bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence and factors associated with the awareness of obstetric fistula among women of reproductive age in The Gambia: a multilevel fixed effects analysis
Authors: Afaya Agani , Abukari Alhassan Sibdow , Mohammed Shamsudeen
Published: September 2022

Background

An obstetric fistula is an inappropriate connection between the vagina, rectum, or bladder that results in faecal or urine incontinence. Young women from rural areas with poor socioeconomic situations and education are the majority of victims, which restricts their access to high-quality healthcare. Obstetric fistulas can have devastating effects on the physical health of affected women if they are not promptly treated. Inadequate awareness of the symptoms delays recognition of the problem, prompt reporting, and treatment. Women with poor awareness of the disorder are also more likely to develop complications, including mental health issues. Using data from a nationally representative survey, this study investigated the prevalence and factors associated with the awareness of obstetric fistula among women of reproductive age in The Gambia.

Methods

This study used population-based cross-sectional data from the 2019–2020 Gambia Demographic and Health survey. A total of 11823 reproductive-aged women were sampled for this study. Stata software version 16.0 was used for all statistical analyses. Obstetric fistula awareness was the outcome variable. Multilevel logistic regression models were fitted, and the results were presented as adjusted odds ratios (aOR) with statistical significance set atp < 0.05.

Results

The prevalence of obstetric fistula awareness was 12.81% (95%CI: 11.69, 14.12). Women aged 45–49 years (aOR = 2.17, 95%CI [1.54, 3.06]), married women (aOR = 1.39, 95%CI [1.04, 1.87]), those with higher education (aOR = 2.80, 95%CI [2.08, 3.79]), and women who worked as professionals or occupied managerial positions (aOR = 2.32, 95%CI [1.74, 3.10]) had higher odds of obstetric fistula awareness. Women who had ever terminated pregnancy (aOR = 1.224, 95%CI [1.06, 1.42]), those who listened to radio at least once a week (aOR = 1.20, 95%CI [1.02, 1.41]), ownership of a mobile phone (aOR = 1.20, 95%CI [1.01, 1.42]) and those who were within the richest wealth index (aOR = 1.39, 95%CI [1.03, 1.86]) had higher odds of obstetric fistula awareness.

Conclusion

Our findings have revealed inadequate awareness of obstetric fistula among women of reproductive-age in The Gambia. Obstetric fistulas can be mitigated by implementing well-planned public awareness initiatives at the institutional and community levels. We, therefore, recommend reproductive health education on obstetric fistula beyond the hospital setting to raise reproductive-age women's awareness.
The outcomes of a mobile just-in-time-learning intervention for teaching bioethics in Pakistan
Authors: Naseem Azra , Nizamuddin Sameer , Ghias Kulsoom
Published: September 2022

Introduction

The study aimed to test the effectiveness and the feasibility of a mobile just-in-time-learning (m-JiTL) approach for teaching bioethics at a university in Pakistan. Over four months, a mobile app (EthAKUL) was used to enhance ethical reasoning among practising nurses, trainee physicians, and medical and nursing students utilising the m-JiTL approach. Participants used EthAKUL to access bioethics modules and participate in asynchronous discussions.

Methods

A mixed methods design was adopted. Pre- and post-knowledge tests were used to assess changes in participants' knowledge of bioethics concepts, while pre- and post-surveys were used to assess changes in participants' attitudes towards m-learning. After the intervention, focus group discussions with the participants were held. Analysis of the discussion posts and meeting notes was conducted.

Results

The learners had a favourable attitude toward using mobile devices for learning purposes at the start of the intervention, and the score remained positive afterwards. Bioethics knowledge test scores improved at the end of the intervention, with medical students experiencing the greatest improvement. However, because of the high drop-out rate and lack of participation after the initial phase, it is unclear whether the increase in score or positive attitude is the result of the intervention, making it difficult to draw firm conclusions about the intervention's success.

Conclusions

EthAKUL is the first of its kind app for teaching bioethics, and the study has offered important insights into adopting new pedagogies and technologies for bioethics teaching. It has also identified issues with the design of the app and m-JiTL pedagogy that must be addressed before curriculum-wide adoption.
Increased healthcare costs by later stage cancer diagnosis
Authors: McGarvey November , Gitlin Matthew , Fadli Ela , Chung Karen C.
Published: September 2022

Background

Cancer represents a significant source of disease burden in the United States (US), both clinically and economically. Diagnosis and treatment of cancer at earlier stages may reduce this burden. To better understand potential impacts of earlier diagnosis, healthcare costs among patients with cancer were assessed by cancer type and stage at diagnosis.

Methods

A retrospective analysis was conducted using Optum’s de-identified Integrated Claims-Clinical data set with Enriched Oncology, which includes data from Medicare Advantage and commercially insured members. Adult members newly diagnosed with solid tumor cancers, cancer stage at diagnosis (diagnosed 1/1/2016–6/30/2020), and continuous enrollment for at least one month post diagnosis were identified. Patients with breast, cervical, colorectal, lung, ovarian, or prostate cancer were reported. Mean standardized costs (2020 USD) were calculated in each month on an annual and cumulative basis through four years post-cancer diagnosis. In each month, costs were calculated for those with continuous enrollment and no death reported in the month. Mean annual cost per patient was estimated by summing month one to 12 mean costs and stratifying by stage at cancer diagnosis; annual year one to four costs were summed to determine cumulative costs.

