bluuebunny/crossref_metadata_2025 huggingface dataset:
Sex Differences in High-Level Managerial Jobs: Evidence From Professional Basketball
Authors: Keefer Quinn A. W.
Published: October 2021

We examine sex differences in a market for high-level managers with simple and clear objectives, head coaches in the Women’s National Basketball Association (WNBA). We find equal proportions of males and females as first-time coaches, and limited evidence that males inherit slightly worse teams. Also, when hired, males are older and have more experience. Males have slightly higher winning percentages for the first few seasons of coaches’ tenures. Furthermore, we find no difference in survival; it is independent of sex and largely determined by performance. Thus, we find female coaches are not held to higher promotion or retention standards in the WNBA.
The Transformative Learning Outcomes and Processes Survey: A Validation Study in the Workplace Context
Authors: Kwon Chang-kyu , Han Seung-hyun , Nicolaides Aliki
Published: October 2021

The purpose of this study was to assess the validity and reliability of the Transformative Learning Outcomes and Processes Survey (TROPOS) in the workplace context. The results of a confirmatory factor analysis of the data gathered from 132 employees of a steel manufacturing company in the United States have shown that the TROPOS is an appropriate instrument for measuring transformative learning in the workplace context. Implications for transformative learning research and practice will be discussed.
‘You’ve met with a terrible fate, haven’t you?’: A Hauntological Analysis of Carceral Violence in Majora’s Mask
Authors: Skott Sara , Skott Bengtson Karl-Fredrik
Published: October 2021

More than mere entertainment, video games can be studied as cultural texts, relevant for the interpretation and understanding of the public imaginary relating to crime. Drawing on ideas of Gothic and popular criminology and using a critical lens of hauntology, this study aims to explore themes of carcerality in the video game The Legend of Zelda: Majora’s Mask. By constructing the text of Majora’s Mask as a horror game, and a cultural text ‘in distress’, encompassing a crypt incorporating a phantom of past trauma, this paper identifies themes of carceral violence within the text as symptomatic of a deep, haunting disillusionment of carceral justice. Relating back to the culture and context in which the game was created, we argue that this cultural text is ‘haunted’ by the trauma of lost ideals in relation to punishment; a deep disillusionment towards a carceral machinery producing the socially dead instead of rehabilitating them.
Hybrid propulsion spacecraft formation control around the planetary displaced orbit
Authors: Zhao Lei , Yuan Changqing , Hao Qingbo , He Jingjiu
Published: October 2021

This paper aims to investigate the feasibility of using the combination of solar radiation pressure and Coulomb force as a propellantless control method for spacecraft formation around the planetary displaced orbit. Firstly, the dynamical equation of spacecraft formation is derived and linearized. Based on the linearized dynamic model, an integral sliding mode controller (ISMC) is designed. Aimed to stabilize the spacecraft formation, the control method is proposed to adjust the product of the charge and the attitude angles of two spacecrafts. Finally, numerical simulations are conducted and the results show that the controller can make the formation achieve the desired configuration with favorable control performances.
Dynamic asymptotic model of rolling bearings with a single fault in the inner raceway
Authors: Li Yunlong , Li Zhinong , Tian Danyang , Tao Junyong
Published: October 2021

In the previous models of rolling bearings with a single fault, the displacement deviation caused by the collision of the fault to the rolling element changes instantly. However, the displacement deviation should change gradually. Here, the asymptotic idea is introduced to describe the change of the displacement deviation. The calculation method of the deviation is given. An asymptotic model of rolling bearings with an inner raceway fault is constructed. Then, the simulation of the SKF6205 bearing with a single fault is carried out. The differences between the previous model and the asymptotic model for the responses and the displacement deviation are compared. The effects of the speed and fault size on the dynamic characteristics are analyzed. Finally, the experiments are carried out to corroborate the rationality of the constructed model. The research results can provide theoretical support for the dynamic analysis, fault diagnosis, and reliability analysis of rolling bearings.
High-capacity stacking apparatus for thermoforming machine – Part II: Structural design of the adjustable stacker driving mechanism
Authors: Penčić Marko , Čavić Maja , Oros Dragana , Čavić Dijana , Orošnjak Marko , Karanović Velibor
Published: October 2021

Part II presents the structural design of a high-capacity adjustable stacker mechanism for thermoforming machines which enables the receival, transport and stacking of cup-like products. It was previously established (please see Part I) that a four-bar linkage mechanism with a one-way clutch is the optimal solution for realizing the intermittent motion of the stacker conveyor. The main objective here is to enable the change of the stacker work parameters, with the goal of changing and adjusting the work stroke of the conveyor. Accordingly, there are two main requirements the solution needs to fulfill. The first is that of the regulation characteristic’s function – the relationship between the change of the work stroke and the change of the regulation parameter, must be linear, and the second is that it allows for regulation within a wide range. Due to this, the adopted solution proposed that two links have variable lengths. The input link should have discreet length values which correspond to different values of the conveyor work stroke, while the output link length should be continuously variable, within a narrow range thus ensuring linear regulation characteristic. Finally, it should be noted that this solution makes the stacker compatible with a wide array of products, which increases the productivity and flexibility, adjusting the stacker to receive a different product can be done quickly and easily and avoiding a halt in the production as it takes less time to adjust the stacker than the thermoforming machine.
Dyslipidemia Is Associated With Increased Risk of Achilles Tendon Disorders in Underweight Individuals to a Greater Extent Than Obese Individuals: A Nationwide, Population-Based, Longitudinal Cohort Study
Authors: Ahn Hyeong Sik , Kim Hyun Jung , Kang Tae Uk , Kazmi Sayada Z. , Suh Jin Soo , Young Choi Jun
Published: October 2021

Background:

The association between dyslipidemia and Achilles tendinopathy (AT) or Achilles tendon rupture (ATR) remains controversial, although some studies have examined this topic.

