bluuebunny/crossref_metadata_2025 huggingface dataset:
Earthquake evacuation simulation of multi-story buildings during earthquakes
Authors: He Jun
Published: September 2020

Through combining a network-based pedestrian dynamics simulation model, simplified probabilistic structural damage assessment, and structural random vibration analysis, a fully random evacuation model is proposed for simulating and analyzing earthquake evacuation processes of multi-story buildings during earthquakes. The model simplifies the simulation of three-dimensional pedestrian dynamics, couples the emergency evacuation processes and damage processes of structures, and takes into account the randomness of pedestrian dynamics, structural damage, and earthquake excitation. The model can be used for the fast pre-evaluation or evaluation of the earthquake evacuation capabilities of multi-story buildings. The simulation and analysis of the earthquake evacuation process of a three-story office building, in which a total of 60 persons work in the first and second stories, illustrates the effectiveness and implementation of the proposed model.
Self-healing polymer/carbon nanotube nanocomposite: A review
Authors: Kausar Ayesha
Published: September 2020

Self-healing polymers have the capability to autonomically heal themselves. Recent breakthroughs in self-healing systems rely on integrating nanoparticles into relevant polymers. This article overviews the self-healing performance of polymer/carbon nanotube nanocomposite. Self-healing carbon nanotube nanocomposites have been designed using epoxy, polyurethane, poly(methyl methacrylate), and rubbers. Great versatility of self-healed polymer/carbon nanotube depends on matrix modification, nanotube functionality, processing strategies, and matrix-nanofiller interaction/compatibility. Special consideration is given to self-healing efficiency of nanocomposites in technical fields, such as coatings, sensors, electronics, radiation shielding, drug delivery, and tissue engineering. Moreover, critical issues and challenges associated with self-healing nanocomposites are considered.
Strain and Electric Field Controllable Schottky Barriers and Contact Types in Graphene-MoTe2 van der Waals Heterostructure
Authors: Lan Yu , Xia Li-Xin , Huang Tao , Xu Weiping , Huang Gui-Fang , Hu Wangyu , Huang Wei-Qing
Published: September 2020

Two-dimensional (2D) transition metal dichalcogenides with intrinsically passivated surfaces are promising candidates for ultrathin optoelectronic devices that their performance is strongly affected by the contact with the metallic electrodes. Herein, first-principle calculations are used to construct and investigate the electronic and interfacial properties of 2D MoTe2 in contact with a graphene electrode by taking full advantage of them. The obtained results reveal that the electronic properties of graphene and MoTe2 layers are well preserved in heterostructures due to the weak van der Waals interlayer interaction, and the Fermi level moves toward the conduction band minimum of MoTe2 layer thus forming an n type Schottky contact at the interface. More interestingly, the Schottky barrier height and contact types in the graphene-MoTe2 heterostructure can be effectively tuned by biaxial strain and external electric field, which can transform the heterostructure from an n type Schottky contact to a p type one or to Ohmic contact. This work provides a deeper insight look for tuning the contact types and effective strategies to design high performance MoTe2-based Schottky electronic nanodevices.
An especial transition phase of hospitals: the adaptation of hospital operations to the development of COVID-19 and policy adjustments
Authors: Liu Xiucheng , Zhuang Wei , Quan Xiaoyu , Zhou Yeqing , Qin Hao , Zou Chenghang , Zhang Hao
Published: September 2020

The ongoing pandemic coronavirus disease 19 (COVID-19) remains a significant issue for global health, economics, and society. In order to balance epidemic control and economic recovery, many countries have successively announced the gradual relaxation of some lockdown restrictions. Hospitals and medical staff constitute the backbone in this war against COVID-19. In response to this serious situation, many hospitals went into emergency and impaired healthcare access to patients with conditions other than COVID-19. Therefore, gradually promoting hospital operations and functions back to the new normal is important, especially when this outbreak has been effectively controlled. In this study, we introduce existing and potential problems that could seriously affect people’s health. Additionally, we propose that an especial transition phase between the emergency and regular modes of hospitals can be well adapted to the current situation.
Mining and evolution analysis of lateral organ boundaries domain (LBD) genes in Chinese white pear (Pyrus bretschneideri)
Authors: Song Bobo , Tang Zikai , Li Xiaolong , Li Jiaming , Zhang Mingyue , Zhao Kejiao , Liu Hainan , Zhang Shaoling , Wu Jun
Published: September 2020

Background

The lateral organ boundaries domain (LBD) gene is a plant-specific transcription factor that plays a critical role in diverse biological processes. However, the evolution and functional divergence of the LBD gene family has not yet been characterized for the Chinese White Pear.

