bluuebunny/crossref_metadata_2025 huggingface dataset:
A high-fidelity crystal-plasticity finite element methodology for low-cycle fatigue using automatic electron backscatter diffraction scan conversion: Application to hot-rolled cobalt–chromium alloy
Authors: Tu Yuhui , Leen Seán B , Harrison Noel M
Published: May 2021

The common approach to crystal-plasticity finite element modeling for load-bearing prediction of metallic structures involves the simulation of simplified grain morphology and substructure detail. This paper details a methodology for predicting the structure–property effect of as-manufactured microstructure, including true grain morphology and orientation, on cyclic plasticity, and fatigue crack initiation in biomedical-grade CoCr alloy. The methodology generates high-fidelity crystal-plasticity finite element models, by directly converting measured electron backscatter diffraction metal microstructure grain maps into finite element microstructural models, and thus captures essential grain definition for improved microstructure–property analyses. This electron backscatter diffraction-based method for crystal-plasticity finite element model generation is shown to give approximately 10% improved agreement for fatigue life prediction, compared with the more commonly used Voronoi tessellation method. However, the added microstructural detail available in electron backscatter diffraction–crystal-plasticity finite element did not significantly alter the bulk stress–strain response prediction, compared to Voronoi tessellation–crystal-plasticity finite element. The new electron backscatter diffraction-based method within a strain-gradient crystal-plasticity finite element model is also applied to predict measured grain size effects for cyclic plasticity and fatigue crack initiation, and shows the concentration of geometrically necessary dislocations around true grain boundaries, with smaller grain samples exhibiting higher overall geometrically necessary dislocations concentrations. In addition, minimum model sizes for Voronoi tessellation–crystal-plasticity finite element and electron backscatter diffraction–crystal-plasticity finite element models are proposed for cyclic hysteresis and fatigue crack initiation prediction.
The Effect of Split-Belt Treadmill Interventions on Step Length Asymmetry in Individuals Poststroke: A Systematic Review With Meta-Analysis
Authors: Dzewaltowski Alex C. , Hedrick Erica A. , Leutzinger Todd J. , Remski Lindsey E. , Rosen Adam B.
Published: May 2021

Background

Individuals poststroke experience gait asymmetries that result in decreased community ambulation and a lower quality of life. A variety of studies have utilized split-belt treadmill training to investigate its effect on gait asymmetry, but many employ various methodologies that report differing results.

Objective

The purpose of this meta-analysis was to determine the effects of split-belt treadmill walking on step length symmetry in individuals poststroke both during and following training.

Methods

A comprehensive search of PubMed/MEDLINE, CINAHL, Web of Science, and Scopus was conducted to find peer-reviewed journal articles that included individuals poststroke that participated in a split-belt treadmill walking intervention. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) was used to assess risk of bias. Pooled Hedge’s g with random effects models were used to estimate the effect of split-belt training on step length symmetry.

Results

Twenty-one studies were assessed and included in the systematic review with 11 of them included in the meta-analysis. Included studies had an average STROBE score of 16.2 ± 2.5. The pooled effects for step length asymmetry from baseline to late adaptation were not significant ( g = 0.060, P = .701). Large, significant effects were found at posttraining after a single session ( g = 1.04, P < .01), posttraining after multiple sessions ( g = −0.70, P = .01), and follow-up ( g = −0.718, P = .023).

Conclusion

Results indicate split-belt treadmill training with the shorter step length on the fast belt has the potential to improve step length symmetry in individuals poststroke when long-term training is implemented, but randomized controlled trials are needed to confirm the efficacy of split-belt treadmill training.
Military scientism and its discontents
Authors: Wallace Rodrick
Published: May 2021

The asymptotic limit theorems of control and information theories allow the examination of systemic failures afflicting “scientific” approaches to armed conflict such as reflexive control, the OODA loop, and East Asian alternatives. Large-scale combat, like other major human enterprise, is a form of dialog between cognitive institutional entities only loosely following shifting “laws” that most often express a path-dependent historical trajectory constrained by powerful cultural riverbanks. Such “conversations,” while having their own grammar and syntax, can involve matters of science, engineering, and technology, but they are not, of themselves, scientific in the Western sense. They may, however, be studied using the methodologies of historiography, social science, human ecology, and the like. Moving much beyond this is to invoke an alternate reality.
One-year results of stent graft repair for carotid artery pseudo-aneurysm in patients with Behcet’s disease
Authors: Shaalan Wael E , El Emam Ali A , Lotfy Hassan I , Naga Ahmad R
Published: May 2021

Objectives

Behcet’s disease is a multisystem disorder of unknown etiology with vascular complications. This study reviewed the mid-term outcome of Behcet’s disease patients with carotid artery pseudo-aneurysms treated by endovascular stent-graft repair at our unit.

Methods

During a period of 11 years, six cases were included. Postoperative ultrasound duplex results were recorded along with computed tomography angiography report done a year after intervention.

