bluuebunny/crossref_metadata_2025 huggingface dataset:
Competing Values Framework as Decoding Tool: Signature Pedagogy in Teaching Business Communication
Authors: Kan Hoi-Yi Katy , Ismail Norhayati
Published: February 2021

This article explicates the operationalization of a theoretically robust framework in the teaching of business communication at an institute of higher learning. This article reimagines the design of a business communication course that focuses on the coalescence of both decoding and encoding processes of messages as a unified pedagogical approach in teaching business communication. This approach is in contrast with more conventional approaches in designing communication courses, which tend to prioritize one process over the other. Participants in the study acknowledged the instrumentality in the course design in promoting communicative values with real-world impact.
Hypochloremia Secondary to Diuretics in Preterm Infants: Should Clinicians Pay Close Attention?
Authors: Kalikkot Thekkeveedu Renjithkumar , Ramarao Sumana , Dankhara Nilesh , Alur Pradeep
Published: February 2021

Diuretic therapy, commonly used in the newborn intensive care unit, is associated with a variety of electrolyte abnormalities such as hyponatremia, hypokalemia, and hypochloremia. Hypochloremia, often ignored, is associated with significant morbidities and increased mortality in infants and adults. Clinicians respond in a reflex manner to hyponatremia than to hypochloremia. Hypochloremia is associated with nephrocalcinosis, hypochloremic alkalosis, and poor growth. Besides, the diuretic resistance associated with hypochloremia makes maintaining chloride levels in the physiological range even more logical. Since sodium supplementation counters the renal absorption of calcium and lack of evidence for spironolactone role in diuretic therapy for bronchopulmonary dysplasia (BPD), alternate chloride supplements such as potassium or arginine chloride may need to be considered in the management of hypochloremia due to diuretic therapy. In this review, we have summarized the current literature on hypochloremia secondary to diuretics and suggested a pragmatic approach to hypochloremia in preterm infants.
“Hear me!”
Authors: Chiakpo Evelyne
Published: February 2021

I am respectfully submitting a narrative essay to this journal. As a faculty member at a residency program, I got interested in contributing this essay after my experience caring for a disabled patient. I presumed we tend to imperfectly decipher what our patients’ needs are and my experience highlighted the need to be more sensitive and less dismissive to patients with disabilities. I started with the assumption that there were minimal teaching points to the house staff since this was an overt outpatient placement case. I was wrong and learnt much more than I expected. As faculty physicians, we tend to highlight pertinent clinical data to the learners and inadvertently gloss over vital nonclinical details that ultimately are as important. This patient was very succinct with her demands and understandably upset with our blatant conjectures with our daily mundane clinical rounds and consults. Taking time to listen to her, having a team meeting in her room and coordinating her care with nursing and medical colleagues was not only a learning experience but made me a better physician and teacher. She was the focus and her needs were met, not ours. I have no financial conflict of interest, and the patient was aware I intended to share my experience with my peers. I will appreciate any feedback and opportunity to learn and improve this narrative with expected revisions.
Journey of Nursing in COVID-19 Crisis: A Qualitative Study
Authors: Monjazebi Fatemeh , dolabi Shirin Esmaeili , Tabarestani Neda Doozandeh , Moradian Gordafarid , Jamaati Hamidreza , Peimani Maryam
Published: February 2021

Background:

Coronavirus disease 2019 (COVID-19) pandemic has exposed nurses to a rapidly changing patient care practice. This study explored nurses’ experiences in caring for COVID-19 patients.

Methods:

Eighteen nurses, head nurses, and clinical supervisors employed in one of the hospitals affiliated to the Shahid Beheshti Medical University to participate in this qualitative content analysis study. Data were collected through interviews and field notes. The data were analyzed with conventional content analysis.

Results:

Data analysis of nurses’ experiences with respect to COVID-19 patients resulted in the extraction of information on 5 major categories: “security in care-giving,” “healing hands, empty hands,” “mental and physical problems,” “multiple feelings,” and “self-reassurance” and 11 subcategories.

Conclusion:

We found that giving care to COVID-19 patients entailed complex, intermingled, and interrelated physical, mental, and emotional aspects that underwent changes over time so that it can be called “journey of nursing in COVID-19 crisis.” The findings of this study further revealed that nurses’ experiences, feelings, and thoughts underwent modifications gradually, over time. They believed that they have undergone development in caregiving and experienced deeper aspects of nursing care.
Investigating functional mix in Europe's dispersed urban areas
Authors: Wandl Alexander , Hausleitner Birgit
Published: February 2021

A large proportion of European inhabitants live in dispersed urban settlements, much of which is labelled as sprawl, defined by monofunctional, low-density areas. However, there is increasing evidence that this may be an overly simplistic way of describing territories-in-between (TiB). This paper defines and maps functional mix in six dispersed urban areas across Europe, applying a method that goes beyond existing land-use-based mixed-use indicators but considers functional mixing on the parcel level. The paper uses data on the location of economic activities and the residential population. It concludes that, in eight cases from four European countries, mixed-use is widespread and that more than 65% of inhabited areas are mixed. Moreover, the paper relates functional mixing to specific settlement characteristics: permeability, grain size, centrality and accessibility, and connectivity. This demonstrates that functional mixing is not the result of local urban morphology or planning instruments, but of the multi-scalar qualities of a location. Therefore, there is a requirement to coordinate planning and design through different scales if mixed-use areas are to be seen as one strategy for achieving greater sustainability in the spatial development of dispersed areas.
Vibration suppression analysis and experimental test of additional constrained damping layer in space science experiment cabinet
Authors: Luo Haitao , Guo Siwei , Yu Changshuai , Fu Jia , Wang Haochen , Liu Guangming , Luo Zhong
Published: February 2021