Results

Among members diagnosed 2016–2020 with breast, cervical, colorectal, lung, ovarian, or prostate cancer, 20,422 eligible members were identified. Mean costs increased by stage of diagnosis across all cancers at the annual and cumulative level through year four post diagnosis. Cumulative mean costs grew over time at a relatively similar rate across stages I to III and more dramatically in stage IV, except for cervical and lung cancer where the rate was relatively stable or slightly fluctuated across stages and ovarian cancer where stages III and IV both increased more sharply compared to stages I and II.

Conclusions

Mean annual and cumulative healthcare costs through year four post cancer diagnosis were significantly higher among those diagnosed at later versus earlier cancer stages. The steeper increase in cumulative costs among those diagnosed in stage IV for many cancer types highlights the importance of earlier cancer diagnosis. Earlier cancer diagnosis may enable more efficient treatment, improve patient outcomes and reduce healthcare costs.
A blood-based miRNA signature for early non-invasive diagnosis of preeclampsia
Authors: Bao Siqi , Zhou Tong , Yan Congcong , Bao Jiale , Yang Fan , Chao Shan , Zhou Meng , Xu Zhangye
Published: September 2022

Background

Preeclampsia (PE) is a multisystemic maternal syndrome with substantial maternal and fetal morbidity and mortality. Currently, there is no clinically viable non-invasive biomarker assay for early detection, thus limiting the effective prevention and therapeutic strategies for PE.

Methods

We conducted a discovery–training–validation three-phase retrospective and prospective study with cross-platform and multicenter cohorts. The initial biomarkers were discovered and verified in tissue specimens by small RNA sequencing and qRT-PCR. A miRNA signature (miR2PE-score) was developed using Firth’s bias-reduced logistic regression analysis and subsequently validated in two independent multinational retrospective cohorts and two prospective plasma cohorts.

Results

We initially identified five PE-associated differentially expressed miRNAs from miRNA sequencing data and subsequently validated two miRNAs (miR-196b-5p and miR-584-5p) as robust biomarkers by association analysis with clinical characteristics and qRT-PCR in tissue specimens in the discovery phase. Using Firth’s bias-reduced logistic regression analysis, we developed the miR2PE-score for the early detection of PE. The miR2PE-score showed a high diagnostic performance with an area under the receiver operating characteristic curve (AUROC) of 0.920, 0.848, 0.864, and 0.812 in training, internal, and two external validation cross-platform and multicenter cohorts, respectively. Finally, we demonstrated the non-invasive diagnostic performance of the miR2PE-score in two prospective plasma cohorts with AUROC of 0.933 and 0.787. Furthermore, the miR2PE-score revealed superior performance in non-invasive diagnosis compared with previously published miRNA biomarkers.

Conclusions

We developed and validated a novel and robust blood-based miRNA signature, which may serve as a promising clinically applicable non-invasive tool for the early detection of PE.

Graphical Abstract
Hcp2a of APEC affects mRNA splicing and protein quality control in DF-1 cells
Authors: Song Xiangjun , Chen Zhe , Li Ziqi , Wang Xiaoru , Hou Manman , Shao Ying , Tu Jian , Qi Kezong
Published: September 2022

Background

Bacteria deliver effector proteins into the host cell via a secretory system that can directly act on the target to cause disease. As an important pipeline structural protein of the type VI secretion system (T6SS) complex, Hcp acts together with other virulence factors in the target cell. There is growing evidence that T6SS plays a key role in the pathogenic mechanism of APEC. However, the regulatory function played by the effector protein Hcp during its interaction with host cells is not clear. Here, tandem mass tag (TMT) analysis was used to quantify the proteins affected by increased expression of Hcp2a in DF-1 cells.

Results

The host response was significantly different between the overexpression and null groups at the protein level. A total of 195 differentially expressed proteins (DEPs) were detected in the overexpression group (upregulated, n = 144, downregulated, n = 51). Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were performed to predict the biological functions and pathways of differentially expressed proteins. The results showed that these DEPs were mainly enriched in RNA degradation, spliceosome, and mRNA surveillance pathways.

Conclusions

This study suggests that Hcp2a, the effector protein of APEC, plays an important role in regulating mRNA splicing and protein quality control in DF-1 cells. These findings provide useful clues to elucidate the pathogenic mechanism of effector protein Hcp2a on host target cells.
Hospitalized patients with isolated distal deep vein thrombosis: anticoagulation therapy or not?
Authors: Luo Xiaolin , Zhang Liying , Hou Changchun , Li Pengda , Wu Shaofa , Wang Zebi , Yang Enpu , Cui Yun , Sun Ning , Yu Yang , An Zhixia , Jin Jun , Qin Zhexue
Published: September 2022

Background

Isolated distal deep vein thrombosis (IDDVT), a disease frequently detected in hospitalized patients, can progress to proximal deep vein thrombosis (PDVT) and pulmonary embolism (PE). Here, we evaluated the effects of anticoagulation in hospitalized IDDVT patients.

Methods

We conducted a retrospective study in our hospital and enrolled hospitalized IDDVT patients diagnosed by compression ultrasonography (CUS) from January to December 2020. Participants were divided into anticoagulation (AC) and non-anticoagulation (non-AC) groups. After propensity score matching (PSM), multivariate Cox regression analyses were performed to assess whether anticoagulation was associated with PDVT/PE, and all-cause mortality.

