bluuebunny/crossref_metadata_2025 huggingface dataset:
Beijing Friendship Hospital Osteoporosis Self-Assessment Tool for Elderly Male (BFH-OSTM) vs Fracture Risk Assessment Tool (FRAX) for identifying painful new osteoporotic vertebral fractures in older Chinese men: a cross-sectional study
Authors: An Ning , Lin Ji Sheng , Fei Qi
Published: June 2021

Background

To compare the validation of four tools for identifying painful new osteoporotic vertebral compression fractures (PNOVCFs) in older Chinese men: bone mineral density (BMD), Asian osteoporosis self-assessment tool (OSTA), World Health Organization fracture risk assessment tool (FRAX) (without BMD) and Beijing Friendship Hospital Osteoporosis Self-Assessment Tool (BFH-OSTM).

Methods

A cross sectional study was conducted from 2013 to 2019. A total of 846 men aged ≥50 were included and were divided into two groups: Fracture Group (patients with PNOVCFs underwent percutaneous vertebroplasty surgery) and Non-Fracture Group (community dwelled subjects for healthy examination). All subjects accepted a dual-energy X-ray BMD test and a structured questionnaire. The results of BMD, OSTA, FRAX and BFH-OSTM scores were assessed and receiver-operating characteristic (ROC) curves were generated to compare the validity of four tools for identifying PNOVCFs. Optimal cutoff points, sensitivity, specificity, and areas under the ROC curves (AUCs) were determined.

Results

There were significant differences including BMD T score (femoral neck, total hip and L1-L4), OSTA, FRAX and BFH-OSTM scores between Fracture group and Non-fracture group. Compared to BMD and OSTA, BFH-OSTM and FRAX had better predictive value, the sensitivity, specificity and AUC value are 0.841, 81.29%, 70.67% and 0.796, 74.85%, 78.52%, respectively. Compared with FRAX, the BFH-OSTM has a better AUC value.

Conclusions

Both BFH-OSTM and FRAX can be used to identify POVCFs, However, BFH-OSTM model may be a more simple and effective tool to identify the risk of POVCFs in Chinese elderly men.
Deferred Action for Childhood Arrivals (DACA) medical students – an examination of their journey and experiences as medical students in limbo
Authors: Gillezeau Christina , Lieberman-Cribbin Wil , Bevilacqua Kristin , Ramos Julio , Alpert Naomi , Flores Raja , Schwartz Rebecca M. , Taioli Emanuela
Published: June 2021

Background

Although the value of DACA medical students has been hypothesized, no data are available on their contribution to US healthcare. While the exact number of DACA recipients in medical school is unknown, DACA medical students are projected to represent an increasing proportion of physicians in the future. The current literature on DACA students has not analyzed the experiences of these students.

Methods

A mixed-methods study on the career intentions and experiences of DACA medical students was performed utilizing survey data and in-depth interviews. The academic performance of a convenience sample of DACA medical students was compared to that of matriculated medical students from corresponding medical schools, national averages, and first-year residents according to specialty.

Results

Thirty-three DACA medical students completed the survey and five participated in a qualitative interview. The average undergraduate GPA (SD) of the DACA medical student sample was 3.7 (0.3), the same as the national GPA of 2017–2018 matriculated medical students. The most common intended residency programs were Internal Medicine (27.2%), Emergency Medicine (15.2%), and Family Medicine (9.1%). In interviews, DACA students discussed their motivation for pursuing medicine, barriers and facilitators that they faced in attending medical school, their experiences as medical students, and their future plans.

Conclusions

The intent of this sample to pursue medical specialties in which there is a growing need further exemplifies the unique value of these students. It is vital to protect the status of DACA recipients and realize the contributions that DACA physicians provide to US healthcare.
Discharge transition experienced by older Korean women after hip fracture surgery: a qualitative study
Authors: Ko Young Ji , Lee Ju Hee , Baek Seung-Hoon
Published: June 2021

Background

This study aimed to explore older Korean women’s discharge transition experiences after hip fracture surgery.

Methods

This was a descriptive qualitative study. Face-to-face interviews following hip fracture surgery were conducted on 12 women aged 65–87 years. Data were collected 1 to 2 days before discharge and again 4 weeks after discharge following hip fracture surgery, and were analyzed using qualitative content analysis.

Results

Four main themes were identified: (1) challenge of discharge transition: unprepared discharge, transfer into other care settings, and eagerness for recovery; (2) physical and psychological distress against recovery: frail physical state and psychological difficulties; (3) dependent compliance: absolute trust in healthcare providers, indispensable support from the family, and passive participation in care; and (4) walking for things they took for granted: hope of walking and poor walking ability.

Conclusions

After their hip fracture surgeries, older women hoped to be able to walk and perform simple daily chores they previously took for granted. Considering the physical and psychological frailty of older women undergoing hip surgery, systematic nursing interventions including collaboration and coordination with other healthcare professionals and settings are necessary to ensure the quality of continuous care during their post-surgery discharge transition. Encouraging partial weight bearing and initiating intervention to reduce fear of falling at the earliest possible time are essential to attain a stable discharge transition. Additionally, older women should be invited to participate in their care, and family involvement should be encouraged during the discharge transition period in South Korea.
The health service use of aged rural-to-urban migrant workers in different types of cities in China
Authors: Xie Yating , Guo Qiuju , Meng Yang
Published: June 2021

Background

The association between different types of cities and the use of health services by aged migrant workers in China has not been widely reported in previous studies. This article aims to focus on rural-to-urban migrant workers in China aged 50 years and older to examine the relationship between the region of these migrant workers’ destination city (eastern, central or western) and migration city type (first-tier, second-tier, third-tier and smaller cities) and their use of health services (e.g., establishing health records, participating in health education, and seeking medical treatment when ill).