Aiming at the problem that the vibration of the space science experimental cabinet is too large during the launch phase of the rocket, the viscoelastic constrained damping layer is used to suppress the vibration. Firstly, to explore the vibration suppression mechanism of the constrained damping layer, the dynamic model of the constrained damping layer is established and the modal loss factor is calculated. Secondly, the influence of the modulus, material thickness, and the position and the area of the damping layer on the loss factor of the structure is analyzed. Finally, the simulation and experiment methods are used to calculate and verify the space science experiment cabinet with additional constrained damping layer. The results show that the viscoelastic constrained damping can effectively reduce the vibration level of the space science experiment cabinet, and the acceleration response in the resonance region is reduced by more than 56%. The viscoelastic constrained damping structure is simple and easy to realize, which can suppress the vibration of the space payload design is of great significance.
The impact of outdoor air pollution on COVID-19: a review of evidence fromin vitro, animal, and human studies
Authors: Bourdrel Thomas , Annesi-Maesano Isabella , Alahmad Barrak , Maesano Cara N. , Bind Marie-Abèle
Published: February 2021

Studies have pointed out that air pollution may be a contributing factor to the coronavirus disease 2019 (COVID-19) pandemic. However, the specific links between air pollution and severe acute respiratory syndrome-coronavirus-2 infection remain unclear. Here we provide evidence fromin vitro, animal and human studies from the existing literature. Epidemiological investigations have related various air pollutants to COVID-19 morbidity and mortality at the population level, however, those studies suffer from several limitations. Air pollution may be linked to an increase in COVID-19 severity and lethality through its impact on chronic diseases, such as cardiopulmonary diseases and diabetes. Experimental studies have shown that exposure to air pollution leads to a decreased immune response, thus facilitating viral penetration and replication. Viruses may persist in air through complex interactions with particles and gases depending on: 1) chemical composition; 2) electric charges of particles; and 3) meteorological conditions such as relative humidity, ultraviolet (UV) radiation and temperature. In addition, by reducing UV radiation, air pollutants may promote viral persistence in air and reduce vitamin D synthesis. Further epidemiological studies are needed to better estimate the impact of air pollution on COVID-19.In vitroandin vivostudies are also strongly needed, in particular to more precisely explore the particle–virus interaction in air.
Elevated MST1 leads to apoptosis via depletion of YAP1 in cardiomyocytes exposed to high glucose
Authors: Su Dongmei , Li Yanhua , Guan Lina , Li Qian , Shi Cuige , Ma Xu , Song Yonghui
Published: February 2021

Background

Gestational diabetes mellitus is a risk factor for congenital heart defects. The article aimed to investigate the expression and roles of MST1, YAP1, Last1/2 and Survivin in modulating HG-induced cardiomyocyte apoptosis and maternal diabetes-induced heart abnormality.

Methods

Diabetes mellitus was induced in rats using streptozotocin. The protein expression and phosphorylation analysis in fetal heart tissue was assessed by western blot and immunohistochemical staining. Hoechst 33342 staining assay was performed to explore H9C2 apoptosis. The gene and protein expression in H9C2 cells was assessed by quantitative PCR and western blot. Knockdown of gene expression was assessed by RNA interference.

Results

Our results revealed that increased MST1 protein levels in the heart tissues of the offspring of diabetic rats in vivo and in H9C2 cardiomyocytes under HG treatment in vitro, respectively. Knockdown and overexpression experiments showed that MST1 played a key role in mediating HG-induced apoptosis in cardiomyocytes. Downregulation of YAP1 was associated with HG-induced, MST1-mediated cardiomyocyte apoptosis. Further study showed that MST1 downregulated the protein level of YAP1 through mediation of YAP1 phosphorylation on Ser127 and Ser397; this process also required LATS1/2 participation. MST1 overexpression increased the phosphorylation levels of LATS1/2, which were also shown to be increased in the heart tissues of diabetic offspring. We also found that YAP1 mediated the expression of Survivin during HG-induced apoptosis, and the Survivin-inhibitor YM155 partially inhibited the role of YAP1 in suppressing apoptosis induced by HG in cardiomyocytes.