Results

A total of 426 IDDVT inpatients with CUS follow-up were screened from 1502 distal DVT patients and finally enrolled. The median age was 67 years with 51.4% males and 15.5% cancer patients. The median follow-up was 11.6 months. There were 288 and 138 patients treated with or without anticoagulants, respectively. Patients in the non-AC group had less body mass index and more comorbidities. Patients in the AC group were treated with rivaroxaban or dabigatran (52.1%), low molecular weight heparin (42.7%), and warfarin (5.2%). The PSM generated 111 pairs of well-matched IDDVT patients with or without anticoagulation. The Kaplan–Meier analysis demonstrated that neither the incidence of PDVT/PE (5.4% vs. 2.7%, log-rank p = 0.313) nor all-cause mortality (27.9% vs. 18.9%, log-rank p = 0.098) was significant different between groups. Anticoagulation was not associated with PDVT/PE and all-cause mortality in the multivariable Cox regression analyses using the matched cohorts. The main risk factors for all-cause mortality were age, malignancy history, BMI, sepsis, heart failure, and white blood cell (WBC) count.

Conclusions

In hospitalized IDDVT patients, the thrombosis extension rate to PDVT/PE was low. Anticoagulation did not reduce the incidence of thrombosis extension of IDDVT and was not associated with all-cause mortality.
Extended functional connectivity of convergent structural alterations among individuals with PTSD: a neuroimaging meta-analysis
Authors: Pankey Brianna S. , Riedel Michael C. , Cowan Isis , Bartley Jessica E. , Pintos Lobo Rosario , Hill-Bowen Lauren D. , Salo Taylor , Musser Erica D. , Sutherland Matthew T. , Laird Angela R.
Published: September 2022

Background

Post-traumatic stress disorder (PTSD) is a debilitating disorder defined by the onset of intrusive, avoidant, negative cognitive or affective, and/or hyperarousal symptoms after witnessing or experiencing a traumatic event. Previous voxel-based morphometry studies have provided insight into structural brain alterations associated with PTSD with notable heterogeneity across these studies. Furthermore, how structural alterations may be associated with brain function, as measured by task-free and task-based functional connectivity, remains to be elucidated.

Methods

Using emergent meta-analytic techniques, we sought to first identify a consensus of structural alterations in PTSD using the anatomical likelihood estimation (ALE) approach. Next, we generated functional profiles of identified convergent structural regions utilizing resting-state functional connectivity (rsFC) and meta-analytic co-activation modeling (MACM) methods. Finally, we performed functional decoding to examine mental functions associated with our ALE, rsFC, and MACM brain characterizations.

Results

We observed convergent structural alterations in a single region located in the medial prefrontal cortex. The resultant rsFC and MACM maps identified functional connectivity across a widespread, whole-brain network that included frontoparietal and limbic regions. Functional decoding revealed overlapping associations with attention, memory, and emotion processes.

Conclusions

Consensus-based functional connectivity was observed in regions of the default mode, salience, and central executive networks, which play a role in the tripartite model of psychopathology. Taken together, these findings have important implications for understanding the neurobiological mechanisms associated with PTSD.
Weaving an innovation network from the middle-out: the case of the renewable energy ecosystem
Authors: Zohar Tali , Parag Yael , Ayalon Ofira
Published: September 2022

Background

Renewable energy (RE) systems are becoming a central component of the clean energy transition and are often seen as the way to combat climate change. Their establishment requires innovation, investments, and deployment policies for emerging technologies. Governments around the world are increasingly trying to create and support the energy-tech and climate-tech innovation ecosystems in their attempt to promote an innovation-supporting environment. However, energy innovation policies are often aligned with the dichotomous notion of technology-push and market-pull and overlook the social, political, and cultural contexts in which RE innovative technologies are embedded, and the multiple actors and interactions that are associated with their development. By combining the Middle-Out Perspective (MOP) and innovation literature, this paper argues that an innovation ecosystem could be weaved from the middle-out.

Methods

This paper analyzes the case of ‘Eilat-Eilot Renewable Energy Initiative’ and Israel’s RE innovation ecosystem creation through the lens of the MOP and applies a socio-technical interpretation to the push and pull terminology. Process tracing methodology was applied to trace a sequence of events to determine whether an actor was pushed or pulled, the formation of a network of actors, and its evolvement to an energy innovation ecosystem from the middle-out. Data for the analysis were collected from interviews, policy papers, media articles, and Governmental decisions.

Results

The analysis demonstrates how middle actors push the implementation of RE technologies in Israel, and at the same time pull decision-makers and other middle actors to promote the low carbon transition. The push and pull forces and the interactions between actors lead to the engagement of new stakeholders in the innovation network, the adoption of more ambitious RE targets and supporting policies, and the creation of an effective RE innovation ecosystem.

Conclusions

This paper uses the MOP as an analytical framework and the push and pull terminology to demonstrate how a middle actor initiates and develops an actor-network by interacting with other actors. As this network broadens, it forms an effective innovation ecosystem. A network of actors has the potential to lead change, provide innovative ideas, initiate research, encourage investments, create employment possibilities, and promote regional sustainable development.
Adolescent overeating and binge eating behavior in relation to subsequent cardiometabolic risk outcomes: a prospective cohort study
Authors: Zhou Joyce C. , Rifas-Shiman Sheryl L. , Haines Jess , Jones Kathryn , Oken Emily
Published: September 2022

Background

Binge eating disorder is bidirectionally associated with obesity and with metabolic syndrome. It is less clear whether overeating and binge eating, or overeating with loss of control, also predicts metabolic risk, and if so, whether these associations are solely attributable to greater weight. The goal of this study was to examine longitudinal associations of overeating and binge eating behavior with cardiometabolic risk markers in adolescence.