Methods

This study’s data were obtained from China Migrants Dynamic Survey in 2017. A total of 14,732 rural-to-urban migrant workers aged 50 years and older were included in the analysis; 6,938 of the migrant workers were either ill or had recently experienced physical discomfort. A chi-square test and binary logistic regression were performed to explore the associations between these rural–urban migrants’ destination cities and their use of health services.

Results

This study found that aged rural migrant workers who moved to the east or to first- or second-tier cities were less likely to establish health records, participate in health education programme, and seek medical care.

Conclusions

Migrant destination cities are linked to the use of local health services by migrant workers aged 50 years and older in China. We found that aged migrant workers who migrated to relatively developed regions and cities accessed fewer health services. Such results signify that more attention should be paid to aged migrant workers’ use of health services in economically developed regions and cities, to eliminate regional differences in healthcare inequality.
Effect of probiotic fermented dairy products on incidence of respiratory tract infections: a systematic review and meta-analysis of randomized clinical trials
Authors: Rashidi Kamil , Razi Bahman , Darand Mina , Dehghani Azadeh , Janmohammadi Parisa , Alizadeh Shahab
Published: June 2021

Background

Previous studies have suggested that the consumption of probiotic fermented dairy products (PFDP) may have a protective effect on respiratory tract infections (RTIs). However, the results of studies are inconclusive. We aimed to systematically investigate the effect of PFDP on RTIs by performing a meta-analysis of randomized controlled trials (RCTs).

Methods

PubMed and Scopus databases were systematically searched up to October 2020 to identify eligible RCTs. Meta-analysis outcomes were risk of incidence of upper (URTIs ) and lower (LRTIs ) respiratory tract infections. A random-effects model was used to pool the relative risks (RR) and corresponding 95 % confidence intervals (CI) for outcomes following conception of PFDP.

Results

A total of 22 RCTs, with a total sample size of 10,190 participants, were included in this meta-analysis. Compared with placebo, consumption of PFDP had a significant protective effect against RTIs in the overall analysis (RR = 0.81, 95 %CI: 0.74 to 0.89) and in children (RR = 0.82, 95 %CI: 0.73 to 0.93), adults (RR = 0.81, 95 %CI: 0.66 to 1.00), and elderly population (RR = 0.78, 95 %CI: 0.61 to 0.98). The significant decreased risk of RTIs was also observed for URTIs (RR = 0.83, 95 %CI: 0.73 to 0.93), while, this effect was marginal for LRTIs (RR = 0.78, 95 %CI: 0.60 to 1.01, P = 0.06). The disease-specific analysis showed that PFDP have a protective effect on pneumonia (RR = 0.76, 95 %CI: 0.61 to 0.95) and common cold (RR = 0.68, 95 %CI: 0.49 to 0.96).

Conclusions

Consumption of PFDP is a potential dietary approach for the prevention of RTIs.
“Association between dietary inflammatory index (DII) and risk of irritable bowel syndrome: a case-control study”
Authors: Eslampour Elham , Ghanadi Koroush , Aghamohammadi Vahideh , Kazemi Alireza Moayed , Mohammadi Rasool , Vahid Farhad , Abbasnezhad Amir
Published: June 2021

Background

Pathophysiology of IBS is not well recognized; however, several studies have shown the possible relationship between diet and risk of IBS. We assessed the ability of the dietary inflammatory index (DII) to predict the risk of IBS.

Methods

The subjects were 155 IBS cases and 310 age- and sex-matched healthy controls (aged ≥18 years). The participants were recruited from June, 2019 to March, 2020. IBS was recognized using the Rome IV criteria. DII score was computed based on dietary intake using a 168-item FFQ. The DII score was calculated based on energy-adjusted amounts of nutrients using residual method. Logistic regression models were used to estimate multivariable odds ratios (ORs).

Results

The mean DII score was significantly higher among IBS patients in comparison to healthy controls (0.78 ± 2.22 vs. − 0.39 ± 2.27). In crude model, increase in DII as continuous variable was associated with a significant increase in the risk of IBS (OR (95% CI): 1.26 (1.1–15.38)). Furthermore, the association remained significant even after adjusting for age and sex (OR (95% CI): 1.28 (1.1–17.41)) and after multivariate adjustment (OR (95% CI): 1.38 (1.2–1.56)). In crude, age and sex adjusted and multivariate-adjusted models subjects in fourth quartile of DII had higher OR in comparison to subjects in first quartile.

