bluuebunny/crossref_metadata_2025 huggingface dataset:
Does speed of recognition predict two-alternative forced-choice performance? Replicating and extending Starns, Dubé, and Frelinger (2018)
Authors: Voormann Anne , Rothe-Wulf Annelie , Starns Jeffrey J , Klauer Karl Christoph
Published: September 2020

Does the speed of single-item recognition errors predict performance in subsequent two-alternative forced-choice (2AFC) trials that include an item with a previous error response? Starns, Dubé, and Frelinger found effects of this kind in two experiments and accounted for them in terms of continuous memory-strength signal guiding recognition decisions. However, the effects of error speed might just as well only reflect an artefact due to an error-correction strategy that uses response latency as a heuristic cue to guide 2AFC responses, elicited through confounding factors in their experimental design such as error-correction instructions and feedback. Using two conditions, a replication condition, replicating the procedure from Starns et al., and an extension condition (each n = 130), controlling for the named shortcomings, we replicated the error speed effect. In both conditions, speed of errors in a single-item recognition task was predictive of subsequent 2AFC performance, including the respective error item. To be more precise, fast errors were associated with decreased 2AFC performance. As there was no interaction with the factor condition, the results support the idea that speed of single-item recognition responses reflects the amount of memory information underlying the respective response rather than being used for a simple error-correction strategy to improve 2AFC performance.
Circulating microRNAs in serum as novel biomarkers for osteoporosis: a case-control study
Authors: Shuai Yi , Liao Li , Su Xiaoxia , Sha Nanxi , Li Xiaobo , Wu Yutao , Jing Huan , Kuang Huijuan , Deng Zhihong , Li Yongqi , Jin Yan
Published: September 2020

Aims: Osteoporosis is underdiagnosed because of the lack of a convenient diagnostic method. Circulating microRNAs (miRNAs) emerge as novel biomarkers for disease diagnosis. Here, we conducted a case-control study that included a total of 448 serum samples collected from 182 healthy participants, 132 osteopenia participants, and 134 osteoporosis patients. Methods: Circulating miRNAs dysregulated during osteoporosis were screened and analyzed in three randomly determined sub-cohorts: the discovery cohort identified 22 candidate miRNAs; the training cohort tested the candidate miRNAs and constructed Index 1, comprising five miRNAs by logistic regression, and Index 2, comprising four miRNAs, was developed by linear combination. Results: Both indices were tested in the validation cohort and showed statistically significant results in distinguishing osteoporosis patients from healthy and osteopenic patients. Moreover, Index 1 also showed improved performance over traditional bone turnover biomarkers type I pro-collagen (tPINP) and type I collagen (β-CTx). Conclusion: In conclusion, circulating miRNAs are potential biomarkers for osteoporosis. The diagnostic panel of circulating miRNAs could be a complementary method for dual-energy X-ray absorptiometry (DXA) in mass screening and routine examination to enhance the osteoporosis detection rate.
Chronic Syndesmotic Injury: Revision and Fixation With a Suture Button and a Quadricortical Screw
Authors: Stake Ingrid Kvello , Andersen Mette Renate , Husebye Elisabeth Ellingsen
Published: September 2020

Background. Chronic syndesmotic injury may cause long-term pain and reduced ankle function. Today, there is no consensus about the best surgical treatment of these injuries. We present the technique and results of revision and fixation with a suture button and a quadricortical screw. Methods. Eleven patients treated for chronic syndesmotic injury were included. The patients completed questionnaires regarding ankle function, and computed tomography scans were obtained to evaluate tibiofibular distance and osteoarthritis. Complications were registered. Results. At mean 45 months follow-up, the mean American Orthopaedic Foot and Ankle Society ankle-hindfoot score was 87 points. There were 5 complications, including 3 hardware-related pain. The tibiofibular distance was significantly reduced with surgery. Seven patients had progression of osteoarthritis. Conclusions. Even though the majority of the patients had progression of radiological signs of osteoarthritis, the functional outcome after revision and fixation with a suture button and a quadricortical screw in chronic syndesmotic ruptures is good and comparable to the results presented in other studies.

Levels of Evidence: Level IV: Case series without control, technical note
Pathologies of the Peroneals: A Review
Authors: Sharma Akhil , Parekh Selene G.
Published: September 2020

Peroneal tendon disorders remain an often overlooked source of lateral hindfoot pain and tenderness. Medical professionals who specialize in foot and ankle care are still far more likely to diagnose a peroneal tendon disorder as an ankle injury. In fact, acute peroneal dislocations are misdiagnosed in up to 40% of cases. The major subsets of peroneal disorders include peroneal tendonitis and tenosynovitis, painful os peroneum syndrome, subluxation, and tearing of the peroneal tendons. Proper history and physical exam maneuvers must be performed to help identify the source of the injury and differentiate these categories. Detailed imaging through X-ray and magnetic resonance imaging must also be used to diagnose the etiology of the patient’s condition in order to direct management. Currently, there is very limited knowledge on peroneal pathologies, and treatment protocol is highly variable and limited to expert opinion. Despite the individual preferences and nuances held by each surgeon when it comes to operating, the overarching principles that guide appropriate management of tendonitis, subluxation, and tendon tear should maintain a higher level of consistency. Therefore, the authors of this review aim to elucidate the most current methods to diagnose these disorders as well as evidence-based practices for optimal management.

