bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationships between students’ individual interest, achievement goals, perceived competence and situational interest: A cluster analysis in swimming
Authors: Roure Cédric , Lentillon-Kaestner Vanessa
Published: October 2021

The purpose of this study was to investigate the relationships between students’ individual interest, achievement goals, perceived competence and situational interest, by using a cluster analysis in swimming. Three hundred and eighty-two secondary school students ( Mage  =  14.8, SD  =  0.9, 52.4% girls, aged 13–17) enrolled in swimming lessons during physical education classes participated in the study. They responded to validated questionnaires assessing their individual and situational interest, achievement goals and perceived competence in swimming. A cluster analysis was performed to examine students’ profiles in relation to their individual interest in swimming. Then, for each profile identified, correlations and multiple regression analyses were used to examine the relationships between students’ individual interest, achievement goals, perceived competence and situational interest. Four different students’ profiles were identified, which represented a continuum from a ‘Very low individual interest and triggering situational interest’ towards a ‘Well-developed individual interest and actualised situational interest’. Each profile was characterised by specific relationships between individual interest, achievement goals, perceived competence and situational interest. Referring to the model of interest development ( Hidi and Renninger, 2006 ), the four profiles identified were aligned with the four phases that represent the transition from students’ situational interest towards students’ individual interest.
Multimorbidity and health literacy: A population-based survey among 28,627 Danish adults
Authors: Pedersen Sofie Emilie , Aaby Anna , Friis Karina , Maindal Helle Terkildsen
Published: October 2021

Aim:

Individuals with multimorbidity often have complex healthcare needs challenging their health literacy skills. This study aimed to investigate the association between the number of physical conditions and health literacy and to examine the difference in health literacy levels between individuals with multimorbidity based on physical conditions and individuals with additional mental disorders.

Methods:

Respondents aged 25 years or older from a Danish population-based survey were included ( N = 28,627). Multimorbidity was assessed based on 18 self-reported chronic conditions; health literacy was measured using two scales from the Health Literacy Questionnaire focusing on understanding health information and engaging with healthcare providers. Associations were examined using multiple logistic regression analysis.

Results:

We found a positive association between number of physical conditions and the odds of having difficulties in understanding health information and engaging with healthcare providers. For example, the adjusted odds ratio (OR) of having difficulties in understanding health information was 1.45 (95% confidence interval (CI): 1.09–1.94) for individuals with two physical conditions compared with individuals without multimorbidity. The associations formed a positive exposure–response pattern. Furthermore, respondents with both mental and physical conditions had more than twice the odds of having health literacy difficulties compared to respondents with only physical conditions (adjusted OR 2.53 (95% CI 2.02–3.18) and 2.28 (95% CI 1.92–2.72) for the scales, respectively).

Conclusions:

Our results suggest that responding to patients’ health literacy needs is crucial for individuals with multimorbidity – especially those with combined mental and physical conditions.
A numerical homogenization technique for unidirectional composites using polygonal generalized finite elements
Authors: Sartorato Murilo
Published: October 2021

The present study proposes a computational methodology to obtain the homogenized effective elastic properties of unidirectional fibrous composite materials by using the generalized finite-element method and penalization techniques to impose periodic boundary conditions on non-uniform polygonal unit cells. Each unit cell is described by a single polygonal finite element using Wachspress functions as base shape functions and different families of enrichment functions to account for the internal fiber influence on stresses and strains fields. The periodic boundary conditions are imposed using reflection laws between two parallel opposing faces using a Lagrange multiplier approach; this reflection law creates a distributed reaction force over the edges of the [Formula: see text]-gon from the direct application of a given deformation gradient, which simulates different macroscopic load cases on the macroscopic body the unit cell is part of. The methodology is validated through a comparison with results for similar unit cells found in the literature and its computational efficiency is compared to simple cases solved using a classic finite-element approach. This methodology showed computational advantages over the classic finite elements in both computational efficiency and total number of degrees of freedom for convergence and flexibility on the shape of the unit cell used. Finally, the methodology provides an efficient way to introduce non-circular fiber shapes and voids.
High temperature impression creep behavior and microstructures of wrought ZM21 magnesium alloy
Authors: Ebenezer D , Koteswara Rao SR , Vijayan S , Rajeswari R
Published: October 2021