Conclusion

These findings reveal a regulatory mechanism of MST1/YAP1/Survivin signaling in modulating cardiomyocyte apoptosis in vitro and maternal diabetes-induced congenital heart defects in vivo.
RETRACTED ARTICLE: Human Umbilical Cord Mesenchymal Stem Cells-Derived Exosomal MicroRNA-18b-3p Inhibits the Occurrence of Preeclampsia by Targeting LEP
Authors: Huang Qin , Gong Meng , Tan Tuantuan , Lin Yunong , Bao Yan , Fan Cuifang
Published: February 2021

Exosomes derived from human umbilical cord mesenchymal stem cells (hucMSCs) expressing microRNAs have been highlighted in human diseases. However, the detailed molecular mechanism of hucMSCs-derived exosomal miR-18b-3p on preeclampsia (PE) remains further investigation. We aimed to investigate the effect of exosomes and miR-18b-3p/leptin (LEP) on occurrence of PE. The morphology of the hucMSC and hucMSC-exosomes (Exos) was identified. The exosomes were infected with different lentivirus expressing miR-18b-3p to explore the role of miR-18b-3p in PE. The PE rat model was established by intraperitoneal injection of N-nitro-l-arginine methyl ester. The expression of LEP and miR-18b-3p was tested in PE rat placenta tissues. Also, the effect of exosomes on LEP and miR-18b-3p expression was detected. The systolic blood pressure (SBP), proteinuria, inflammatory factors, the weight of fetal rat and placenta and cell apoptosis in PE rats were detected. Finally, the relationship between miR-18b-3p and LEP was verified using dual-luciferase reporter gene assay and RNA pull-down assay. Exosomes, restoring miR-18b-3p or inhibiting LEP reduced SBP and proteinuria of PE rats as well as increased the weight of fetal rat and placenta, decreased serum levels of inflammatory factors as well as suppressed apoptotic cells of PE rats, exerting a suppressive effect on PE progression. miR-18b-3p was decreased and LEP was increased in placenta tissues of PE rats. LEP was the direct target gene of miR-18b-3p. Upregulation of miR-18b-3p or treatment of the exosomes suppressed LEP expression and reduced PE occurrence, while downregulation of miR-18b-3p had contrary effects. Downregulated LEP reversed the effect of miR-18b-3p reduction on PE rats. HucMSCs-derived exosomal miR-18b-3p targets LEP to participate in the occurrence and development of PE. This study may provide a novel theoretical basis for the mechanism and investigation of PE.
The trade-off behaviours between virtual and physical activities during the first wave of the COVID-19 pandemic period
Authors: Bin Elisa , Andruetto Claudia , Susilo Yusak , Pernestål Anna
Published: February 2021

Introduction

The first wave of COVID-19 pandemic period has drastically changed people’s lives all over the world. To cope with the disruption, digital solutions have become more popular. However, the ability to adopt digitalised alternatives is different across socio-economic and socio-demographic groups.

Objective

This study investigates how individuals have changed their activity-travel patterns and internet usage during the first wave of the COVID-19 pandemic period, and which of these changes may be kept.

Methods

An empirical data collection was deployed through online forms. 781 responses from different countries (Italy, Sweden, India and others) have been collected, and a series of multivariate analyses was carried out. Two linear regression models are presented, related to the change of travel activities and internet usage, before and during the pandemic period. Furthermore, a binary regression model is used to examine the likelihood of the respondents to adopt and keep their behaviours beyond the pandemic period.

Results

The results show that the possibility to change the behaviour matter. External restrictions and personal characteristics are the driving factors of the reduction in ones' daily trips. However, the estimation results do not show a strong correlation between the countries' restriction policy and the respondents' likelihood to adopt the new and online-based behaviours for any of the activities after the restriction period.

Conclusion

The acceptance and long-term adoption of the online alternatives for activities are correlated with the respondents' personality and socio-demographic group, highlighting the importance of promoting alternatives as a part of longer-term behavioural and lifestyle changes.
Physicians’ perceptions regarding acute bleeding management: an international mixed qualitative quantitative study
Authors: Roche Tadzio R. , Wetli Doreen J. , Braun Julia , Kataife Ezequiel D. , Mileo Federico G. , Spahn Donat R. , Tscholl David W. , Said Sadiq
Published: February 2021

Background

Acute bleeding is an omnipresent challenge for all physicians. Uncontrolled hemorrhage is the most common preventable cause of death after trauma worldwide. In different surgical disciplines, hemorrhage represents an independent risk factor for increased postoperative morbimortality, directly affecting patients’ outcomes. This study asked anesthesiologists about their personal perceived challenges when treating bleeding patients.

Methods

This investigator-initiated, prospective, international, dual-center, mixed qualitative and quantitative study interrogated anesthesiologists about what they found easy and what difficult in treating acutely bleeding patients. Following the template approach for qualitative research, we identified major and minor topics through free inductive coding and word count. In a second step, we derived ten statements from the participants’ answers. Using a field survey, we then asked the participants to rate their level of agreement with the derived statements. We analyzed the answers using one sample Wilcoxon test and the Mann-Whitney test.

Results

We included a total of 84 physicians in the qualitative interrogations and a different group of 42 anesthesiologists in the quantitative part. We identified 11 major topics and 19 associated subtopics. The main topics and the degree of agreement (here as agree or strongly agree) were as follows: “Complexity of the topic” (52.4% agreed to find the topic complex), “Cognitive aids” (92.9% agreed to find them helpful), “Time management” (64.3% agreed to feeling time pressure), “Human factors” (95.2% agreed that human factors are essential), “Resources” (95.2% agreed that resources are essential), “Experience” and “Low frequency of cases” (57.1% agreed to lack practice), “Diagnostic methods” (31.0% agreed that the interpretation of test results is difficult), “Anticoagulation” (85.7% agreed to it being difficult), “Treatment” (81.0% agreed to knowing the first therapeutic steps), and “Nothing”.