Results

In our study, a total of 60 PbrLBDs were identified in the pear genome. The PbrLBD gene family was divided into two classes based on gene structure and phylogenetic analysis: class I (53) and class II (7). Cis-acting element analysis results suggested that PbrLBDs may participate in various biological processes, such as flavonoid biosynthetic and stress response. Synteny analysis results indicated that segmental duplication played a key role in the expansion of the PbrLBD gene family. The mean Ks and 4DTv values showed that the PbrLBD gene family had undergone only one recent whole-genome duplication event occurring at 30–45 MYA. Purifying selection was a primary force during the PbrLBD gene family evolution process. Transcriptome data analysis revealed that 10 PbrLBDs were expressed in all six examined tissues, and 73.33% of members in the PbrLBD gene family were expressed in pear sepal. qRT-PCR was conducted to verify the expression levels of 11 PbrLBDs in these six tissues. Specifically, PbrLBD20, PbrLBD35 and PbrLBD53 genes were down-regulated when anthocyanin concentrations were high, whereas PbrLBD33 was significantly up-regulated in pear when anthocyanin concentrations were high. Furthermore, PbrLBD20, one of the candidate genes related to anthocyanins was localized in the nucleus.

Conclusions

Our analysis provides valuable information for understanding the evolution of the PbrLBD gene family, and provides new insights into the regulation of pear pigment metabolism and lays a foundation for the future disclosure of the molecular mechanism of LBD gene regulating flavonoid metabolism.
Root-associated endophytic bacterial community composition and structure of three medicinal licorices and their changes with the growing year
Authors: Dang Hanli , Zhang Tao , Li Guifang , Mu Yudi , Lv Xinhua , Wang Zhongke , Zhuang Li
Published: September 2020

Background

The dried roots and rhizomes of medicinal licorices are widely used worldwide as a traditional medicinal herb, which are mainly attributed to a variety of bioactive compounds that can be extracted from licorice root. Endophytes and plants form a symbiotic relationship, which is an important source of host secondary metabolites.

Results

In this study, we used high-throughput sequencing technology and high-performance liquid chromatography to explore the composition and structure of the endophytic bacterial community and the content of bioactive compounds (glycyrrhizic acid, liquiritin and total flavonoids) in different species of medicinal licorices (Glycyrrhiza uralensis,Glycyrrhiza glabra, andGlycyrrhiza inflata) and in different planting years (1–3 years). Our results showed that the contents of the bioactive compounds in the roots of medicinal licorices were not affected by the species, but were significantly affected by the main effect growing year (1–3) (P < 0.05), and with a trend of stable increase in the contents observed with each growing year. In 27 samples, a total of 1,979,531 effective sequences were obtained after quality control, and 2432 effective operational taxonomic units (OTUs) were obtained at 97% identity. The phylum Proteobacteria, Actinobacteria, Bacteroidetes and Firmicutes, and the genera unified-Rhizobiaceae,Pseudomonas,Novosphingobium, andPantoeawere significantly dominant in the 27 samples. Distance-based redundancy analysis (db-RDA) showed that the content of total flavonoids explained the differences in composition and distribution of endophytic bacterial communities in roots of cultivated medicinal liquorices to the greatest extent. Total soil salt was the most important factor that significantly affected the endophytic bacterial community in soil factors, followed by ammonium nitrogen and nitrate nitrogen. Among the leaf nutrition factors, leaf water content had the most significant effect on the endophytic bacterial community, followed by total phosphorus and total potassium.

Conclusions

This study not only provides information on the composition and distribution of endophytic bacteria in the roots of medicinal licorices, but also reveals the influence of abiotic factors on the community of endophytic bacteria and bioactive compounds, which provides a reference for improving the quality of licorice.
Responses of leaf gas exchange attributes, photosynthetic pigments and antioxidant enzymes in NaCl-stressed cotton (Gossypium hirsutum L.) seedlings to exogenous glycine betaine and salicylic acid
Authors: Hamani Abdoul Kader Mounkaila , Wang Guangshuai , Soothar Mukesh Kumar , Shen Xiaojun , Gao Yang , Qiu Rangjian , Mehmood Faisal
Published: September 2020

Background

Application of exogenous glycine betaine (GB) and exogenous salicylic acid (SA) mitigates the adverse effects of salinity. Foliar spraying with exogenous GB or SA alleviates salt stress in plants by increasing leaf gas exchange and stimulating antioxidant enzyme activity. The effects of foliar application of exogenous GB and SA on the physiology and biochemistry of cotton seedlings subjected to salt stress remain unclear.

Results

Results showed that salt stress of 150 mM NaCl significantly reduced leaf gas exchange and chlorophyll fluorescence and decreased photosynthetic pigment quantities and leaf relative water content. Foliar spray concentrations of 5.0 mM exogenous GB and 1.0 mM exogenous SA promoted gas exchange and fluorescence in cotton seedlings, increased quantities of chlorophyll pigments, and stimulated the antioxidant enzyme activity. The foliar spray also increased leaf relative water content and endogenous GB and SA content in comparison with the salt-stressed only control. Despite the salt-induced increase in antioxidant enzyme content, exogenous GB and SA in experimental concentrations significantly increased the activity of glutathione reductase, ascorbate peroxidase, superoxide dismutase, catalase and peroxidase, and decreased malondialdehyde content under salt stress. Across all experimental foliar spray GB and SA concentrations, the photochemical efficiency of photosystem II (FV/FM) reached a peak at a concentration of 5.0 mM GB. The net photosynthetic rate (Pn) and FV/FM were positively correlated with chlorophyll a and chlorophyll b content in response to foliar spraying of exogenous GB and SA under salt stress.