Mg-Zn alloys are promising candidates for their application in automotive, electronics and aerospace applications. For their successful application, one of the performance parameters that needs to be evaluated is their creep behavior at elevated temperatures. Hence this paper evaluates the high temperature creep behavior of wrought ZM21 magnesium alloy by impression test The tests were performed under constant temperature and stress. A flat ended cylindrical punch was used to create impressions. The temperature was varied between 398 K and 598 K while the stresses were varied from 200 MPa to 500 MPa (normalized stress: 0.014 ≤  σimp/ G ≥ 0.032). A power-law creep deformation was assumed to calculate creep exponent and activation energy using the steady state minimum impression velocity obtained from impression tests. The creep behavior was analyzed with the help of impression creep curves and plastic deformation was analyzed with the help of micrographs. It was found that creep exponent varied between 4.5 and 6 and activation energy between 73.28 and 113.35 kJ/mol were obtained. From the study it was concluded that the creep mechanism involved was pipe-diffusion-controlled dislocation climb.
Numerical simulation of cavitating flow in maritime high-pressure direct fuel injection nozzles and assessment of cavitation-erosion damage
Authors: Falsafi Sherwin , Blume Martin , Klaua Thomas , Indrich Maximilian , Wloka Johann , Skoda Romuald
Published: October 2021

The internal flow of Heavy Fuel Oil (HFO) in two maritime direct fuel injector nozzles is studied by 3D flow simulations for the assessment of erosion-sensitive wall regions. The nozzle geometries differ in number, diameter and inclination angle of holes as well as sac wall curvature. Long-term endurance experiments reveal characteristic damage locations for both nozzles. Simulations are performed by a compressible density-based flow solver with a barotropic cavitation model to capture shock wave dynamics. Real geometries and the entire injection cycle with time-dependent rail pressure and transient needle movement are considered. A statistical evaluation of individual collapsing voids in terms of their condensation rate yield an erosion probability that is compared against experimental damage locations. Due to the scatter in the values of viscosity of real fuels a viscosity variation is carried out, which shows that while a lower viscosity leads to a rise of erosion probability, the location of erosion-sensitive wall zones is not significantly changed. The analysis of 3D velocity and void field evolutions motivates the introduction of distinct injection sub-phases of the entire cycle. Erosion probability is separately evaluated within each sub-phase. By this simulation procedure, experimentally found erosion spots are associated with particular sub-phases and can be traced back to characteristic flow and void structures that are linked to particular nozzle geometry features.
Are the Lowest-Paid UFC Fighters Really Overpaid? A Comment on Gift (2019)
Authors: Caves Kevin , Tatos Ted , Urschel Augustus
Published: October 2021

In a recent article in this Journal, Gift (2019) attempts to measure the marginal revenue product (MRP) of individual Ultimate Fighting Championship (UFC) fighters. According to Gift’s estimates, top-tier UFC Fighters are frequently and substantially underpaid relative to their MRP while “a sizable percentage of UFC fighters generated little to no MRP,” and are consequently “overpaid by traditional measures.” In this Comment, we examine possible explanations for this finding, including various limitations of Gift’s data and methods. We also examine the underlying economics of the sport, in which quasi-fixed broadcast revenue streams, ignored in Gift's MRP estimates, play a large and increasingly dominant role. As Berri et al. (2015 ) have emphasized, comparisons of athlete compensation and standard MRP metrics (even if estimated correctly) are “meaningless” in the presence of substantial quasi-fixed revenues. Critically, Gift assumes zero MRP for all fighters in all bouts in all non-Pay-Per-View (PPV) events. As a result, Gift's method assumes fighters are “overpaid” for the vast majority (75 percent) of fighter-bouts. Even setting this aside, we argue that Gift's use of Google Trends data—at best an extremely crude proxy for a fighter's contribution to PPV revenue—suffers from measurement error, producing attenuation bias. As a consequence, Gift's data and methods are likely to substantially underestimate UFC fighters’ economic value.
Parent–Child Interaction Therapy for a 3-Year-Old Girl With Post-Traumatic Stress Disorder: Restoration to Her Father’s Care Following a Period in Out-of-Home Care
Authors: Warren Jessica M. , Hanstock Tanya , Hunt Sally , Halpin Sean
Published: October 2021