Results

The mean age (±SD) was 38 (±5.2) years. The mean (±SD) pseudo-aneurysm size was 33 (±12.2) mm. Technical success was 83%; failed cannulation of the internal carotid artery was encountered in one case. On day 2 post-operative, a duplex ultrasound revealed complete exclusion and thrombosis of the false aneurysm in all cases. A year later, a computed tomography angiography revealed a primary patency rate of 80%, and only one case had a recurrent pseudo-aneurysm at the distal margin of the stent graft. All cases, however, had complete thrombosis in the pseudo-aneurysms lumen with a mean (±SD) regression in size of 18 (±6) mm. The mean (±SD) percentage of in-stent stenosis was 34.5% (±11.73%).

Conclusions

Stent graft repair for carotid artery pseudo-aneurysm in Behcet’s disease patients might be the preferable first line of treatment since it had a high technical success and mid-term primary patency rates, with additional fact that it obviously avoids the hazardous complications of surgery.
Primary biliary cholangitis: a rare diagnosis during pregnancy
Authors: Lopes Inês Felizardo , Palma dos Reis Catarina R. , Alves Maria José , Calinas Filipe , Borges Maria Augusta
Published: May 2021

Primary biliary cholangitis is an autoimmune disease that mostly affects women. It is uncommon in women of childbearing age and the diagnosis during pregnancy is rare and can be challenging. Described here is a case of primary biliary cholangitis first manifesting during pregnancy, with the onset of pruritus, jaundice, biochemical liver abnormalities and positive antimitochondrial antibodies. Although treatment with ursodeoxycholic acid was started at the time of diagnosis, there was a progressive worsening of cholestatic biochemical markers throughout pregnancy. In addition, fasting hyperglycemia with polyhydramnios was diagnosed, consistent with gestational diabetes. She had a spontaneous preterm delivery at 31 weeks of gestation, of a newborn who was admitted to the neonatal intensive care unit but who subsequently had no long-term sequelae of preterm delivery. A maternal postpartum flare occurred. Treatment with ursodeoxycholic acid was well tolerated during pregnancy and lactation.
Childhood adversity, prenatal depression, and maternal inflammation across pregnancy
Authors: Bublitz Margaret H , Freeburg Taylor , Sharp Meghan , Salameh Myriam , Bourjeily Ghada
Published: May 2021

Background

To examine whether change in neutrophil–lymphocyte ratio, a marker of systemic inflammation, differs by childhood adversity and prenatal depression.

Methods

Prenatal complete blood count data were used to calculate neutrophil–lymphocyte ratio in first and third trimesters. The Adverse Childhood Experiences scale measured childhood adversity, and the Patient Health Questionnaire-9 measured depression. This is a secondary analysis of a study of predictors of risk for sleep-disordered breathing.

Results

Participants were 98 pregnant women, mean age 30 years ( SD = 5), mean body mass index of 35 kg/m2 ( SD = 7), 61% identified as white, and 28% identified as Hispanic. Women who reported childhood sexual abuse history displayed greater increase in neutrophil–lymphocyte ratio over pregnancy relative to women without childhood sexual abuse. Change in neutrophil–lymphocyte ratio across pregnancy did not differ by prenatal depression.

Conclusion

Experiences of sexual abuse in childhood may impact markers of systemic inflammation in pregnancy.
Effectiveness of simulation-based training for obstetric internal medicine: Impact of cognitive load and emotions on knowledge acquisition and retention
Authors: Hurd Kelle D , Vlasschaert Meghan EO , Hawkins T Lee Ann , Haws Jolene , Kupis Julia N , Ma Irene WY
Published: May 2021

Background

Simulation-based training’s impact on learning outcomes may be related to cognitive load or emotions during training. We evaluated the association of validated measures of cognitive load and emotion with learning outcomes in simulation-based obstetric internal medicine cases.

Methods

All internal medicine learners (n = 15) who completed the knowledge test pre-training, post-training (knowledge acquisition), and at 3–6 months (knowledge retention) for all three simulation cases were included.

Results

Mean knowledge scores differed over time in all three cases (p < 0.0001 for all). Knowledge retention scores were significantly higher only for cases 1 and 3. Cognitive load associated with frustration was positively associated with knowledge acquisition for case 2 (beta = 5.18, P = 0.007), while excitement was negatively associated with knowledge retention in case 1 (beta = –33.07, p = 0.04).

Conclusion

Simulation-based education for obstetric internal medicine can be effective in select cases. Attention to cognitive load and emotion may optimize learning outcomes.
Alcoholic pancreatitis
Authors: Gibbs Rebecca , Gibbs William
Published: May 2021

Alcohol misuse is a common cause of pancreatitis, both acute and chronic. Alcoholic pancreatitis can present a significant diagnostic challenge for GPs, and a high index of suspicion must be maintained to avoid delayed or missed diagnoses. Management is multi-faceted and an enduring relationship between patient and GP ensures the best patient outcomes. This article will discuss both acute and chronic alcoholic pancreatitis, the diagnosis of alcohol-induced pancreatitis in its different forms and how to create a management plan that addresses symptom control as well as improving long term patient outcomes.
Emotion Curves: Creativity and Methodological “Fit” or “Commensurability”
Authors: Donaghey Jim , Magowan Fiona
Published: May 2021

