bluuebunny/crossref_metadata_2025 huggingface dataset:
Atorvastatin and growth, rupture of small unruptured intracranial aneurysm: results of a prospective cohort study
Authors: Wang Jie , Weng Jiancong , Li Hao , Jiao Yuming , Fu Weilun , Huo Ran , Yan Zihan , Xu Hongyuan , Zhan Jiong , Wang Shuo , Du Xin , Cao Yong , Zhao Jizong
Published: April 2021

Background and aims:

The role of statins in unruptured intracranial aneurysm (UIA) growth and rupture remains ambiguous. This study sought to determine whether atorvastatin is associated with aneurysm growth and rupture in patients harboring UIA <7 mm.

Methods:

This prospective, multicenter cohort study consecutively enrolled patients with concurrent UIA <7 mm and ischemic cerebrovascular disease from four hospitals between 2016 and 2019. Baseline and follow-up patient information was recorded. Because of the strong anti-inflammatory effect of aspirin, patients using aspirin were excluded. Patients taking atorvastatin 20 mg daily were atorvastatin users. The primary and exploratory endpoints were aneurysm rupture and growth, respectively.

Results:

Among the 1087 enrolled patients, 489 (45.0%) took atorvastatin, and 598 (55%) took no atorvastatin. After a mean follow-up duration of 33.0 ± 12.5 months, six (1.2%) and five (0.8%) aneurysms ruptured in atorvastatin and non-atorvastatin groups, respectively. In the adjusted multivariate Cox analysis, UIA sized 5 to <7 mm, current smoker, and uncontrolled hypertension were associated with aneurysm rupture, whereas atorvastatin [adjusted hazard ratio (HR) 1.495, 95% confidence interval (CI) 0.417–5.356, p = 0.537] was not. Of 159 patients who had follow-up imaging, 34 (21.4%) took atorvastatin and 125 (78.6%) took no atorvastatin. Aneurysm growth occurred in five (14.7%) and 21 (16.8%) patients in atorvastatin and non-atorvastatin groups (mean follow-up: 20.2 ± 12.9 months), respectively. In the adjusted multivariate Cox analysis, UIAs sized 5 to <7 mm and uncontrolled hypertension were associated with a high growth rate; atorvastatin (adjusted HR 0.151, 95% CI 0.031–0.729, p = 0.019) was associated with a reduced growth rate.

Conclusions:

We conclude atorvastatin use is associated with a reduced risk of UIA growth, whereas atorvastatin is not associated with UIA rupture. The trial registry name: The Clinic Benefit and Risk of Oral Aspirin for Unruptured Intracranial Aneurysm Combined With Cerebral Ischemia Clinical Trial Registration-URL: http://www.clinicaltrials.gov Unique identifier: NCT02846259
Design and Development of a Mobile-Based Self-Care Application for Patients with Type 2 Diabetes
Authors: Mehraeen Esmaeil , Mehrtak Mohammad , Janfaza Nazanin , Karimi Amirali , Heydari Mohammad , Mirzapour Pegah , Mehranfar Adele
Published: April 2021

Introduction:

Mobile-based applications play a leading role in changes in life-style, improve medication adherence, and provide a unique opportunity to aid patients with type 2 diabetes mellitus (T2DM) elevate their healthcare level. Therefore, we aim to design and develop a mobile-based self-care application for patients with T2DM.

Methods:

The present study was an applied and developmental study to design and develop a mobile-based self-care application for people living with T2DM conducted in 2020. The design and development of the T2DM self-care application were done in 2 main phases of determining the key features and capabilities, and design and development of the T2DM self-care mobile app.

Results:

We identified the main model and a set of capabilities and features for the T2DM self-care application. By content analysis on 32 different applications and a previous study by the author, 18 features were extracted for the T2DM self-care mobile app. JAVA programming languages were used to design T2DM applications. Moreover, because of the cost-effectiveness, the Android operating system (AOS) was selected as a platform, and because of the widespread use of smartphones; these phones were chosen as the format of T2DM self-care application.

Conclusions:

In this study, we design and develop a mobile-based self-care application for patients with type 2 diabetes that shows potential in solving the shortcomings of mobile apps for diabetes care. By utilizing the T2DM self-care mobile app we are able to deploy a self-care application with a wide range of functionality such as text messaging, blood glucose monitoring, insulin dose suggestions, educational messaging, metabolic management, pedometer counts, and reporting. Future studies are needed to develop self-care applications for a different type of diabetes with different functions of diabetes care.
Methadone-Induced Polymorphic Ventricular Tachycardia Complicated by Takotsubo Cardiomyopathy in a Malnourished Patient
Authors: Ali Mohammed , Adam Omeralfaroug , Subahi Ahmed , Awadelkarim Abdalaziz , Fatiwala Lubna , Singh Manmeet M. , Alhusain Rashid , Lieberman Randy
Published: April 2021

Takotsubo cardiomyopathy (TC) is a syndrome characterized by acute and transient regional systolic myocardial dysfunction. TC often mimics myocardial infarction without obstructive coronary disease. We present a case of a 48-year-old woman who developed TC following the onset of polymorphic ventricular tachycardia in the setting of methadone intoxication.
A Missed Opportunity? Instructional Content Redundancy in Pre-K and Kindergarten
Authors: Cohen-Vogel Lora , Little Michael , Jang Wonkyung , Burchinal Margaret , Bratsch-Hines Mary
Published: April 2021