Child abuse and neglect in very young children can lead to trauma-related stress symptoms that can be challenging to treat. Children exposed to multiple traumas occurring in the context of a caregiving relationship are sometimes more severely affected, evidenced by diverse negative behavioral, physical, social, and emotional consequences. Some of these children go on to develop post-traumatic stress disorder (PTSD). Parent–child interaction therapy (PCIT) is a dyadic play-based treatment for children with behavior problems and their parents or caregivers. There is limited research relating to the application of PCIT with very young children with PTSD with some studies actively excluding families where PTSD was present (Herschell et al., 2017). Additionally, there are no articles relating to treatment of a child restored to the care of a parent following out-of-home care (OOHC) and fewer still relating to a child restored to the care of her father. This case study illustrates the use of PCIT with a 3-year-old girl with PTSD, recently restored to her father’s care. It highlights how the use of PCIT in this case not only improved behavioral indicators of traumatic stress, but also afforded this child permanency and stability. The case study provides a summary of the progression of this intervention and the results obtained throughout treatment and 4 years post-intervention. The results indicated that PCIT, with trauma-informed tailoring, was an effective treatment in this case and contributed to safe and permanent care for this child.
Capturing the Impact of Public Narrative: Methodological Challenges Encountered and Opportunities Opened
Authors: Aiello Emilia , Sorde-Marti Teresa
Published: October 2021

Public narrative is a leadership practice of translating values into action. It links the three elements of self, us, and now: why I am called, why we are called, and why we are called to act now. Taught and learned for more than 15 years now through various learning environments (in-person or online courses, in-person or online workshops, etc.), the Narratives4Change research project (H2020, Nr. 841355) aimed at studying how public narrative is being used by individuals as a leadership practice within different domains of practice and across diverse cultural and geographical contexts, as well as what are the impacts achieved. An endeavor never carried before, capturing evidence of impact of public narrative going beyond the usage and transference posed several methodological challenges. To overcome them, we engaged in an on-going process of dialogue with researchers experienced in social impact analysis, and practitioners and leaders well experienced in using public narrative. Drawing on the work done in the framework of the Narratives4Change project, this article explains its methodological design, presenting and discussing two of the strategies adopted to capture the impact dimension, and how they were implemented. On the one hand, the communicative orientation of the mixed-methods research design of the project allowed researchers to empirically grasp the manifold agentic orientations that can be triggered by public narrative. On the other hand, how the Social Impact Open Repository criteria for social impact analysis was incorporated at the time of exploring and deepening into the social reality that was being observed sets us off on an “impact-oriented analytical mindset” that facilitated identifying evidence of impacts. Specific examples of how each of these strategies played out during the methodological design and implementation of the research are discussed, drawing lessons that can also inform the design of future research projects.
Street gangs and coercive control: The gendered exploitation of young women and girls in county lines
Authors: Havard Tirion Elizabeth , Densley James A , Whittaker Andrew , Wills Jane
Published: October 2021

This article explores young women and girls’ participation in gangs and ‘county lines’ drug sales. Qualitative interviews and focus groups with criminal justice and social service professionals found that women and girls in gangs often are judged according to androcentric, stereotypical norms that deny gender-specific risks of exploitation. Gangs capitalise on the relative ‘invisibility’ of young women to advance their economic interests in county lines and stay below police radar. The research shows gangs maintain control over women and girls in both physical and digital spaces via a combination of threatened and actual (sexual) violence and a form of economic abuse known as debt bondage – tactics readily documented in the field of domestic abuse. This article argues that coercive control offers a new way of understanding and responding to these gendered experiences of gang life, with important implications for policy and practice.
Oncology workload in a tertiary hospital during the COVID-19 pandemic
Authors: Chiang Jianbang , Yang Valerie , Han Shuting , Zhuang Qingyuan , Zhou Siqin , Mathur Sachin , Kang Mei Ling , Ngeow Joanne , Yap Swee Peng , Tham Chee Kian
Published: October 2021

Introduction

Workload in oncology during a pandemic is expected to increase as manpower is shunted to other areas of need in combating the pandemic. This increased workload, coupled with the high care needs of cancer patients, can have negative effects on both healthcare providers and their patients.