The “emotion curve” is a creative methodology that asks research participants to express in graphic form changes in their emotional responses over time, reflecting on a given time period or on a particular activity or event (in our case, music-based activities). This methodology was developed as part of our research with community music-making NGO Musicians Without Borders at their “Music Bridge” participatory music and movement training program in Derry/Londonderry, Northern Ireland. This article discusses how the “post-conflict” context of our research, and our engagement with the principles of prefiguration and participatory action research, shaped the development of this innovative methodology, paying particular attention to achieving methodological “fit” (or commensurability) with the practices, objectives, and ethos of our research partners. This creative and “fitting” (or commensurate) methodology has been the basis of a “mutually transformative dialog” with our research partners.
Thinking (and feeling) with Anthropocene (Pacific) islands
Authors: Perez Craig Santos
Published: May 2021

This commentary responds to David Chandler and Jonathan Pugh’s (2021) thought-provoking article, ‘Anthropocene Islands: There Are Only Islands After the End of the World’. It begins by highlighting the new visibility of Pacific islands and islanders in the discourses and media coverage of climate change and the Anthropocene. I argue that scholars need to be critical of reductionist representations of the Pacific and should, instead, highlight the complexities of Pacific agency, complexity, and subjectivity in order to think more fully about the Anthropocene in the Pacific. Moreover, scholars should delve into the Pacific humanities to become attuned to how Pacific Islanders are feeling the precarity and urgency of climate change.
Silencing the virus? Government communication and MMR vaccination campaigns – the Australian case
Authors: Dimitrov Roumen
Published: May 2021

In this paper I analyse a series of Australian MMR (measles-mumpsrubella) vaccination campaigns and policies from the last decade. Using the Bruno Latour’s Actor Network Theory (ATN), I locate human and non-human mediators – including the virus and vaccine – in the complex pro-vaccination alliance led by government campaigners. I identify the vaccine hesitant parents – a large group that ‘sits on the fence’ between the ‘vaccine confident’ and ‘vaccine refusing’ parents – as the main target of pro-vaccination campaigns. PR literature on pro-vaccination campaigns has applied ATN to the independence of the media as network agents. This paper contributes with the problematisation of several more actors such as the health workers, medical experts and the vaccine hesitant parents themselves. Even when they are keen members of a pro-vaccination network, they cannot be taken for granted. This is where understanding of stigma, silence and voice helps. To align their group interests and discourses, government should know how to communicate strategically – including how to communicate indirectly, avoiding stigma and keeping certain internal affinities and communicative distances intact. In conclusion, I make suggestions about strategic communication in pro-vaccination campaigns. Communication of statistical risks and side effects should be central. It is a winning strategy because it establishes a more credible balance between individual rights and collective obligations in achieving herd immunity. And mandating vaccination cannot replace communication. Research shows that legislating compulsory vaccination may have short-term and relatively small effects. They are almost negligible in the long run. Mandate may trigger compliance, but it also causes anger and mistrust. Mandating vaccine has negative side effects. It punishes with economic and cultural sanctions the socially disadvantaged, who are not active refusers. It also has the opposite effect on vaccine hesitant parents. It does not weaken but rather strengthens their resistance to the vaccine and pushes them to the lager of antivaxxers.
Resolving the conflict between traditional Islam and human rights: A comparative study of Mahmoud Mohammed Taha’s and Mohsen Kadivar’s views
Authors: Goudarzi Masoumeh Rad
Published: May 2021

In the recent decades, many Muslim intellectuals have devoted their intellectual efforts to reconstructing the jurisprudence through a new interpretation of Islam in order to solve the problem of human rights. While they have mostly tried to find a solution based on Ijtihad in derivation of Shari’a, Mahmoud Mohammad Taha and Mohsen Kadivar have asked for structural Ijtihad, presenting reversed and rational abrogation theories. In the current article, the researcher aims to focus on three main questions: Why do they believe that traditional jurisprudence and Ijtihad in derivatives are not able to solve the conflict between Islam and human rights? What are the most important governing principles in the corrective theory of each thinker, and how can their proposed theories lead to the reconciliation of Islam and human rights? And finally, what are the most fundamental principles and common features that lie in the theory of the two thinkers?
Identification of Streptococcus suis in a cat with endomyocarditis
Authors: Wood James , Reagan Krystle L , Gunther-Harrington Catherine , Sykes Jane E
Published: May 2021

Case summary

A 3-year-old neutered male domestic mediumhair cat was evaluated for a 4-month history of a fever that was responsive to pradofloxacin. A grade III/VI left parasternal systolic heart murmur was noted on examination. Findings on thoracic radiography were consistent with left-sided congestive heart failure and findings on echocardiographic examination suggested endomyocarditis. Aerobic blood cultures yielded growth of a Streptococcus species that was identified as Streptococcus suis using both matrix-associated laser desorption ionization-time of flight mass spectrometry and 16S rRNA gene sequencing. The cat was treated but clinically deteriorated and was euthanized 23 days after diagnosis.