Conclusions

Anesthesiologists in two large tertiary care facilities in different parts of the world found coagulation management, especially in anticoagulated patients, complex. We identified the delayed diagnostic test results and their interpretation as challenges. Resources, treatment protocols and human factors such as team communication were perceived to facilitate management. Future studies should explore the challenges in smaller hospitals and other parts of the world and test new technologies addressing the identified difficulties.
Relationship between resting 12-lead electrocardiogram and all-cause death in patients without structural heart disease: Shinken Database analysis
Authors: Hirota Naomi , Suzuki Shinya , Arita Takuto , Yagi Naoharu , Otsuka Takayuki , Kishi Mikio , Semba Hiroaki , Kano Hiroto , Matsuno Shunsuke , Kato Yuko , Uejima Tokuhisa , Oikawa Yuji , Matsuhama Minoru , Iida Mitsuru , Inoue Tatsuya , Yajima Junji , Yamashita Takeshi
Published: February 2021

Background

Resting 12-lead electrocardiography is widely used for the detection of cardiac diseases. Electrocardiogram readings have been reported to be affected by aging and, therefore, can predict patient mortality.

Methods

A total of 12,837 patients without structural heart disease who underwent electrocardiography at baseline were identified in the Shinken Database among those registered between 2010 and 2017 (n = 19,170). Using 438 electrocardiography parameters, predictive models for all-cause death and cardiovascular (CV) death were developed by a support vector machine (SVM) algorithm.

Results

During the observation period of 320.4 days, 55 all-cause deaths and 23 CV deaths were observed. In the SVM prediction model, the mean c-statistics of 10 cross-validation models with training and testing datasets were 0.881 ± 0.027 and 0.927 ± 0.101, respectively, for all-cause death and 0.862 ± 0.029 and 0.897 ± 0.069, respectively for CV death. For both all-cause and CV death, high values of permutation importance in the ECG parameters were concentrated in the QRS complex and ST-T segment.

Conclusions

Parameters acquired from 12-lead resting electrocardiography could be applied to predict the all-cause and CV deaths of patients without structural heart disease. The ECG parameters that greatly contributed to the prediction were concentrated in the QRS complex and ST-T segment.
Rivastigmine improves dual-task gait velocity in patients with Alzheimer’s disease
Authors: Shimura Hideki , Saiko Aiba , Hayashi Akito , Hattori Nobutaka , Urabe Takao
Published: February 2021

Background

Gait impairments are common in patients with Alzheimer’s disease. Cholinesterase inhibitors are used to treat the symptoms of patients with Alzheimer’s disease, but they have not been shown to reduce the severity of Alzheimer’s disease-related gait disorders.

Methods

This was a prospective, single-arm, open-label, non-randomized study. The aim of the present study was to determine the effect of the acetylcholinesterase inhibitor rivastigmine on gait in 21 newly diagnosed patients with mild to moderate Alzheimer’s disease. The outcome variables were velocity, stride length, and cadence during single-task and dual-task gait trials. The subjects were also assessed with the Mini-Mental State Examination, Alzheimer’s Disease Cooperative Study Activities of Daily Living, Functional Assessment Staging, and Geriatric Depression Scale.

Results

After 12 weeks of treatment with rivastigmine, gait velocity was significantly improved in the dual-task gait trials; gait velocity was increased from 40.59 ± 13.59 m/min at baseline to 46.88 ± 12.73 m/min when counting backward from 100 in steps of 7 while walking, and gait velocity was increased from 37.06 ± 15.57 m/min at baseline to 42.03 ± 14.02 m/min when naming animals while walking. In the single-task gait trials, which consisted only of walking at their usual pace or at a fast pace, gait velocity was not increased by rivastigmine administration.

Conclusion

Our findings indicated that rivastigmine improved gait in subjects with mild to moderate Alzheimer’s disease during dual-task trials. The observed enhancement of dual-task gait might be caused by an improvement of cognitive function rather than motor function.

Trial registration

UMIN, UMIN000025869. Registered December 16, 2016, https://upload.umin.ac.jp/cgi-open-bin/icdr/ctr_view.cgi?recptno=R000029744
Prevalence and determinants of violence against health care in the metropolitan city of Peshawar: a cross sectional study
Authors: Khan Muhammad Naseem , Haq Zia Ul , Khan Mirwais , Wali Sadia , Baddia Faryal , Rasul Shaista , Khan Salman , Polkowski Maciej , Ramirez-Mendoza Jessica Yohana
Published: February 2021

Background

Violence against healthcare personnel is a major public health problem. Healthcare personnel are at the frontline dealing with people in stressful and unpredictable situations. Therefore, this study was conducted to determine the prevalence and associated factors of violence against health care personnel.

Methods

A cross sectional study was conducted in the district Peshawar. Healthcare personnel from public and private sectors working in both the primary and tertiary levels of healthcare were invited to participate. Violence was assessed through a structured questionnaire previously used in Pakistan and was defined as experiencing and/or witnessing any form of violence in the last 12 months. Mental health was assessed through the General Health Questionnaire. Logistic regression was used to estimate the association of violence against healthcare personnel with psychological distress and demographic characteristics. Data entry and analysis were conducted in STATA 14.