Conclusions

This study showed a possible positive association between a pro-inflammatory diet and the risk of IBS. Thus, encouraging intake of more anti-inflammatory dietary factors and reducing intake of pro-inflammatory factors may be a strategy for reducing risk of IBS.
Smek1 deficiency exacerbates experimental autoimmune encephalomyelitis by activating proinflammatory microglia and suppressing the IDO1-AhR pathway
Authors: Duan Ruo-Nan , Yang Chun-Lin , Du Tong , Liu Ai , Wang An-Ran , Sun Wen-Jie , Li Xi , Li Jiang-Xia , Yan Chuan-Zhu , Liu Qi-Ji
Published: June 2021

Background

Experimental autoimmune encephalomyelitis (EAE) is an animal disease model of multiple sclerosis (MS) that involves the immune system and central nervous system (CNS). However, it is unclear how genetic predispositions promote neuroinflammation in MS and EAE. Here, we investigated how partial loss-of-function of suppressor of MEK1 (SMEK1), a regulatory subunit of protein phosphatase 4, facilitates the onset of MS and EAE.

Methods

C57BL/6 mice were immunized with myelin oligodendrocyte glycoprotein 35-55 (MOG35-55) to establish the EAE model. Clinical signs were recorded and pathogenesis was investigated after immunization. CNS tissues were analyzed by immunostaining, quantitative polymerase chain reaction (qPCR), western blot analysis, and enzyme-linked immunosorbent assay (ELISA). Single-cell analysis was carried out in the cortices and hippocampus. Splenic and lymph node cells were evaluated with flow cytometry, qPCR, and western blot analysis.

Results

Here, we showed that partial Smek1 deficiency caused more severe symptoms in the EAE model than in controls by activating myeloid cells and that Smek1 was required for maintaining immunosuppressive function by modulating the indoleamine 2,3-dioxygenase (IDO1)-aryl hydrocarbon receptor (AhR) pathway. Single-cell sequencing and an in vitro study showed that Smek1-deficient microglia and macrophages were preactivated at steady state. After MOG35-55 immunization, microglia and macrophages underwent hyperactivation and produced increased IL-1β in Smek1-/+ mice at the peak stage. Moreover, dysfunction of the IDO1-AhR pathway resulted from the reduction of interferon γ (IFN-γ), enhanced antigen presentation ability, and inhibition of anti-inflammatory processes in Smek1-/+ EAE mice.

Conclusions

The present study suggests a protective role of Smek1 in autoimmune demyelination pathogenesis via immune suppression and inflammation regulation in both the immune system and the central nervous system. Our findings provide an instructive basis for the roles of Smek1 in EAE and broaden the understanding of the genetic factors involved in the pathogenesis of autoimmune demyelination.
Characterisation of a highly potent and near pan-neutralising anti-HIV monoclonal antibody expressed in tobacco plants
Authors: Moore Catherine M. , Grandits Melanie , Grünwald-Gruber Clemens , Altmann Friedrich , Kotouckova Maria , Teh Audrey Y.-H. , Ma Julian K.-C.
Published: June 2021

Background

HIV remains one of the most important health issues worldwide, with almost 40 million people living with HIV. Although patients develop antibodies against the virus, its high mutation rate allows evasion of immune responses. Some patients, however, produce antibodies that are able to bind to, and neutralise different strains of HIV. One such ‘broadly neutralising’ antibody is ‘N6’. Identified in 2016, N6 can neutralise 98% of HIV-1 isolates with a median IC50 of 0.066 µg/mL. This neutralisation breadth makes N6 a very promising therapeutic candidate.

Results

N6 was expressed in a glycoengineered line of N. benthamiana plants (pN6) and compared to the mammalian cell-expressed equivalent (mN6). Expression at 49 mg/kg (fresh leaf tissue) was achieved in plants, although extraction and purification are more challenging than for most plant-expressed antibodies. N-glycoanalysis demonstrated the absence of xylosylation and a reduction in α(1,3)-fucosylation that are typically found in plant glycoproteins. The N6 light chain contains a potential N-glycosylation site, which was modified and displayed more α(1,3)-fucose than the heavy chain. The binding kinetics of pN6 and mN6, measured by surface plasmon resonance, were similar for HIV gp120. pN6 had a tenfold higher affinity for FcγRIIIa, which was reflected in an antibody-dependent cellular cytotoxicity assay, where pN6 induced a more potent response from effector cells than that of mN6. pN6 demonstrated the same potency and breadth of neutralisation as mN6, against a panel of HIV strains.

Conclusions

The successful expression of N6 in tobacco supports the prospect of developing a low-cost, low-tech production platform for a monoclonal antibody cocktail to control HIV in low-to middle income countries.

Graphic abstract
Impact of joint management of a COVID-19 mother and her newborn on the virus transmission: a case report
Authors: De Nardo Maria Chiara , Bellomo Anna Rita , Perfetti Francesca , Battaglia Francesco Antonino , Lichtner Miriam , Lubrano Riccardo
Published: June 2021

Background

Since last year, COVID-19, the disease caused by the novel Sars-Cov-2 virus, has been globally spread to all the world. COVID-19 infection among pregnant women has been described. However, transplacental transmission of Sars-Cov-2 virus from infected mother to the newborn is not yet established. The appropriate management of infants born to mothers with confirmed or suspected COVID-19 and the start of early breastfeeding are being debated.

Case presentation

We report a case of the joint management of a healthy neonate with his mother tested positive for Covid-19 before the delivery and throughout neonatal follow-up. The infection transmission from the mother to her baby is not described, even after a long period of contact between them and breastfeeding.