Methods

Adolescents (n = 619) in the Project Viva research study self-reported overeating and binge eating behavior in early adolescence (median 12.9 years, “baseline”). In late adolescence (median 17.4 years, “follow-up”), we assessed outcomes of adiposity and blood pressure, and in a subset of participants (n = 270–424), biomarkers of dyslipidemia, insulin resistance, liver dysfunction, inflammation, and adipokine homeostasis. We conducted multivariable linear regression analyses adjusted for socio-demographics and prenatal obesogenic exposures, and additionally for baseline body mass index (BMI) z-score.

Results

At baseline, 58 (9%) participants reported overeating behavior, and of those, 24 (41%) had binge eating behavior (e.g., overeating accompanied by loss of control). In adjusted models, adolescents with overeating had higher adiposity at follow-up ~ 5 years later (e.g., % body fat 4.03; 95% confidence interval (CI) 1.76, 6.31) than those not reporting overeating behavior; additional adjustment for baseline BMI z-score attenuated associations generally except for % body fat (2.95; 95% CI 1.03, 4.87). Overeating behavior was also associated with higher inflammation and greater adipokine dysfunction, remaining positively associated with interleukin-6 (IL-6) (log-transformed β = 0.42 pg/mL; 95% CI 0.12, 0.73) and negatively with adiponectin (log-transformed β = −0.28 ug/mL; 95% CI − 0.47, − 0.08) even after adjusting for baseline BMI z-score. Overeating behavior was not consistently associated with other outcomes. Adolescents reporting binge eating behavior generally had the greatest adiposity, (e.g., % body fat 5.00; 95% CI 1.74, 8.25) as compared to those without overeating.

Conclusions

Adolescents reporting overeating and binge eating behavior had higher adiposity and poorer inflammatory and adipokine profiles, but no difference in other outcomes, than adolescents who did not endorse these behaviors. These associations were only partially accounted for by higher baseline BMI z-score. These differences may signal increased risk for future cardiovascular disease.
Quality assessment of different brands of atorvastatin tablets available in Riyadh, Saudi Arabia
Authors: AlMuhsin Ali , Ahad Abdul , Bin Jardan Yousef A. , Raish Mohammad , Ahmad Ajaz , Alkharfy Khalid M. , Al-Jenoobi Fahad I.
Published: September 2022

Background

Hypolipidemic agents have been shown to be helpful in the primary and secondary prevention of cardiovascular disease. Most often, statins are prescribed to treat hyperlipidemia. There are a number of statins available in the market today, but atorvastatin is the most widely prescribed. It is essential that the drugs should have the appropriate amount of active pharmaceutical ingredient and meet the necessary physical properties. The main purpose of the study was to evaluate the quality of different marketed brands of atorvastatin calcium tablets available in Saudi Arabia.

Methods

In this study, innovator product coded as (AS-1) and five generics brands (coded as AS-2 to AS-6) of atorvastatin tablets 20 mg available in Saudi Arabia were evaluated forin vitrodissolution test, weight variations, friability and hardness tests. The analysis of drug was carried out by “high-performance liquid chromatography” (HPLC) method using C18column (4.6 × 150 mm, 5 μm). The mobile phase was consisted of acetonitrile and HPLC water (pH 2.1, adjusted with orthophosphoric acid) in ratio of 52:48 v/v, the flow rate was 1.0 ml/min. Atorvastatin was detected at a wavelength of 254 nm.

Results

According to the results of the dissolution study, the investigated products released more than 90% of atorvastatin in 15 min. Within 60 min, the brands AS-1, AS-3, AS-5, and AS-6 depicted nearly 100% atorvastatin release, while the brand AS-2 displayed 91.69% drug release. According to our findings, the investigated atorvastatin innovator (AS-1) and generic brands such as AS-2 to AS-6 were of good pharmaceutical quality.

Conclusions

All generic brands of atorvastatin tablets available in the Saudi Arabian market met the pharmacopoeia's consistency checks such as weight variation, friability, hardness and in vitro dissolution. Hence, focusing on their in vitro release properties, it was determined that these brands could be used interchangeably.
Role of great artery annulus ratio to predict transannular patch enlargement in repair of tetralogy of Fallot
Authors: Samal Satyajit , Sharma Rakesh , Minhas Harpreet Singh , G Girish , Agarwal Saket , Naqvi Sayyed Ehtesham Hussain , Geelani Muhammad Abid
Published: September 2022

Background

Traditionally, the pulmonary valve annulus (PVA) z-score is used to predict the requirement of transannular patch enlargement (TAPE) of right ventricular outflow tract (RVOT) and main pulmonary artery (MPA) in repair of tetralogy of Fallot (TOF). PVA z-score is highly variable and many other parameters are being reported to be accurate in predicting need of TAPE. In this study, we analyze the role of great artery annulus ratio (pulmonary valve annulus to aortic valve annulus ratio, PVA/AVA) to be used as a predictor for TAPE.

Methods

We analyzed 90 patients of TOF retrospectively who underwent repair between January 2021 and December 2021. The patients were divided as TAPE group who required TAPE of RVOT and MPA and non-TAPE group who did not have TAPE. Their baseline parameters, PVA Z-score, and cut-off great artery annulus ratio were compared.