Methods

This study aims to quantify the workload of medical oncologists compared to internal medicine physicians and general surgeons during the current COVID-19 pandemic, as well as the previous H1N1 pandemic in 2009.

Results

Our data showed decrease in inpatient and outpatient workload across all three specialties, but the decrease was least in medical oncology (medical oncology −18.5% inpatient and −3.8% outpatient, internal medicine −5.7% inpatient and −24.4% outpatient, general surgery −17.6% inpatient, and −39.1% outpatient). The decrease in general surgery workload was statistically significant. The proportion of emergency department admissions to medical oncology increased during the COVID-19 pandemic. Furthermore, the study compared the workload during COVID-19 with the prior H1N1 pandemic in 2009 and showed a more drastic decrease in patient numbers across all three specialties during COVID-19.

Discussion

We conclude that inpatient and outpatient workload in medical oncology remains high despite an ongoing COVID-19 pandemic. The inpatient medical oncology workload is largely contributed by the stable number of emergency department admissions, as patients who require urgent care will present to a healthcare facility, pandemic or not. Healthcare systems should maintain manpower in medical oncology to manage this vulnerable group of patients in light of the prolonged COVID-19 pandemic.
The role of C-reactive protein in predicting the severity of COVID-19 disease: A systematic review
Authors: Yitbarek Getachew Yideg , Walle Ayehu Gashaw , Asnakew Sintayehu , Ayele Fanos Yeshanew , Bariso Gare Moyeta , Mulu Anemut Tilahun , Dagnaw Fentaw Teshome , Melesie Biruk Demissie
Published: October 2021

Since December 2019, coronavirus diseases-2019 (COVID-19) dispersed into 200 countries and affected more than 70 million people. The clear picture of the SARS-CoV-2 infection is still under investigation. In this review, we evaluated whether C-reactive protein biomarker is able to predict the clinical outcomes or correlated with the severity of COVID-19 disease. The databases MEDLINE, Hinari, Google Scholar, and Google search were used to find potential studies published from COVID-19 epidemic until May 2021. A format prepared in Microsoft Excel spreadsheet was used to extract the appropriate details from each original report. For further review, the extracted data were exported to STATA/MP version 16.0 software. Keywords including “COVID-19,” “SARS-CoV-2,” and “C-reactive protein,” among others were used to search relevant articles. Only studies which reported the average C-reactive protein value and COVID-19 disease stage outcomes were included. Twenty articles were included in the review. All studies found considerably higher level of C-reactive protein in patients with severe COVID-19 as compared to mildly infected patients. This review evidenced that it is still there for a given biomarker to early identify the state of progression in asymptomatic and/or mildly infected individuals into severe disease; the level of C-reactive protein may be used in predicting the likelihood of disease progression. Findings from this review showed level of C-reactive protein is a good biomarker to predict the severity of COVID-19 disease. Although COVID-19 researches are at the early stages, investigation of C-reactive protein levels throughout the disease course may have paramount importance for clinicians in early detection of severe manifestations and subsequently improve the prognosis. However, further large-scale studies are required to confirm these findings.
Podocyte Infolding Glomerulopathy, First Case Report From North America
Authors: Ting Julie Anne , Hung Wayne , McRae Susanna A. , Barbour Sean J. , Copland Michael , Riazy Maziar
Published: October 2021

Rationale:

Podocyte infolding glomerulopathy (PIG) is a newly described condition with only 37 cases reported worldwide. Due to its rarity, the pathogenesis and evolution of this disease is unclear. This case report contributes to our collective knowledge about the clinical and histological progression of this disease.

Presenting concerns of the patient:

Over the course of a year, a 52-year-old Malaysian woman with no known prior medical history developed progressively worsening edema and other findings consistent with nephrotic syndrome.

Diagnosis:

Unlike most patients with PIG, this patient did not have any autoimmune disease. She was Hepatitis B core antibody positive with a Hepatitis B surface antibody >1000, suggesting prior Hepatitis B infection with immunity. A renal biopsy was performed which was consistent with PIG. A second renal biopsy was done 2 years later which again showed characteristic findings of PIG with worsened podocyte effacement but no interval change in chronicity.