Levels of Evidence: Level V
Systematic Review of Nonoperative Functional Protocols for Acute Achilles Ruptures Utilizing a Formal Rehabilitation Protocol Showing Lowest Rerupture Rates
Authors: Harrington Tara L. , Breedlove Gerald J. , Sharpe Jonathan J.
Published: September 2020

Aim. To lay out a comprehensive protocol for practitioners and physical therapists that has the lowest rerupture rates for nonoperative treatment of acute Achilles ruptures. Method. Relevant articles were searched in PubMed, CINAHL Plus, and Cochrane Library using keyword combinations: nonoperative AND/OR Achilles rupture AND functional AND/OR protocol or functional AND/OR rehabilitation. To be included in the full analysis, the studies had to have detailed functional protocols with physical therapy program details and outcome scores of rupture rates and/or Achilles Tendon Rupture Score (ATRS). We ultimately found 7 articles that fit our inclusion criteria for analysis. All of them had rerupture rates, and 4 had ATRS scores and functional protocols with mention of formal physical therapy programs. Results. Lowest rerupture rates were found in strict functional rehabilitation protocols that were full weightbearing in boot immediately at full equinus or 30° plantar flexed. They started active range of motion at 5 to 8 weeks and started formal physical therapy at 10 weeks.

Levels of Evidence: Level III: Evidence obtained from well-designed non-experimental descriptive studies
Hyperosmolar Ionic Solutions Modulate Inflammatory Phenotype and sGAG Loss in a Cartilage Explant Model
Authors: Arabiyat Ahmad S. , Chen Hongyu , Erndt-Marino Josh , Burkhard Katie , Scola Lisa , Fleck Allison , Wan Leo Q. , Hahn Mariah S.
Published: September 2020

Objective

The objective of this study was to compare the effects of hyperosmolar sodium (Na+), lithium (Li+) and potassium (K+) on catabolic and inflammatory osteoarthritis (OA) markers and sulfated glycosaminoglycan (sGAG) loss in TNF-α-stimulated cartilage explants.

Methods

Explants from bovine stifle joints were stimulated with TNF-α for 1 day to induce cartilage degradation followed by supplementation with 50 mM potassium chloride (KCl), 50 mM lithium chloride (LiCl), 50 mM sodium chloride (NaCl), or 100 nM dexamethasone for an additional 6 days. We assessed the effect of TNF-α stimulation and hyperosmolar ionic treatment on sGAG loss and expression of OA-associated proteins: ADAMTS-5, COX-2, MMP-1, MMP-13, and VEGF.

Results

TNF-α treatment increased sGAG loss ( P < 0.001) and expression of COX-2 ( P = 0.018), MMP-13 ( P < 0.001), and VEGF ( P = 0.017) relative to unstimulated controls. Relative to activated controls, LiCl and dexamethasone treatment attenuated sGAG loss ( P = 0.008 and P = 0.042, respectively) and expression of MMP-13 ( P = 0.005 and P = 0.036, respectively). In contrast, KCl treatment exacerbated sGAG loss ( P = 0.032) and MMP-1 protein expression ( P = 0.010). NaCl treatment, however, did not alter sGAG loss or expression of OA-related proteins. Comparing LiCl and KCl treatment shows a potent reduction ( P < 0.05) in catabolic and inflammatory mediators following LiCl treatment.

Conclusion

These results suggest that these ionic species elicit varying responses in TNF-α-stimulated explants. Cumulatively, these findings support additional studies of hyperosmolar ionic solutions for potential development of novel intraarticular injections targeting OA.
Economic Inequality Shapes the Relationship Between Globalization and Prejudice
Authors: Caluori Nava , Brown-Iannuzzi Jazmin L. , Cipolli William
Published: September 2020

As globalization increases worldwide, it redefines our conceptions of other cultures, the media we consume, and our day-to-day interactions. Despite this increased interconnectivity, we lack a fundamental understanding of how globalization is related to prejudicial attitudes between social groups. We hypothesized that economic inequality may shape the relationship between globalization and intergroup prejudice. We tested this prediction with data from over 66,000 respondents across 44 countries. We found that globalization—and particularly its social aspects such as tourism and migration—is related to increased prejudice in countries with high economic inequality and is related to decreased prejudice in countries with low economic inequality. These findings offer new insight into how and why globalization may shape intergroup relations around the world.
New technique of inguinal hernia repair during prostatectomy
Authors: Talebpour Mohammad , Khatami Fatemeh , Aghaii Maryam , Aghamir Seyed Mohammad Kazem
Published: September 2020