Policy observers have expressed concern over whether misalignment between pre-K and K–12 has negative consequences for children. This study considers students’ exposure to redundant content across the pre-K and kindergarten years. Specifically, it asks, to what extent are skills and concepts taught in kindergarten redundant with skills and concepts taught in one state’s public pre-K program, and for whom is redundancy most likely? Overall, findings from teacher surveys show that about 37% of the language, literacy, and math content covered in kindergarten is redundant with content covered in pre-K. The highest rates of redundancy seem to occur for basic (rather than advanced) content items, including the identification of letters and sight words. Moreover, children from families who live at or below the poverty line experience significantly higher rates of redundant content. Implications for policy, practice, and future research are discussed.
Reinforcement learning approaches to hippocampus-dependent flexible spatial navigation
Authors: Tessereau Charline , O’Dea Reuben , Coombes Stephen , Bast Tobias
Published: April 2021

Humans and non-human animals show great flexibility in spatial navigation, including the ability to return to specific locations based on as few as one single experience. To study spatial navigation in the laboratory, watermaze tasks, in which rats have to find a hidden platform in a pool of cloudy water surrounded by spatial cues, have long been used. Analogous tasks have been developed for human participants using virtual environments. Spatial learning in the watermaze is facilitated by the hippocampus. In particular, rapid, one-trial, allocentric place learning, as measured in the delayed-matching-to-place variant of the watermaze task, which requires rodents to learn repeatedly new locations in a familiar environment, is hippocampal dependent. In this article, we review some computational principles, embedded within a reinforcement learning framework, that utilise hippocampal spatial representations for navigation in watermaze tasks. We consider which key elements underlie their efficacy, and discuss their limitations in accounting for hippocampus-dependent navigation, both in terms of behavioural performance (i.e. how well do they reproduce behavioural measures of rapid place learning) and neurobiological realism (i.e. how well do they map to neurobiological substrates involved in rapid place learning). We discuss how an actor–critic architecture, enabling simultaneous assessment of the value of the current location and of the optimal direction to follow, can reproduce one-trial place learning performance as shown on watermaze and virtual delayed-matching-to-place tasks by rats and humans, respectively, if complemented with map-like place representations. The contribution of actor–critic mechanisms to delayed-matching-to-place performance is consistent with neurobiological findings implicating the striatum and hippocampo-striatal interaction in delayed-matching-to-place performance, given that the striatum has been associated with actor–critic mechanisms. Moreover, we illustrate that hierarchical computations embedded within an actor–critic architecture may help to account for aspects of flexible spatial navigation. The hierarchical reinforcement learning approach separates trajectory control via a temporal-difference error from goal selection via a goal prediction error and may account for flexible, trial-specific, navigation to familiar goal locations, as required in some arm-maze place memory tasks, although it does not capture one-trial learning of new goal locations, as observed in open field, including watermaze and virtual, delayed-matching-to-place tasks. Future models of one-shot learning of new goal locations, as observed on delayed-matching-to-place tasks, should incorporate hippocampal plasticity mechanisms that integrate new goal information with allocentric place representation, as such mechanisms are supported by substantial empirical evidence.
Pericardial Hydatidosis in a Young Boy
Authors: Bhat Aditya , Sachdev Manvinder Singh , Bhan Anil
Published: April 2021

Persistent chest pain is an uncommon entity in adolescent population, with majority of cases having no discernible cardiac etiology. We report a young boy presenting with chest discomfort due to underlying large pericardial hydatid cyst. Initial diagnostic confirmation was based on classic echocardiographic features, including presence of sonographic water lily sign. Patient subsequently underwent successful surgical excision of cyst under cardiopulmonary bypass, along with perioperative antihelminthic and anti-inflammatory drug therapy. Patient continues to remain symptom free on follow-up, with no recurrence in cyst formation. This case highlights the high index of suspicion needed in diagnosing such atypical cardiac cysts, especially in patients from endemic zones.
Identification of co-expression network correlated with different periods of adipogenic and osteogenic differentiation of BMSCs by weighted gene co-expression network analysis (WGCNA)
Authors: Liu Yu , Tingart Markus , Lecouturier Sophie , Li Jianzhang , Eschweiler Jörg
Published: April 2021

Background

The differentiation of bone marrow mesenchymal stem cells is a complex and dynamic process. The gene expression pattern and mechanism of different periods of adipogenic and osteogenic differentiation remain unclear. Additionally, the interaction between these two lineage determination requires further exploration.

Results

Five modules that were most significantly associated with osteogenic or adipogenic differentiation of BMSCs were selected for further investigation. Biological terms (e.g. ribosome biogenesis, TNF-α signalling pathway, glucose import and fatty acid metabolism) along with hub transcription factors (e.g. PPARG and YY1) and hub miRNAs (e.g. hsa-mir-26b-5p) were enriched in different modules. The expression pattern of 6 hub genes, ADIPOQ, FABP4, SLC7A5, SELPLG, BIRC3, and KLHL30 was validated by RT-qPCR. Finally, cell staining experiments extended the findings of bioinformatics analysis.