Conclusion

It may consider an appropriate practice to keep mother and her newborn infant together in order to facilitate their contact and to encourage breastfeeding, although integration with infection prevention measures is needed.
Expression of miR-195 and its target gene Bcl-2 in human intervertebral disc degeneration and their effects on nucleus pulposus cell apoptosis
Authors: Lin Xue-Lin , Zheng Zhao-Yun , Zhang Qing-Shan , Zhang Zhen , An You-Zhi
Published: June 2021

Objective

To investigate the expression of miR-195 and its target gene Bcl-2 in intervertebral disc degeneration (IVDD) and its effect on nucleus pulposus (NP) cell apoptosis.

Methods

The expressions of miR-195 and Bcl-2 in NP tissues of IVDD patients were quantified by qRT-PCR and western blotting, respectively. NP cells were divided into blank group, TNF-α group, TNF-α + miR-NC group, TNF-α + siBcl-2 group, and TNF-α + miR-195 inhibitors + siBcl-2 group. Cell proliferation was detected by MTT assay, cell apoptosis evaluated by flow cytometry, and mitochondrial membrane potential (MMP) tested by JC-1 staining. Moreover, the function of miR-195 on IVDD in vivo was investigated using a puncture-induced IVDD rat model.

Results

IVDD patients had significantly increased miR-195 expression and decreased Bcl-2 protein expression in NP tissues. The expression of miR-195 was negatively correlated with the expression of Bcl-2 in IVDD patients. Dual-luciferase reporter gene assay indicated that Bcl-2 was a target gene of miR-195. In comparison with blank group, TNF-α group showed decreased cell proliferation and MMP, increased cell apoptosis, upregulated expression of miR-195, Bax, and cleaved caspase 3, and downregulated Bcl-2 protein, while these changes were attenuated by miR-195 inhibitors. Additionally, siBcl-2 can reverse the protective effect of miR-195 inhibitors on TNF-α-induced NP cells. Besides, inhibition of miR-195 alleviated IVDD degeneration and NP cell apoptosis in the rat model.

Conclusion

MiR-195 was significantly upregulated in NP tissues of IVDD patients, and inhibition of miR-195 could protect human NP cells from TNF-α-induced apoptosis via upregulation of Bcl-2.
Knockdown of long noncoding RNA HOTAIR inhibits osteoarthritis chondrocyte injury by miR-107/CXCL12 axis
Authors: Lu Jipeng , Wu Zhongxiong , Xiong Ying
Published: June 2021

Background

Osteoarthritis (OA) is a joint disease characterized via destruction of cartilage. Chondrocyte damage is associated with cartilage destruction during OA. Long noncoding RNAs (lncRNAs) are implicated in the regulation of chondrocyte damage in OA progression. This study aims to investigate the role and underlying mechanism of lncRNA homeobox antisense intergenic RNA (HOTAIR) in OA chondrocyte injury.

Methods

Twenty-three OA patients and healthy controls without OA were recruited. Chondrocytes were isolated from OA cartilage tissues. HOTAIR, microRNA-107 (miR-107) and C-X-C motif chemokine ligand 12 (CXCL12) levels were measured by quantitative real-time polymerase chain reaction and western blot. Cell proliferation, apoptosis and extracellular matrix (ECM) degradation were measured using cell counting kit-8, flow cytometry and western blot. The target interaction was explored by bioinformatics, luciferase reporter and RNA immunoprecipitation assays.

Results

HOTAIR expression was enhanced, and miR-107 level was reduced in OA cartilage samples. HOTAIR overexpression inhibited cell proliferation, but induced cell apoptosis and ECM degradation in chondrocytes. HOTAIR knockdown caused an opposite effect. MiR-107 was sponged and inhibited via HOTAIR, and knockdown of miR-107 mitigated the effect of HOTAIR silence on chondrocyte injury. CXCL12 was targeted by miR-107. CXCL12 overexpression attenuated the roles of miR-107 overexpression or HOTAIR knockdown in the proliferation, apoptosis and ECM degradation. CXCL12 expression was decreased by HOTAIR silence, and restored by knockdown of miR-107.

Conclusion

HOTAIR knockdown promoted chondrocyte proliferation, but inhibited cell apoptosis and ECM degradation in OA chondrocytes by regulating the miR-107/CXCL12 axis.
RETRACTED ARTICLE: Tree species diversity predicts aboveground carbon storage through functional diversity and functional dominance in the dry evergreen Afromontane forest of Hararghe highland, Southeast Ethiopia
Authors: Wondimu Mengistu Teshome , Nigussie Zebene Asfaw , Yusuf Muktar Mohammed
Published: June 2021

Background

Regarding the most important ecological challenges, scientists are increasingly debating the relationship between biodiversity and ecosystem function. Despite this, several experimental and theoretical researches have shown inconsistencies in biodiversity and ecosystem function relationships, supporting either the niche complementarity or selection effect hypothesis. The relationship between species diversity, functional diversity, and aboveground biomass carbon was investigated in this study employing standing aboveground carbon (AGC) stock as a proxy measure for ecosystem function. We hypothesized that (i) effects of diversity on AGC can be transmitted through functional diversity and functional dominance; (ii) effects of diversity on AGC would be greater for functional dominance than functional diversity; and (iii) effects of functional diversity and functional dominance on carbon stock varied with metrics and functional traits. Community-weighted means (CWM) of functional traits (wood density, specific leaf area, and maximum plant height) were calculated to assess functional dominance (selection effects). As for functional diversity (complementarity effects), multi-trait functional diversity (selection effects) indices were computed. We tested the first hypothesis using structural equation modeling. For the second hypothesis, the effects of environmental variables such as slope, aspect, and elevation were tested first, and separate linear mixed-effects models were fitted afterward for functional diversity, functional dominance, and the two together.