Conclusions

We concluded, from our results, that concentrations of 5.0 mM GB or 1.0 mM SA are optimal choices for mitigating NaCl-induced damage in cotton seedlings because they promote leaf photosynthesis, increase quantities of photosynthetic pigments, and stimulate antioxidant enzyme activity. Among, 5.0 mM GB and 1.0 mM SA, the best performance in enhancing endogenous GB and SA concentrations was obtained with the foliar application of 1.0 mM SA under salt stress.
Antinociceptive effects of magnesium sulfate for monitored anesthesia care during hysteroscopy: a randomized controlled study
Authors: Gao Peng-fei , Lin Jing-yan , Wang Shun , Zhang Yun-feng , Wang Guo-qiang , Xu Qi , Guo Xiao
Published: September 2020

Background

Opioids are the most effective antinociceptive agents, they have undesirable side effects such as respiratory depressant and postoperative nausea and vomiting. The purpose of the study was to evaluate the antinociceptive efficacy of adjuvant magnesium sulphate to reduce intraoperative and postoperative opioids requirements and their related side effects during hysteroscopy.

Methods

Seventy patients scheduled for hysteroscopy were randomly divided into 2 groups. Patients in the magnesium group (Group M) received intravenous magnesium sulfate 50 mg/kg in 100 ml of isotonic saline over 15 min before anesthesia induction and then 15 mg/kg per hour by continuous intravenous infusion. Patients in the control group (Group C) received an equal volume of isotonic saline as placebo. All patients were anesthetized under a BIS guided monitored anesthesia care with propofol and fentanyl. Intraoperative hemodynamic variables were recorded and postoperative pain scores were assessed with verbal numerical rating scale (VNRS) 1 min, 15 min, 30 min, 1 h, and 4 h after recovery of consciousness. The primary outcome of our study was total amount of intraoperative and postoperative analgesics administered.

Results

Postoperative serum magnesium concentrations in Group C were significantly decreased than preoperative levels (0.86 ± 0.06 to 0.80 ± 0.08 mmol/L, P = 0.001) while there was no statistical change in Group M (0.86 ± 0.07 to 0.89 ± 0.07 mmol/L, P = 0.129). Bradycardia did not occur in either group and the incidence of hypotension was comparable between the two groups. Total dose of fentanyl given to patients in Group M was less than the one administered to Group C [100 (75–150) vs 145 (75–175) μg, median (range); P < 0.001]. In addition, patients receiving magnesium displayed lower VNRS scores at 15 min, 30 min, 1 h, and 4 h postoperatively.

Conclusions

In hysteroscopy, adjuvant magnesium administration is beneficial to reduce intraoperative fentanyl requirement and postoperative pain without cardiovascular side effects. Our study indicates that if surgical patients have risk factors for hypomagnesemia, assessing and correcting magnesium level will be necessary.

Trial registration

ChiCTR1900024596. date of registration: July 18th 2019.
Predictive capacity of obesity indices for high blood pressure among southern Ethiopian adult population: a WHO STEPS survey
Authors: Gutema Befikadu Tariku , Chuka Adefris , Ayele Gistane , Megersa Nega Degefa , Bekele Muluken , Baharu Alazar , Gurara Mekdes Kondal
Published: September 2020

Background

World Health Organization (WHO) consultation experts recommend countries to have guidance to identify public health action points suitable for their country. The objective of the study was to evaluate different obesity indices to predict high blood pressure and its optimal cutoff values among the adult population.

Method

A total of 3368 individuals age from 25 to 64 years were included in this study. Data was collected based on the WHO Stepwise approach. Body mass index (BMI), waist circumference (WstC), waist to hip ratio (WHpR) and waist to height ratio (WHtR) were measured and calculated. High blood pressure was considered for those with systolic blood pressure above 135 mmHg, diastolic blood pressure above 85 mmHg or taking antihypertensive medications. To generate cutoff values, the receiver operator characteristic curve was generated with the maximum Youden index.

Result

Women had a significantly higher hip circumference (P = 0.003), BMI (P = 0.036) and WHtR (P < 0.001) than men. Men had significantly higher WHpR (P = 0.027) than women. There were significantly higher BMI, WstC, WHpR, and WHtR among those with high blood pressure. The cutoff values for BMI, WstC, WHpR and WHtR were 22.86 kg/m2, 84.05 cm, 0.91 and 0.50 for men and 24.02 kg/m2, 79.50 cm, 0.91 and 0.51 for women, respectively.