Results

Total 44 (48.9%) patients had transannular patch (TAPE) repair and 46 (51.1%) patients had non-transannular patch repair. The great artery annulus ratio and PVA z-score was lower in case of TAPE group with statistical significance. Receiver operating characteristic curve analysis showed great artery annulus ratio as more accurate predictor of TAPE.

Conclusion

Great artery annulus ratio can be used as a simple and accurate predictor for transannular patch enlargement along with PVA z-score during repair of TOF.
Gridiron Capital
Authors: Uperesa Lisa
Published: September 2022

Since the 1970s, a “Polynesian Pipeline” has brought football players from American Sāmoa to Hawaii and the mainland United States to play at the collegiate and professional levels. In Gridiron Capital Lisa Uperesa charts the cultural and social dynamics that have made football so central to Samoan communities. For Samoan athletes, football is not just an opportunity for upward mobility; it is a way to contribute to, support, and represent their family, village, and nation. Drawing on ethnographic fieldwork, archival research, and media analysis, Uperesa shows how the Samoan ascendancy in football is underpinned by the legacies of US empire and a set of imperial formations that mark Indigenous Pacific peoples as racialized subjects of US economic aid and development. Samoan players succeed by becoming entrepreneurs: building and commodifying their bodies and brands to enhance their football stock and market value. Uperesa offers insights into the social and physical costs of pursuing a football career, the structures that compel Pacific Islander youth toward athletic labor, and the possibilities for safeguarding their health and wellbeing in the future.

Duke University Press Scholars of Color First Book Award recipient
Music Performance Anxiety in Musical Theater Performers: A Pilot Study
Authors: James Aisha S. M. , Shipley Michael
Published: September 2022

Objectives: Performance anxiety (PA) is debilitating and impacts the sufferer's ability to perform. Forgetfulness, concentration loss, and physical symptoms develop, leading to some giving up performing.
 Methods: An online questionnaire was used to gather data, including
demographic questions and the Kenny Music Performance Anxiety Inventory (K-MPAI). The questionnaire was distributed via social media and the British Association for Performing Arts Medicine (BAPAM) database. Data was collected over a 2-month period and was analyzed using simple proportions
with a score of ≥ 104 on the K-MPAI indicating the presence of PA and ≥ 130 indicating notable levels of PA.
 Results: Thirty-three participants completed the questionnaire (57.6% female). When looking at the ages of participants (18 to 80), the most common age range was 31
to 35 (33%). Two-thirds of participants were deemed to suffer from PA after completing the K-MPAI. A large proportion of participants with PA (63.6%) scored above the threshold score of 130 indicating "significant performance anxiety." Females or currently unemployed performers showed higher
levels of PA than other subgroups. However, a chi-squared test showed no significance between sexes (p = 0.32) or employment status (p = 0.31) and the incidence of PA.
 Conclusion: The research showed that PA is a significant issue in musical theater, as it is with other musicians
who have been studied extensively. We conclude that more research is needed to look at appropriate treatments specifically for musical theater performers.
New records of Palisada tenerrima and Hincksia mitchelliae from the Maltese Islands revealed by molecular analysis
Authors: BARTOLO ANGELA G. , ZAMMIT GABRIELLE , KÜPPER FRITHJOF C.
Published: September 2022

We report two new algal records from the Maltese islands: Hincksia mitchelliae (= Feldmannia mitchelliae) (Phaeophyceae) and Palisada tenerrima (Rhodophyceae). The former species was grown in culture from an Ulva sp. blade, while the latter was collected in the field. Our study employed an innovative integrative approach including morphological criteria as well as molecular analysis. DNA data and subsequent phylogenetic analysis of the COI gene and the rbcL plus RuBisCO spacer supported the separation of these two species from the closest-related congeners that had previously been reported from the Maltese islands.
Mediterranean spreading of the bicolor purse oyster, Isognomon bicolor, and the chicken trigger, Malleus sp., vs. the Lessepsian prejudice
Authors: GARZIA MATTEO , FURFARO GIULIA , RENDA WALTER , ROSATI ALESSANDRA-MARIA , MARIOTTINI PAOLO , GIACOBBE SALVATORE
Published: September 2022

The introduction rate of alien species in the Mediterranean Sea is rapidly growing, and their taxonomical identification is increasingly challenging. This uncertain identification often leads to an incorrect estimation of the number of alien species, their route of introduction, and their potential negative effects. This is particularly true for some bivalves, which are characterized by high variation in their shells, resulting in uncertain morphological identification. This is the case for two alien bivalves, i.e., an Isognomonidae and a Malleidae species, both characterized by confused historical colonization records in the Mediterranean Sea, misidentifications, and controversial and changing nomenclatures that have insofar negatively affected our knowledge on their geographical distributions. In this respect, molecular approaches provide a strategy that is especially useful when traditional taxonomy fails, and DNA barcoding is a powerful and well-known tool to obtain reliable identifications through efficient molecular markers. In this work, we used the 16S rRNA marker to assess the preliminary identification of Isognomon sp. and Malleus sp. specimens from different localities in the Southern Mediterranean Sea. Bayesian inference (BI) and maximum likelihood (ML) methods were applied to test the monophyly of the phylogenetic linages and to clarify their taxonomic positions, allowing a complete overview of the colonization and spreading of these two alien bivalves in the Mediterranean Sea. In particular, the Isognomon sp. specimens were identified as the Atlantic I. bicolor, highlighting that previously suggested invasive migration patterns, (i.e., the Lessepsian migration), must be reconsidered with stronger critical attention in light of currently occurring global changes.
Observations of juvenile sandbar sharks Carcharhinus plumbeus (Nardo, 1827) around the Bojana River delta (Southern Adriatic Sea)
Authors: ĆETKOVIĆ ILIJA , JAMBURA PATRICK L. , PEŠIĆ ANA , IKICA ZDRAVKO , JOKSIMOVIĆ ALEKSANDAR
Published: September 2022