Interventions:

The patient was treated with blood pressure control and renin-angiotensin-aldosterone system (RAAS) blockade with irbesartan and spironolactone. She was also treated with prednisone at 1 mg/kg for 2 months followed by a taper for a total of 7 months of prednisone treatment.

Outcomes:

The patient had a partial response to a course of prednisone. However, since stopping steroids, her proteinuria and renal function has been gradually worsening.

Teaching points:

PIG is mostly found in patients of East Asian descent. It presents as proteinuria and is often associated with autoimmune disease but can be idiopathic. It is characterized on renal biopsy by infolding or protrusion of podocyte cytoplasm into glomerular basement membrane, as well as intramembranous cytoplasmic microspherules or microtubules. Atypical membranous nephropathy should be ruled out prior to diagnosis. Unlike membranous nephropathy, PIG usually responds at least partially to steroid monotherapy. To our knowledge, this is the first reported case of PIG from North America. Furthermore, it is the first case of PIG with repeat biopsy showing interval worsening of PIG rather than either resolution of PIG or transformation of PIG to a different diagnosis.
Community Health Workers Improve Smoking Cessation When They Recruit Patients in Their Home Villages
Authors: Umnuaypornlert Adinat , Dede Adam J. O. , Pangtri Sudarat
Published: October 2021

Introduction/Objective:

Community health workers (CHWs) can play a vital role in many aspects of healthcare, particularly for underserved communities, but it is unclear what factors are most important in determining the success of CHW-based programs. We wanted to assess what factors contribute to the effectiveness of CHWs in a smoking cessation program.

Methods:

We trained CHWs in 3 areas regarding smoking cessation: knowledge, attitude, and practice (KAP). The training program utilized the 5A’s as approach. CHWs actively sought out people addicted to cigarettes to participate. Patients received support from CHWs and a team of medical professionals for a year. At the conclusion of the program, focus group discussions with a group of CHWs, a group of patients, and a group of medical professionals were conducted.

Results:

On average, patients reduced their cigarettes/day by 7.2% and 29% of patients were completely cigarette free at a 1-year follow-up. Patients marginally decreased exhalation CO levels and increased lung capacity. CHWs gained a good understanding of health risks associated with smoking and common methods to help quit. Their attitude became more sympathetic and caring. CHWs exhibited patient-specific solutions to help with smoking cessation and actively sought out people to participate in the smoking cessation program.

Conclusions:

A smoking cessation program combining CHWs and pharmacists was effective. Key factors were having CHWs that are respected and established in their communities, using CHWs who know their patients and can provide individually tailored solutions, and empowering CHWs with intensive training.
Exploring the Similarity of Partners’ Love Styles and Their Relationships With Marital Satisfaction: A Dyadic Approach
Authors: Agus Mirian , Puddu Luisa , Raffagnino Rosalba
Published: October 2021

In this paper, we report on the findings of our exploratory research investigating how the similarity or difference of the partners’ love styles could be related to dyadic and familial satisfaction. The empirical literature outlines how love styles are differently associated with various couple dimensions. While most studies employ an individual approach, we assessed whether the similarity of the prevalent love style in each couple was associated with greater dyadic satisfaction. In our sample, comprising 146 heterosexual couples (all married or cohabitating), no such association emerged. Storge and Pragma were the most prevalent love styles; moreover, there was a similar prevalence of the similarity in these two love styles between partners. Hence, the love styles similarity does not show a direct association with marital satisfaction. To establish whether there is some relationship between these variables, it would be useful for future research to investigate the impact of further individual and relational factors and of their interaction.
Patient Satisfaction in Outpatient Radiology: Effects of Modality and Patient Demographic Characteristics
Authors: Ajam Amna A. , Xing Bin , Siddiqui Arham , Yu Joseph S. , Nguyen Xuan V.
Published: October 2021