Conclusion

BMI, WstC, WHpR, and WHtR are a useful predictor of high blood pressure among adults’ rural residents of southern Ethiopia. As the sensitivity for the cutoff values of most of indices were low, further surveys in different settings may need to be done before a conclusion can be drawn on whether or not to review the anthropometric cut offs for high blood pressure in Ethiopia.
Semiparametric estimation of the attributable fraction when there are interactions under monotonicity constraints
Authors: Wang Wei , Small Dylan S. , Harhay Michael O.
Published: September 2020

Background

The population attributable fraction (PAF) is the fraction of disease cases in a sample that can be attributed to an exposure. Estimating the PAF often involves the estimation of the probability of having the disease given the exposure while adjusting for confounders. In many settings, the exposure can interact with confounders. Additionally, the exposure may have a monotone effect on the probability of having the disease, and this effect is not necessarily linear.

Methods

We develop a semiparametric approach for estimating the probability of having the disease and, consequently, for estimating the PAF, controlling for the interaction between the exposure and a confounder. We use a tensor product of univariate B-splines to model the interaction under the monotonicity constraint. The model fitting procedure is formulated as a quadratic programming problem, and, thus, can be easily solved using standard optimization packages. We conduct simulations to compare the performance of the developed approach with the conventional B-splines approach without the monotonicity constraint, and with the logistic regression approach. To illustrate our method, we estimate the PAF of hopelessness and depression for suicidal ideation among elderly depressed patients.

Results

The proposed estimator exhibited better performance than the other two approaches in the simulation settings we tried. The estimated PAF attributable to hopelessness is 67.99% with 95% confidence interval: 42.10% to 97.42%, and is 22.36% with 95% confidence interval: 12.77% to 56.49% due to depression.

Conclusions

The developed approach is easy to implement and supports flexible modeling of possible non-linear relationships between a disease and an exposure of interest.
Impact of donor lung colonized bacteria detected by next-generation sequencing on early post-transplant outcomes in lung transplant recipients
Authors: Liu Dong , Zhang Ji , Wu Bo , Liu Feng , Ye Shugao , Wang Hongmei , Lv Jian , Weng Xing , Chen Yan , Han Weili , Chen Jingyu
Published: September 2020

Background

The effect of donor lung colonized bacteria on the prognosis of lung transplantation is not clear. We used the technique of next-generation sequencing (NGS) to detect the colonized bacteria from the lower respiratory tract and analyzed whether the colonized bacteria of donor lung could affect the outcomes of lung transplantation.

Methods

Seventeen patients who underwent lung transplantation from March 2018 to June 2018 at Wuxi People’s Hospital affiliated to Nanjing Medical University were included in this study. Twelve cases of donor lung were obtained, and 17 lung transplants were performed, including 12 single lung transplantation and 5 bilateral lung transplantation. The colonized bacteria in the lower lobe tissue of donor lung were detected by NGS, and the bacteria culture method was used to detect the bacteria in the airway secretion before and after the operation. The information of length of extracorporeal membrane oxygenation (ECMO) support, mechanical ventilation time, length of intensive care unit (ICU) stay, duration of fever and length of hospital stay were collected for prognostic analysis.

Results

Compared with bacterial culture methods, the positive rate by using NGS in the lungs were higher (52.9% vs 41.2%). Among the patients who were transplanted with donor lungs with detected bacteria by NGS before surgery, only one patient (1/9) developed the same bacteria after lung transplantation. Based on results of NGS and bacterial culture, there was no association between the colonized bacteria in donor lungs and the patients’ outcomes of immediate posttransplant period.

Conclusion

NGS showed more sensitive than bacterial culture for detection of bacteria. The colonized bacteria in different parts of the lung are inconsistent. There is no association between the colonized bacteria in donor lungs and short-term outcome of lung transplantation patients.
Signs and symptoms do not predict, but may help rule out acute Q fever in favour of other respiratory tract infections, and reduce antibiotics overuse in primary care
Authors: Hackert Volker H. , Dukers-Muijrers Nicole H. T. M. , Hoebe Christian J. P. A.
Published: September 2020

Background

From early 2009, the Dutch region of South Limburg experienced a massive outbreak of Q fever, overlapping with the influenza A(H1N1)pdm09 pandemic during the second half of the year and affecting approximately 2.9% of a 300,000 population. Acute Q fever shares clinical features with other respiratory conditions. Most symptomatic acute infections are characterized by mild symptoms, or an isolated febrile syndrome. Pneumonia was present in a majority of hospitalized patients during the Dutch 2007–2010 Q fever epidemic. Early empiric doxycycline, guided by signs and symptoms and patient history, should not be delayed awaiting laboratory confirmation, as it may shorten disease and prevent progression to focalized persistent Q fever. We assessed signs’ and symptoms’ association with acute Q fever to guide early empiric treatment in primary care patients.

Methods

In response to the outbreak, regional primary care physicians and hospital-based medical specialists tested a total of 1218 subjects for Q fever. Testing activity was bimodal, a first “wave” lasting from March to December 2009, followed by a second “wave” which lasted into 2010 and coincided with peak pandemic influenza activity. We approached all 253 notified acute Q fever cases and a random sample of 457 Q fever negative individuals for signs and symptoms of disease. Using data from 140/229(61.1%) Q fever positive and 194/391(49.6%) Q fever negative respondents from wave 1, we built symptom-based models predictive of Q-fever outcome, validated against subsets of data from wave 1 and wave 2.