The sandbar shark (Carcharhinus plumbeus) is considered rare in the Adriatic Sea and the majority of records originate from the northern Adriatic, where a nursery area for this species close to the Po delta system has been repeatedly proposed. This study provides 5 new records and analyses the previously published records of sandbar sharks recorded around the delta of the River Bojana (in Montenegro, in the south-eastern Adriatic). The River Bojana located on the border between Montenegro and Albania, is the second largest river flowing into the Adriatic Sea, where it forms a highly productive ecosystem already known as a local hotspot for smooth-hound sharks (Mustelus spp.). New records of sandbar sharks have emerged as a result of citizen science (a social media survey) and direct reports from fishermen. The total length of C. plumbeus juveniles ranged from approximately 800 mm to 1100 mm, and most (n=5) were caught by set gillnets. The data presented here show that juveniles are consistently present around the estuary and indicate the importance of this fragile estuarine ecosystem for sandbar sharks. Additionally, this study also provides morphometric data collected from a single individual.
New Alien Mediterranean Biodiversity Records (August 2022)
Authors: TIRALONGO FRANCESCO , AKYOL OKAN , AL MABRUK SARA A.A. , BATTAGLIA PIETRO , BETON DAMLA , BITLIS BANU , BORG JOSEPH A. , BOUCHOUCHA MARC , ÇINAR MELIH ERTAN , CROCETTA FABIO , DRAGIČEVIĆ BRANKO , JDULČIĆ Jakov DULČIĆ , EVANGELOPOULOS ATHANASIOS , JEVANS JULIAN , FORTIČ ANA , GAUFF ROBIN P.M. , GEORGIADIS CONSTANTINOS G. , GÖKOĞLU MEHMET , DANIELE GRECH DANIELE , GUY-HAIM TAMAR , HUSEYINOGLU MEHMET FATIH , LOMBARDO ANDREA , MARLETTA GIULIANA , MASTROTOTARO FRANCESCO , MONTESANTO FEDERICA , NUNES FLAVIA , ÖZGÜL AYTAÇ , ÖZTÜRK BILAL , RAMMOU DIMITRA-LIDA , SCUDERI DANILO , TERBIYIK KURT TUBA , TRAINITO EDIGIO , TRKOV DOMEN , ULMAN AYLIN , ÜNAL VAHDET , VELASQUEZ XIMENA
Published: September 2022

In this Collective Article on alien and cryptogenic diversity in the Mediterranean Sea we report a total of 19 species belonging to nine Phyla and coming from nine countries. Several of these records concern fish species, and of particular interest are the first records of: Terapon puta for Italian waters; Pteragopus trispilus from Malta; Plotosus lineatus from Cyprus; and the northernmost Mediterranean record of Lagocephalus sceleratus. The northernmost Mediterranean record was also reported for the sea urchin Diadema setosum. The portunid crab Thalamita poissonii was recorded for the first time in Libya. The copepod Pseudodiaptomus marinus was recorded for the first time in the Marmara Sea. The polychaete Branchiomma luctuosum was recorded for the first time from the Mediterranean coast of France. The alien anemone Diadumene lineata was recorded for the first time from Slovenia. The macroalgae Sargassum furcatum was recorded for the first time from Italy. The new Mediterranean records here reported help tracing abundance and distribution of alien and cryptic species in the Mediterranean Sea.
Construction method of high-horsepower tractor digital twin
Authors: Zhang Yanan , Du Yuefeng , Yang Zihan , Chen Du , Song Zhenghe , Zhu Zhongxiang
Published: September 2022

Background: Agricultural machinery equipment is the core element of advanced agricultural productivity. The operation system of agricultural machinery equipment involves machine-human-environment-society interactions. Limited by the production mode, operation mode, etc., the design and development, manufacturing, operation and maintenance control, recycling and other links of agricultural machinery equipment are still independent of each other. The massive information in the agricultural production process has not been fully utilized, so there are some outstanding problems such as low operating performance, low production efficiency, and poor integration of agricultural machinery and agronomy.

Methods: Focusing on the agricultural production process, this paper proposes the construction method for a high-horsepower tractor digital twin, and expounds on its operation mechanism. Taking high-horsepower tractor ploughing operation as an example, by deploying tractors, central servers, and an Internet of Things (IoT) platform, we developed a digital twin service platform for the agricultural production system of intelligent agricultural machinery equipment and built a tractor digital twin to verify the effectiveness of the proposed method.

Results: The accuracy rate of the tractor ploughing quality prediction service based on this platform is 96.65%. Under open-loop control, the number of excellent, good, medium and poor sets of the tractor ploughing quality are 153, 955, 1470, and 1422, respectively. After adopting closed-loop control, the number of excellent and good sets increased by 378, and 821, respectively, and the number of medium and poor groups decreases by 119 and 1080, respectively. Through this platform, the operation quality can be effectively and accurately predicted and improved, which verifies the effectiveness of the proposed construction method of high-horsepower tractor digital twin.