Results

Results revealed that slope had a significant effect on aboveground carbon storage. Functional diversity and functional dominance were significant predictors of the aboveground carbon storage (22.4%) in the dry evergreen Afromontane forest. The effects of species richness on aboveground carbon storage were mediated by functional diversity and functional dominance of species. This shows that both the selection effects and the niche complementarity are important for aboveground carbon storage prediction. However, the functional diversity effects (niche complementarity) were greater than functional dominance effects (selection effects).

Conclusions

Linking diversity and biodiversity components to aboveground carbon provides better insights into the mechanisms that explain variation in aboveground carbon storage in natural forests, which may help improve the prediction of ecosystem functions.
Masticatory performances and maximum occlusal forces of immediate and conventional loaded two-implant supported overdentures retained by magnetic attachments: preliminary study of randomized controlled clinical trial
Authors: Katheng Awutsadaporn , Kanazawa Manabu , Komagamine Yuriko , Miyayasu Anna , Uehara Yoko , Sato Daisuke , Minakuchi Shunsuke
Published: June 2021

Background

The appropriate loading protocol to improve masticatory performance (MP) is still unclear in elderly patients and two-implant overdentures (2-IODs) wearers. This study aimed to compare the long-term MP and maximum occlusal force of immediate loading (IL) and conventional loading (CL) of 2-IODs retained by magnetic attachments. Nineteen edentulous patients were randomly assigned to either an IL (n=10) or CL group (n = 9). In the IL group, the implant was loaded on the same day as insertion, whereas it was loaded 3 months after insertion in the CL group. Magnetic attachments were used to retain all overdentures to the implants. MP, measured by a piece of color-changeable chewing gum and a gummy jelly test, and maximum occlusal force, measured using an occlusal force measuring device, were assessed in both groups at baseline and at 3-, 4-, and 5-year follow-ups.

Results

No significant differences were observed in the MP and the maximum occlusal force between the IL and CL groups at any time point. However, a significantly higher MP was observed at the 3-year time point in the IL group (P = 0.036). The maximum occlusal force revealed a significant correlation with MP, both with the color-changeable chewing gum and gummy jelly at 5 years.

Conclusion

After long-term observation, no significant differences in MP and maximum occlusal force were observed between the IL and CL groups. However, compared to pre-implant insertion of the complete denture, the MP in the IL group significantly improved at 3 years. Furthermore, the maximum occlusal force was significantly correlated with MP at 5 years.

Trial registration

UMIN, UMIN000009889. Registered on 28 January 2013.
Quality of life and its predictors in adults with tuberous sclerosis complex (TSC): a multicentre cohort study from Germany
Authors: Zöllner Johann Philipp , Conradi Nadine , Sauter Matthias , Knuf Markus , Knake Susanne , Kurlemann Gerhard , Mayer Thomas , Hertzberg Christoph , Bertsche Astrid , Immisch Ilka , Klein Karl Martin , Marquard Klaus , Meyer Sascha , Noda Anna H. , von Podewils Felix , Schäfer Hannah , Thiels Charlotte , Zukunft Bianca , Schubert-Bast Susanne , Grau Janina , Willems Laurent M. , Rosenow Felix , Reese Jens-Peter , Strzelczyk Adam
Published: June 2021

Background

Tuberous sclerosis complex (TSC) is a monogenetic, multisystemic disease characterised by the formation of benign tumours that can affect almost all organs, caused by pathogenic variations inTSC1orTSC2. In this multicentre study from Germany, we investigated the influence of sociodemographic, clinical, and therapeutic factors on quality of life (QoL) among individuals with TSC.

Methods

We assessed sociodemographic and clinical characteristics and QoL among adults with TSC throughout Germany using a validated, three-month, retrospective questionnaire. We examined predictors of health-related QoL (HRQoL) using multiple linear regression analysis and compared the QoL among patients with TSC with QoL among patients with other chronic neurological disorders.

Results

We enrolled 121 adults with TSC (mean age: 31.0 ± 10.5 years; range: 18–61 years, 45.5% [n = 55] women). Unemployment, a higher grade of disability, a higher number of organ manifestations, the presence of neuropsychiatric manifestations or active epilepsy, and a higher burden of therapy-related adverse events were associated with worse QoL, as measured by two QoL instruments (EuroQoL-5 dimensions [EQ-5D] and Quality of Life in Epilepsy Patients [QOLIE-31]). Neuropsychiatric and structural nervous system manifestations, the number of affected organs, and therapy-related adverse events were also associated with higher depression, as measured by the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E). In multiple regression analysis, more severe therapy-related adverse events (large effect,p < 0.001), active epilepsy (large effect,p < 0.001), and neuropsychiatric manifestations (medium effect,p = 0.003) were independently associated with worse HRQoL, explaining 65% of the variance (p < 0.001). The HRQoL among patients with active TSC-associated epilepsy was worse than that among patients with drug-refractory mesial temporal lobe epilepsy (p < 0.001), and the generic QoL among patients with more than three TSC organ manifestations was similar to those of patients with severe migraine and uncontrolled asthma.