Results

A total of 842 healthcare personnel participated in the study. The prevalence of violence experienced and/or witnessed by healthcare personnel in Peshawar was 51%. Verbal violence remained the predominant form of violence and almost half of the healthcare personnel (45%) were exposed to it. A quarter of the respondents (24%) reported physical violence alone or in combination with other forms of violence. In almost two third of the incidents the perpetrators were either attendants, relatives or the patients. The emergency unit and wards within healthcare facilities were the most common places where violent events took place. The major factors responsible for the violent incidents were communication failure, unreasonable expectations and perceived substandard care. No uniform policy/procedure existed to manage the incidents and the healthcare personnel adopted different responses in the wake of violent events targeting health care. Working in public healthcare facilities and having a larger number of co-workers/colleagues significantly increased the risk of violence in the healthcare settings while being a paramedic significantly reduced the risk as compared to physicians.

Conclusions

Violence against healthcare personnel is a serious public health issue and the prevalence is quite high. A holistic effort is needed by all stakeholders including healthcare community, the administration, lawmakers, law enforcement, civil society, and international organizations.
Poor cardiovascular health is associated with subclinical atherosclerosis in apparently healthy sub-Saharan African populations: an H3Africa AWI-Gen study
Authors:   as part of the H3Africa AWI-Gen study, Nonterah Engelbert A. , Crowther Nigel J. , Oduro Abraham , Agongo Godfred , Micklesfield Lisa K. , Boua Palwendé R. , Choma Solomon S. R. , Mohamed Shukri F. , Sorgho Herman , Tollman Stephen M. , Norris Shane A. , Raal Frederick J. , Grobbee Diederick E. , Ramsay Michelé , Bots Michiel L. , Klipstein-Grobusch Kerstin
Published: February 2021

Background

The cardiovascular health index (CVHI) introduced by the American Heart Association is a valid, accessible, simple, and translatable metric for monitoring cardiovascular health in a population. Components of the CVHI include the following seven cardiovascular risk factors (often captured as life’s simple 7): smoking, dietary intake, physical activity, body mass index, blood pressure, glucose, and total cholesterol. We sought to expand the evidence for its utility to under-studied populations in sub-Saharan Africa, by determining its association with common carotid intima-media thickness (CIMT).

Methods

We conducted a cross-sectional study involving 9011 participants drawn from Burkina Faso, Ghana, Kenya, and South Africa. We assessed established classical cardiovascular risk factors and measured carotid intima-media thickness of the left and right common carotid arteries using B-mode ultrasonography. Adjusted multilevel mixed-effect linear regression was used to determine the association of CVHI with common CIMT. In the combined population, an individual participant data meta-analyses random-effects was used to conduct pooled comparative sub-group analyses for differences between countries, sex, and socio-economic status.

Results

The mean age of the study population was 51 ± 7 years and 51% were women, with a mean common CIMT of 637 ± 117 μm and CVHI score of 10.3 ± 2.0. Inverse associations were found between CVHI and common CIMT (β-coefficients [95% confidence interval]: Burkina Faso, − 6.51 [− 9.83, − 3.20] μm; Ghana, − 5.42 [− 8.90, − 1.95]; Kenya, − 6.58 [− 9.05, − 4.10]; and South Africa, − 7.85 [− 9.65, − 6.05]). Inverse relations were observed for women (− 4.44 [− 6.23, − 2.65]) and men (− 6.27 [− 7.91, − 4.64]) in the pooled sample. Smoking (p < 0.001), physical activity (p < 0.001), and hyperglycemia (p < 0.001) were related to CIMT in women only, while blood pressure and obesity were related to CIMT in both women and men (p < 0.001).

Conclusion

This large pan-African population study demonstrates that CVHI is a strong marker of subclinical atherosclerosis, measured by common CIMT and importantly demonstrates that primary prevention of atherosclerotic cardiovascular disease in this understudied population should target physical activity, smoking, obesity, hypertension, and hyperglycemia.
Who should be prioritized for COVID-19 vaccination in China? A descriptive study
Authors: Yang Juan , Zheng Wen , Shi Huilin , Yan Xuemei , Dong Kaige , You Qian , Zhong Guangjie , Gong Hui , Chen Zhiyuan , Jit Mark , Viboud Cecile , Ajelli Marco , Yu Hongjie
Published: February 2021

Background

All countries are facing decisions about which population groups to prioritize for access to COVID-19 vaccination after the first vaccine products have been licensed, at which time supply shortages are inevitable. Our objective is to define the key target populations, their size, and priority for a COVID-19 vaccination program in the context of China.

Methods

On the basis of utilitarian and egalitarian principles, we define and estimate the size of tiered target population groups for a phased introduction of COVID-19 vaccination, considering evolving goals as vaccine supplies increase, detailed information on the risk of illness and transmission, and past experience with vaccination during the 2009 influenza pandemic. Using publicly available data, we estimated the size of target population groups, and the number of days needed to vaccinate 70% of the target population. Sensitivity analyses considered higher vaccine coverages and scaled up vaccine delivery relative to the 2009 pandemic.