Conclusions: This research provides a method framework for the construction of the digital twin of tractor operation and maintenance control processes, and provides strong support for the vigorous development of intelligent agriculture.
Bridgework: A Model of Brokering Relationships Across Social Boundaries in Organizations
Authors: Johnson Tiffany D. , Joshi Aparna , Kreiner Glen E.
Published: September 2022

Relationships are central to organizing, work, and organizations. Yet, in many instances, relationships do not build themselves, and third-party actors are often needed to intervene in situations, persuade individuals, and facilitate connections across disconnected actors in organizations. Little is known about the strategies through which third-party actors can broker relationships across what are considered to be intractable social boundaries—membership in stigmatized or nonstigmatized social identity-based groups. We build a process theory of what we call “bridgework,” the strategy used by third-party agents, intermediaries, and allies to bridge by shifting value-related perceptions about actors on the other side of social identity-based divides. More specifically, we focus on a stigmatizing social identity that can create boundaries that are often reinforced through informal network ties. Based on interviews, participatory observation, and archival data with job coaches for adults with autism spectrum disorders and related developmental disabilities, we showcase a model of bridgework—a combination of internal and external strategies across three stages (adding, stabilizing, and maintaining perceptions of value) to facilitate relationships between stigmatized and nonstigmatized members of organizations. We discuss how our grounded model contributes to the rich traditions of research on stigma, brokerage, disability studies, positive relationships, and compassion in organizations.

Funding: This project was supported by a Smeal Small Research Grant in Spring 2015.
Rare health conditions 62: acute flaccid myelitis, infantile onset encephalomyopathy mitochondrial DNA depletion syndrome and chronic granulomatous disease
Authors: Barber Chris
Published: September 2022

The purpose of this series is to highlight a range of rare health conditions. Rare health conditions are those that affect no more and usually fewer than one person in every 2000 and many healthcare assistants (HCAs) and nurses will encounter some of these conditions, given the high number of them. This 62nd article will explore three of these conditions: acute flaccid myelitis, infantile onset encephalomyopathy mitochondrial DNA depletion syndrome and chronic granulomatous disease.
Non-invasive cardiac output monitoring with electrical velocimetry after cardiac surgery in infants
Authors: Iddawela S , Naseem S , Stickley J , Botha P , Khan NE , Barron DJ , Jones TJ , Drury NE
Published: September 2022

Introduction

Low cardiac output following cardiac surgery is a major determinant of outcome that may be improved by early detection, yet there are no widely accepted methods for its measurement in young children. We evaluated the feasibility of the routine use of electrical velocimetry, a non-invasive technique providing continuous measurement of cardiac output, in infants in the early postoperative period.

Methods

With ethical approval and parental consent, infants undergoing cardiac surgery were recruited. The ICON electrical velocimetry monitor was attached on admission to the intensive care unit (ICU) and remained for up to 24h.

Results

A total of 15 infants were recruited, median age 3 months (interquartile range (IQR) 0.5–7.5) and weight 4.8kg (IQR 3.9–7.1), undergoing various operations. Cardiac index had a weak correlation with arterial lactate (r=−0.24, p=0.02) and no correlation with blood pressure, central venous pressure or arteriovenous oxygen difference. Data were recorded for a median of 19h (range 5–24), with lead detachment or movement artefact the most common causes of data loss. There was marked minute-to-minute variability, with 25% of consecutive measurements having >5% variability.

Conclusion

Cardiac index measured by electrical velocimetry in infants in the early postoperative period is impaired by frequent data loss and marked intrapatient variability. Our feasibility study suggests that it is unsuitable for use as a routine monitoring tool in the setting of postsurgical ICU care.
Major trauma care at a regional trauma centre during the COVID-19 lockdown in England
Authors: Waseem S , Romann R , Davies BM , Rawal J , Hull P , Carrothers A , Chou D
Published: September 2022

Introduction

The COVID-19 pandemic has changed the presentation of many medical and surgical conditions, including major trauma. We aimed to assess how lockdown changed the presentation, severity and management of major trauma patients at our level 1 trauma centre in England.

Methods

Data were collected retrospectively from the Trauma Audit and Research Network’s database between 23 March and 28 April 2020 and compared with the same period in 2019. Collected data included patient demographics, and the mechanism, severity and management of injuries.

Results

We experienced a 56.4% reduction in major trauma admissions during the lockdown period when compared with 2019. In 2020, more patients arrived in haemodynamic shock (25.3% vs 12.2%, p=0.02); however, Glasgow Coma Scale and Injury Severity Score were unchanged. A higher proportion of incidents occurred at home (37.2% vs 53.5%, p=0.018), with no difference in trauma secondary to substance abuse or assault. During lockdown, patients had a significantly shorter hospital (17 vs 10 days, p=0.029) and critical care stay (2 vs 1 day, p=0.033). A higher proportion of major trauma patients were assessed by specialty trainees in the emergency department in 2020 (12.8% vs 53.1%, p=0.0001) with a lower proportion assessed by a consultant (69.8% vs 46.7%, p=0.001).

Conclusions

The COVID-19 pandemic and lockdown drastically changed human behaviour, as reflected in the change in presentation of major trauma. Changes in the management of these patients reflect adaptive measures to manage the pressures generated by the worldwide pandemic.
Evaluating the measures in patient-reported outcomes, values and experiences (EMPROVE study): a collaborative audit of PROMs practice in orthopaedic care in the United Kingdom
Authors: Matthews A , Evans JP ,   The National PROMs Network, EMPROVE Collaborative*
Published: September 2022

Introduction

All national orthopaedic societies advocate the use of patient reported outcome measures (PROMs), but clear guidance on their use is limited. We utilised a collaborative methodology to perform a national audit aiming to assess the perceived variability in PROMs practice in orthopaedic surgery in the United Kingdom.