Objective: To characterize predictors of patient satisfaction in outpatient radiology, we examined whether patient satisfaction differs across radiology modalities and demographic groups. Methods: A random sampling of Press-Ganey outpatient services surveys for radiology and non-radiology visits from September 2008 to September 2017 were retrospectively analyzed. Composite scores averaged across all Likert items were analyzed as both a continuous variable and a dichotomous variable of dissatisfaction (defined as ≤3 on the 5-point scale). Results: Among 9983 radiology surveys, mammography had higher composite scores than MRI, CT, radiography, US, and NM/PET (p < 0.001) and lower dissatisfaction (3.9%) than CT (6.7%), MRI (7.3%), and radiography (8.2%). Low-scoring responses were most common in the Facilities domain (7.8%) and least common in Overall Assessment (3.8%). Satisfaction metrics were lowest for ages 20–29 and highest for ages 70–79. Lower dissatisfaction rates were seen among Hispanics (3%) and whites (6%), compared to blacks (10%) and Asians (18%). Conclusion: Significant differences in patient satisfaction were found across imaging modalities and demographic variables. Further investigations to identify contributing factors may help improve patient experiences.
Two-sided Institutional Impacts and Informal Entrepreneurship Motivation in Nigeria
Authors: Adike Abinotam J. , Anosike Paschal U. , Wang Yong
Published: October 2021

Institutions are developed to direct individuals’ behaviours in ways that lead to their fulfilment. However, either by deliberate human design or other factors, institutions can also either impact positively or negatively on individuals with entrepreneurial ambition. This characterisation is typical of Nigeria’s institutions because of their often two-sided impacts on the individual. This article uses interview data from a qualitative study to demonstrate how ambiguity, as reflected in the often conflicting effects of institutional arrangements in Nigeria influence the decision to engage in informal entrepreneurship. In particular, the finding that both the enforcement and the absence of enforcement of formal laws potentially cause informality, presents a challenge that seriously implicate policy formulation and point to the need for more targeted research.
Degradation of paraquat herbicide using hybrid AOP process: statistical optimization, kinetic study, and estimation of electrical energy consumption
Authors: Ghavi Azam , Bagherian Ghadamali , Rezaei-Vahidian Hadi
Published: October 2021

Background

This work studied the performance of UV/PS/TiO2NPs and UV/PI/TiO2NPs as hybrid advanced oxidation processes for degradation of paraquat in aqueous solution, because this very toxic herbicide is used third most widely.

Results

The effects of several factors such as UV irradiation, initial oxidant concentration, TiO2 nanoparticles dosage, and pH on the degradation efficiency were investigated. The process optimization was performed by the central composite design as a tool of response surface methodology for 30 mgL−1 of the herbicide initial concentration at 25 ℃ and 40 min of degradation process. Based on the results, a degradation efficiency of 77% and 90% were obtained for the UV/PS/TiO2NPs and UV/PI/TiO2NPs processes, respectively, in the optimum conditions. The mineralization efficiency of the paraquat solution using UV/PS/TiO2NPs and UV/PI/TiO2NPs processes are about 32% and 55%, respectively, after 40 min. The kinetic studies show that both processes follow a pseudo-first-order kinetic model, and the kinetic constants are 0.0299 min−1 for the PS process and 0.0604 min−1 for the PI process. The electrical energy consumption was estimated to be about 481.60 kWhm−3 for the PS process and 238.41 kWhm−3 for the PI process.

Conclusions

The degradation and mineralization efficiency of the paraquat solution using the UV/PI/TiO2NPs process was more than that of the UV/PS/TiO2NPs process at the optimum conditions after 40 min.
A computational model of mutual antagonism in the mechano-signaling network of RhoA and nitric oxide
Authors: Surendran Akila , Forbes Dewey C. , Low Boon Chuan , Tucker-Kellogg Lisa
Published: October 2021

Background

RhoA is a master regulator of cytoskeletal contractility, while nitric oxide (NO) is a master regulator of relaxation, e.g., vasodilation. There are multiple forms of cross-talk between the RhoA/ROCK pathway and the eNOS/NO/cGMP pathway, but previous work has not studied their interplay at a systems level. Literature review suggests that the majority of their cross-talk interactions are antagonistic, which motivates us to ask whether the RhoA and NO pathways exhibit mutual antagonism in vitro, and if so, to seek the theoretical implications of their mutual antagonism.

Results

Experiments found mutual antagonism between RhoA and NO in epithelial cells. Since mutual antagonism is a common motif for bistability, we sought to explore through theoretical simulations whether the RhoA-NO network is capable of bistability. Qualitative modeling showed that there are parameters that can cause bistable switching in the RhoA-NO network, and that the robustness of the bistability would be increased by positive feedback between RhoA and mechanical tension.