Purpose:

To evaluate the correlation of dyslipidemia and the risk of AT or ATR, and its association with body mass index (BMI), by assessing data from a nationwide population-based cohort.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

We used the National Health Insurance database, which includes the entire population of the Republic of Korea, to evaluate participants in the National Health Screening Program between January 2009 and December 2010. Participants diagnosed with AT or ATR before December 31, 2017, were selected. The variables assessed were age, sex, frequency of high-intensity exercise per week, BMI, waist circumference, systolic blood pressure, and levels of low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and fasting blood glucose. Multivariate Cox proportional hazards regression was used for data analysis.

Results:

A total of 16,830,532 participants were included. Of these, 125,814 and 31,424 participants developed AT and ATR, respectively. A higher level of LDL-C was associated with an increased risk of AT (adjusted hazard ratio [HR], 1.16) and ATR (adjusted HR, 1.18). A slightly increased risk of AT was observed in participants with higher TG levels (adjusted HR, 1.03), whereas higher HDL-C level was associated with a slight risk reduction for AT (adjusted HR, 0.95). However, no significant association was observed between higher TG or HDL-C levels and ATR. In the underweight group (BMI <18.5 kg/m2), a higher LDL-C level was associated with an increased risk of AT and ATR by 37% and 116%, respectively, compared with lower LDL-C. Higher LDL-C level was associated with an increased risk of AT and ATR by 10% and 16%, respectively, in the obese group (BMI ≥25 kg/m2).

Conclusion:

Dyslipidemia was related to the development of AT and ATR. The association of higher LDL-C levels with AT and ATR risk was more pronounced in underweight than in overweight and obese individuals.
Unpacking the Possible: A Qualitative Case Study of Inclusive Teacher Practice in India
Authors: Forber-Pratt Anjali J. , Sarkar Tanushree
Published: October 2021

Research on teachers and inclusive education in India has largely been conducted using standardised, quantitative measures of teacher attitudes, efficacy and behaviour. There is little focus on teachers’ perspectives on their practice. Such findings promote a deficit view of teachers, recommending interventions to ‘correct’ teacher attitudes and behaviour, with little attention to institutional and policy contexts within which the teachers operate. The existing studies focus on what is absent or lacking, rather than what is possible. The present study attempts to offer a perspective of what is possible in inclusive education in the Indian context. The purpose of this intrinsic case study research is to better understand the inclusion of girls with disabilities in Kolkata, India, at a home and school for orphan girls. Non-institutionalised, inclusive, community-based care is rare in India, specifically for individuals with disabilities. The overall case study involved interviews ( N = 32) with students, teachers and staff, observations and document analysis, and this focuses on the n = 7 teacher interviews. All transcripts were analysed using structural and in vivo codes. These findings are centred on teacher voices and perspectives – identifying best practices, dilemmas and challenges. However, teacher perspectives are discussed within a larger school and institutional context. An important feature is the description of teachers’ inclusive practice as an iterative process, supported by feedback and input from the school leader. The findings highlight how the school provides and serves as a space of familial bonding, allowing teachers to challenge the views of educability, within the backdrop of a community that stigmatises disability. It is in this way that these teacher-centred voices demonstrate resilience in their teaching and conceptualisation of inclusion and disability.
‘We Are Helpless, Hopeless and Living in Despair’: Impact of COVID-19 on the Overall Health and Well-being, and Participation of the Transgender Community in India
Authors: Dasgupta Satarupa , Sinha Sunny , Roy Raina
Published: October 2021

This article investigates the impact of COVID-19 on the health and lived experiences of the transgender community in India. In particular, the study analyses how COVID-19 affects the lives of the transgender community in terms of their interaction with the government policymaking and identity negotiation, livelihoods, access to health resources, availability of gender transition services and status of mental health. The analysis shows that the COVID-19 pandemic and the government strategies to curb the spread of infection have exacerbated the challenges faced by the transgender community in India and threatened their survival. As disease outbreaks traditionally perpetuate gender inequities and increase vulnerabilities borne by marginalised groups, the analysis has implications for purposefully creating appropriate platforms for participation of the transgender community and designing and delivering suitable programs and services to enhance their welling and human dignity.
Comparative analysis of full-length mitochondrial genomes of five Skeletonema species reveals conserved genome organization and recent speciation
Authors: Liu Shuya , Wang Yichao , Xu Qing , Zhang Mengjia , Chen Nansheng
Published: October 2021

Background

Skeletonema species are prominent primary producers, some of which can also cause massive harmful algal blooms (HABs) in coastal waters under specific environmental conditions. Nevertheless, genomic information of Skeletonema species is currently limited, hindering advanced research on their role as primary producers and as HAB species. Mitochondrial genome (mtDNA) has been extensively used as “super barcode” in the phylogenetic analyses and comparative genomic analyses. However, of the 21 accepted Skeletonema species, full-length mtDNAs are currently available only for a single species, S. marinoi.