Relevance and novel information

To our knowledge, this is the first report of S suis bacteremia, an emerging pathogen, in association with endomyocarditis in the cat. This case also highlights the role of echocardiography to document progressive hemodynamic changes as a result of valvular erosion in the course of infective endocarditis treatment and the role of blood cultures as a diagnostic tool in cats presenting with fever.
Indigenous Peoples and the Right to Education: The Dumagat Experience in the Provinces of Nueva Ecija and Aurora, in the Philippines
Authors: Eduardo Jesster P. , Gabriel Arneil G.
Published: May 2021

The Philippine historical accounts show that Indigenous Peoples (IPs) in the Philippines have long been suffering from discrimination and lack of access to Education. The IPs comprise about 10% to 20% of the Philippines’s 102.9 million total populations. The Philippine educational system’s neo-colonial background creates injustice on some cultural minorities who can attend school. For this matter, the study measures the perceptions of the Dumagats on their rights to Education. It focuses on the Dumagat communities in the provinces of Nueva Ecija and Aurora in the Philippines. By using the simple binary quantitative tool, the qualitative method of research, the application of Indigenous research methods, and critical pedagogy as analytical lens, the study found that (a) the implementation of the Philippine policies on the rights to Education as reflected on the Indigenous Peoples’ Rights Act (IPRA) of 1997 is more of a tokenism; (b) the enjoyment of the right to Education of IPs is hindered mainly by poverty; (c) English remains the widely used medium of instruction in most IP curricula; and (d) the IPs’ limited knowledge on specific provisions of IPRA related to the access to Education and culture is short of the policy ideals. The above findings necessitate change agents to start a process of pedagogical liberation. The National Commission on Indigenous Peoples (NCIP) personnel and IP teachers can play a vital role as change agents and may act to correct the historical injustices on IPs’ rights and welfare.
Identity Development and Major Choice Among Underrepresented Students Interested in STEM Majors: A Longitudinal Qualitative Analysis
Authors: McLean Kate C. , Koepf Isabella M. , Lilgendahl Jennifer P.
Published: May 2021

The present study employed a narrative identity analysis to the examination of identity development in relation to major choice for college-going emerging adults. We focused on underrepresented minorities (URMs) who expressed an interest in Science Technology Engineering and Math (STEM) majors. In a qualitative, longitudinal, case-based study of URMs at two different campuses ( n = 26), we followed their development through college over 4 years, engaging in a comprehensive analysis of their experiences, including individual differences in pathways of identity formation. Results revealed five trajectories of development that focused on the degree of certainty in major and career choice, and general psychological functioning and identity integration. Implications include the need to examine a diversity of experiences to understand the “whole person,” which includes attending to motivations and psychological well-being, along with experiences in the classroom.
Anesthetic Management for Pediatric Liver Transplantation in a Patient With Propionic Acidemia: A Case Report
Authors: Rodriguez Luis I. , Tainsh Erica J. , Varga Eliane , Mavarez Ana C.
Published: May 2021

Propionic acidemia is an inborn error of metabolism characterized by accumulation of propionic acid due to deficiency of propionyl-CoA carboxylase. Main stay of treatment focuses on reducing dietary protein. However, orthotropic liver transplantation decreases the frequency of metabolic decompensations and improves life expectancy. We report a case of a 4-year-old boy undergoing orthotropic liver transplantation to treat propionic acidemia. This case highlights the use of intraoperative monitoring of metabolic markers like urine ketones, arterial ammonia, and lactate levels as these patients are at risk for hyperammonemia and metabolic acidosis. Also, the relevance in outcomes when performing early extubation in fast-tracking recovery.
From carceral punitivism to systematic killing: The necropolitics of policing in post-Chávez Venezuela
Authors: Hanson Rebecca , Zubillaga Verónica
Published: May 2021

Since 2017, state security forces in Venezuela have been responsible for over 20% of violent deaths in the country. This represents an unprecedented period of state repression in the country’s history that demands examination. In this article, we argue that in order to understand the recent increase in violent deaths in Venezuela during the post-Chávez period, we must place at the center of our analysis the discourses and practices of an extremely privileged actor, the state, in the context of the collapse of oil prices. We propose that this upsurge of lethal violence can be understood within the historical process of militarization of citizen security. In the first phase, starting in 2009, we see an increase in carceral punitivism—the hyperreaction of the penal state. In the second, a new stage in militarized raids is launched which, over the years, gave way to a practice of systematic extralegal killings that became the fundamental strategy of social control. These raids represent a necropolitical approach to governance in a context of extreme economic and political crisis.
Impact of Bi Doping into Boron Nitride Nanosheets on Electronic and Optical Properties Using Theoretical Calculations and Experiments
Authors: Ikram Muhammad , Wakeel Muhammad , Hassan Jahanzeb , Haider Ali , Naz Sadia , Ul-Hamid Anwar , Haider Junaid , Ali Salamat , Goumri-Said Souraya , Kanoun Mohammed Benali
Published: May 2021