Background: Several benefits of inguinal hernia repair concurrent with simple prostatectomy have been proposed recently. For the first time we represent this surgery in the form of retroperitoneal mesh insertion without an additional surgical cut for the inguinal hernia repair. Methods: We selected 19 patients for this trial of a new surgery method. The simple prostatectomy was performed and from the same surgical cut the hernia sac recognized. Two methods of prostatectomy surgery were undertaken: Millin’s and Freyer’s prostatectomy. The retroperitoneal insertion of monofilament polypropylene was undertaken for hernia repair. Results: All patients were prospectively followed for three years for clinical outcomes and hernia recurrence. No complications after surgery, including wound infection, pelvic collections, sepsis and recurrence of the hernia were seen. Conclusions: Our new retroperitoneal mesh insertion technique is safe, effective and simultaneously practical with simple prostatectomy. This new method is strongly recommended to other surgeons, since it has beneficial results with no noteworthy raise in operative duration or further complications.
Is the use of a powered dermatome an aerosol-generating procedure (AGP)? Implications for personal protection against COVID-19 virus
Authors: Shokrollahi Kayvan , Kyriazidis Ioannis , Zak-Williams Shomari , Jones Claire , Murgatroyd Elisa , Gurusinghe Dilnath
Published: September 2020

Introduction:

Many healthcare workers have contracted SARS-CoV-2 during the pandemic, many cases of which have resulted in severe illness and death. No studies have assessed the potential for powered dermatomes to generate aerosol, an essential technique in burns and plastic surgery. The primary aim of the present study was to capture video footage to illustrate the potential for a powered dermatome to generate significant spray and hence aerosol.

Methods:

We utilised a simulated skin graft harvest experimental method. Fluorescein-stained saline was used with ultraviolet (UV) backlighting to demonstrate fluorescent spray from a popular brand of air-powered dermatome. Ultra-slow-motion (960 frames/s) video was used to demonstrate the oscillation of the dermatome blade and the origin within the machine of any spray generated, and the extent of spray generated.

Results:

The key finding from this study is the captured video footage linked with this paper. Droplets of various sizes are seen spraying out from the leading edge at the sides where the blade oscillates. UV backlighting provides a clear demonstration of the dermatome generating fine spray.

Conclusion:

Our study demonstrates that powered dermatome usage is likely to generate aerosol from blood or blood-contaminated fluid, but does not demonstrate or quantify to what extent this may be clinically relevant in terms of viral transmission potential. We suggest ways to reduce the risk of spray from dermatomes including limiting donor-site bleeding and avoiding a wet donor area.

Lay Summary

A dermatome is a device used by surgeons to harvest split skin grafts (SSGs). SSGs are an essential component of burns and reconstructive plastic surgery. Aerosol-generating procedures (AGPs) have implications for transmission of viruses including COVID-19. It has not previously been formally assessed whether use of a dermatome should be classified as an AGP. This study uses a fluorescent dye in the context of simulated surgery using a dermatome to see if any, and how much, fine spray is generated from the device and also utilises ultra-slow-motion videography to see how any spray may be generated. At the heart of this study is the included video footage that demonstrates considerable fine spray generation which suggests it is best to assume that dermatomes are likely to generate some degree of aerosol depending on the clinical scenario and how it is used. However, this information does not translate to providing any information about the risk of transmission of the virus from using a dermatome, especially in relation to COVID-19, and separate research would be required to answer this.
Determinative Variables Toward Promoting Use of Active Modes of Transportation: Enhancing Level of Sustainable Mobility in Communities
Authors: Dehghanmongabadi Abolfazl , Hoşkara Şebnem
Published: September 2020

Most current transportation systems around the world are cause for pressing concern and a menace to sustainability of social justice, and economic and environmental vitality. From a universal agreement that transportation needs an urgent alteration in travel modes, policies, planning, and behaviors through to the emergence of sustainability in the transportation sector, a significant and central vision has emerged to guide urban policymakers, transportation planners, and public health officials. During the last four decades, a shift in transportation modes toward use of active modes of transportation has been encouraged, and it is one of the main sustainability movements appearing in many developing and developed countries. This research provides a narrative review and parsing of existing literature, which focuses on promoting active modes of transportation. The aim is to clarify key determinative variables that must be considered by planners and policymakers toward promoting use of active modes of transportation for daily mobility.
Visualizing the Regionalized Structure of Mobility between Countries Worldwide
Authors: Deutschmann Emanuel
Published: September 2020

Despite the sociological relevance of human mobility between nation-states, our knowledge about its planet-scale structure is still limited. Here, geographic mapping, algorithm-based community detection, network visualization, and conventional line plots are combined to display the network structure of 2.3 billion estimated trips between countries worldwide in 2016, together with information about the (non)evolution of this structure over time. The graph reveals that transnational mobility is highly regionalized: 80 percent of all human movements between countries occur within world regions. Despite strong increases in the absolute amount of transnational mobility, this share remains extremely stable between 2011 and 2016. The community detection algorithm reveals six mobility clusters that clearly correspond to world regions: Africa, Asia and Oceania, the Americas, Eurasia, Europe, and the Middle East. This stable, regionalized structure suggests that a fully globalized “world society” is unlikely to emerge, as social ties remain parochial, even in the transnational sphere.
President's Emergency Plan for AIDS Relief (PEPFAR) Policy Process and the Conversation around HIV/AIDS in the United States
Authors: Jacobson Laura E.
Published: September 2020