Results

In this study, we constructed full-length mtDNAs for six strains of five Skeletonema species, including S. marinoi, S. tropicum, S. grevillei, S. pseudocostatum and S. costatum (with two strains), which were isolated from coastal waters in China. The mtDNAs of all of these Skeletonema species were compact with short intergenic regions, no introns, and no repeat regions. Comparative analyses of these Skeletonema mtDNAs revealed high conservation, with a few discrete regions of high variations, some of which could be used as molecular markers for distinguishing Skeletonema species and for tracking the biogeographic distribution of these species with high resolution and specificity. We estimated divergence times among these Skeletonema species using 34 mtDNAs genes with fossil data as calibration point in PAML, which revealed that the Skeletonema species formed the independent clade diverging from Thalassiosira species approximately 48.30 Mya.

Conclusions

The availability of mtDNAs of five Skeletonema species provided valuable reference sequences for further evolutionary studies including speciation time estimation and comparative genomic analysis among diatom species. Divergent regions could be used as molecular markers for tracking different Skeletonema species in the fields of coastal regions.
Intestinal ulcers in a patient with myelodysplastic syndrome: a case report
Authors: Zhang Xiaofen , Jin Meng , Shen Zhe , Wan Xingyong , Li Lan , Zhang Yuwei , Zhou Xinping , Mei Chen , Tong Hongyan , Yu Chaohui
Published: October 2021

Background

Trisomy 8 positivity myelodysplastic syndrome with Behçet's disease is rare. Isolated trisomy 8 is a frequent cytogenetic abnormality in the MDS, but the characteristic of trisomy 8 and the association between trisomy 8 positivity myelodysplastic syndrome and Behçet's disease is unclear.

Case presentation

Here, we reported a 63‐year‐old man, who presented with fever, abdominal pain and hematochezia. Imaging studies revealed bowel wall thickening and mural hyperenhancement of terminal ileum and cecum. Colonoscopy found multiple round ulcers in terminal ileum, ileocecal valve and multiple yellow dotted pseudomembranous attachments throughout the colon. Capsule endoscopy also revealed multiple irregular ulcers in lower ileum. Serum C-reactive protein levels and fecal calprotectin were abnormally high. The clostridium difficile toxin A and B was positive. However, the patient's intestinal ulcers did not resolve after two weeks course of vancomycin. Considered that the patient was diagnosed as MDS-RAEB2 with a karyotype of 47 XX, + 8. And detailed inquiry of medical history revealed epifolliculitis and frequently recurrent oral ulcers 2 months before admission. A diagnosis of trisomy 8 positivity MDS with BD was made. Then he received glucocorticoid along with the 5th course of azacytidine. The follow-up endoscopy showed significantly improved intestinal ulcer 2 months after treatment. we report a rare disease and provide the diagnose and treatment ideas.

Conclusions

We highlight the challenges and the process of thinking about of the diagnosis. This may provide a new idea for the diagnosis of intestinal ulcers.
Surgical management of tuberculous epididymo-orchitis: a retrospective study of 81 cases with long-term follow-up
Authors: Huang Yin , Chen Bo , Cao Dehong , Chen Zeyu , Li Jin , Guo Jianbing , Dong Qiang , Wei Qiang , Liu Liangren
Published: October 2021

Background

Nowadays, most studies of tuberculous epididymo-orchitis (TBEO) are case reports or small sample cohort series. Our study is aimed to present the largest series of TBEO with our management experiences and long-term follow-up outcomes.

Methods

Patients diagnosed with TBEO after surgical procedures at Department of Urology, West China Hospital from 2008 to 2019 were included. All clinical features, auxiliary examination results, treatment and histopathological findings were extracted if available.

Results

Eighty-one patients (mean age 50.77 ± 16.1 years) were included. Scrotal swelling (N = 47, 58.0%) and pain (N = 29, 35.8%) were the most common presenting complaint. Pyuria and microscopic hematuria were observed in twenty-two (27.2%) and eight patients (9.9%), respectively. Urine acid fast bacilli cultures were available in 16 patients and all were negative. The mean duration between the onset of symptoms and the definite diagnosis was 6.42 ± 7.0 months. TBEO was considered in 30 (37.0%), tumors in 28 (34.6%) and nonspecific bacterial epididymo-orchitis in 23 (28.4%) patients. All patients received triple therapy of chemotherapy-surgery-pharmacotherapy and definite diagnosis was confirmed through histopathology of surgical specimens. Fifty-five patients were followed up regularly (mean follow-up 82.35 ± 36.6 months). One patient (1.2%) died from liver cirrhosis and no recurrence was observed. Postoperative complications included erectile dysfunction in 4 patients (4.9%), premature ejaculation in 5 patients (6.2%) and sterility in 7 patients (8.6%).