Conclusion

This study identified the key genes, biological functions, and regulators of each time point of adipogenic and osteogenic differentiation of BMSCs and provided novel evidence and ideas for further research on the differentiation of BMSCs.
Effects of ectomycorrhizal fungi (Suillus variegatus) on the growth, hydraulic function, and non-structural carbohydrates of Pinus tabulaeformis under drought stress
Authors: Wang Jiaxing , Zhang Haoqiang , Gao Jing , Zhang Yu , Liu Yaqin , Tang Ming
Published: April 2021

Background

A better understanding of non-structural carbohydrate (NSC) dynamics in trees under drought stress is critical to elucidate the mechanisms underlying forest decline and tree mortality from extended periods of drought. This study aimed to assess the contribution of ectomycorrhizal (ECM) fungus (Suillus variegatus) to hydraulic function and NSC in roots, stems, and leaves ofPinus tabulaeformissubjected to different water deficit intensity. We performed a continuous controlled drought pot experiment from July 10 to September 10, 2019 usingP. tabulaeformisseedlings under 80, 40, and 20% of the field moisture capacity that represented the absence of non-drought, moderate drought, and severe drought stress, respectively.

Results

Results indicated thatS. variegatusdecreased the mortality rate and increased height, root biomass, and leaf biomass ofP. tabulaeformisseedlings under moderate and severe drought stress. Meanwhile, the photosynthetic rates, stomatal conductance, and transpiration rates ofP. tabulaeformiswere significantly increased afterS. variegatusinoculation. Moreover, the inoculation ofS. variegatusalso significantly increased the NSC concentrations of all seedling tissues, enhanced the soluble sugars content, and increased the ratios of soluble sugars to starch on all tissues under severe drought. Overall, the inoculation ofS. variegatushas great potential for improving the hydraulic function, increasing the NSC storage, and improving the growth ofP. tabulaeformisunder severe drought.

Conclusions

Therefore, theS. variegatuscan be used as a potential application strain for ecological restoration on arid regions of the Loess Plateau, especially in theP. tabulaeformiswoodlands.
A birth population-based survey of preterm morbidity and mortality by gestational age
Authors: Guo Xiaojing , Li Xiaoqiong , Qi Tingting , Pan Zhaojun , Zhu Xiaoqin , Wang Hui , Dong Ying , Yue Hongni , Sun Bo
Published: April 2021

Background

Despite 15–17 millions of annual births in China, there is a paucity of information on prevalence and outcome of preterm birth. We characterized the outcome of preterm births and hospitalized preterm infants by gestational age (GA) in Huai’an in 2015, an emerging prefectural region of China.

Methods

Of 59,245 regional total births, clinical data on 2651 preterm births and 1941 hospitalized preterm neonates were extracted from Huai’an Women and Children’s Hospital (HWCH) and non-HWCH hospitals in 2018–2020. Preterm prevalence, morbidity and mortality rates were characterized and compared by hospital categories and GA spectra. Death risks of preterm births and hospitalized preterm infants in the whole region were analyzed with multivariable Poisson regression.

Results

The prevalence of extreme, very, moderate, late and total preterm of the regional total births were 0.14, 0.53, 0.72, 3.08 and 4.47%, with GA-specific neonatal mortality rates being 44.4, 15.8, 3.7, 1.5 and 4.3%, respectively. There were 1025 (52.8% of whole region) preterm admissions in HWCH, with significantly lower in-hospital death rate of inborn (33 of 802, 4.1%) than out-born (23 of 223, 10.3%) infants. Compared to non-HWCH, three-fold more neonates in HWCH were under critical care with higher death rate, including most extremely preterm infants. Significantly all-death risks were found for the total preterm births in birth weight <  1000 g, GA < 32 weeks, amniotic fluid contamination, Apgar-5 min < 7, and birth defects. For the hospitalized preterm infants, significantly in-hospital death risks were found in out-born of HWCH, GA < 32 weeks, birth weight <  1000 g, Apgar-5 min < 7, birth defects, respiratory distress syndrome, necrotizing enterocolitis and ventilation, whereas born in HWCH, antenatal glucocorticoids, cesarean delivery and surfactant use decreased the death risks.

Conclusions

The integrated data revealed the prevalence, GA-specific morbidity and mortality rate of total preterm births and their hospitalization, demonstrating the efficiency of leading referral center and whole regional perinatal-neonatal network in China. The concept and protocol should be validated in further studies for prevention of preterm birth.
Person-centered antenatal care and associated factors in Rwanda: a secondary analysis of program data
Authors: Miller Phoebe , Afulani Patience A. , Musange Sabine , Sayingoza Felix , Walker Dilys
Published: April 2021

Background

Research suggests that women’s experience of antenatal care is an important component of high-quality antenatal care. Person-centered antenatal care (PCANC) reflects care that is both respectful of, and responsive to, the preferences, needs, and values of pregnant women. Little is known in Rwanda about either the extent to which PCANC is practiced or the factors that might determine its use. This is the first study to quantitatively examine the extent of and the factors associated with PCANC in Rwanda.

Methods

We used quantitative data from a randomized control trial in Rwanda. A total of 2150 surveys were collected and analyzed from 36 health centers across five districts. We excluded women who were less than 16 years old, were referred to higher levels of antenatal care or had incomplete survey responses. Both bivariate and multivariate logistic regression analyses were used to test the hypothesis that certain participant characteristics would predict high PCANC.

Results

PCANC level was found to be sub-optimal with one third of women leaving antenatal care (ANC) with questions or confused and one fourth feeling disrespected. In bivariate analysis, social support, greater parity, being in the traditional care (control group), and being from Burera district significantly predict high PCANC. Additionally, in the multivariate analysis, being in the traditional care group and the district in which women received care were significantly associated with PCANC.