Results

Our models had poor to moderate AUC scores (0.68 to 0.72%), with low positive (4.6–8.3%), but high negative predictive values (91.7–99.5%). Male sex, fever, and pneumonia were strong positive predictors, while cough was a strong negative predictor of acute Q fever in these models.

Conclusion

Whereas signs and symptoms of disease do not appear to predict acute Q fever, they may help rule it out in favour of other respiratory conditions, prompting a delayed or non-prescribing approach instead of early empiric doxycycline in primary care patients with non-severe presentations. Signs and symptoms thus may help reduce the overuse of antibiotics in primary care during and following outbreaks of Q fever.
Early-onset COQ8B (ADCK4) glomerulopathy in a child with isolated proteinuria: a case report and literature review
Authors: Zhai Shu-bo , Zhang Li , Sun Bai-chao , Zhang Yan , Ma Qing-shan
Published: September 2020

Background

Herein, a 3-year-old boy presented with hidden-onset isolated proteinuria was reported. The disease was induced by COQ8B (previously termed ADCK4) compound heterozygous variants, including c.[271C > T] and c.[737G > A], which were inherited from his father and mother, respectively.

Case presentation

The patient visited our clinic due to non-nephrotic range proteinuria for 3 months, but no obvious abnormality was detected in the vital signs or laboratory test results. Renal histopathology revealed mitochondrial nephropathy, which manifested as mild glomerular abnormalities under light microscope, together with mitochondrial proliferation and hypertrophy and crowded arrangement under electron microscope. As suggested by whole exome sequencing, the patient inherited the COQ8B compound heterozygous variants from both of his parents who showed normal phenotype. After literature review, it was confirmed that one of the variant site (c.[271C > T]) had not been reported among the East Asian populations so far.

Conclusions

Steroid-resistant nephrotic syndrome and focal segmental glomerulosclerosis are the most common phenotypes and renal histopathological manifestations of COQ8B variant. Nonetheless, our case shows that such variant may have hidden and mild clinical manifestations at the early onset. Therefore, early diagnosis will help to identify children at the early disease stage who have opportunity to benefit from oral coenzyme Q10 supplementation.
Mediastinal lymph node enlargement in idiopathic pulmonary fibrosis: relationships with disease progression and pulmonary function trends
Authors: Sgalla Giacomo , Larici Anna Rita , Golfi Nicoletta , Calvello Mariarosaria , Farchione Alessandra , Del Ciello Annemilia , Varone Francesco , Iovene Bruno , Manfredi Riccardo , Richeldi Luca
Published: September 2020

Background and objectives

Evidence of mediastinal Lymph Node Enlargement (LNE) on CT scan is a common finding in idiopathic pulmonary fibrosis (IPF). We sought to investigate whether the involvement of mediastinal lymph nodes is associated with accelerated disease progression, and explored the changes occurring in mediastinal lymph nodes during the radiological follow up of these patients.

Methods

This retrospective study included IPF patients referred to a single ILD centre in Italy. A consensus-based assessment of mediastinal LNE on chest CT scan was performed by two thoracic radiologists. Kaplan-Meier curves and multivariate Cox proportional hazards regression were used to assess hazard ratios for mortality and disease progression (defined as categorical FVC decline ≥10%). The annualized rates of change in functional parameters for each patient were calculated using mixed linear models.

Results

The study population consisted of 152 IPF patients, of whom 135 (89%) received antifibrotic treatment for IPF during the study follow up. Patients having evidence of 3 or more enlarged mediastinal lymph nodes on baseline CT scan showed increased rates of mortality (HR 5.03, 95% CI 1.86–13.62,p ≤ 0.001) and significant disease progression (HR 2.99, 95% CI 1.22–7.33,p = 0.17) as compared to patients without LNE, after adjusting for GAP stage. Among 62 patients with LNE who underwent a follow up CT scan of the chest and received antifibrotic treatment, 57 (92%) maintained evidence mediastinal LNE over time.

Conclusions

Diffuse mediastinal lymph node involvement predicts clinically meaningful functional deterioration in patients with IPF.
The severity of developmental dysplasia of the hip does not correlate with the abnormality in pelvic incidence
Authors: Cheng Rongshan , Huang Muyin , Kernkamp Willem Alexander , Li Huiwu , Zhu Zhenan , Wang Liao , Tsai Tsung-Yuan
Published: September 2020

Background

The purpose of this study was to investigate the association between the severity of Developmental dysplasia of the hip (DDH) and the abnormality in pelvic incidence (PI).

Methods

This was a retrospective study analyzing 53 DDH patients and 53 non-DDH age-matched controls. Computed tomography images were used to construct three-dimensional pelvic model. The Crowe classification was used to classify the severity of DDH. The midpoint of the femoral head centers and sacral endplates were projected to the sagittal plane of the pelvis. The PI was defined as the angle between a line perpendicular to the sacral plate at its midpoint and a line connecting this point to the axis of the femoral heads. Independent sample t-tests were used to compare the differences between the PI of DDH group and the non-DDH controls group. Kendall’s coefficient of concordance was used to determine the correlation between the severity of DDH and PI.