In the present work, boron nitride (BN) nanosheets were prepared through bulk BN liquid phase exfoliation while various wt. ratios (2.5, 5, 7.5 and 10) of bismuth (Bi) were incorporated as dopant using hydrothermal technique. Our findings exhibit that the optical investigation showed absorption spectra in near UV region. Density functional theory calculations indicate that Bi doping has led to various modifications in the electronic structures of BN nanosheet by inducing new localized gap states around the Fermi level. It was found that bandgap energy decrease with the increase of Bi dopant concentrations. Therefore, in analysis of the calculated absorption spectra, a redshift has been observed in the absorption edges, which is consistent with the experimental observation. Additionally, host and Bi-doped BN nanosheets were assessed for their catalytic and antibacterial potential. Catalytic activity of doped free and doped BN nanosheets was evaluated by assessing their performance in dye reduction/degradation process. Bactericidal activity of Bi-doped BN nanosheets resulted in enhanced efficiency measured at 0–33.8% and 43.4–60% against S. aureus and 0–38.8% and 50.5–85.8% against E. coli, respectively. Furthermore, In silico molecular docking predictions were in good agreement with in-vitro bactericidal activity. Bi-doped BN nanosheets showed good binding score against DHFR of E. coli (− 11.971 kcal/mol) and S. aureus (− 8.526 kcal/mol) while binding score for DNA gyrase from E. coli (− 6.782 kcal/mol) and S. aureus (− 7.819 kcal/mol) suggested these selected enzymes as possible target.
Risk factors associated with functional dyspepsia in Chinese children: a cross-sectional study
Authors: Wei Zhongcao , Yang Xing , Xing Xin , Dong Lei , Wang Jinhai , Qin Bin
Published: May 2021

Background

There is no study assessing the risk factors associated with functional dyspepsia (FD) in Chinese children based on the Rome IV criteria.

Methods

In this cross-sectional study, we analyzed data from eight representative primary and secondary schools to assess the risk factors associated with FD in Chinese children based on the Rome IV criteria.

Results

A total of 6976 Chinese children were enrolled. The mean age was 14.3 ± 2.5 years, with a range from 7 to 17 years, and 3497 (50.1%) participants were female. FD was prevalent in 209 (3.0%) of the Chinese child population studied. Age (OR = 1.112, P = 0.006), living independent of parents (OR = 1.677, P < 0.001), prolonged school meals (OR = 2.107, P < 0.001), never eat breakfast (OR = 2.192, P = 0.003), often/daily eat cold foods (OR = 2.296, P = 0.002; OR = 2.736, P = 0.011), and often eat pickled foods (OR = 2.390, P = 0.001) were found to be independent risk factors for FD. A nomogram with these risk factors had good discrimination (AUC = 0.727) and calibration (Hosmer–Lemeshow test was 0.851).

Conclusions

Age, living independent of parents, prolonged school meals, never eat breakfast, often/daily eat cold foods and often eat pickled foods were independent risk factors for FD. The nomogram could be used as a quick screening tool to assess FD in Chinese children.
Efficacy and safety of selective internal radiation therapy with yttrium-90 for the treatment of unresectable hepatocellular carcinoma
Authors: Van Thai Nguyen , Thinh Nguyen Tien , Ky Thai Doan , Bang Mai Hong , Giang Dinh Truong , Ha Le Ngoc , Son Mai Hong , Tien Dao Duc , Lee Hyun Woong
Published: May 2021

Background

This retrospective analysis was undertaken to evaluate the efficiency of SIRT with Y-90 microspheres and determined prognostic factors affecting patients with unresectable HCC.

Methods

A total of 97 patients diagnosed with unresectable HCC who underwent SIRT with Y-90 microspheres. Patient survival was assessed using the Kaplan–Meier method, and prognostic factors affecting survival were assessed using log-rank tests and Cox proportional hazards regression.

Results

Among the 97 patients (90 males, mean age 60.4 ± 12.3 years) who underwent SIRT, the median clinical follow-up was 16.4 (1.8–62) months. The median overall survival (OS) was 23.9 ± 2.4 months. Tumor response according to the Modified RECIST in patients followed up beyond 6 months included a complete response (CR) to treatment in 12 patients (18.8%), partial response (PR) in 23 (35.8%), stable disease (SD) in 8 (12.5%), and progressive disease (PD) in 21 (32.8%). Factors associated with longer OS included age > 65 years, BCLC stage B, tumor size < 5 cm, tumor burden < 25%, and tumor response (CR/PR). In multivariate analysis, unilobar disease and objective tumor response (CR/PR) were predictors of longer OS.

Conclusion

SIRT was an effective treatment for unresectable HCC. Unilobar disease before SIRT and tumor response (CR/PR) were positive prognostic factors.
Colon cancer survival differs from right side to left side and lymph node harvest number matter
Authors: Mangone Lucia , Pinto Carmine , Mancuso Pamela , Ottone Marta , Bisceglia Isabella , Chiaranda Giorgio , Michiara Maria , Vicentini Massimo , Carrozzi Giuliano , Ferretti Stefano , Falcini Fabio , Hassan Cesare , Rossi Paolo Giorgi
Published: May 2021

Background

Right-sided colorectal cancer (CRC) has worse survival than does left-sided CRC. The objective of this study was to further assess the impact of right-side location on survival and the role of the extent of lymphadenectomy.

Methods

All CRCs diagnosed between 2000 and 2012 in Emilia-Romagna Region, Italy, were included. Data for stage, grade, histology, screening history, and number of removed lymph nodes (LN) were collected. Multivariable Cox regression models were used to estimate hazard ratios (HR), with relative 95% confidence intervals (95%CI), of right vs. left colon and of removing < 12, 12–21 or > 21 lymph nodes by cancer site.