Conclusions

We recommend patients with advanced TBEO to receive triple therapy of chemotherapy-surgery-pharmacotherapy. Physicians should pay more attention to patients’ sexual function and fertility during follow up after treatment completed.
Molecular characterization of rpoB gene mutations in isolates from tuberculosis patients in Cubal, Republic of Angola
Authors: Rando-Segura Ariadna , Aznar María Luisa , Moreno María Milagros , Espasa Soley Mateu , Sulleiro Igual Elena , Bocanegra Garcia Cristina , Gil Olivas Eva , Nindia Eugénio Arlete , Escartin Huesca Carlos , Zacarias Adriano , Vegue Collado Josep , Katimba Domingos , Vivas Cano Maria Carmen , Gabriel Estevao , López García Maria Teresa , Pumarola Suñe Tomas , Molina Romero Israel , Tórtola Fernández María Teresa
Published: October 2021

Background

The importance of Mycobacterium tuberculosis strains with disputed rpoB mutations remains to be defined. This study aimed to assess the frequency and types of rpoB mutations in M. tuberculosis isolates from Cubal, Angola, a country with a high incidence of tuberculosis.

Methods

All isolates included (n = 308) were analyzed using phenotypic drug susceptibility testing and GenoType MTBDRplus assay. DNA sequencing of the rpoB gene and determination of rifampicin MIC by macrodilution method were additionally performed on isolates yielding discordant results (n = 12) and those in which the mutation detected was not characterized (n = 8).

Results

In total, 85.1% (74/87) of rifampicin-resistant strains had undisputed rpoB mutations -S450L (49), D435V (15), H445D (3), H445Y (2), Q432ins (1), L449M plus S450F (1), S450F (1), S450W (1) and S450Y (1)-; 10.3% (9/87) had disputed rpoB mutations—L430P plus S493L (1), N437del (1), H445L (3), D435Y (2), L452P (2)-, 2.3% (2.3%) showed no rpoB mutations and 2.3% (2/87) showed heteroresistance—D435Y plus L452P and L430P plus S493L-.

Conclusion

Disputed rpoB mutations were common, occurring in 10.3% of rifampicin resistant isolates. Current phenotyping techniques may be unable to detect this resistance pattern. To increase their sensitivity, a lower concentration of RIF could be used in these tests or alternatively, rpoB mutations could be screened and characterized in all M. tuberculosis strains.
Multimodel magnetic resonance imaging of mass-forming autoimmune pancreatitis: differential diagnosis with pancreatic ductal adenocarcinoma
Authors: Jia Huihui , Li Jialin , Huang Wenjun , Lin Guangwu
Published: October 2021

Purpose

To assess the value of the multimodel magnetic resonance imaging (MRI), including unenhanced images, dynamic contrast-enhanced MRI (DCE-MRI), MR-cholangiopancreatography (MRCP), and diffusion-weighted imaging (DWI), in differentiation of mass-forming autoimmune pancreatitis (AIP) from pancreatic ductal adenocarcinoma (PDAC).

Methods

Twelve patients with mass-forming AIP and 30 with PDAC were included. All patients underwent unenhanced MRI, DCE-MRI, DWI, and MRCP. Relevant values including sensitivity and specificity of the imaging features and their diagnostic performance for predicting mass-forming AIP were analyzed.

Results

Several statistically significant MR findings and quantitative indexes differentiating mass-forming AIP from PDAC, including multiplicity, irregularity or conformation, capsule-like rim enhancement, absence of internal cystic or necrotic portion, homogeneous enhancement during pancreatic, venous, and delayed phases, skipped stricture or stricture of MPD, absence of side branch dilation, maximum upstream MPD diameter < 2.4 mm, ContrastUP > 0.739, ContrastAP > 0.710, ContrastPP > 0.879, and ContrastVP or ContrastDP > 0.949, indicated mass-forming AIP (P < 0.05). The apparent diffusion coefficient (ADC) value was also significantly lower in mass-forming AIP compared to that in PDAC (P = 0.006). The cutoff value of ADC for distinguishing mass-forming AIP from PDAC was 1.099 × 10−3 mm2/s.

Conclusion

Multimodel MRI, including unenhanced MRI, DCE-MRI with DWI and MRCP can provide qualitative and quantitative information about mass-forming AIP characterization. Multimodel MRI are valuable for differentiating mass-forming AIP from PDAC.
Longitudinal extensive transverse myelitis following ChAdOx1 nCOV-19 vaccine: a case report
Authors: Tan Wee Yong , Yusof Khan Abdul Hanif Khan , Mohd Yaakob Mohd Naim , Abdul Rashid Anna Misyail , Loh Wei Chao , Baharin Janudin , Ibrahim Azliza , Ismail Mohd Redzuan , Inche Mat Liyana Najwa , Wan Sulaiman Wan Aliaa , Basri Hamidon , Hoo Fan Kee
Published: October 2021

Background

Transverse myelitis (TM) is a relatively uncommon condition, and vaccine-associated myelitis is even rarer. Concern regarding neurological complications following vaccination escalated following the report of TM during the safety and efficacy trials of the COVID-19 vaccine.

Case presentation

We report the first case of Longitudinal Extensive Transverse Myelitis (LETM) in Malaysia following administration of the chimpanzee adenovirus-vectored (ChAdOx1 nCoV-19) vaccine. A 25-year-old female presented with bilateral lower limb weakness and inability to walk with a sensory level up to T8 with absent visual symptoms. Urgent gadolinium-enhanced magnetic resonance imaging (MRI) of the spine showed long segment TM over the thoracic region. Cerebrospinal fluid autoantibodies for anti-aquaporin-4 and anti-myelin-oligodendrocyte were negative. A diagnosis of LETM following vaccination was made, and the patient was started on a high dose of intravenous methylprednisolone. The patient eventually made a recovery following treatment.

