ventilated at least 1 day, (N = 1455) and all patients (N = 10,637). Total ICU costs were regressed on the number of ICU days. Finally, costs were analyzed separately by ICD-10 chapter of main diagnosis.

Results

Daily non-ventilated costs were €999 (95%CI €924 - €1074), and ventilated costs were €1590 (95%CI €1524 - €1657), a 59% increase. Costs per non-ventilated ICU day differed substantially and were lowest for endocrine, nutritional or metabolic diseases (€844), and highest for musculoskeletal diseases (€1357). Costs per ventilated ICU day were lowest for diseases of the circulatory system (€1439) and highest for cancer patients (€1594). The relative cost increase due to ventilation was highest for diseases of the respiratory system (94%) and even non-systematic for patients with musculoskeletal diseases (13%, p = 0.634).

Conclusions

Results show substantial variability of ICU costs for different underlying diseases and underline mechanical ventilation as an important driver of ICU costs.
In search of universal health coverage – highlighting the accessibility of health care to students with disabilities in Ghana: a qualitative study
Authors: Abodey Eric , Vanderpuye Irene , Mensah Isaac , Badu Eric
Published: March 2020

Background

Accessibility of health care to students with disabilities is a global concern. This is no less important in Ghana, however, to date, no study has been undertaken regarding access to health care to students with disabilities. This study, therefore, aims to explore the accessibility of health care to students with disabilities, in the quest of achieving universal health coverage in Ghana.

Methods

Qualitative methods, involving in-depth interviews were employed to collect data from 54 participants (29 students with disabilities, 17 health workers and 8 school mothers), selected through purposive sampling. Thematic analysis was used to analyze the data.

Results

The study identified three themes – accessibility, adequacy, and affordability. The study findings highlighted that universal health coverage for students with disabilities has not been achieved due to barriers in accessing health care. The barriers faced by students with disabilities were unfriendly physical environments, structures, equipment, limited support services and poor health insurance policy to finance health care.

Conclusion

The study concludes that the government should prioritize disability-related issues in health policy formulation, implementation and monitoring. The current provisions and requirements in the disability act should be prioritized, enforced and monitored to ensure adequate inclusion of disability issues in health services. Further, the current exemption policy under the National Health Insurance Scheme should be revised to adequately address the needs of people with disabilities.
Dose-response of resistance training for neck-and shoulder pain relief: a workplace intervention study
Authors: Saeterbakken Atle Hole , Makrygiannis Paula , Stien Nicolay , Solstad Tom Erik Jorung , Shaw Matthew , Andersen Vidar , Pedersen Helene
Published: March 2020

Background

Musculoskeletal disorders are highly prevalent among office workers, with strong evidence suggesting that workplace-based resistance training programs can prevent several upper extremity musculoskeletal disorders. The aim of the present study was to examine the dose-response relationship between resistance training frequency and pain relief among office workers with neck- and shoulder pain.

Methods

Thirty participants with mild to moderate neck- and shoulder pain attended a 16-week intervention starting with an eight-week control period followed by an eight-week training period. After the control period, the participants were randomized into either a 10 min (TG10) or 2 × 10 min (TG2) workplace-based, high-intensity neck- and shoulder specific resistance training program that was executed 5 days per week and consisting of four exercises. The participants were tested pre and post each period for mean and worst pain using the 0-100 mm visual analog scale (VAS), 0-100 mm health-related quality of life and isometric strength of the neck-and shoulder region. The analysis of variance (ANOVA) and Friedman with Bonferroni post hoc corrections were used to assess differences in between and within groups for the three testing times pre, mid and post intervention.

Results

No differences were observed between the groups in any of the variables in the control period (p = 0.27–0.97) or training period (p = 0.37–0.68). When merging the two groups, the mean and worst pain was reduced by 25 and 43% (p = 0.05 and < 0.01, ES = 0.41 and 0.55) in the training period in addition to 10.6% increase in health-related quality of life (p = 0.01, ES = 0.52). No difference in strength was observed (p = 0.29–0.85).

Conclusion

Daily bouts of specific high-intensity resistance training of the shoulder and neck region at the workplace reduced neck- and shoulder pain and improved quality of life of office workers. However, 10 min bouts were equally effective as 2 × 10 min bouts per day. The authors recommend office workers to perform daily neck- and shoulder resistance training to possibly prevent and/or decrease pain in the neck- and shoulder area.

Trial registration

ISRCTN69968888, retrospectively registered (24/09/2019).