Results

Essential workers, including staff in the healthcare, law enforcement, security, nursing homes, social welfare institutes, community services, energy, food and transportation sectors, and overseas workers/students (49.7 million) could be prioritized for vaccination to maintain essential services in the early phase of a vaccination program. Subsequently, older adults, individuals with underlying health conditions and pregnant women (563.6 million) could be targeted for vaccination to reduce the number of individuals with severe COVID-19 outcomes, including hospitalizations, critical care admissions, and deaths. In later stages, the vaccination program could be further extended to target adults without underlying health conditions and children (784.8 million), in order to reduce symptomatic infections and/or to stop virus transmission. Given 10 million doses administered per day, and a two-dose vaccination schedule, it would take 1 week to vaccinate essential workers but likely up to 7 months to vaccinate 70% of the overall population.

Conclusions

The proposed framework is general but could assist Chinese policy-makers in the design of a vaccination program. Additionally, this exercise could be generalized to inform other national and regional strategies for use of COVID-19 vaccines, especially in low- and middle-income countries.
Postponing tumor onset and tumor progression can be achieved by alteration of local tumor immunity
Authors: Mei Yan , Wang Mingdian , Lu Guanming , Li Jiangchao , Peng Lixia , Lang Yanhong , Yang Mingming , Jiang Lingbi , Li Changzhi , Zheng Lisheng , Liu Zhijie , Xie Dehuan , Guo Lingling , Huang Bijun , Zeng Musheng , Shi Yanxia , Qian Chaonan
Published: February 2021

Background

It has been known for years that the same genetic defects drive breast cancer formation, yet, the onset of breast cancer in different individuals among the same population differs greatly in their life spans with unknown mechanisms.

Methods

We used a MMTV-PyMT mouse model with different genetic backgrounds (FVB/NJ vs. C57BL/6J) to generate different cancer onset phenotypes, then profiled and analyzed the gene expression of three tumor stages in both Fvb.B6 and Fvb mice to explore the underlying mechanisms.

Results

We found that in contrast with the FVB/N-Tg (MMTV-PyMT) 634Mul mice (Fvb mice), mammary tumor initiation was significantly delayed and tumor progression was significantly suppressed in the Fvb.B6 mice (generated by crossing FVB/NJ with C57BL/6J mice). Transcriptome sequencing and analysis revealed that the differentially expressed genes were enriched in immune-related pathways. Flow cytometry analysis showed a higher proportion of matured dendritic cells in the Fvb.B6 mice. The plasma levels of interleukin-6 (IL-6) and vascular endothelial growth factor (VEGF) were significantly reduced in the Fvb.B6 mice. IL-6 also impaired the maturation of bone marrow dendritic cells (BMDCs) of the Fvb mice in vitro.

Conclusion

All these findings suggest that immunity levels (characterized by a reduced IL-6 level and intact DC maturation in Fvb.B6 mice) are the key factors affecting tumor onset in a murine mammary cancer model.
A secondary analysis of the childhood obesity prevention Cochrane Review through a wider determinants of health lens: implications for research funders, researchers, policymakers and practitioners
Authors: Nobles James , Summerbell Carolyn , Brown Tamara , Jago Russell , Moore Theresa
Published: February 2021

Background

Randomised controlled trials (RCTs) are often regarded as the gold standard of evidence, and subsequently go on to inform policymaking. Cochrane Reviews synthesise this type of evidence to create recommendations for practice, policy, and future research. Here, we critically appraise the RCTs included in the childhood obesity prevention Cochrane Review to understand the focus of these interventions when examined through a wider determinants of health (WDoH) lens.

Methods

We conducted a secondary analysis of the interventions included in the Cochrane Review on “Interventions for Preventing Obesity in Children”, published since 1993. All 153 RCTs were independently coded by two authors against the WDoH model using an adaptive framework synthesis approach. We used aspects of the Action Mapping Tool from Public Health England to facilitate our coding and to visualise our findings against the 226 perceived causes of obesity.

Results

The proportion of interventions which targeted downstream (e.g. individual and family behaviours) as opposed to upstream (e.g. infrastructure, environmental, policy) determinants has not changed over time (from 1993 to 2015), with most intervention efforts (57.9%) aiming to change individual lifestyle factors via education-based approaches. Almost half of the interventions (45%) targeted two or more levels of the WDoH. Where interventions targeted some of the wider determinants, this was often achieved via upskilling teachers to deliver educational content to children. No notable difference in design or implementation was observed between interventions targeting children of varying ages (0–5 years, 6–12 years, 13–18 years).