Conclusion

LETM is a rare but serious adverse reaction following vaccination. Previously reported cases showed an onset of symptoms between 10 to 14 days post-vaccination, suggesting a delayed immunogenic reaction. However, the incidence of myelitis in COVID-19 is much more common, far greater than the risk associated with vaccination.
Associations of living arrangements with symptoms and functioning in schizophrenia
Authors: Ang Mei San , Rekhi Gurpreet , Lee Jimmy
Published: October 2021

Background

Living arrangements and accommodation are closely related, but no study had concurrently investigated their associations with outcomes in schizophrenia. This study seeks to describe and compare socio-demographic, clinical and functioning profiles of people with schizophrenia in different living arrangements and accommodation, and to examine the associations of living arrangements and accommodation with symptomatic remission and functioning.

Methods

Community dwelling outpatients with schizophrenia (n = 276) were inquired on living arrangements, accommodation, socio-demographics and assessed on the Positive and Negative Syndrome Scale (PANSS) and the Social and Occupational Functioning Scale (SOFAS). Socio-demographics, symptoms and functioning of outpatients in different living arrangements and accommodation were compared. Symptomatic remission was investigated using logistic regression with living arrangements, socio-demographics and clinical variables as independent variables. Functioning was investigated using multiple regression with the same set of independent variables and the addition of PANSS factors. The same analyses were conducted with accommodation as independent variable.

Results

185 (67.03%) participants lived with family and 195 (70.65%) participants lived in owned accommodation. People living with their spouses had significantly higher SOFAS, lower PANSS Total and PANSS Positive than people living with family, independently, or in rehabilitation centres. They also had lower PANSS Negative than people living with family and a higher likelihood to have achieved symptomatic remission. Types of accommodation was not associated with symptoms, symptomatic remission, and functioning.

Conclusion

Living arrangements, but not types of accommodation, were associated with symptoms and functioning in schizophrenia. Family education and support is important to help maintain a conducive environment for people with schizophrenia. People living independently may need more support.
Altered spatiotemporal consistency in pediatric bipolar disorder patients with and without psychotic symptoms
Authors: Gao Weijia , Cui Dong , Jiao Qing , Su Linyan , Lu Guangming , Yang Rongwang
Published: October 2021

Objective

Psychotic symptoms are quite common in patients with pediatric bipolar disorder (PBD) and may affect the symptom severity and prognosis of PBD. However, the potential mechanisms are less well elucidated until now. Thus, the purpose of this study was to investigate the brain functional differences between PBD patients with and without psychotic symptoms.

Method

A total of 71 individuals including: 27 psychotic PBD (P-PBD), 25 nonpsychotic PBD (NP-PBD), and 19 healthy controls were recruited in the present study. Each subject underwent 3.0 Tesla functional magnetic resonance imaging scan. Four-dimensional (spatiotemporal) Consistency of local neural Activities (FOCA) was employed to detect the local brain activity changes. Analyses of variance (ANOVA) were used to reveal brain regions with significant differences among three groups groups of individuals, and inter-group comparisons were assessed using post hoc tests.

Results

The ANOVA obtained significant among-group FOCA differences in the left triangular inferior frontal gyrus, left supplementary motor area, left precentral gyrus, right postcentral gyrus, right superior occipital gyrus, and right superior frontal gyrus. Compared with the control group, the P-PBD group showed decreased FOCA in the left supplementary motor area and bilateral superior frontal gyrus and showed increased FOCA in the left triangular inferior frontal gyrus. In contrast, the NP-PBD group exhibited decreased FOCA in the right superior occipital gyrus and right postcentral gyrus and showed increased FOCA in the left orbital inferior frontal gyrus. Compared to the NP-PBD group, the P-PBD group showed decreased FOCA in the right superior frontal gyrus.

Conclusion

The present findings demonstrated that the two groups of PBD patients exhibited segregated brain functional patterns, providing empirical evidence for the biological basis of different clinical outcomes between PBD patients with and without psychotic symptoms.
Prediction of readmission in patients with acute exacerbation of chronic obstructive pulmonary disease within one year after treatment and discharge
Authors: Chen Lili , Chen Shiping
Published: October 2021

Background

To investigate the risk factors and construct a logistic model and an extreme gradient boosting (XGBoost) model to compare the predictive performances for readmission in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients within one year.

Methods

In total, 636 patients with AECOPD were recruited and divided into readmission group (n = 449) and non-readmission group (n = 187). Backward stepwise regression method was used to analyze the risk factors for readmission. Data were divided into training set and testing set at a ratio of 7:3. Variables with statistical significance were included in the logistic model and variables with P < 0.1 were included in the XGBoost model, and receiver operator characteristic (ROC) curves were plotted.

Results

Patients with acute exacerbations within the previous 1 year [odds ratio (OR) = 4.086, 95% confidence interval (CI) 2.723–6.133, P < 0.001), long-acting β agonist (LABA) application (OR = 4.550, 95% CI 1.587–13.042, P = 0.005), inhaled corticosteroids (ICS) application (OR = 0.227, 95% CI 0.076–0.672, P = 0.007), glutamic-pyruvic transaminase (ALT) level (OR = 0.985, 95% CI 0.971–0.999, P = 0.042), and total CAT score (OR = 1.091, 95% CI 1.048–1.136, P < 0.001) were associated with the risk of readmission. The AUC value of the logistic model was 0.743 (95% CI 0.692–0.795) in the training set and 0.699 (95% CI 0.617–0.780) in the testing set. The AUC value of XGBoost model was 0.814 (95% CI 0.812–0.815) in the training set and 0.722 (95% CI 0.720–0.725) in the testing set.