Results

During the study period, 29,358 patients were registered (8828 right colon, 18,852 left colon, 1678 transverse). Patients with right cancer were more often older, females, with advanced stage and high grade, and higher number of removed LNs. Five-year survival was lower in the right than in the left colon (55.2% vs 59.7%). In multivariable analysis, right colon showed a lower survival when adjusting for age, sex, and screening status (HR 1.12, 95%CI 1.04–1.21). Stratification by number of lymph nodes removed (12–21 or > 21) was associated with better survival in right colon (HR 0.54, 95%CI 0.40–0.72 and HR 0.40, 95%CI 0.30–0.55, respectively) compared to left colon (HR 0.89, 95%CI 0.76–1.06 and HR 0.83, 95%CI 0.69–1.01, respectively).

Conclusions

This study confirms that right CRC has worse survival; the association is not due to screening status. An adequate removal of lymph nodes is associated with better survival, although the direction of the association in terms of causal links is not clear.
Lived experiences of people living with HIV: a descriptive qualitative analysis of their perceptions of themselves, their social spheres, healthcare professionals and the challenges they face daily
Authors: Senyurek Gamze , Kavas Mustafa Volkan , Ulman Yesim Isil
Published: May 2021

Background

Human immunodeficiency virus (HIV) infection rates have been gradually increasing in Istanbul, Turkey. Many people living with HIV (PLWH) here encounter difficulties, for example, in adapting to the chronic disease and obtaining continuous access to healthcare services. In this study, we aimed to explore the challenges PLWH face in their daily lives and understand their perceptions of themselves, healthcare professionals and services, and their social spheres via their expressed lived experiences in the healthcare setting.

Method

Individual semi-structured in-depth interviews were conducted face-to-face with 20 PLWH in Istanbul. All the interviews were voice-recorded and transcribed verbatim except one, upon participant request, for which the interviewer took notes. These logs and the interviewer’s notes were analyzed thematically using the inductive content analysis method.

Results

The themes concerned experiences in three distinct contexts: 1) Interactions with healthcare providers; 2) Participants’ responses to their HIV diagnosis; and 3) Interactions with their social networks. Firstly, the results highlighted that the participants perceived that healthcare professionals did not inform them about the diagnosis properly, failed to protect patients’ confidentiality and exhibited discriminative behaviors towards them. Secondly, after the diagnosis the participants had difficulty in coping with their unsettled emotional state. While many ceased sexual activities and isolated themselves, some sought support. Lastly, living with HIV affected their relationships with their families and friends either positively or negatively. Moreover, they had to face the difficulties concerning spouse/partner notification issues about which many needed professional support.

Conclusion

Healthcare professionals’ discriminative or inappropriate attitudes and customs in healthcare institutions are perceived to impair PLWH’s utilization of healthcare services. Structural factors such as social pressure, societal ignorance about HIV, limited access to HIV prevention, and regulatory barriers might contribute to these challenges. The results suggest that it is necessary to raise healthcare professionals’ and society’s awareness about HIV and develop national policies to establish a well-functioning referral system and appropriate spouse/partner notification services.
Effects of the surface charge of polyamidoamine dendrimers on cellular exocytosis and the exocytosis mechanism in multidrug-resistant breast cancer cells
Authors: Zhang Jie , Li Mingjuan , Wang Mingyue , Xu Hang , Wang Zhuoxiang , Li Yue , Ding Baoyue , Gao Jianqing
Published: May 2021

Background

Polyamidoamine (PAMAM) dendrimer applications have extended from tumor cells to multidrug-resistant tumor cells. However, their transportation in multidrug-resistant tumor cells remains unclear. Herein, we investigated the exocytosis rule and mechanism of PAMAM dendrimers in multidrug-resistant tumor cells.

Results

Using a multidrug-resistant human breast cancer cell model (MCF-7/ADR), we performed systematic analyses of the cellular exocytosis dynamics, pathways and mechanisms of three PAMAM dendrimers with different surface charges: positively charged PAMAM-NH2, neutral PAMAM-OH and negatively charged PAMAM-COOH. The experimental data indicated that in MCF-7/ADR cells, the exocytosis rate was the highest for PAMAM-NH2 and the lowest for PAMAM-OH. Three intracellular transportation processes and P-glycoprotein (P-gp) participated in PAMAM-NH2 exocytosis in MCF-7/ADR cells. Two intracellular transportation processes, P-gp and multidrug resistance (MDR)-associated protein participated in PAMAM-COOH exocytosis. P-gp and MDR-associated protein participated in PAMAM-OH exocytosis. Intracellular transportation processes, rather than P-gp and MDR-associated protein, played major roles in PAMAM dendrimer exocytosis. PAMAM-NH2 could enter MCF-7/ADR cells by forming nanoscale membrane holes, but this portion of PAMAM-NH2 was eliminated by P-gp. Compared with PAMAM-OH and PAMAM-COOH, positively charged PAMAM-NH2 was preferentially attracted to the mitochondria and cell nuclei. Major vault protein (MVP) promoted exocytosis of PAMAM-NH2 from the nucleus but had no effect on the exocytosis of PAMAM-OH or PAMAM-COOH.