Conclusions

Active epilepsy, neuropsychiatric manifestations (such as anxiety and depression), and therapy-related adverse events are important independent predictors of worse quality of life among adults with TSC. Generic quality of life in TSC with several manifestations is similar to uncontrolled severe chronic diseases and significantly negatively correlates with TSC severity.

Trial registration

DRKS,DRKS00016045. Registered 01 March 2019.
Case of refractory delirious mania responsive to lithium
Authors: Pereira Herrera Manuel , Zimmerman Aphrodite Marta
Published: June 2021

Delirious mania is an uncommon condition that is challenging to diagnose and treat. More often seen in patients with a history of bipolar disorder, it frequently presents with prominent catatonic features and overlaps with other diseases in the catatonic spectrum, such as neuroleptic malignant syndrome, serotonin syndrome and malignant catatonia. We present a case of delirious mania refractory to high doses of lorazepam, several antipsychotics and valproic acid, which responded dramatically to therapy with lithium after 26 days of minimal improvement with the other medications. The pathophysiology of delirious mania is reviewed, and the unique actions of lithium are discussed, highlighting possible reasons as to why lithium might offer advantages in the treatment of this disease.
Uncovering trends in training progression for a national cohort of psychiatry trainees: discrete-time survival analysis
Authors: Silkens Milou E.W.M. , Sarker Shah-Jalal , Medisauskaite Asta
Published: June 2021

Background

The global rise in mental health issues calls for a strong psychiatry workforce. Yet, psychiatry training worldwide is facing recruitment challenges, causing unfilled consultant posts and possibly threatening the quality of patient care. An in-depth understanding of trainees’ progression through training is warranted to explore what happens to recruited trainees during training.

Aims

To uncover current trends in psychiatry trainees’ progression through training in the UK.

Method

This national retrospective cohort study with data from the UK Medical Education Database used discrete-time survival analysis to analyse training progression for those trainees who started their core psychiatry post in 2012–2017 (2820 trainees; 59.6% female, 67.6% UK graduates (UKGs)). The impact of sociodemographic characteristics on training progression were also investigated.

Results

The overall probability of completing training in 6 years (minimum years required to complete psychiatry training in the UK) was 17.2% (ranging from 4.8% for non-UKG females to 29% for UKG males). The probability to not progress was highest (57.1%) from core to specialty training. For UKGs, trainees from ethnicities other than White, trainees with a disability, and trainees who had experienced childhood social deprivation (measured as entitlement to free school meals) had a significantly (P≤ 0.02) lower probability of completing training in 6 years.

Conclusions

Less than one in five psychiatry trainees are likely to complete training in 6 years and this probability varies across groups of doctors. Completing psychiatry training in 6 years is, therefore, the exception rather than the norm and this has important implications for trainees, those planning psychiatry workforces or responsible for psychiatry training.
Development and Pilot Implementation of the Genomic Risk Assessment for Cancer Implementation and Sustainment (GRACIAS) Intervention in Mexico
Authors: Blazer Kathleen R. , Chavarri-Guerra Yanin , Villarreal Garza Cynthia , Nehoray Bita , Mohar Alejandro , Daneri-Navarro Adrian , del Toro Azucena , Aguilar Dione , Arteaga Jazmin , Álvarez Rosa Maria , Mejia Rosa , Herzog Josef , Castillo Danielle , Fernandez Maria , Weitzel Jeffrey N.
Published: June 2021

PURPOSE

Genomic cancer risk assessment (GCRA) is standard-of-care practice that uses genomic tools to identify individuals with increased cancer risk, enabling screening for early detection and cancer prevention interventions. GCRA is not available in most of Mexico, where breast cancer (BC) is the leading cause of cancer death and ovarian cancer has a high mortality rate.

METHODS

Guided by an implementation science framework, we piloted the Genomic Risk Assessment for Cancer Implementation and Sustainment (GRACIAS) intervention, combining GCRA training, practice support, and low-cost BRCA1/ 2 ( BRCA) gene testing at four centers in Mexico. The RE-AIM model was adapted to evaluate GRACIAS intervention outcomes, including reach, the proportion of new patients meeting adapted National Comprehensive Cancer Network criteria who participated in GCRA. Barriers to GCRA were identified through roundtable sessions and semistructured interviews.

RESULTS

Eleven clinicians were trained across four sites. Mean pre-post knowledge score increased from 60% to 67.2% (range 53%-86%). GCRA self-efficacy scores increased by 31% (95% CI, 6.47 to 55.54; P = .02). Participant feedback recommended Spanish content to improve learning. GRACIAS promoted reach at all sites: 77% in Universidad de Guadalajara, 86% in Instituto Nacional de Cancerología, 90% in Tecnológico de Monterrey, and 77% in Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Overall, a pathogenic BRCA variant was identified in 15.6% (195 of 1,253) of patients. All trainees continue to provide GCRA and address barriers to care.