Results

Patients with DDH had a significantly (p = 0.041) higher PI than the non-DDH controls (DDH 47.6 ± 8.2°, normal 44.2 ± 8.8°). Crowe type I patients had a significantly (p = 0.038) higher PI (48.2 ± 7.6°) than the non-DDH controls. No significant difference between the PI in Crowe type II or III patients and the PI in non-DDH controls were found (Crowe type II, 50.2 ± 9.6°, p = 0.073; Crowe type III, 43.8 ± 7.2°, p = 0.930). No correlation was found between the severity of DDH and the PI (r = 0.091, p = 0.222).

Conclusions

No correlation was found between the severity of DDH and the PI. The study confirmed that the PI in DDH (Crowe type I) group was higher than that of the non-DDH control group, while the PI does not correlate with the severity of DDH.
Is low-back pain a limiting factor for senior workers with high physical work demands? A cross-sectional study
Authors: Nygaard Patrick Pascal , Skovlund Sebastian Venge , Sundstrup Emil , Andersen Lars Louis
Published: September 2020

Background

Low-back pain (LBP) is highly prevalent among senior workers and may affect work ability, especially among those with hard physical work. This study determined the joint association of LBP intensity and physical work demands with work limitiations due to pain in senior workers.

Methods

In the SeniorWorkingLife study (2018), 11,738 senior workers (≥50 years) replied to questions about physical work demands, LBP intensity, and work limitations due to pain. Using logistic regression analyses and controlling for potential confounders, associations between the physical work demands and LBP intensity (interaction) with work limitiations due to pain (outcome) was modeled.

Results

Higher LBP intensity, as well as higher physical work demands, significantly increased the odds of experiencing work limitiations due to pain, and these two factors interacted with each other (p < 0.0001). In analyses stratified for LBP intensity, higher physical work demands gradually increased the odds of experiencing work limitiations due to pain.

Conclusions

Senior workers with a combination of physically demanding work and LBP are more affected by their pain during everyday work tasks compared to workers with similar LBP-intensity in sedentary occupations. Accommodation of work demands seems especially relevant for this group of workers.
Diaper rashes can indicate systemic conditions other than diaper dermatitis
Authors: Lebsing Sirirus , Chaiyarit Jitjira , Techasatian Leelawadee
Published: September 2020

Background

Although the majority of rashes in the diaper area are caused by irritation from urine and feces, irritant diaper dermatitis; IDD, there are some less common but potentially serious cutaneous eruptions associated with systemic diseases that should not be discounted.

Methods

This prospective descriptive study aimed to explore variation in cutaneous disease in the diaper area. It was conducted as a prospective descriptive study between October 2016 and November 2019 in the pediatric department of a tertiary-level hospital.

Results

Three hundred consecutive patients with rashes in the diaper area were enrolled. The most common diagnosed was IDD (125 cases; 41.7%), followed by rashes exacerbated by the diaper (101 cases; 33.67%) and non-diaper-related rashes (74 cases; 24.67%).

Conclusions

Our finding suggests that when diagnosing rashes that occur in the diaper area, general pediatricians should consider, in addition to IDD, the possibility of less-common conditions. The simultaneous presence of cutaneous lesions at other sites was linked to diagnoses of systemic diseases other than IDD, (P < 0.001).
Improving the response of primary care providers to rural First Nation women who experience intimate partner violence: a qualitative study
Authors: Rizkalla Kristin , Maar Marion , Pilon Roger , McGregor Lorrilee , Reade Maurianne
Published: September 2020

Background

Some legacies of colonialism are that Indigenous women living in Canada experience higher rates of intimate partner violence (IPV) and that violence is often more severe relative to non-Indigenous women. This results in avoidable physical, psychological, emotional, financial, sexual and spiritual harm in the lives of Indigenous women, families, and communities. Trusted primary care providers are well positioned to provide brief interventions and referrals to treatment and services, but little is known about the providers’ preparedness to support Indigenous women. Information on what enables or prevents providers to respond to Indigenous patients who experience IPV is needed in order to ensure this potential lifeline for support is realized.

Methods

The purpose of this community-based participatory study was to elucidate the barriers and facilitators to care for rural Indigenous women who experience IPV from the perspectives of primary care providers and to recommend strategies to improve their preparedness. Using a Grounded Theory approach, we conducted qualitative research with 31 providers to discuss their experiences with patients affected by IPV.

Results

The results showed providers often feel a degree of unpreparedness to deal with IPV in a clinical setting.