Conclusions

This study highlights that interventions, evaluated via RCTs, have persisted to focus on downstream, individualistic determinants of obesity over the last 25 years, despite the step change in our understanding of its complex aetiology. We hope that the findings from our analysis will challenge research funders, researchers, policymakers and practitioners to reflect upon, and critique, the evidence-based paradigm in which we operate, and call for a shift in focus of new evidence which better accounts for the complexity of obesity.
Actualized inventory of medicinal plants used in traditional medicine in Oaxaca, Mexico
Authors: Lucía Cruz-Pérez Alejandra , Jacqueline Barrera-Ramos , Alberto Bernal-Ramírez Luis , David Bravo-Avilez , Beatriz Rendón-Aguilar
Published: February 2021

Background

Oaxaca is one of the most diverse states in Mexico from biological and cultural points of view. Different ethnic groups living there maintain deep and ancestral traditional knowledge of medicinal plants as well as traditional practices and beliefs about diseases/illnesses and cures. Previous ethnobotanical research in this state has helped document this knowledge, but with the addition of more studies, more records appear. We updated the inventory of medicinal knowledge between the different ethnic groups that inhabit the Oaxacan territory.

Methods

A database was constructed from two sources: (1) original data from a 3-year project in 84 municipalities of Oaxaca inhabited by eight ethnic groups and (2) different electronic databases.

Results

Records of 1032 medicinal plants were obtained; 164 families were registered, with Asteraceae, Fabaceae, and Rubiaceae being the most commonly used. A total of 770 species were reported in 14 vegetation types; the most important species came from temperate forests. Only 144 species corresponded to introduced species, and 272 were listed in a risk category.

Illnesses of the digestive and genitourinary systems as well as culture-bound syndromes were treated with high numbers of medicinal plants. The Mestizo, Mixe, Mixtec, and Zapotec ethnic groups exhibited the greatest number of recorded medicinal plants. The 17 species that were used among almost all ethnic groups in Oaxaca were also used to cure the highest number of diseases.

Discussion

Inventories of medicinal plants confirm the persistence of traditional knowledge and reflect the need to recognize and respect this cosmovision. Many species are gathered in wild environments. The most important illnesses or diseases recorded in the present inventory are also mentioned in different studies, suggesting that they are common health problems in the rural communities of Mexico.

Conclusions

Medicinal plants are essential for ethnic groups in Oaxaca. It is necessary to recognize and understand the complex ancestral processes involved in the human-nature interaction and the role of these processes in the conservation of biodiversity and in the survivorship of ethnic groups that have persisted for centuries. Finally, this study serves as a wake-up call to respect those worldviews.
How are patients with rare diseases and their carers in the UK impacted by the way care is coordinated? An exploratory qualitative interview study
Authors: Simpson Amy , Bloom Lara , Fulop Naomi J. , Hudson Emma , Leeson-Beevers Kerry , Morris Stephen , Ramsay Angus I. G. , Sutcliffe Alastair G. , Walton Holly , Hunter Amy
Published: February 2021

Background

Care coordination is considered important for patients with rare conditions, yet research addressing the impact of care coordination is limited. This study aimed to explore how care coordination (or lack of) impacts on patients and carers. Semi-structured interviews were conducted with 15 patients and carers/parents in the UK, representing a range of rare conditions (including undiagnosed conditions). Transcripts were analysed thematically in an iterative process.

Results

Participants described a range of experiences and views in relation to care coordination. Reports of uncoordinated care emerged: appointments were uncoordinated, communication between key stakeholders was ineffective, patients and carers were required to coordinate their own care, and care was not coordinated to meet the changing needs of patients in different scenarios. As a result, participants experienced an additional burden and barriers/delays to accessing care. The impacts described by patients and carers, either attributed to or exacerbated by uncoordinated care, included: impact on physical health (including fatigue), financial impact (including loss of earnings and travel costs), and psychosocial impact (including disruption to school, work and emotional burden). Overall data highlight the importance of flexible care, which meets individual needs throughout patients’/carers’ journeys. Specifically, study participants suggested that the impacts may be addressed by: having support from a professional to coordinate care, changing the approach of clinics and appointments (where they take place, which professionals/services are available and how they are scheduled), and improving communication through the use of technology, care plans, accessible points of contact and multi-disciplinary team working.

Conclusion

This study provides further evidence of impacts of uncoordinated care; these may be complex and influenced by a number of factors. Approaches to coordination which improve access to care and lessen the time and burden placed on patients and carers may be particularly beneficial. Findings should influence future service developments (and the evaluation of such developments). This will be achieved, in the first instance, by informing the CONCORD Study in the UK.
The effect of the ongoing civil strife on key immunisation outcomes in the North West and South West regions of Cameroon
Authors: Saidu Yauba , Vouking Marius , Njoh Andreas Ateke , Bachire Hassan Ben , Tonga Calvin , Mofor Roberts , Bayiha Christain , Ewane Leonard , Cornelius Chebo , Mbida Ndi Daniel Daddy , Abizou Messang Blandine , Njie Victor Mbome , Nzuobontane Divine
Published: February 2021

Background

Civil strife has long been recognized as a significant barrier in the fight against vaccine preventable diseases in several parts of the world. However, little is known about the impact of the ongoing civil strife on the immunisation system in the Northwest (NW) and Southwest (SW) regions of Cameroon, which erupted in late 2016. In this paper, we assessed the effect of the conflict on key immunisation outcomes in the North West and South West regions of Cameroon.

Methods

Data were obtained from the standard EPI data reporting tool, the District Vaccine and Data Management Tool (DVDMT), from all the districts in the two regions. Completed forms were then reviewed for accuracy prior to data entry at central level. Summary statistics were used to estimate the variables of interest for each region for the years 2016 (pre-conflict) and 2019 (during conflict).