Methods

A multicentre collaborative audit of practice was performed extracting PROMs data on 21 commonly performed orthopaedic procedures. For each procedure, data were collected for frequency of PROM collection, type of PROM chosen, administration intervals, method and reason for collection. Compliance with national society recommendations was undertaken.

Results

Sixty-three trusts enrolled to participate in the study with a completion rate of 60% (38 trusts). The most frequently reported PROMs were those associated with best practice tariffs (83.3% and 80.6% for hip and knee replacements, respectively). Outside incentivised programmes we observed a higher rate of variation in PROMs practice which failed to meet our audit standard. Across all procedures evaluated, 69% (221/318) of respondents to the study used paper as the primary method of PROM collection.

Conclusions

This is the first national audit of PROMs collection in orthopaedics. The integration of PROMs within best practice tariff platforms positively influences the frequency and standardisation of collection. Outside this initiative, PROMS collection is infrequent and highly varied despite the presence of several registries. Because PROMs collection is a recommendation across all procedures using implantable devices, the success of this will depend on the adequacy of funding, resource delivery and the presence of clearer recommendations.
Does titanium cage subsidence affect clinical outcomes in ACDF surgery? A tertiary centre experience
Authors: Milczynska WM , Ahmad A , Ahmed AI , Panchmatia JR , Fakouri B , Liantis P , Panteliadis P
Published: September 2022

Background

Cage subsidence after anterior cervical discectomy and fusion (ACDF) surgery has been well documented with rates of up to 40%. Cages fill the void after cervical discectomy and promote fusion. These materials have different biomechanical profiles with differing rates of subsidence. This retrospective cohort study aimed to determine subsidence rates specifically associated with the novel Emerging Implant Technologies (EIT) titanium cage, identify risk factors associated with subsidence, and evaluate whether subsidence affects clinical outcomes.

Methods

ACDF with insertion of stand-alone EIT cage was performed in 39 patients (64 levels) between December 2016 and February 2019 with a median follow-up of 11 months. Patients were classified into two groups; subsidence and non-subsidence, and were compared in terms of the resultant clinical outcomes as well as presence of risk factors. Health-related quality of life (HRQOL) outcomes were assessed using Visual Analogue Scale (VAS) for neck and arm pain, EuroQol 5-Dimension 5-Level (EQ-5D-5L), EuroQol Visual Analogue Scale (EQ VAS) and Neck Disability Index (NDI) scores.

Results

Cage subsidence (>3mm) was present in nine patients (23%), which corresponded to ten levels treated (16%). Development of subsidence was not associated with gender (p = 0.12), age (p = 0.27), smoking (p = 0.13), number of treatment levels (p = 0.10) or cage size used (p = 0.34). It had no effect on any of the HRQOL outcomes, namely VAS Neck (p = 0.07), VAS Arms (p = 0.08), EQ-5D-5L (p = 0.36), EQ VAS (p = 0.85) and NDI (p = 0.80).

Conclusions

The EIT cage seems to be associated with lower rates of subsidence compared with other cage types. Cage subsidence was not associated with HRQOL outcomes or risk factors.
Robotic colectomy with CME versus laparoscopic colon resection with or without CME for colon cancer: a systematic review and meta-analysis
Authors: Oweira H , Reissfelder C , Elhadedy H , Rahbari N , Mehrabi A , Fattal W , Khan JS , Chaouch MA
Published: September 2022

Introduction

This systematic review with meta-analysis aimed to compare the robotic complete mesocolon excision (RCME) to laparoscopic colectomy (LC) with (LCME) or without CME (LC non-CME) in postoperative outcomes, harvested lymph nodes and disease-free survival.

Methods

We performed a systematic review with meta-analysis according to PRISMA 2020 and AMSTAR 2 guidelines.

Results

The literature search yielded seven comparative studies including 677 patients: 269 patients in the RCME group and 408 in the LC group. The pooled analysis concluded to a lower conversion rate in the RCME group (OR=0.17; 95% CI [0.04, 0.74], p=0.02). There was no difference between the two groups in terms of morbidity (OR=1.03; 95% CI [0.70, 1.53], p=0.87), anastomosis leakage (OR=0.83; 95% CI [0.18, 3.72], p=0.81), bleeding (OR=1.90; 95% CI [0.64, 5.58], p=0.25), wound infection (OR=1.37; 95% CI [0.51, 3.68], p=0.53), operative time (mean difference (MD)=36.32; 95% CI [−24.30, 96.93], p=0.24), hospital stay (MD=−0.94; 95% CI [−2.03, 0.15], p=0.09) and disease-free survival (OR=1.29; 95% CI [0.71, 2.35], p=0.41). In the subgroup analysis, the operative time was significantly shorter in the LCME group than RCME group (MD=50.93; 95% CI [40.05, 61.81], p<0.01) and we noticed a greater number of harvested lymph nodes in the RCME group compared with LC non-CME group (MD=8.96; 95% CI [5.98, 11.93], p<0.01).

Conclusions

The robotic approach for CME ensures a lower conversion rate than the LC. RCME had a longer operative time than the LCME subgroup and a higher number of harvested lymph nodes than the LC non-CME group.
The waiting game
Authors: Jones Alice
Published: September 2022

Our Political Editor looks at the status of surgical waiting lists across the UK, and what can be done to tackle these – once the leadership race is over.