CONCLUSION

We describe the first project to use implementation science methods to develop and deliver an innovative multicomponent implementation intervention, combining low-cost BRCA testing, comprehensive GCRA training, and practice support in Mexico. Scale-up of the GRACIAS intervention will promote risk-appropriate care, cancer prevention, and reduction in related mortality.
Concordance in HPV Detection Between Self-Collected and Health Provider–Collected Cervicovaginal Samples Using careHPV in Tanzanian Women
Authors: Katanga Johnson J. , Rasch Vibeke , Manongi Rachel , Pembe Andrea B. , Mwaiselage Julius D. , Kjaer Susanne K.
Published: June 2021

PURPOSE

Cervical cancer screening is one of the strategies to prevent the disease among women at risk. Human papillomavirus (HPV) DNA testing is increasingly used as the cervical cancer screening method because of its high sensitivity. Self-collection of cervical specimens has the potential to improve participation. However, there is only limited information on comparison between self-collected and provider-collected samples with regard to detection of high-risk HPV using the careHPV method. The study aimed to compare HPV detection by careHPV in self-collected and provider-collected cervical samples and to assess the acceptability of self-collection techniques.

MATERIAL AND METHODS

Women attending cervical cancer screening clinics at Ocean Road Cancer Institute, Kilimanjaro Christian Medical Centre or Mawenzi Hospital in Tanzania were included in the study. They underwent a face-to-face interview, HIV testing, and collected a self-sample using Evalyn Brush. Subsequently, they had a cervical sample taken by a health provider. Both samples were tested for high-risk HPV DNA using careHPV.

RESULTS

Overall, 464 women participated in the study. The high-risk HPV prevalence was 19.0% (95% CI, 15.6 to 22.9) in the health provider samples, but lower (13.8%; 95% CI, 10.9 to 17.3) in the self-collected samples. There was a good overall agreement 90.5% (95% CI, 87.5 to 93.0) and concordance (κ = 0.66; 95% CI, 0.56 to 0.75) between the two sets of samples. Sensitivity and specificity were 61.4% (95% CI, 50.4 to 71.6) and 97.3% (95% CI, 95.2 to 98.7), respectively, varying with age. Most women preferred self-collection (79.8%).

CONCLUSION

Overall, self-sampling seems to be a reliable alternative to health-provider collection and is acceptable to the majority of women. However, instructions on proper procedures for sample collection to the women are important.
Substantial Reduction in Adjuvant Chemotherapy With the Use of the 21-Gene Test to Manage Early Breast Cancer in a Public Hospital in Brazil
Authors: Mattar André , Fonseca Guilherme R. , Romão Murilo B. A. , Shida Jorge Y. , de Oliveira Vilmar M. , Bastos Maria C. S. , Bagnoli Fabio , Rinaldi Jose F. , Stiepcich Monica M. Á. , da Silva Maria A. L. G. , Jakubowski Debbie M. , Chao Calvin , Oliveira Sergio C. , Gebrim Luiz H.
Published: June 2021

PURPOSE

We evaluated the impact of 21-gene test results on treatment decisions for patients with early-stage breast cancer treated under the public health care system in Brazil, Sistema Único de Saúde.

METHODS

Eligible patients treated at Hospital Pérola Byington and Santa Casa de Misericórdia de São Paulo in Brazil were required to have the following characteristics: postsurgery with hormone receptor–positive, human epidermal growth factor 2–negative, node-negative and node-positive, and T1/T2 breast cancer and patients with these characteristics were candidates for adjuvant systemic therapy. Treatment recommendations, chemotherapy plus hormonal therapy (CT + HT) or HT alone, were captured before and after 21-gene test results.

RESULTS

From August 2018 to April 2019, 179 women were enrolled. The mean age was 58 years (29-86 years), 135 (76%) were postmenopausal, and 58 (32%) had node-positive breast cancer. Most patients (61%) had a tumor > 2 cm, including 7% with tumors > 4 cm. Using Recurrence Score (RS) result cut points on the basis of the TAILORx trial, 40 (22%) had RS 0-10, 91 (51%) had RS 11-25, and 48 (27%) had RS 26-100. Before 21-gene testing, 162 of 179 (91%) patients were recommended for CT. After testing, 117 of 179 patients (65%) had changes in CT recommendation: 112 (63%) who were initially recommended CT received HT alone and five (3%) who were initially recommended HT alone received CT + HT. After 21-gene testing, 99% of physicians reported strong confidence in their treatment recommendations.

CONCLUSION

The change in clinical practice at these public hospitals was greater than expected: 66% of initial treatment recommendations were changed to omit CT with 21-gene test results. Clinicopathologic features did not correlate well with 21-gene test results and did not adequately identify those most likely to benefit from CT.
Flipped, Broken, and PausedClave
Authors: Simpson-Litke Rebecca
Published: June 2021

This article examines some of the complex interactions between salsa music and dance by focusing on physical interpretations of specific types of metric ambiguities and disruptions. It explores both the fairly frequent displacement dissonances that arise when the established clave pattern is flipped, paused, or broken and the grouping dissonances that are somewhat rare occurrences in salsa music, showing how dancers' responses to these metric disruptions depend heavily on the unique features of each musical context. Annotated videos break down salsa's fundamental dance and musical structures, encouraging readers to contemplate the artful interpretations presented by experienced dance practitioners and to engage with these interesting musical passages more intimately by trying out the dance steps for themselves.
Music in the Body
Authors: Stevens Alison
Published: June 2021