Conclusions

This quantitative analysis indicates sub-optimal levels of PCANC amongst our study population in Rwanda. We find lower levels of PCANC to be regional and defined by the patient characteristics parity and social support. Given the benefits of PCANC, improvements in PCANC through provider training in Rwanda might promote an institutional culture shift towards a more person-centered model of care.
Prognostic factors and epidemiology of adult open globe injuries from Western Sydney: a twelve-year review
Authors: Ho Haochi , Foo Jane , Li Yi-Chiao , Bobba Samantha , Go Christopher , Chandra Jaya , Fung Adrian T.
Published: April 2021

Background

To identify prognostic factors determining final visual outcome following open globe injuries.

Methods

Retrospective case series of patients presenting to Westmead Hospital, Sydney, Australia with open globe injuries from 1st January 2005 to 31st December 2017. Data collected included demographic information, ocular injury details, management and initial and final visual acuities.

Results

A total of 104 cases were identified. Predictors of poor final visual outcomes included poor presenting visual acuity (p < 0.001), globe rupture (p < 0.001), retinal detachment (p < 0.001), Zone III wounds (p < 0.001), hyphema (p = 0.003), lens expulsion (p = 0.003) and vitreous hemorrhage (p < 0.001). Multivariate analysis demonstrated presenting visual acuity (p < 0.001), globe rupture (p = 0.013) and retinal detachment (p = 0.011) as being statistically significant for predicting poor visual outcomes. The presence of lid laceration (p = 0.197) and uveal prolapse (p = 0.667) were not significantly associated with the final visual acuity.

Conclusions

Poor presenting visual acuity, globe rupture and retinal detachment are the most important prognostic factors determining final visual acuity following open globe injury.
Risk factors of local recurrence following implant-based breast reconstruction in breast cancer patients
Authors: Fujihara Miwa , Yamasaki Rie , Ito Mitsuya , Shien Tadahiko , Maeda Reina , Kin Takanori , Ueno Ayako , Kajiwara Yukiko , Kawasaki Kensuke , Ichimura Kouichi , Mihara Hiroya , Kimura Naritaka , Ohtani Shoichiro
Published: April 2021

Background

The number of patients desiring implant-based breast reconstruction has been increasing. While local recurrence is observed in patients with breast reconstruction, only a few reports have focused on the risk factors for local recurrence and the prognosis after developing local recurrence.

Methods

We analyzed 387 patients who underwent implant-based breast reconstruction during the period from 2004 to 2017 in Hiroshima City Hospital. We retrospectively examined the risk factors for local recurrence and the outcomes of patients developing such recurrence after implant-based breast reconstruction.

Results

The median follow-up time was 59 months. The local recurrence rate was 3.1% (n = 12). The most common reason for detecting local recurrence was a palpable mass. Four patients with local recurrence had recurrence involving the skin just above the primary lesion and needle biopsy tract. All patients with local recurrence received surgery and systemic therapy and most patients received radiation therapy, all have remained free of new recurrence to date. Multivariate analysis showed lymphatic vessel invasion (HR, 6.63; 95% CI, 1.40–31.36; p = 0.017) and positive or < 2 mm vertical margin (HR, 9.72; 95%CI, 1.23–77.13; p = 0.047) to be associated with significantly increased risk of local recurrence.

Conclusions

The risk factors for local recurrence following implant-based breast reconstruction were lymphatic vessel invasion and positive or < 2 mm vertical margin. Removal of the skin just above the primary lesion and needle biopsy tract and adjuvant radiation therapy might improve local outcomes. Patients with local recurrence following implant-based breast reconstruction appear to have good outcomes with appropriate treatment.
Acute and chronic exposure to air pollution in relation with incidence, prevalence, severity and mortality of COVID-19: a rapid systematic review
Authors: Katoto Patrick D. M. C. , Brand Amanda S. , Bakan Buket , Obadia Paul Musa , Kuhangana Carsi , Kayembe-Kitenge Tony , Kitenge Joseph Pyana , Nkulu Celestin Banza Lubaba , Vanoirbeek Jeroen , Nawrot Tim S. , Hoet Peter , Nemery Benoit
Published: April 2021

Background

Air pollution is one of the world’s leading mortality risk factors contributing to seven million deaths annually. COVID-19 pandemic has claimed about one million deaths in less than a year. However, it is unclear whether exposure to acute and chronic air pollution influences the COVID-19 epidemiologic curve.

Methods

We searched for relevant studies listed in six electronic databases between December 2019 and September 2020. We applied no language or publication status limits. Studies presented as original articles, studies that assessed risk, incidence, prevalence, or lethality of COVID-19 in relation with exposure to either short-term or long-term exposure to ambient air pollution were included. All patients regardless of age, sex and location diagnosed as having COVID-19 of any severity were taken into consideration. We synthesised results using harvest plots based on effect direction.