Underlying the feelings of unpreparedness were:

Recognition of patients’ under disclosure of IPV due to stigma, shame and fear

Lack of formal provider training on appropriate approaches to IPV

Lack of referral network due to fragmented, scarce services for IPV

Lack of understanding of jurisdictional complexity of First Nations and non-First Nations specific services for IPV

Uncertainty how to negotiate cultural safety around IPV

Multiple-role relationship & confidentiality dilemmas characteristic of small communities

Risk of jeopardizing patient-provider relationship

Conclusions

Our recommendations to improve provider preparedness to address IPV include reducing the stigma of IPV; creating effective referral pathways; improving cultural safety within the referral network; developing services for perpetrators; engaging natural helpers in the community, and; developing policies, procedures and continuing education related to patients who experience IPV in the clinical and community setting. We suggest that increasing providers’ comfort to respond to IPV for rural and Indigenous women will ultimately lead to improved safety and health outcomes.
Ethnobotanical survey on plants used in the treatment of candidiasis in traditional markets of southern Benin
Authors: Fanou Brice Armand , Klotoe Jean Robert , Fah Lauris , Dougnon Victorien , Koudokpon Charles Hornel , Toko Ghislaine , Loko Frédéric
Published: September 2020

Background

Candidiasis, an opportunistic cosmopolitan disease is nowadays like bacterial infections which is a real public health problem. In view of the emergence of Candida strains resistant to existing antifungal agents, alternative solutions should be considered. This is the purpose of this ethnobotanical survey, which aims to identify the medicinal plant species traditionally used to treat candidiasis in traditional markets of southern Benin.

Methods

The study was performed from October 2015 to January 2018 in the traditional markets of Southern-Benin. Data were collected by two complementary methods: triplet purchase of medicinal recipes (ATRM) from herbalists markets and semi-structured interview (ISS) from traditional healers.

Results

A total of 109 species of medicinal plants belonging to 44 families have been listed and identified. The most frequently cited species were Pteleopsis suberosa Engl. & Diels, Lantana camara L., Cyanthillium cinereum (L.) H. Rob, Ocimum gratissimum L. and Lippia multiflora Moldenke with respectively 43.84, 39.73 and 34.25% citation frequencies for the last three species respectively. Leguminosae (20.18%), Euphorbiaceae (5.50%) and Apocynaceae (5.50%) were the most represented botanical families. Leafy stems were more used than other plant organs. The decoction and the oral route were the most appropriate methods of preparation and administration reported by traditional healers.

Conclusion

Benin’s plant cover is made up of a wide variety of medicinal plant species used in the traditionnal treatment of candidiasis and which may constitute new sources of medicines to be developed.
Value and feasibility of South-South Medical Elective Exchanges in Africa
Authors: Daniels Katy , Thomson Emma , Nawagi Faith , Flinkenflögel Maaike
Published: September 2020

Background

An elective is part of the curriculum where students have the flexibility to choose both the study topic and location. International medical electives are a well-established part of curricula at most medical schools in high-income countries. They are highly valued by students and have proven educational benefits, though do come with challenges, such as lack of reciprocity. Low and middle-income countries frequently host students from high-income countries providing learning opportunities, yet also carry the burden of supervision and resource consumption, whilst their students get few elective opportunities. This study explores the value and feasibility of South-South Medical Elective Exchanges (SSMEE), which creates elective opportunities for African medical students in other African countries to create reciprocity within the elective system.

Method

A qualitative evaluation of the South-South Medical Elective Exchanges was conducted using a case study approach. Four African medical schools, College of Medicine, Malawi; University of Rwanda, Rwanda; University of Witwatersrand, South Africa and Makerere University, Uganda participated in the pilot study in 2017/18. Each institution selected two students to participate in a four-week elective to another participating institute. Participating students completed a pre-elective questionnaire and a post-elective interview exploring expectations, learning outcomes, challenges and how they are applying this learning. Data was analysed thematically.

Results

Data presented is from six of the eight participating students. All students found the elective a valuable experience and learning was demonstrated in four key areas: clinical knowledge and skills; attitudes; personal and professional development and global perspectives. For some, it challenged their assumptions of what an elective is because valuable learning can be achieved whilst remaining in Africa. The main challenge found related to funding the elective.

Conclusions

The SSMEE model is feasible and provides valuable learning for participating students and their peers/colleagues. Financing electives remains the biggest challenge. Since this pilot study, SSMEE has become part of a regional elective exchange network in Africa with an additional four institutions in three other countries. As such SSMEE has resulted in increased opportunities for African medical students and better educational outcomes that are likely to have a positive effect on healthcare systems in Africa.
Challenges and prospects for implementation of community health volunteers’ digital health solutions in Kenya: a qualitative study
Authors: Bakibinga Pauline , Kamande Eva , Kisia Lyagamula , Omuya Milka , Matanda Dennis J. , Kyobutungi Catherine
Published: September 2020

Background

The value of digital health technologies in delivering vital health care interventions, especially in low resource settings is increasingly appreciated. We co-developed and tested a decision support mobile health (m-Health) application (app);with some of the forms used by Community Health Volunteers (CHVs) in Kenya to collect data and connected to health facilities. This paper explores the experiences of CHVs, health workers and members of Sub-County Health Management Teams following implementation of the project.

Methods

Data were collected in December 2017 through in-depth interviews and focus group discussions with CHVs and key informant interviews with health care workers and health managers in Kamukunji sub-County of Nairobi, Kenya. Data coding and analysis was performed in NVivo 12.