In 2003, the George W. Bush administration passed the President’s Emergency Plan for AIDS Relief (PEPFAR), a US government initiative to address the human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) epidemic primarily in Africa. PEPFAR’s US$18 billion budget remains the largest commitment from any nation towards a single disease and has saved countless lives. Given the historical and current political resistance to foreign aid, PEPFAR’s drastic spike in spending on HIV/AIDS raises questions over how the policy process resulted in bipartisan support. Using two policy process theories, punctuated equilibrium theory (PET) and the Narrative Policy Framework (NPF), this analysis helps explain the framing of the global HIV/AIDS epidemic and the factors that resulted in the creation of PEPFAR. The analysis of the PEPFAR policy process reveals a ‘tipping point’ in the early 2000s, when political actors, the media and advocacy coalitions benefitted from issue framing, narrative change and measures of political attention to elevate the global HIV/AIDS crisis to the public agenda. The findings highlight an increase in presidential attention, the evolution of the HIV/AIDS narrative away from stigma and the formation of powerful coalitions. Looking back on the combination of policy process factors that led to PEPFAR’s bipartisan success might lead to insights for dismantling the grand public health challenges of the present and future. This study’s findings have implications for currently stigmatised public health crises, such as the opioid epidemic.
The profile and support needs of parents in paediatric palliative care: comparing cancer and non-cancer groups
Authors: Aoun Samar M. , Gill Fenella J. , Phillips Marianne B. , Momber Suzanne , Cuddeford Lisa , Deleuil Renee , Stegmann Roswitha , Howting Denise , Lyon Maureen E.
Published: September 2020

Background:

Parents of children with life-limiting illnesses experience considerable burden and distress, yet few interventions have targeted their well-being.

Objectives:

Evaluate the use and feasibility of the Paediatric Carer Support Needs Assessment Tool (pCSNAT) in assessing and addressing parents’ needs caring for cancer and non-cancer conditions. Carer well-being outcomes were also tested.

Methods:

A non-randomised prospective intervention pilot study. Twenty-eight parents (out of 42 approached) and 5 health professionals working in paediatric palliative care services in Western Australia (2018–2019) completed the pilot study.

Results:

Two-thirds of eligible parents completed the study. The highest support needs included having time for yourself; practical help in the home; knowing what to expect in the future; financial, legal or work issues; and knowing who to contact if you are concerned. Almost all needs were considerably more pronounced for the non-cancer group. The pCSNAT seemed feasible and outcomes demonstrated a tendency to improve.

Conclusion:

Using the pCSNAT provided a concise and comprehensive ‘one stop shop’ for health professionals to evaluate difficulties encountered by parents. The disadvantages reported by the non-cancer group warrant increased attention. Paediatric palliative care should adopt routine assessment of parents’ support needs to anticipate early and tailored supports including partnerships with the community.
Selecting suitable reference genes for qPCR normalization: a comprehensive analysis in MCF-7 breast cancer cell line
Authors: Jain Nityanand , Nitisa Dina , Pirsko Valdis , Cakstina Inese
Published: September 2020

Background

MCF-7 breast cancer cell line is undoubtedly amongst the most extensively studied patient-derived research models, providing pivotal results that have over the decades translated to constantly improving patient care. Many research groups, have previously identified suitable reference genes for qPCR normalization in MCF-7 cell line. However, over the course of identification of suitable reference genes, a comparative analysis comprising these genes together in a single study has not been reported. Furthermore, the expression dynamics of these reference genes within sub-clones cultured over multiple passages (p) has attracted limited attention from research groups. Therefore, we investigated the expression dynamics of 12 previously suggested reference genes within two sub-clones (culture A1 and A2) cultured identically over multiple passages. Additionally, the effect of nutrient stress on reference gene expression was examined to postulate an evidence-based recommendation of the least variable reference genes that could be employed in future gene expression studies.

Results

The analysis revealed the presence of differential reference gene expression within the sub-clones of MCF-7. In culture A1, GAPDH-CCSER2 were identified as the least variable reference genes while for culture A2, GAPDH-RNA28S were identified. However, upon validation using genes of interest, both these pairs were found to be unsuitable control pairs. Normalization of AURKA and KRT19 with triplet pair GAPDH-CCSER2-PCBP1 yielded successful results. The triplet also proved its capability to handle variations arising from nutrient stress.

Conclusions

The variance in expression behavior amongst sub-clones highlights the potential need for exercising caution while selecting reference genes for MCF-7. GAPDH-CCSER2-PCBP1 triplet offers a reliable alternative to otherwise traditionally used internal controls for optimizing intra- and inter-assay gene expression differences. Furthermore, we suggest avoiding the use of ACTB, GAPDH and PGK1 as single internal controls.
Role of diversity-generating retroelements for regulatory pathway tuning in cyanobacteria
Authors: Vallota-Eastman Alec , Arrington Eleanor C. , Meeken Siobhan , Roux Simon , Dasari Krishna , Rosen Sydney , Miller Jeff F. , Valentine David L. , Paul Blair G.
Published: September 2020

Background

Cyanobacteria maintain extensive repertoires of regulatory genes that are vital for adaptation to environmental stress. Some cyanobacterial genomes have been noted to encode diversity-generating retroelements (DGRs), which promote protein hypervariation through localized retrohoming and codon rewriting in target genes. Past research has shown DGRs to mainly diversify proteins involved in cell-cell attachment or viral-host attachment within viral, bacterial, and archaeal lineages. However, these elements may be critical in driving variation for proteins involved in other core cellular processes.