Results

Included studies were cross-sectional (n = 10), retrospective cohorts (n = 9), ecological (n = 6 of which two were time-series) and hypothesis (n = 1). Of these studies, 52 and 48% assessed the effect of short-term and long-term pollutant exposure, respectively and one evaluated both. Pollutants mostly studied were PM2.5 (64%), NO2 (50%), PM10 (43%) and O3 (29%) for acute effects and PM2.5 (85%), NO2 (39%) and O3 (23%) then PM10 (15%) for chronic effects. Most assessed COVID-19 outcomes were incidence and mortality rate. Acutely, pollutants independently associated with COVID-19 incidence and mortality were first PM2.5 then PM10, NO2 and O3 (only for incident cases). Chronically, similar relationships were found for PM2.5 and NO2. High overall risk of bias judgments (86 and 39% in short-term and long-term exposure studies, respectively) was predominantly due to a failure to adjust aggregated data for important confounders, and to a lesser extent because of a lack of comparative analysis.

Conclusion

The body of evidence indicates that both acute and chronic exposure to air pollution can affect COVID-19 epidemiology. The evidence is unclear for acute exposure due to a higher level of bias in existing studies as compared to moderate evidence with chronic exposure. Public health interventions that help minimize anthropogenic pollutant source and socio-economic injustice/disparities may reduce the planetary threat posed by both COVID-19 and air pollution pandemics.
NLRP7 deubiquitination by USP10 promotes tumor progression and tumor-associated macrophage polarization in colorectal cancer
Authors: Li Bing , Qi Zhi-Peng , He Dong-Li , Chen Zhang-Han , Liu Jing-Yi , Wong Meng-Wai , Zhang Jia-Wei , Xu En-Pan , Shi Qiang , Cai Shi-Lun , Sun Di , Yao Li-Qing , Zhou Ping-Hong , Zhong Yun-Shi
Published: April 2021

Background

NOD-like receptors affect multiple stages of cancer progression in many malignancies. NACHT, LRR, and PYD domain-containing protein 7 (NLRP7) is a member of the NOD-like receptor family, although its role in tumorigenesis remains unclear. By analyzing clinical samples, we found that NLRP7 protein levels were upregulated in colorectal cancer (CRC). We proposed the hypothesis that a high level of NLRP7 in CRC may promote tumor progression. Here, we further investigated the role of NLRP7 in CRC and the underlying mechanism.

Methods

NLRP7 expression in human CRC and adjacent non-tumorous tissues was examined by quantitative real-time polymerase chain reaction (qRT-PCR), western blotting, and immunohistochemistry. The effect of NLRP7 in CRC progression was investigated in vitro and in vivo. Proteins interacting with NLRP7 were identified by immunoprecipitation and mass spectrometry analysis while immunofluorescence staining revealed the cellular location of the proteins. Cellular ubiquitination and protein stability assays were applied to demonstrate the ubiquitination effect on NLRP7. Cloning and mutagenesis were used to identify a lysine acceptor site that mediates NLRP7 ubiquitination. Cytokines/chemokines affected by NLRP7 were identified by RNA sequencing, qRT-PCR, and enzyme-linked immunosorbent assay. Macrophage phenotypes were determined using qRT-PCR, flow cytometry, and immunohistochemistry.

Results

NLRP7 protein levels, but not mRNA levels, were upregulated in CRC, and increased NLRP7 protein expression was associated with poor survival. NLRP7 promoted tumor cell proliferation and metastasis in vivo and in vitro and interacted with ubiquitin-specific protease 10, which catalyzed its deubiquitination in CRC cells. NLRP7 stability and protein levels in CRC cells were modulated by ubiquitination and deubiquitination, and NLRP7 was involved in the ubiquitin-specific protease 10 promotion of tumor progression and metastasis in CRC. K379 was an important lysine acceptor site that mediates NLRP7 ubiquitination in CRC cells. In CRC, NLRP7 promoted the polarization of pro-tumor M2-like macrophages by inducing the secretion of C-C motif chemokine ligand 2. Furthermore, NLRP7 promoted NF-κB nuclear translocation and activation of C-C motif chemokine ligand 2 transcription.

Conclusions

We showed that NLRP7 promotes CRC progression and revealed an as-yet-unidentified mechanism by which NLRP7 induces the polarization of pro-tumor M2-like macrophages. These results suggest that NLRP7 could serve as a biomarker and novel therapeutic target for the treatment of CRC.
An international tool to measure perceived stressors in intensive care units: the PS-ICU scale
Authors: Laurent Alexandra , Fournier Alicia , Lheureux Florent , Martin Delgado Maria Cruz , Bocci Maria G. , Prestifilippo Alessia , Aslanian Pierre , Henriques Julie , Paget-Bailly Sophie , Constantin Jean-Michel , Besch Guillaume , Quenot Jean-Pierre , Anota Amelie , Bouhemad Belaid , Capellier Gilles
Published: April 2021

Background

The intensive care unit is increasingly recognized as a stressful environment for healthcare professionals. This context has an impact on the health of these professionals but also on the quality of their personal and professional life. However, there is currently no validated scale to measure specific stressors perceived by healthcare professionals in intensive care. The aim of this study was to construct and validate in three languages a perceived stressors scale more specific to intensive care units (ICU).