Conclusions

The XGBoost model showed a better predictive value in predicting the risk of readmission within one year in the AECOPD patients than the logistic regression model. The findings of our study might help identify patients with a high risk of readmission within one year and provide timely treatment to prevent the reoccurrence of AECOPD.
Accuracy of virtual surgical planning in segmental osteotomy in combination with bimaxillary orthognathic surgery with surgery first approach
Authors: Ying Xiaowu , Tian Kaiyue , Zhang Kaiyu , Ma Xiaohui , Guo Hongming
Published: October 2021

Background

This study aimed to assess the accuracy of virtual surgical planning (VSP) in segmental osteotomy in combination with bimaxillary orthognathic surgery with surgery first approach (SFA) by means of three-dimensional (3D) measuring and superimposition, so as to promote the application of digital technology in combined orthodontic-orthognathic treatment.

Methods

20 patients treated with segmental osteotomy in combination with bimaxillary orthognathic surgery with SFA from 2018 to 2020 were included. All of them acquired VSP performed by ProPlan CMF 3.0 software (Materialise Corporation, Belgium). The preoperative (T0) 3D model of VSP and the postoperative (T1) 3D model, reconstructed by the cone-beam computed tomography (CBCT) data acquired one week after surgery, were compared by measuring the 3D coordinates of the landmarks as well as 3D model superimposition for deviation analysis. The deviation analysis was achieved by Geomagic Studio 2013 (3D Systems Corporation, USA). The differences which represented the accuracy of VSP were evaluated by the root mean square deviation (RMSD) and the Bland–Altman method.

Results

There was no statistically significant difference between the 3D coordinates of T1 and T0 (P > 0.05), and the mean overall RMSD was 1.37 mm, within the clinical relevance of 2 mm. The RMSD of sagittal direction (1.76 mm) was greater than that of coronal and vertical directions (1.09 mm and 1.24 mm), and the RMSD of maxillary and mandibular aspects were basically equal (1.30 mm and 1.45 mm). The Bland–Altman method showed the T0 and T1 measurements were in good agreement. The mean RMSD obtained from the deviation analysis was 1.85 mm, within the clinical relevance.

Conclusions

VSP in segmental osteotomy in combination with bimaxillary orthognathic surgery with SFA proved to acquire accurate outcome in this study.
The effect of a single session of 30-min mindful breathing in reducing fatigue among patients with haematological cancer – a randomised controlled trial
Authors: Ng Diana-Leh-Ching , Gan Gin-Gin , Anuar Nur Adila , Tung Yu-Zhen , Lai Natalie-Zi , Tan Yi-Wen , Said Siti Norazilah Mohd , Madihie Amalia , Chai Chee-Shee , Tan Seng-Beng
Published: October 2021

Background

Patients with haematological cancer had considerable symptom burden, in which fatigue was the most prevalent. Almost 70% of haematological cancer patients reported fatigue.

Methods

We conducted a parallel-group, non-blinded, randomised control trial at the haemato-oncology unit of University Malaya Medical Centre, from 1st October 2019 to 31st May 2020. Patients included were ≥ 18 years, had histopathological diagnosis of haematological cancer, and fatigue score of ≥4 based on the fatigue subscale of Edmonton Symptom Assessment System (ESAS). Patients allocated to the intervention group received standard care plus a guided 30-min mindful breathing session, while those in control group received standard care. The study outcomes include fatigue severity according to the fatigue subscale of ESAS, visual analogue scale of 0 – 10, and Functional Assessment of Chronic Illness Therapy Fatigue Scale Version 4, at minute 0 and minute 30.

Results

Of 197 patients screened, 80 were eligible and they were equally randomised into 30-min mindful breathing versus standard care. Lymphoma (58.9%) was the commonest haematological malignancy, followed by multiple myeloma (13.8%), acute leukaemia (11.3%), myeloproliferative neoplasm (6.3%), chronic leukaemia (5.0%) and myelodysplastic syndrome (5.0%). There was no difference in the demographic and clinical characteristics between the 2 groups.

At minute 0, both arms of patients had similar ESAS-fatigue score (median, 5) and FACIT-fatigue score (mean ± SD, 24.7 ± 10.6 for intervention group versus 24.7 ± 9.7 for control group). At minute 30, intervention group had lower ESAS-fatigue score (median, 3 versus 5) and FACIT-fatigue score (mean ± SD, 17.1 ± 10.5 versus 24.8 ± 11.3) compared to control group. Both the ESAS-fatigue score reduction (median, − 2 versus 0, p = 0.002) and FACIT-fatigue score reduction (mean ± SD, − 6.7 versus + 0.8; p < 0.001) for the intervention group were statistically significant. The calculated effect size Cohen’s d was 1.4 for between-group comparison of differences in total FACIT-fatigue score.

Conclusions

Our results provide evidence that a single session of 30-min mindful breathing was effective in reducing fatigue in haematological cancer patients. On top of all the currently available methods, 30-min mindful breathing can prove a valuable addition.