Results

Members of 31 cyanobacterial genera encode at least one DGR, and together, their retroelements form a monophyletic clade of closely-related reverse transcriptases. This class of retroelements diversifies target proteins with unique domain architectures: modular ligand-binding domains often paired with a second domain that is linked to signal response or regulation. Comparative analysis indicates recent intragenomic duplication of DGR targets as paralogs, but also apparent intergenomic exchange of DGR components. The prevalence of DGRs and the paralogs of their targets is disproportionately high among colonial and filamentous strains of cyanobacteria.

Conclusion

We find that colonial and filamentous cyanobacteria have recruited DGRs to optimize a ligand-binding module for apparent function in signal response or regulation. These represent a unique class of hypervariable proteins, which might offer cyanobacteria a form of plasticity to adapt to environmental stress. This analysis supports the hypothesis that DGR-driven mutation modulates signaling and regulatory networks in cyanobacteria, suggestive of a new framework for the utility of localized genetic hypervariation.
Comparative transcriptomic analysis of Rickettsia conorii during in vitro infection of human and tick host cells
Authors: Narra Hema P. , Sahni Abha , Alsing Jessica , Schroeder Casey L. C. , Golovko George , Nia Anna M. , Fofanov Yuriy , Khanipov Kamil , Sahni Sanjeev K.
Published: September 2020

Background

Pathogenic Rickettsia species belonging to the spotted fever group are arthropod-borne, obligate intracellular bacteria which exhibit preferential tropism for host microvascular endothelium in the mammalian hosts, resulting in disease manifestations attributed primarily to endothelial damage or dysfunction. Although rickettsiae are known to undergo evolution through genomic reduction, the mechanisms by which these pathogens regulate their transcriptome to ensure survival in tick vectors and maintenance by transovarial/transstadial transmission, in contrast to their ability to cause debilitating infections in human hosts remain unknown. In this study, we compare the expression profiles of rickettsial sRNAome/transcriptome and determine the transcriptional start sites (TSSs) of R. conorii transcripts during in vitro infection of human and tick host cells.

Results

We performed deep sequencing on total RNA from Amblyomma americanum AAE2 cells and human microvascular endothelial cells (HMECs) infected with R. conorii. Strand-specific RNA sequencing of R. conorii transcripts revealed the expression 32 small RNAs (Rc_sR’s), which were preferentially expressed above the limit of detection during tick cell infection, and confirmed the expression of Rc_sR61, sR71, and sR74 by quantitative RT-PCR. Intriguingly, a total of 305 and 132 R. conorii coding genes were differentially upregulated (> 2-fold) in AAE2 cells and HMECs, respectively. Further, enrichment for primary transcripts by treatment with Terminator 5′-Phosphate-dependent Exonuclease resulted in the identification of 3903 and 2555 transcription start sites (TSSs), including 214 and 181 primary TSSs in R. conorii during the infection to tick and human host cells, respectively. Seventy-five coding genes exhibited different TSSs depending on the host environment. Finally, we also observed differential expression of 6S RNA during host-pathogen and vector-pathogen interactions in vitro, implicating an important role for this noncoding RNA in the regulation of rickettsial transcriptome depending on the supportive host niche.

Conclusions

In sum, the findings of this study authenticate the presence of novel Rc_sR’s in R. conorii, reveal the first evidence for differential expression of coding transcripts and utilization of alternate transcriptional start sites depending on the host niche, and implicate a role for 6S RNA in the regulation of coding transcriptome during tripartite host-pathogen-vector interactions.
Measurement of drug concentration and bacterial contamination after diluting morphine for intrathecal administration: an experimental study
Authors: Teunissen Aart Jan W. , Koning Mark V. , Ruijgrok Elisabeth J. , Liefers Willem J. , de Bruijn Bart , Koopman Seppe A.
Published: September 2020

Background

Low concentrations of morphine are required for safe dosing for intrathecal injections. Sometimes, manual dilution of morphine is performed to achieve these low concentrations, but risks dilution errors and bacterial contamination. The primary goal was to compare the concentrations of morphine and bupivacaine between four groups of syringes. The secondary goal was to investigate the difference in contamination rate between these groups.

Methods

Twenty-five experienced anesthesia providers were asked to prepare a mixture of bupivacaine 2.0 mg/ml and morphine 60 μg/ml using 3 different methods as clean and precise as possible. The fourth method used was the aspiration of ampoules prepared by the pharmacy. The concentrations of morphine and bupivacaine were measured by High-Pressure Liquid Chromatography (HPLC). The medication was cultured for bacterial contamination.