Results

Regarding users and health managers’ perceptions towards the system; three main themes were identified: 1) variations in use, 2) barriers to use and 3) recommendations to improve use. Health workers at the private facility and some CHVs used the system more than health workers at the public facilities. Four sub-themes under barriers to use were socio-political environment, attitudes and behaviour, issues related to the system and poor infrastructure. A prolonged health workers’ strike, the contentious presidential election in the year of implementation, interrupted electricity supply and lack of basic electric fixtures were major barriers to use. Suggestions to improve usage were: 1) integration of the system with others in use and making it available on users’ regular phones, and 2) explore sustainable motivation models to users as well as performance based remuneration.

Conclusions

The findings reveal the importance of considering the readiness of information and communication technologies (ICT) users before rollout of ICT solutions. The political and sociocultural environment in which the innovation is to be implemented and integration of new solutions into existing ones is critical for success. As more healthcare delivery models are developed, harnessing the potential of digital technologies, strengthening health systems is critical as this provides the backbone on which such innovations draw support.
Study protocol for the implementation of the Gabby Preconception Care System - an evidence-based, health information technology intervention for Black and African American women
Authors: Walter Angela Wangari , Julce Clevanne , Sidduri Nireesha , Yinusa-Nyahkoon Leanne , Howard Jessica , Reichert Matthew , Bickmore Timothy , Jack Brian W.
Published: September 2020

Background

Improving the health of women before pregnancy and throughout a woman’s lifespan could mitigate disparities and improve the health and wellbeing of women, infants and children. The preconception period is important for reducing health risks associated with poor maternal, perinatal and neonatal outcomes, and eliminating racial and ethnic disparities in maternal and child health. Low cost health information technology interventions provided in community-based settings have the potential to reach and reduce disparities in health outcomes for socially disadvantaged, underserved and health disparity populations. These interventions are particularly important for Black and African American women who have a disproportionate burden of pregnancy-related complications and infant mortality rates compared to any other racial and ethnic group in the U.S.

Methods

This is a hybrid type II implementation-effectiveness cohort study aimed at evaluating appropriateness, acceptability and feasibility implementation outcomes, while also systematically examining the clinical effectiveness of a preconception care (PCC) intervention, the Gabby System, for Black and African American women receiving health services in community-based sites. The intervention will be implemented in six Community Health Centers and six Healthy Start programs across the U.S. Each study site will recruit and enroll 25–50 young Black and African American women who will participate in the intervention for a 6-month period. Appropriateness, acceptability and feasibility of implementing the PCC intervention will be assessed using: 1) Qualitative data derived from individual interviews with Gabby System end-users (clients and patients) and site staff; and, 2) Quantitative data from staff surveys, Gabby System usage and uptake. Aggregate health risk and utilization measures collected directly from the Gabby server will be used to examine the effectiveness of the Gabby System on self-reported behavior change.

Discussion

This study will examine implementation outcomes and clinical effectiveness of an evidence-based PCC intervention for Black and African American women receiving services in Healthy Start programs and Community Health Centers. Contextual factors that influence uptake and appropriate implementation strategies will be identified to inform future scalability of the intervention.

Trial registration

ClinicalTrials.gov NCT04514224.

Date of registration: August 14, 2020. Retrospectively Registered.
Understanding access to professional healthcare among asylum seekers facing gender-based violence: a qualitative study from a stakeholder perspective
Authors: Rodella Sapia Mirjam D. , Wangmo Tenzin , Dagron Stéphanie , Elger Bernice S.
Published: September 2020

Background

When it comes to gender-based violence (GBV), migrant women and girls represent the most vulnerable group. GBV can happen at any stage of migrants’ flight and/or during the asylum process. It has severe consequences on their life and health. Victims therefore need timely access to healthcare. This study explores the context GBV victims face when they seek refuge in Switzerland.

Methods

Qualitative methodology was used where we conducted five semi-structured focus groups and three interviews. A total of sixteen stakeholders participated in the study. They were either involved in the asylum process or provided healthcare to asylum seekers. We analyzed the data using framework analysis.

Results

Study participants noted lack of confidence of the GBV victims in the legal and in the healthcare systems as major barriers to disclosure of GBV. Since only GBV exerted before fleeing the home country gives the right to asylum, they pointed out that victims do not disclose GBV that took place after they left their home country. Language was identified as a barrier to disclosure of GBV as well as to healthcare access. Continuity of care at the moment of transfer from federal to cantonal (i.e. state) accommodations is another issue that was deemed critical. Study participants felt that health professionals must be trained to identify GBV victims. The first-contact caregiver available to these victims was deemed as the most competent professional that could act as a “GBV coordinator”.

Conclusion

In Switzerland, access to healthcare is guaranteed to all asylum seekers on a legal and structural level. Yet, health seeking by GBV survivors is hindered by factors such as lack of confidence in the legal system, trust in health providers, and continuity of care during the asylum process. Building trust in legal institutions, health structures, and professionals should be enhanced to facilitate disclosure and to strengthen resilience. This includes a healthcare system with competent professionals, support with language and cultural needs, as well as seamless continuity of care beyond cantonal borders.