Results

We conducted a three-phase study between 2016 and 2019: (1) identification of stressors based on the verbatim of 165 nurses and physicians from 4 countries (Canada, France, Italy, and Spain). We identified 99 stressors, including those common to most healthcare professions (called generic), as well as stressors more specific to ICU professionals (called specific); (2) item elaboration and selection by a panel of interdisciplinary experts to build a provisional 99-item version of the scale. This version was pre-tested with 70 professionals in the 4 countries and enabled us to select 50 relevant items; (3) test of the validity of the scale in 497 ICU healthcare professionals. Factor analyses identified six dimensions: lack of fit with families and organizational functioning; patient- and family-related emotional load; complex/at risk situations and skill-related issues; workload and human resource management issues; difficulties related to team working; and suboptimal care situations. Correlations of the PS-ICU scale with a generic stressors measure (i.e., the Job Content Questionnaire) tested its convergent validity, while its correlations with the Maslach Burnout Inventory-HSS examined its concurrent validity. We also assessed the test–retest reliability of PS-ICU with intraclass correlation coefficients.

Conclusions

The perceived stressors in intensive care units (PS-ICU) scale have good psychometric properties in all countries. It includes six broad dimensions covering generic or specific stressors to ICU, and thus, enables the identification of work situations that are likely to generate high levels of stress at the individual and unit levels. For future studies, this tool will enable the implementation of targeted corrective actions on which intervention research can be based. It also enables national and international comparisons of stressors’ impact.
Self-efficacy of direct care workers providing care to older people in residential aged care settings: a scoping review protocol
Authors: Shrestha Sumina , Alharbi Rayan Jafnan M. , While Christine , Ellis Julie , Rahman Muhammad Aziz , Wells Yvonne
Published: April 2021

Background

Self-efficacy is developed through a person’s interaction with his/her physical and social environment. Self-efficacy in caring is an essential attribute of care workers to develop a positive attitude towards their clients, improve work performance, and enhance job satisfaction. Care workers’ self-efficacy may vary according to the context in which the care is being provided. Aged care is a multidimensional and challenging setting, and characteristics of aged care services are different from those of acute care services. The objective of this review is to give an overview of the self-efficacy of residential aged care workers in caring for older people and factors influencing their self-efficacy.

Methods

The protocol for this review is based on the Joanna Briggs Institute Reviewer’s Manual for Scoping Review. A systematic search of the literature on electronic databases MEDLINE, PsycINFO, CINAHL, AgeLine, SCOPUS, and ProQuest Dissertations and Theses Global will be carried out using predefined search terms to identify relevant studies. This review will include studies that examined the self-efficacy of direct care workers in caring for older people living in residential aged care facilities. All primary studies irrespective of the study design will be included. Studies conducted to develop measures or studies with informal care workers or students as study participants will not be considered. Two reviewers will independently conduct title and abstract screening, full-text screening, and data charting. A third reviewer will resolve discrepancies, while the final decision for conflicting studies will be made by consensus within the review team. Descriptive statistics will be utilized to analyze the quantitative findings, and the result will be presented in narrative form accompanied by tables and charts. Content analysis will be carried to analyze the qualitative findings and will be presented in narrative form supported by illustrative quotations.

Discussion

This study will be an important source of knowledge to policymakers and aged care providers to understand the self-efficacy of aged care workers to support and enhance their self-efficacy and thereby improve their caring behaviors towards their clients.

Scoping review registration

Joanna Briggs Institute Systematic Review Register with the title “A scoping review of factors influencing caring efficacy of direct care workers providing care to older people”.
Motion Pictures of the Royal Family
Authors: Heinemann Julia
Published: April 2021

This article explores the role of letter writing in the political practice of the French royal family. By focusing on the use of letters exchanged by Henri III, François d'Anjou, and Catherine de’ Medici between 1574 and 1584, it analyzes how both kinship relations and notions of royal authority were negotiated and intertwined by letter. In a dynamic communication process, the correspondents discussed and framed familial relationships and political concepts. The letters were read, seen, and heard by a broader audience at court, thus transcending modern categories such as public and private, formal and informal, or intimate and official. The article argues that the correspondence produced specific, sometimes opposing pictures of the royal family that were supposed to be visible. This use of letters shaped social relations and political processes during the Wars of Religion in early modern France.

Cet article traite du rôle de la correspondance dans les pratiques politiques de la famille royale française. En me concentrant sur l'usage des lettres par Henri III, François d'Anjou et leur mère Catherine de Médicis dans les années 1574–84, j'analyse comment les correspondants négocient ensemble les relations de parenté et les concepts politiques. La discussion et la modélisation de cette conception familiale de l'autorité royale par les lettres sont partie prenante d'un processus de communication dynamique. La fonction de ces lettres est d’être lues, vues et entendues à la cour. Ce faisant, cette communication outrepasse les divisions « modernes » entre le privé et le public, le formel et l'informel ou encore l'intime et l'officiel. Cet usage de l’écrit est spécifique aux relations sociales et aux processus politiques pendant les guerres de Religion à l’époque moderne.
Coagulopathy and Venous Thromboembolic Events Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
Authors: Dranichnikov Paul , Mahteme Haile , Cashin Peter H. , Graf Wilhelm
Published: April 2021

Background

Coagulopathy after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is recognized but few details have been studied.

Objectives

The aim of this study was to investigate changes in coagulation biomarkers and their predictive ability for venous thromboembolism (VTE).

Methods

Patients undergoing CRS and HIPEC at Uppsala University Hospital, Sweden, from 2004 to 2014 were included in a prospective study of coagulation biomarkers. Prothrombin time international normalized ratio (PT-INR), activated partial thromboplastin time (APTT), fibrinogen, antithrombin, D-dimer, and platelets were sampled on postoperative days 1, 2, 5, and 10. Logistic regression analysis was used to evaluate predictive capacity for coagulation-related complications.