Results

Group 1 (median 60 μg/ml; 95% CI: 59–110 μg/ml) yielded 3 outliers above 180 μg/ml morphine concentration. Group 2 (76 μg/ml; 95% CI: 72–80 μg/ml) and 3 (69 μg/ml; 95% CI: 66–71 μg/ml) were consistently higher than the target concentration of 60 μg. The group “pharmacy” was precise and accurate (59 μg/ml; 95% CI: 59–59 μg/ml). Group 2 and “pharmacy” had one contaminated sample with a spore-forming aerobic gram-positive rod.

Conclusion

Manually diluted morphine is at risk for deviating concentrations, which could lead to increased side-effects. Medication produced by the hospital pharmacy was highly accurate. Furthermore, even when precautions are undertaken, contamination of the medication is a serious risk and appeared to be unrelated to the dilution process.
Liver fibrosis assessments using FibroScan, virtual-touch tissue quantification, the FIB-4 index, and mac-2 binding protein glycosylation isomer levels compared with pathological findings of liver resection specimens in patients with hepatitis C infection
Authors: Ueda Naoyuki , Kawaoka Tomokazu , Imamura Michio , Aikata Hiroshi , Nakahara Takashi , Murakami Eisuke , Tsuge Masataka , Hiramatsu Akira , Hayes C. Nelson , Yokozaki Michiya , Chayama Kazuaki
Published: September 2020

Background

Evaluation of fibrosis stage is important to monitor progression of liver disease and risk of hepatocellular carcinoma (HCC). While liver biopsy is the gold standard, the method is invasive and faces several limitations. The aim of this study was to determine correlations among METAVIR scores and FibroScan, Virtual-Touch tissue quantification (VTQ), fibrosis index based on four factors (FIB-4 index), and Mac-2 binding protein glycosylation isomer (M2BPGi) level, and for examine differences in the reliability of non-invasive methods to evaluate fibrosis.

Methods

We used liver resection specimens from patients with hepatitis C virus (HCV), correlations were assessed between METAVIR scores and non-invasive method. Receiver operating characteristic (ROC) curves were generated to determine the sensitivity, specificity, and cut off values of the methods.

Results

All Patients group: In F0–2 vs F3–4, the areas under the ROC curve (AUC) (0.85) of FibroScan was significantly higher than that (0.67) of FIB-4 index (p = 0.002) and that (0.67) of M2BPGi (p = 0.001). The AUC (0.83) of VTQ was significantly higher than that (0.67) of FIB-4 index (p = 0.01) and that (0.67) of M2BPGi (p = 0.002). In F0–3 vs F4, the AUC (0.86) of VTQ was significantly higher than that (0.65) of FIB-4 index (p = 0.04). The AUC (0.89) of FibroScan was significantly higher than that (0.65) of FIB-4 index (p = 0.002) and that (0.76) of M2BPGi (p = 0.02).

Non-SVR group: In F0–2 vs F3–4, the AUC (0.85) of FibroScan was significantly higher than that (0.84) of FIB-4 index (p = 0.02) and that (0.73) of M2BPGi (p = 0.003). The AUC (0.84) of VTQ was significantly higher than that (0.74) of FIB-4 index (p = 0.04). In F0–3 vs F4, the AUC (0.91) of FibroScan was significantly higher than that (0.67) of FIB-4 index (p = 0.003) and that (0.78) of M2BPGi (p = 0.02). The AUC (0.88) of VTQ was significantly higher than that of FIB-4 index (0.67) and that of M2BPGi (0.78) (p = 0.04).

Conclusions

FibroScan and VTQ best reflected the results of hepatic fibrosis diagnosis using liver resection specimens among the four examination methods evaluated.
Left-sided heart disease and risk of death in patients with end-stage kidney disease receiving haemodialysis: an observational study
Authors: Axelsson Raja Anna , Warming Peder E. , Nielsen Ture L. , Plesner Louis L. , Ersbøll Mads , Dalsgaard Morten , Schou Morten , Rydahl Casper , Brandi Lisbet , Iversen Kasper
Published: September 2020

Background

Cardiovascular disease is the most common cause of death in patients with end-stage kidney disease on haemodialysis. The potential clinical consequence of systematic echocardiographic assessment is however not clear. In an unselected, contemporary population of patients on maintenance haemodialysis we aimed to assess: the prevalence of structural and functional heart disease, the potential therapeutic consequences of echocardiographic screening and whether left-sided heart disease is associated with prognosis.

Methods

Adult chronic haemodialysis patients in two large dialysis centres had transthoracic echocardiography performed prior to dialysis and were followed prospectively. Significant left-sided heart disease was defined as moderate or severe left-sided valve disease or left ventricular ejection fraction (LVEF) ≤40%.

Results

Among the 247 included patients (mean 66 years of age [95%CI 64–67], 68% male), 54 (22%) had significant left-sided heart disease. An LVEF ≤40% was observed in 31 patients (13%) and severe or moderate valve disease in 27 (11%) patients. The findings were not previously recognized in more than half of the patients (56%) prior to the study. Diagnosis had a potential impact on management in 31 (13%) patients including for 18 (7%) who would benefit from initiation of evidence-based heart failure therapy. After 2.8 years of follow-up, all-cause mortality among patients with and without left-sided heart disease was 52 and 32% respectively (hazard ratio [HR] 1.95 (95%CI 1.25–3.06). A multivariable adjusted Cox proportional hazard analysis showed that left-sided heart disease was an independent predictor of mortality with a HR of 1.60 (95%CI 1.01–2.55) along with age (HR per year 1.05 [95%CI 1.03–1.07]).