Trial registration

NCT 05029024, date of registration 15th August 2021. (Retrospectively registered).
A model for national assessment of barriers for implementing digital technology interventions to improve hypertension management in the public health care system in India
Authors: Patel Shivani A. , Vashist Kushagra , Jarhyan Prashant , Sharma Hanspria , Gupta Priti , Jindal Devraj , Venkateshmurthy Nikhil Srinivasapura , Pfadenhauer Lisa , Mohan Sailesh , Tandon Nikhil
Published: October 2021

Background

There is substantial interest in leveraging digital health technology to support hypertension management in low- and middle-income countries such as India. The potential for healthcare infrastructure and broader context to support such initiatives in India has not been examined. We evaluated existing healthcare infrastructure to support digital health interventions and examined epidemiologic, socioeconomic, and geographical contextual correlates of healthcare infrastructure in 544 districts covering 29 states and union territories across India.

Methods

The study was a cross-sectional analysis of India’s Fourth District Level Household and Facility Survey (DLHS-4; 2012–2014), the most up-to-date nationally representative district-level healthcare infrastructure data. Facilities were the unit of analysis, and analyses accounted for clustering within states. The main outcome was healthcare system infrastructural context to implement hypertension management programs. Domains included diagnostics (functional BP instrument), medications (anti-hypertensive medication in stock), essential clinical staff (e.g., staff nurse, medical officer, pharmacist), and IT specific infrastructure (regular power supply, internet connection, computer availability). Descriptive analysis was conducted for infrastructure indicators based on the Indian Public Health Standards, and logistic regression was conducted to estimate the association between epidemiologic and geographical context (exposures) and the composite measure of healthcare system.

Results

Data from 32,215 government facilities were analyzed. Among lowest-tier subcenters, 30% had some IT infrastructure, while at the highest-tier district hospitals, 92% possessed IT infrastructure. At mid-tier primary health centres and community health centres, IT infrastructure availability was 28 and 51%, respectively. For all but sub-centres, the availability of essential staff was lower than the availability of IT infrastructure. For all but district hospitals, higher levels of blood pressure, body mass index, and urban residents were correlated with more favorable infrastructure. By region, districts in Western India tended towards having the best prepared health facilities.

Conclusions

IT infrastructure to support digital health interventions is more frequently lacking at lower and mid-tier healthcare facilities compared with apex facilities in India. Gaps were generally larger for staffing than physical infrastructure, suggesting that beyond IT infrastructure, shortages in essential staff impose significant constraints to the adoption of digital health interventions. These data provide early benchmarks for state- and district-level planning.
Exosomal lncRNA SNHG10 derived from colorectal cancer cells suppresses natural killer cell cytotoxicity by upregulating INHBC
Authors: Huang Yiwen , Luo Yanbo , Ou Wentao , Wang Yuanyuan , Dong Dong , Peng Xiaowen , Luo Yuqi
Published: October 2021

Background

Exosome-mediated crosstalk between cancer cells and immune cells contributes to tumor growth. In this study, we investigated the mechanism underlying the exosome-mediated immune escape of colorectal cancer (CRC) cells from natural killer (NK) cells via the transfer of long noncoding RNAs (lncRNAs).

Methods

An epithelial–mesenchymal transition (EMT) model of SW480 cells was established by transforming growth factor beta (TGF-β), followed by the assessment of the effect of EMT-derived exosomes (EMT-exo) on the functions of NK cells. RNA sequencing was performed to identify exosomal lncRNAs and target genes. The function of exosomal lncRNAs in tumor growth was further verified in vivo.

Results

EMT-exo suppressed the proliferation, cytotoxicity, IFN-γ production, and perforin-1 and granzyme B secretion of NK cells. RNA sequencing revealed that SNHG10 expression was upregulated in EMT-exo compared with that in non-EMT-exo. Moreover, SNHG10 expression was upregulated in tumor tissues in CRC, which was associated with poor prognosis. Overexpression of SNHG10 in exosomes (oe-lnc-SNHG10 exo) significantly suppressed the viability and cytotoxicity of NK cells. Transcriptome sequencing of NK cells revealed that the expression levels of 114 genes were upregulated in the oe-lnc-SNHG10 exo group, including inhibin subunit beta C (INHBC), which was involved in the TGF-β signaling pathway. Si-INHBC treatment abrogated the effect of oe-lnc-SNHG10 exo on NK cells. oe-lnc-SNHG10 exo induced tumor growth and upregulated INHBC expression in mice and downregulated the expression of perforin, granzyme B, and NK1.1 in tumor tissues.

Conclusions

The CRC cell-derived exosomal lncRNA SNHG10 suppresses the function of NK cells by upregulating INHBC expression. This study provides evidence that exosomal lncRNAs contribute to immune escape by inducing NK cell inhibition and proposes a potential treatment strategy for CRC.
Community health workers at the dawn of a new era: 3. Programme governance
Authors: Lewin Simon , Lehmann Uta , Perry Henry B.
Published: October 2021

Background

Community health workers (CHWs) can play a critical role in primary healthcare and are seen widely as important to achieving the health-related Sustainable Development Goals (SDGs). The COVID-19 pandemic has emphasized the key role of CHWs. Improving how CHW programmes are governed is increasingly recognized as important for achieving universal access to healthcare and other health-related goals. This paper, the third in a series on “Community Health Workers at the Dawn of a New Era”, aims to raise critical questions that decision-makers need to consider for governing CHW programmes, illustrate the options for governance using examples of national CHW programmes, and set out a research agenda for understanding how CHW programmes are governed and how this can be improved.