Dance in general and the contredanse in particular have long been recognized as important to eighteenth-century European music. But music theorists have tended to understate the contredanse's unique contribution, when they haven't overlooked it entirely: dances are more often treated as musical styles or topics than as movement patterns, and the minuet, with more explicit connections to art music, has received more attention than the contredanse. This article analyzes the choreography as well as the music of eighteenth-century contredanses to show how this dance supported the development of hypermetrical hearing. The contredanse had surpassed the minuet in popularity by the second half of the eighteenth century, probably in part because of its participatory rather than performative nature. More important, it was the first dance in which alignment of choreography and music consistently extended to multiple hypermetric levels. In addressing the importance of contredanse choreography to eighteenth-century hypermeter, this article makes a broader appeal for incorporation of dance and the body into the study of meter.
Family Labor Supply Responses to Severe Health Shocks: Evidence from Danish Administrative Records
Authors: Fadlon Itzik , Nielsen Torben Heien
Published: June 2021

We provide new evidence on households’ labor supply responses to fatal and severe nonfatal health shocks in the short run and medium run. To identify causal effects, we leverage administrative data on Danish families and construct counterfactuals using households that experience the same event a few years apart. Fatal events lead to considerable increases in surviving spouses’ labor supply, which the evidence suggests is driven by families who experience significant income losses. Nonfatal shocks have no meaningful effects on spousal labor supply, consistent with their adequate insurance coverage. The results support self-insurance as a driving mechanism for the family labor supply responses. (JEL D12, D15, G22, I12, J22)
‘That’s hard’: Christopher Marlowe’s Doctor Faustus and the Trauma of Reprobation
Authors: Scott Mark James Richard
Published: June 2021

Christopher Marlowe’s Doctor Faustus is generally treated as a soteriological riddle: is Faustus damned, and if so, when, and why? This essay argues that such approaches miss the overwhelming emphasis (in both surviving versions of the play) on Faustus’s reprobation. Faustus, instead of presenting a puzzle waiting to be solved, is better appreciated as an incomparable portrait of the experience of reprobate living. Even more, via its textual and performance history, Faustus sheds light on the collective and collaborative practices of real Renaissance actors and theatregoers coming to terms with the post-Reformation religious trauma they shared with the lonely doctor.
Perambulation and Performance in Early Modern Festive Culture
Authors: Woodcock Matthew
Published: June 2021

This essay examines the performative aspect of observances and festivities associated with Rogationtide, or ‘perambulation day’, in early modern England. After considering pre- and post-Reformation Rogationtide traditions, it identifies how these occasions were an opportunity for communities and parishes to reflect upon and consolidate local boundaries and identities. It also explores how documentary evidence for perambulations broadens critical understandings of the mimetic, musical, and festive activities recorded in the Records of Early English Drama (REED) project, posing methodological questions about using performance as well as mimesis as a characteristic determining a record’s inclusion in a REED collection.
Panel Data in Research on Mobility and Migration: A Review of Recent Advances
Authors: Vidal Sergi , Lersch Philipp M.
Published: June 2021

Panel data has become the gold standard for causal assessments of complex human behaviour in quantitative social science. The objective of this review is to examine and discuss how panel data and related methods contribute to the identification of causal relationships in spatial mobility research. We illustrate this by providing a succinct overview of recent progress in spatial mobility research, drawing on panel data. The review outlines research from a number of scholarly disciplines that maps patterns, establishes determinants and assesses the impact of spatial mobility for a range of outcomes. Studies presented in this article are used to decipher complex interdependencies over the life course, scrutinise the selectivity of migrants, and shed light on the interplay between individual agency, social embeddedness and socio-structural contexts. The article concludes with a set of critical issues for future research.

* This article belongs to a special issue on "Identification of causal mechanisms in demographic research: The contribution of panel data".
Integrating services: translating data into practice
Authors: Thomas Sue
Published: June 2021

The 2021 MS Trust conference offered many valuable insights, including into the way in which nurses and allied health professionals are currently undertaking bladder management. Using one of the symposiums as a foundation, Sue Thomas outlines how health professionals can use data to provide quality improvements in relation to bladder management in multiple sclerosis.
Alzheimer's disease and diet: the missing link?
Authors: Winter George
Published: June 2021

Alzheimer's disease is an increasingly prevalent health concern. A new understanding of the condition, linked to diet and diabetes, is emerging, and it is speculated that dietary interventions might influence disease progression. George Winter explains.
How debriefing post cardiopulmonary arrest and resuscitation can be used to improve training
Authors: Jones Clare
Published: June 2021

Debriefing is a form of discussion used in human medicine following significant events, such as cardiopulmonary arrest (CPA) and resuscitation. There are no studies in veterinary medicine specifically exploring the benefits of debriefing post CPA, showing known knowledge gaps. However, there are studies in training for resuscitation and staff resilience that mention debriefing as tools, and there are studies in human medicine that look at different types of debriefing and benefits. This literature review discusses ways in which debriefing may be implemented into a veterinary environment as well as the impact it could have on staff training, wellbeing and patient outcome.
Fibroadenomas in rats
Authors: Sibbald Rachel
Published: June 2021

This article looks at one of the most common reasons for presentation to practice in rats, mammary fibroadenomas. There is an extremely high incidence of this disease process in rats over 1 year of age and veterinary nurses have a duty of care towards these patients to provide up-to-date nursing techniques and engage in clinical discussions with veterinary surgeons to implement appropriate treatment plans. Surgical and medical options are explored along with tips for successful anaesthetic management of these patients. Although these neoplasms are benign, they are often fast growing and can significantly affect quality of life in rat companions.