Conclusion

Left ventricular systolic dysfunction and moderate to severe valve disease are common and often unrecognized in patients with end-stage kidney failure on haemodialysis and are associated with a higher risk of death. For more than 10% of the included patients, systematic echocardiographic assessment had a potential clinical consequence.
Depressive symptoms among orphans and vulnerable adolescents in childcare homes in Nepal: a cross-sectional study
Authors: Bhatt Kumari Bandana , Apidechkul Tawatchai , Srichan Peeradone , Bhatt Navin
Published: September 2020

Background

Orphans and vulnerable adolescents (OVAs) living in child care homes (CCHs) are vulnerable to depressive symptoms due to a poor environment and a lack of receiving good care and love from their parents. This study aimed to estimate the presence of depressive symptoms and determine factors associated with it among OVAs living in CCHs in Nepal.

Methods

A cross-sectional study was conducted to collect the information from OVAs aged 13–17 years living in 22 CCHs from five districts of Nepal. The CCHs were selected by a simple random method. A validated questionnaire and the Beck Depression Inventory-II (BDI-II) were used to assess depressive symptoms among the participants. Those with mild to severe BDI-II scores were defined as having clinically relevant depressive symptoms. Logistic regression was used to detect associations between variables at the significance level α = 0.05.

Results

A total of 602 adolescents participated in the study; 51.0% were females, the average age was 14.7 years, and 32.2% were members of indigenous groups. The overall presence of clinically relevant depressive symptoms was 33.2%. After controlling for all potential confounding factors, five factors were found to be associated with depress among OVAs. Females were 1.96 times more likely to develop depressive symptoms than males (95% CI = 1.36–2.83). Those adolescents who used alcohol were 3.42 times more likely to develop depressive symptoms than those who did not (95% CI = 1.16–10.12). Those who had health problems were 2.00 times more likely to develop depressive symptoms than those who did not (95% CI = 1.36–2.94). Those who had low social support were 1.81 times more likely to develop depressive symptoms than those who had high social support (95% CI = 1.08–3.03), and those who had been bullied were 1.97 times more likely to develop depressive symptoms than those who were not bullied (95% CI = 1.23–3.15).

Conclusion

The magnitude of clinically relevant depressive symptoms in adolescents living in CCHs was found to be high in Nepal. There is an urgent need for effective intervention to curtail this problem among OVAs in CCHs in Nepal, with a focus on females, alcohol users, those with physical health problems and with less social support, and those who are bullied.
Trick or treat? – when children with childhood food allergies lead parents into unhealthy food choices
Authors: Mahmoud Ali B. , Hack-Polay Dieu , Fuxman Leonora , Naquiallah Dina , Grigoriou Nicholas
Published: September 2020

Background

This study examines the relationships between childhood food allergy and parental unhealthy food choices for their children across attitudes towards childhood obesity as mediators and parental gender, income and education as potential moderators.

Methods

We surveyed parents with at least one child between the ages of 6 and 12 living in Canada and the United States. We received 483 valid responses that were analysed using structural equation modelling approach with bootstrapping to test the hypothetical path model and its invariance across the moderators.

Results

The analysis revealed that pressure to eat fully mediated the effects of childhood food allergy and restriction on parental unhealthy food choices for their children. Finally, we found that parental gender moderated the relationship between childhood food allergy and the pressure to eat.

Conclusions

The paper contributes to the literature on food allergies among children and the marginalisation of families with allergies. Our explorative model is a first of its kind and offers a fresh perspective on complex relationships between variables under consideration. Although our data collection took place prior to Covid-19 outbreak, this paper bears yet particular significance as it casts light on how families with allergies should be part of the priority groups to have access to food supply during crisis periods.
Prevalence and genotype distribution of genital human papillomavirus infection in female sex workers in the world: a systematic review and meta-analysis
Authors: Farahmand Mohammad , Moghoofei Mohsen , Dorost Abolfazl , Abbasi Saeedeh , Monavari Seyed Hamidreza , Kiani Seyed Jalal , Tavakoli Ahmad
Published: September 2020

Background

Female sex workers (FSWs) are amongst the most susceptible groups to acquire human papillomavirus (HPV) infection and consequently, to develop cervical intraepithelial neoplasia and cervical cancer. This is the first systematic review and meta-analysis to provide estimates of the pooled prevalence of HPV infection and the distribution of HPV types among FSWs across the world.

Methods

Five computerized databases were searched for relevant studies published since the inception date of databases to September 2019. The pooled HPV prevalence was calculated by the random effect model described by DerSimonian-Laird. Subgroup analysis was performed to identify the probable sources of heterogeneity. The meta-analysis was performed using the “Metaprop” function in the R package Meta.