Methods

We draw from a review of the literature as well as from the knowledge and experience of those involved in the planning and management of CHW programmes.

Results

Governing comprises the processes and structures through which individuals, groups, programmes, and organizations exercise rights, resolve differences, and express interests. Because CHW programmes are located between the formal health system and communities, and because they involve a wide range of stakeholders, their governance is complex. In addition, these programmes frequently fall outside of the governance structures of the formal health system or are poorly integrated with it, making governing these programmes more challenging. We discuss the following important questions that decision-makers need to consider in relation to governing CHW programmes: (1) How and where within political structures are policies made for CHW programmes? (2) Who implements decisions regarding CHW programmes and at what levels of government? (3) What laws and regulations are needed to support the programme? (4) How should the programme be adapted across different settings or groups within the country or region?

Conclusion

The most appropriate and acceptable models for governing CHW programmes depend on communities, on local health systems, and on the political system in which the programme is located. Stakeholders in each setting need to consider what systems are currently in place and how they might be adapted to local needs and systems.
Community health workers at the dawn of a new era
Authors: Zulu Joseph M. , Perry Henry B.
Published: October 2021

Background

There is now rapidly growing global awareness of the potential of large-scale community health worker (CHW) programmes not only for improving population health but, even more importantly, for accelerating the achievement of universal health coverage and eliminating readily preventable child and maternal deaths. However, these programmes face many challenges that must be overcome in order for them to reach their full potential.

Findings

This editorial introduces a series of 11 articles that provide an overview highlighting a broad range of issues facing large-scale CHW programmes. The series addresses many of them: planning, coordination and partnerships; governance, financing, roles and tasks, training, supervision, incentives and remuneration; relationships with the health system and communities; and programme performance and its assessment. Above all, CHW programmes need stronger political and financial support, and this can occur only if the potential of these programmes is more broadly recognized. The authors of the papers in this series believe that these challenges can and will be overcome—but not overnight. For this reason, the series bears the title “Community Health Workers at the Dawn of a New Era”. The scientific evidence regarding the ability of CHWs to improve population health is incontrovertible, and the favourable experience with these programmes at scale when they are properly designed, implemented, and supported is compelling. CHW programmes were once seen as a second-class solution to a temporary problem, meaning that once the burden of disease from maternal and child conditions and from communicable diseases in low-income countries had been appropriately reduced, there would be no further need for CHWs. That perspective no longer holds. CHW programmes are now seen as an essential component of a high-performing healthcare system even in developed countries. Their use is growing rapidly in the United States, for instance. And CHWs are also now recognized as having a critically important role in the control of noncommunicable diseases as well as in the response to pandemics of today and tomorrow in all low-, middle-, and high-income countries throughout the world.

Conclusion

The promise of CHW programmes is too great not to provide them with the support they need to achieve their full potential. This series helps to point the way for how this support can be provided.
Determinants of adolescent pregnancy in indigenous communities from the Peruvian central jungle: a case–control study
Authors: Mejia Jhonatan R. , Quincho-Estares Ángel J. , Flores-Rondon Asstrid J. , Reyes-Beltran Giancarlo , Arias-Sulca Irene L. , Palomino-Hilario Estephanie , Barrientos-Cochachi Jessica E. , Toro-Huamanchumo Carlos J.
Published: October 2021

Background

Adolescent pregnancy carries a high risk of severe health issues for both the mother and the newborn. Worldwide, 21 million adolescents give birth every year, with high percentages in Latin America. Most of the risk factors are met in indigenous communities, which is an underrepresented and poorly studied population. We aimed to assess the determinants of adolescent pregnancy in indigenous communities from the Peruvian central jungle.

Methods

Through a case–control study, female adolescents aged 13 to 19 years old from seven indigenous communities of the Peruvian central jungle were interviewed. Adolescents with (cases) and with no (controls) pregnancy history, such as current pregnancy, children and abortion, fulfilled our eligible criteria. Our instrument explored: sociodemographic, adolescent and family characteristics, as well as perceptions of adolescent pregnancy. We performed a penalized maximum likelihood logistic regression analysis to obtain Odds Ratios (OR) and their 95% confidence intervals (95% CI).

Results

We enrolled 34 cases and 107 controls. Overall, 53.9% were 15 to 19 years old. We found a significant association of being 15–19 years old (OR = 6.88, 95% CI 2.38–19.86, p < 0.0001) and an elementary school level of instruction (OR = 5.59, 95% CI 1.95–16.06, p = 0.001) with the risk of adolescent pregnancy. A marginal statistical significance between having five to six siblings and adolescent pregnancy was also reported (OR = 2.70, 95% CI 0.85–8.61, p = 0.094). Furthermore, adolescents with sexual and reproductive health communication with parents had a lower risk of adolescent pregnancy (OR = 0.17, 95% CI 0.06–0.47, p = 0.001).

Conclusion

Our results suggest that public health and educational efforts should be age-specific focused within indigenous communities of the Peruvian central jungle, encouraging parents to talk about sexual and reproductive health topics with adolescents.