Results

In the two regions, the security situation has deteriorated in almost all districts, which in turn has disrupted basic healthcare delivery in those areas. A total of 26 facilities were destroyed and 11 healthcare workers killed in both regions. Reported immunisation coverage rates for key antigens including, BCG, DPT-3 and MR, witnessed a dramatic decline between 2016 and 2019, ranging from 22% points decline for BCG in the NW and to 42% points decline for DPT-3 in the SW. Similarly, the proportion of districts with DPT-3 coverage of at least 80% dropped from 75% in 2016 to 11% in 2019 in the NW. In the SW this proportion dropped from 16% in 2016 to 0 % in 2019.

Conclusion

Our data demonstrates the marked negative impact of the ongoing civil strife on key immunisation outcomes in the two regions and the country at large. This decline could amplify the risk of vaccine preventable diseases vaccine preventable diseases outbreaks in the two regions. Besides the ongoing actions to contain the crises, effective strategies for reaching children in the conflict zones as well as the internally displaced population are needed. There is also the need to rebuild destroyed facilities as well as to protect health facilities and staff from targeted violence.
High activity and low toxicity of a novel CD71-targeting nanotherapeutic named The-0504 on preclinical models of several human aggressive tumors
Authors: Falvo Elisabetta , Damiani Verena , Conti Giamaica , Boschi Federico , Messana Katia , Giacomini Patrizio , Milella Michele , De Laurenzi Vincenzo , Morea Veronica , Sala Gianluca , Fracasso Giulio , Ceci Pierpaolo
Published: February 2021

Background

Ferritin receptor (CD71) is an example of a very attractive cancer target, since it is highly expressed in virtually all tumor types, including metastatic loci. However, this target can be considered to be inaccessible to conventional target therapies, due to its presence in many healthy tissues. Here, we describe the preclinical evaluation of a tumor proteases-activatable human ferritin (HFt)-based drug carrier (The-0504) that is able to selectively deliver the wide-spectrum topoisomerase I inhibitor Genz-644282 to CD71-expressing tumors, preventing the limiting toxic effects associated with CD71-targeting therapies.

Methods

CD71 expression was evaluated using flow cytometry and immunohistochemistry techniques. The-0504 antiproliferative activity towards several cancer cell lines was assessed in vitro. The-0504 antitumor efficacy and survival benefit were evaluated in different human tumors, which had been grown either as xenografts or patient-derived xenografts in mice. The-0504 toxicology profile was investigated in multiple-cycle repeat-dose study in rodents.

Results

In vitro studies indicate that The-0504 is highly specific for CD71 expressing cells, and that there is a relationship between CD71 levels and The-0504 anticancer activity. In vivo treatments with The-0504 showed a remarkable efficacy, eradicating several human tumors of very diverse and aggressive histotypes, such as pancreas, liver and colorectal carcinomas, and triple-negative breast cancer.

Conclusions

Durable disease-free survival, persistent antitumor responses after discontinuation of treatment and favorable toxicology profile make The-0504 an ideal candidate for clinical development as a novel, CD71-targeted, low-toxicity alternative to chemotherapy.
Klebsiella pneumoniae infection causes mitochondrial damage and dysfunction in bovine mammary epithelial cells
Authors: Cheng Jia , Zhang Jv , Yang Jingyue , Yi Bing , Liu Gang , Zhou Man , Kastelic John P. , Han Bo , Gao Jian
Published: February 2021

Klebsiella pneumoniae, an important cause of bovine mastitis worldwide, is strongly pathogenic to bovine mammary epithelial cells (bMECs). Our objective was to determine the role of mitochondrial damage in the pathogenicity of K. pneumoniae on bMECs, by assessing several classical indicators of mitochondrial dysfunction, as well as differentially expressed genes (DEGs). Two K. pneumoniae strains (HLJ-D2 and HB-AF5), isolated from cows with clinical mastitis (CM), were used to infect bMECs (MAC-T line) cultured in vitro. In whole-transcriptome analysis of bMECs at 6 h post-infection (hpi), there were 3453 up-regulated and 3470 down-regulated genes for HLJ-D2, whereas for HB-AF5, there were 2891 up-regulated and 3278 down-regulated genes (P < 0.05). Based on GO term enrichment of differentially expressed genes (DEGs), relative to the controls, the primary categories altered in K. pneumoniae-infected bMECs included cellular macromolecule metabolism, metabolic process, binding, molecular function, etc. Infections increased (P < 0.05) malondialdehyde concentrations and formation of reactive oxygen species in bMECs. Additionally, both bacterial strains decreased (P < 0.05) total antioxidant capacity in bMECs at 6 and 12 hpi. Furthermore, infections decreased (P < 0.05) mitochondrial membrane potential and increased (P < 0.01) mitochondrial calcium concentrations. Finally, severe mitochondrial swelling and vacuolation, as well as mitochondrial rupture and cristae degeneration, were detected in infected bMECs. In conclusion, K. pneumoniae infections induced profound mitochondrial damage and dysfunction in bMECs; we inferred that this caused cellular damage and contributes to the pathogenesis of K. pneumoniae-induced CM in dairy cows.