Results

Sixty-two studies involving 21,402 FSWs from 33 countries were included in this meta-analysis, and the pooled HPV prevalence was 42.6% (95% confidence interval (CI): 38.5–46.7%). HPV-16 (10.1, 95% CI: 8.2–12.5%), HPV-52 (7.9, 95% CI: 5.9–10.7%), and HPV-53 (6.0, 95% CI: 4.4–8.1%) were the most common high-risk HPV types identified among FSWs. The pooled estimated prevalence of HPV infection among FSWs before and after 2010 were slightly different, 43.6% (95% CI: 36.1–51.4%) and 41.9% (95% CI: 37.2–46.8%), respectively.

Conclusion

Due to the high prevalence of HPV infection, particularly with high-risk types, FSWs have a great susceptibility to the development of cervical and vaginal cancers. Furthermore, they can transmit their infection to their clients, which may result in a high prevalence of HPV and the incidence of HPV-associated malignancies among the general population.
Healthcare managers’ experiences of technostress and the actions they take to handle it – a critical incident analysis
Authors: Stadin Magdalena , Nordin Maria , Fransson Eleonor I. , Broström Anders
Published: September 2020

Background

Healthcare managers, in comparison with other healthcare professionals, have an increased likelihood of experiencing technostress at work. Since knowledge about the causes and severity of technostress and about the strategies healthcare managers use to handle it is limited, the aim of this study was to describe their experience of technostress and the actions they employ to address it.

Methods

An explorative design based on the critical incident technique was used. In total, 20 healthcare managers (10 women, 10 men) from four hospitals in two county councils in Sweden were purposively selected according to professional background, hierarchical management position, control span, time in the management position, and sex. Semi-structured interviews with regard to critical incidents and actions taken to handle technostress were conducted.

Results

Healthcare managers’ experiences of technostress (n = 279) were categorised related to three main areas. These involved ‘negative aspects of digital communication’ (e.g. high workload, invasion of private life, and negative feelings related to digital communication), ‘poor user experience of ICT systems (such as illogicality of the ICT system, time-consuming ICT system, or malfunctioning ICT system) and ‘needs to improve organisational resources’ (e.g. needs associated with digital literacy, user influence and distribution of work and ICT systems). Actions taken to handle technostress (n=196) were described relating to three main areas involving ‘culture, norms and social support’ (such as good email culture, and co-worker support), ‘individual resources’ (e.g. individual strategies and competence) and ‘organisational resources’ (such as IT-related assistance and support).

Conclusions

Healthcare managers described negative aspects of digital communication, poor user experience of ICT systems, and lack of organisational resources as potential technostress creators. These problems were handled by taking action related to culture, norms and social support, and individual as well as organisational resources. All these features, along with consideration of healthcare managers’ job demands and resources in general, should be incorporated into actions monitored by healthcare organisations to improve or maintain a sustainable digitalised environment for healthcare managers.

Trial registration

Regional Ethics Board in Linköping #2017/597–31. Registered 20 March 2018. URL not available.
Sortilin levels correlate with major cardiovascular events of diabetic patients with peripheral artery disease following revascularization: a prospective study
Authors: Biscetti Federico , Nardella Elisabetta , Rando Maria Margherita , Cecchini Andrea Leonardo , Bonadia Nicola , Bruno Piergiorgio , Angelini Flavia , Di Stasi Carmine , Contegiacomo Andrea , Santoliquido Angelo , Pitocco Dario , Landolfi Raffaele , Flex Andrea
Published: September 2020

Background

Peripheral artery disease (PAD) represents one of the most relevant vascular complications of type 2 diabetes mellitus (T2DM). Moreover, T2DM patients suffering from PAD have an increased risk of major adverse cardiovascular events (MACE) and major adverse limb events (MALE). Sortilin, a protein involved in apolipoproteins trafficking, is associated with lower limb PAD in T2DM patients.

Objective

To evaluate the relationship between baseline serum levels of sortilin, MACE and MALE occurrence after revascularization of T2DM patients with PAD and chronic limb-threatening ischemia (CLTI).

Research design and methods

We performed a prospective non-randomized study including 230 statin-free T2DM patients with PAD and CLTI. Sortilin levels were measured before the endovascular intervention and incident outcomes were assessed during a 12 month follow-up.

Results

Sortilin levels were significantly increased in individuals with more aggressive PAD (2.25 ± 0.51 ng/mL vs 1.44 ± 0.47 ng/mL, p < 0.001). During follow-up, 83 MACE and 116 MALE occurred. In patients, who then developed MACE and MALE, sortilin was higher. In particular, 2.46 ± 0.53 ng/mL vs 1.55 ± 0.42 ng/mL, p < 0.001 for MACE and 2.10 ± 0.54 ng/mL vs 1.65 ± 0.65 ng/mL, p < 0.001 for MALE. After adjusting for traditional atherosclerosis risk factors, the association between sortilin and vascular outcomes remained significant in a multivariate analysis. In our receiver operating characteristics (ROC) curve analysis using sortilin levels the prediction of MACE incidence improved (area under the curve [AUC] = 0.94) and MALE (AUC = 0.72).

Conclusions

This study demonstrates that sortilin correlates with incidence of MACE and MALE after endovascular revascularization in a diabetic population with PAD and CLTI.