Results

Overall, 380 patients were included (214 females, mean age 56 years); 38 patients had a history of thromboembolism and 57 were active smokers. Mean perioperative blood loss was 1228 mL and 231 (61%) received perioperative blood transfusions. PT-INR and APTT were elevated directly after surgery but returned to normal levels on postoperative day 5. Conversely, fibrinogen, platelet count, D-dimer, and antithrombin increased by postoperative day 5 and continued to increase up to day 10. There were 23 radiologically verified cases of VTE within 6 months. The multivariate analysis identified a completeness of cytoreduction score of 2–3 (p = 0.047) and day 2 D-dimer (p = 0.0082) as independent risk factors for postoperative VTE.

Conclusion

Significant postoperative changes in coagulation biomarkers occur with dynamic changes over 10 days postoperatively. The incidence of symptomatic VTE was low. Residual tumor at completion of surgery and elevated D-dimer on day 2 were independent risk factors for postoperative VTE.
Non-medical prescribing for paramedics in primary care
Authors: Dixon Matt
Published: April 2021

As paramedic roles continue to grow and diversity, the number of paramedics working in primary care is on the rise. Knowledge of non-medical prescribing specifically for paramedics in these settings is necessary, as are new frameworks for medicines management beyond the ambulance services and for general practice in particuar. This instalment in the Prescribing Paramedic series discusses prescribing in primary care settings including some of the more practical aspects of relevance to paramedics.
Being the change
Authors: Bandali Mahdiyah
Published: April 2021

After being acutely aware of her difference as a student, Mahdiyah Bandali begins to find her footing as a newly qualified paramedic, as she grows accustomed to ‘being the change’
Social class and sex differences in higher-education attainment among adults in Scotland since the 1960s
Authors: Paterson Lindsay
Published: April 2021

An important question about adult education is whether it compensates for or exacerbates initial inequality. The paper looks at this question in relation to higher education in Scotland, considering inequality with respect to sex and to social class. The data come from three cohorts followed from birth to 2011–12. The oldest is unique to Scotland, consisting of people born in 1936. The other two are the Scottish components of British cohorts who were born in 1958 and 1970. This range of time allows an investigation of the effects of half a century of higher-education expansion, drawing a distinction between all higher education and degree-level higher education. The conclusions are that the proportion of women who gained any higher-education qualification was lower than that of men in the 1936 cohort right up to age 75, was equal to men’s in the 1958 cohort up to age 54, and in the 1970 cohort was higher than men’s from the outset and moved increasingly ahead up to early middle age. For degrees, the female proportion converged with but did not overtake the male proportion. On social class, inequality for all higher education widened with age in the oldest cohort, did not change in the middle cohort, and narrowed with age in the youngest cohort. For degrees, inequality did not change across cohorts or across ages within cohort. Thus any widening of access by adults to higher education has depended mainly on levels below that of degrees.
Flipped learning design fidelity, self-regulated learning, satisfaction, and continuance intention in a university flipped learning course
Authors: Kim Nam Hui , So Hyo-Jeong , Joo Young Ju
Published: April 2021

For effective flipped learning, beyond simply switching the sequence of lectures and homework, it is important to understand and implement the fundamental design principles of flipped learning. A new notion is proposed called flipped learning design fidelity, defined as the degree to which a class is faithfully designed to be close to an ideal flipped learning class operationalised with four proxy indicators of the F-L-I-P™ model (flexible environment, learning culture, intentional content, and professional educator). This study empirically examines the effect of both learner-related factor (self-regulated learning) and design-related factor (design fidelity) on learning outcomes (satisfaction, continuance intention) in a university flipped course. We hypothesised that flipped learning design fidelity and self-regulated learning affect student satisfaction and intention to continue participating in a flipped learning course. The participants were 134 Korean students of a university course taught in a flipped learning mode. The results revealed that the level of flipped learning design fidelity had a significant effect on satisfaction, but did not affect continuance intention. In addition, the level of self-regulated learning had a significant effect on satisfaction and continuance intention. Drawn from the key findings, we suggest implications for the design of flipped learning courses in a university context.
Envisioning the World Within or Without Limits: on Representation and Creativity in the Aesthetics of 17th Century China
Authors: Lukicheva Polina
Published: April 2021

This essay examines a number of statements on painting and visual perception by Chinese literati artists of the late Ming – early Qing periods. It argues that the approaches to pictorial representation and creativity entailed in these statements reveal a considerable impact of Buddhist theories of consciousness. In the theories analyzed, pictorial representation is discussed in terms of ways and modes of how the mind relates to the world. As will be demonstrated, the function of expressing cognitive organization in representation is given more prominence than the function of rendering an external reality. The view of pictorial representation as being essentially what the mind produces in its relation to the world provides a basis for the assumption of a fundamental affinity between the creation of an image and the process how phenomenal reality unfolds by virtue of cognitive operations. This assumption seems to broadly underpin the painting theories discussed. And it is this assumption that provides a clue how and why the literati artists adopt Buddhist theories of cognition to the understanding of art. In the last section of the essay, we turn to the sources which cast still another perspective on artistic practice, namely a practice which captures a single moment of pure direct perception.
Clinical validation of the Siemens quantitative SARS-CoV-2 spike IgG assay (sCOVG) reveals improved sensitivity and a good correlation with virus neutralization titers
Authors: Irsara Christian , Egger Alexander E. , Prokop Wolfgang , Nairz Manfred , Loacker Lorin , Sahanic Sabina , Pizzini Alex , Sonnweber Thomas , Holzer Barbara , Mayer Wolfgang , Schennach Harald , Loeffler-Ragg Judith , Bellmann-Weiler Rosa , Hartmann Boris , Tancevski Ivan , Weiss Günter , Binder Christoph J. , Anliker Markus , Griesmacher Andrea , Hoermann Gregor
Published: April 2021