Conclusions

Positive charges on the surface of PAMAM dendrimer promote its exocytosis in MCF-7/ADR cells. Three intracellular transportation processes, attraction to the mitochondria and cell nucleus, as well as nuclear efflux generated by MVP led to the highest exocytosis observed for PAMAM-NH2. Our findings provide theoretical guidance to design a surface-charged tumor-targeting drug delivery system with highly efficient transfection in multidrug-resistant tumor cells. Especially, to provide more DNA to the nucleus and enhance DNA transfection efficiency in multidrug-resistant tumor cells using PAMAM-NH2, siRNA-MVP or an inhibitor should be codelivered to decrease MVP-mediated nuclear efflux.

Graphical abstract
Reliability of generic quality-of-life instruments in assessing health-related quality of life among children and adolescents with idiopathic nephrotic syndrome: a systematic review
Authors: Aronu Ann E. , Uwaezuoke Samuel N. , Muoneke Uzoamaka V.
Published: May 2021

Introduction

Most of the studies reporting the negative impact of idiopathic nephrotic syndrome on health-related quality of life in children and adolescents were conducted with generic quality-of-life instruments rather than disease-specific instruments. The consistency of these studies' findings using these generic instruments is not well established.

Aim

This systematic review aims to determine the reliability of current generic quality-of-life instruments in assessing health-related quality of life among children and adolescents with idiopathic nephrotic syndrome.

Methods

We searched the PubMed, MEDLINE, EMBASE, and Google Scholar databases for articles published between 2000 and 2020, using appropriate descriptors. We included primary studies that met the eligibility criteria, independently screened their titles and abstracts, and removed all duplicates during the study-selection process. We resolved disagreements until a consensus was reached on study selection. We independently retrieved relevant data, including the generic quality-of-life instruments and the subjects’ and controls’ aggregate health-related quality of life scores, using a preconceived data-extraction form.

Results

Ten original articles were selected for qualitative and quantitative analyses. Some of the studies reported the following significant findings. The mean health-related quality of life scores for children with prevalent and incident nephrotic syndrome were 68.6 (range, 52.6–84.6) and 73.7 (range, 55.9–91.5), respectively. Children with idiopathic nephrotic syndrome and their controls with other chronic diseases had median scores of 65 (interquartile range, 59–68.75) and 62.2 (interquartile range, 58.05–65.78). Patients on oral immunosuppressive drug and intravenous rituximab reportedly had median scores of 76.2 and 72.6 and mean scores of 71.4 (range, 55.4–87.4) and 61.6 (range, 42.1–81.1) respectively for quality-of-life assessment on the ‘school functioning domain.’

Conclusions

The health-related quality of life scores in patients with idiopathic nephrotic syndrome are consistently low. Lower scores occur in prolonged disease duration and severe clinical phenotypes, whereas the scores are higher than the scores obtained in other chronic diseases. These consistent findings underscore the reliability of the current generic instruments in assessing health-related quality of life in patients with idiopathic nephrotic syndrome.
Migrant physicians’ choice of employment and the medical specialty general practice: a mixed-methods study
Authors: Sturesson Linda , Palmgren Per J. , Öhlander Magnus , Nilsson Gunnar H. , Stenfors Terese
Published: May 2021

Objective

In many countries, migrant physicians (MP) tend to fill staff shortages in medical specialties perceived as low status. The aim of this study was to explore aspects that influence MPs’, with a medical degree from outside EU/EEA, choice of employment and medical specialty in Sweden, and to explore and understand a potential over-representation in general practice (family medicine), a specialty suffering from staff shortages in Sweden.

Methods

A mixed-methods approach was applied. This included questionnaire data from 101 MPs training and working as medical specialists in Sweden and semi-structured interview data from four MPs specializing in general practice.

Results

Regardless of specialty, the most influential aspects when choosing employment were the ability to combine work with family, to develop one´s competence, and to have highly competent colleagues. Women scored higher on some aspects related to private life and the surroundings. More than half (55%) of the respondents specialized in general practice, and more women than men. The MPs in general practice scored higher on the aspect ‘ability to have the same patients for a longer period’ than MPs specializing in other specialties. No significant difference between MP general practitioner respondents and MPs in other medical specialties was found in relation to the item ‘Was the specialty your first choice?ʼ. Aspects identified in the interviews that influenced the choice to specialize in general practice related to job opportunities, positive experiences of primary health care, working conditions, and family conditions.

Conclusion

Labour market conditions such as high competition, and the time-consuming recertification process, can influence the choice to specialize in general practice as this reduces the time to become a medical specialist. We however did not find any results indicating that MPs’ decision to specialize in general practice and to work as general practitioners was any less voluntary than that of MPs who chose other specialties.
Barriers and facilitators to online medical and nursing education during the COVID-19 pandemic: perspectives from international students from low- and middle-income countries and their teaching staff
Authors: Li Wen , Gillies Robyn , He Mingyu , Wu Changhao , Liu Shenjun , Gong Zheng , Sun Hong
Published: May 2021

Background

The COVID-19 pandemic posed a huge challenge to the education systems worldwide, forcing many countries to provisionally close educational institutions and deliver courses fully online. The aim of this study was to explore the quality of the online education in China for international medical and nursing students from low- and middle-income countries (LMICs) as well as the factors that influenced their satisfaction with online education during the COVID-19 pandemic.

Methods

Questionnaires were developed and administered to 316 international medical and nursing students and 120 teachers at a university in China. The Chi-square test was used to detect the influence of participants’ personal characteristics on their satisfaction with online education. The Kruskal–Wallis rank-sum test was employed to identify the negative and positive factors influencing the online education satisfaction. A binary logistic regression model was performed for multiple-factor analysis to determine the association of the different categories of influential factors—crisis-, learner-, instructor-, and course-related categories, with the online education satisfaction.

Results

Overall, 230 students (response rate 72.8%) and 95 teachers (response rate 79.2%) completed the survey. It was found that 36.5% of students and 61.1% of teachers were satisfied with the online education. Teachers’ professional title, students’ year of study, continent of origin and location of current residence significantly influenced the online education satisfaction. The most influential barrier for students was the severity of the COVID-19 situation and for teachers it was the sense of distance. The most influential facilitating factor for students was a well-accomplished course assignment and for teachers it was the successful administration of the online courses.

Conclusions

Several key factors have been identified that affected the attitudes of international health science students from LMICs and their teachers towards online education in China during the COVID-19 pandemic. To improve the online education outcome, medical schools are advised to promote the facilitating factors and cope with the barriers, by providing support for students and teaching faculties to deal with the anxiety caused by the pandemic, caring for the state of mind of in-China students away from home, maintaining the engagement of out-China students studying from afar and enhancing collaborations with overseas institutions to create practice opportunities at students’ local places.
Age, gender, height and weight in relation to joint cartilage thickness among school-aged children from ultrasonographic measurement
Authors: Gau Chun-Chun , Yao Tsung-Chieh , Gan Shu-Ting , Lin Syh-Jae , Yeh Kuo-Wei , Chen Li-Chen , Ou Liang- Shiou , Lee Wen-I , Wu Chao-Yi , Huang Jing-Long
Published: May 2021

Background

Among school-age children, the decrease of cartilage thickness (Cth) with increasing age is well known. However, the influence of body mass index (BMI), height or weight on Cth has not been revealed. Here in, we aim to establish an age- and gender-specific Cth standard reference among Asians and investigate the possible prestige of BMI, height and weight.

Methods

A cross-sectional study was performed in healthy Asian children. Bilateral knees, ankles, wrists, second metacarpophalangeals (MCPs) and proximal interphalangeals (PIPs) were measured using ultrasound. The children’s height, weight and BMI were also recorded for later adjustment.

Results

A total of 200 school age Asian children (including 86 girls and 114 boys, aged between 5 to 13 years-old) were investigated. Cth differences were observed in the knees, ankles, wrists, MCPs and PIPs between sexes (p < 0.05), with girls having thinner cartilage thickness. While Cth decreases with increasing age (p < 0.0001, 0.039, 0.001, 0.023, 0.091 in girls’ knees, ankles, wrists, MCPs and PIPs and p = 0.002, 0.001, < 0.0001, 0.001, 0.045 in boys’, respectively). Our data showed that weight, height and BMI are not the main factors contributing to Cth. A formula to calculate gender-specific cartilage thickness for Asian school age children is suggested. There was no difference in Cth after adjusting for height or weight between Asian or Caucasian group.

Conclusions

A formula to calculate gender-specific cartilage thickness for Asian school age children is suggested. Height, weight and BMI were not the major contributor for Cth among school age children.
A bibliometric review of oncolytic virus research as a novel approach for cancer therapy
Authors: Mozaffari Nejad Amir Sasan , Noor Tehjeeb , Munim Ziaul Haque , Alikhani Mohammad Yousef , Ghaemi Amir
Published: May 2021

Background

In recent years, oncolytic viruses (OVs) have drawn attention as a novel therapy to various types of cancers, both in clinical and preclinical cancer studies all around the world. Consequently, researchers have been actively working on enhancing cancer therapy since the early twentieth century. This study presents a systematic review of the literature on OVs, discusses underlying research clusters and, presents future directions of OVs research.

Methods

A total of 1626 published articles related to OVs as cancer therapy were obtained from the Web of Science (WoS) database published between January 2000 and March 2020. Various aspects of OVs research, including the countries/territories, institutions, journals, authors, citations, research areas, and content analysis to find trending and emerging topics, were analysed using the bibliometrix package in the R-software.

Results

In terms of the number of publications, the USA based researchers were the most productive (n = 611) followed by Chinese (n = 197), and Canadian (n = 153) researchers. The Molecular Therapy journal ranked first both in terms of the number of publications (n = 133) and local citations (n = 1384). The most prominent institution was Mayo Clinic from the USA (n = 117) followed by the University of Ottawa from Canada (n = 72), and the University of Helsinki from Finland (n = 63). The most impactful author was Bell J.C with the highest number of articles (n = 67) and total local citations (n = 885). The most impactful article was published in the Cell journal. In addition, the latest OVs research mainly builds on four research clusters.

Conclusion

The domain of OVs research has increased at a rapid rate from 2000 to 2020. Based on the synthesis of reviewed studies, adenovirus, herpes simplex virus, reovirus, and Newcastle disease virus have shown potent anti-cancer activity. Developed countries such as the USA, Canada, the UK, and Finland were the most productive, hence, contributed most to this field. Further collaboration will help improve the clinical research translation of this therapy and bring benefits to cancer patients worldwide.