Objectives

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections cause coronavirus disease 2019 (COVID-19) and induce a specific antibody response. Serological assays detecting IgG against the receptor binding domain (RBD) of the spike (S) protein are useful to monitor the immune response after infection or vaccination. The objective of our study was to evaluate the clinical performance of the Siemens SARS-CoV-2 IgG (sCOVG) assay.

Methods

Sensitivity and specificity of the Siemens sCOVG test were evaluated on 178 patients with SARS-CoV-2-infection and 160 pre-pandemic samples in comparison with its predecessor test COV2G. Furthermore, correlation with virus neutralization titers was investigated on 134 samples of convalescent COVID-19 patients.

Results

Specificity of the sCOVG test was 99.4% and sensitivity was 90.5% (COV2G assay 78.7%; p<0.0001). S1-RBD antibody levels showed a good correlation with virus neutralization titers (r=0.843; p<0.0001) and an overall qualitative agreement of 98.5%. Finally, median S1-RBD IgG levels increase with age and were significantly higher in hospitalized COVID-19 patients (median levels general ward: 25.7 U/mL; intensive care: 59.5 U/mL) than in outpatients (3.8 U/mL; p<0.0001).

Conclusions

Performance characteristics of the sCOVG assay have been improved compared to the predecessor test COV2G. Quantitative SARS-CoV-2 S1-RBD IgG levels could be used as a surrogate for virus neutralization capacity. Further harmonization of antibody quantification might assist to monitor the humoral immune response after COVID-19 disease or vaccination.
Comprehensive assessment of humoral response after Pfizer BNT162b2 mRNA Covid-19 vaccination: a three-case series
Authors: Danese Elisa , Montagnana Martina , Salvagno Gian Luca , Peserico Denise , Pighi Laura , De Nitto Simone , Henry Brandon M. , Porru Stefano , Lippi Giuseppe
Published: April 2021

Objectives

Since universal vaccination is a pillar against coronavirus disease 2019 (COVID-19), monitoring anti-SARS-CoV-2 neutralizing antibodies is essential for deciphering post-vaccination immune response.

Methods

Three healthcare workers received 30 μg BNT162b2 mRNA Covid-19 Pfizer Vaccine, followed by a second identical dose, 21 days afterwards. Venous blood was drawn at baseline and at serial intervals, up to 63 days afterwards, for assessing total immunoglobulins (Ig) anti-RBD (receptor binding domain), anti-S1/S2 and anti-RBD IgG, anti-RBD and anti-N/S1 IgM, and anti-S1 IgA.

Results

All subjects were SARS-CoV-2 seronegative at baseline. Total Ig anti-RBD, anti-S1/S2 and anti-RBD IgG levels increased between 91 and 368 folds until 21 days after the first vaccine dose, then reached a plateau. The levels raised further after the second dose (by ∼30-, ∼8- and ∼8-fold, respectively), peaking at day 35, but then slightly declining and stabilizing ∼50 days after the first vaccine dose. Anti-S1 IgA levels increased between 7 and 11 days after the first dose, slightly declined before the second dose, after which levels augmented by ∼24-fold from baseline. The anti-RBD and anti-N/S1 IgM kinetics were similar to that of anti-S1 IgA, though displaying substantially weaker increases and modest peaks, only 4- to 7-fold higher than baseline. Highly significant inter-correlation was noted between total Ig anti-RBD, anti-S1/S2 and anti-RBD IgG (all r=0.99), whilst other anti-SARS-CoV-2 antibodies displayed lower, though still significant, correlations. Serum spike protein concentration was undetectable at all-time points.

Conclusions

BNT162b2 mRNA vaccination generates a robust humoral immune response, especially involving anti-SARS-Cov-2 IgG and IgA, magnified by the second vaccine dose.
Kennings in Old English Verse and in the Poetic Edda
Authors: Fulk Robert D.
Published: April 2021

To shed light on questions pertaining to the similarities and differences between kennings in Old English and in the Poetic Edda, a survey is undertaken of the density of kenning use in the two corpora. The likeliest conclusion to be drawn from a comparison of findings is that the two poetic traditions are rather similar in regard to kenning use. In both traditions, kennings are notably simpler and less riddle-like than in skaldic poetry, though theEddacontains a few kennings of sufficient complexity to suggest skaldic influence. Although kennings, on average, occur more frequently in Old English, the incidence is broadly similar to that in the Poetic Edda. Kennings are not uncommonly explained by the use of variation (apposition) in Old English, but less commonly in theEdda, although the difference does not specifically suggest discrepant attitudes toward kenning use in the two traditions, since variation is rare in theEddaunder all circumstances. Although the possibility of the influence of one tradition upon the other cannot be ruled out, the similarities, in the main, are probably best explained as the result of common inheritance. This explanation garners support from the number of instances in which more or less precise cognate kennings appear in the two bodies of literature.