Conclusions

We conclude that the RhoA-NO bistability is robust enough in silico to warrant the investment of further experimental testing. Tension-dependent bistability has the potential to create sharp concentration gradients, which could contribute to the localization and self-organization of signaling domains during cytoskeletal remodeling and cell migration.
RNA-Seq reveals different responses to drought in Neotropical trees from savannas and seasonally dry forests
Authors: Sobreiro Mariane B. , Collevatti Rosane G. , dos Santos Yuri L. A. , Bandeira Ludmila F. , Lopes Francis J. F. , Novaes Evandro
Published: October 2021

Background

Water is one of the main limiting factors for plant growth and crop productivity. Plants constantly monitor water availability and can rapidly adjust their metabolism by altering gene expression. This leads to phenotypic plasticity, which aids rapid adaptation to climate changes. Here, we address phenotypic plasticity under drought stress by analyzing differentially expressed genes (DEG) in four phylogenetically related neotropical Bignoniaceae tree species: two from savanna, Handroanthus ochraceus and Tabebuia aurea, and two from seasonally dry tropical forests (SDTF), Handroanthus impetiginosus and Handroanthus serratifolius. To the best of our knowledge, this is the first report of an RNA-Seq study comparing tree species from seasonally dry tropical forest and savanna ecosystems.

Results

Using a completely randomized block design with 4 species × 2 treatments (drought and wet) × 3 blocks (24 plants) and an RNA-seq approach, we detected a higher number of DEGs between treatments for the SDTF species H. serratifolius (3153 up-regulated and 2821 down-regulated under drought) and H. impetiginosus (332 and 207), than for the savanna species. H. ochraceus showed the lowest number of DEGs, with only five up and nine down-regulated genes, while T. aurea exhibited 242 up- and 96 down-regulated genes. The number of shared DEGs among species was not related to habitat of origin or phylogenetic relationship, since both T. aurea and H impetiginosus shared a similar number of DEGs with H. serratifolius. All four species shared a low number of enriched gene ontology (GO) terms and, in general, exhibited different mechanisms of response to water deficit. We also found 175 down-regulated and 255 up-regulated transcription factors from several families, indicating the importance of these master regulators in drought response.

Conclusion

Our findings show that phylogenetically related species may respond differently at gene expression level to drought stress. Savanna species seem to be less responsive to drought at the transcriptional level, likely due to morphological and anatomical adaptations to seasonal drought. The species with the largest geographic range and widest edaphic-climatic niche, H. serratifolius, was the most responsive, exhibiting the highest number of DEG and up- and down-regulated transcription factors (TF).
Fatal and nonfatal firearm injuries in the eastern Democratic Republic of Congo: a hospital-based retrospective descriptive cohort study assessing correlates of adult mortality
Authors: Budema Paul Munguakonkwa , Murhega Roméo Bujiriri , Tshimbombu Tshibambe Nathanael , Toha Georges Kuyigwa , Cikomola Fabrice Gulimwentuga , Mudekereza Paterne Safari , Mubenga Léon-Emmanuel , Maheshe-Balemba Ghislain , Badesire Darck Cubaka , Kanmounye Ulrick Sidney
Published: October 2021

Introduction

The Eastern Democratic Republic of Congo (DRC) has been the battleground for multiple armed conflicts, resulting in many fatal and nonfatal firearm injuries (F&NFFIs). Chronic insecurity has stressed the health system’s resources and created barriers to seeking, reaching, and receiving timely care further increasing the F&NFFI burden. Our institution is the largest trauma center in the region and receives the bulk of F&NFFI cases. We aimed to identify correlates of mortality in Congolese F&NFFI patients.

Methods

We included all F&NFFI patients admitted to our institution between 2017 and 2020. We extracted data from patient charts and admission logs. We identified mortality correlates using the two-sample t-test, Chi-square test, and multivariable regression analysis. A P-value of less than 0.05 was considered statistically significant.

Results

This study included 814 adult patients, mostly male (86%) with an average age of 34.5 years and living 154.4 km away from the hospital on average. The most affected anatomical sites were the lower limbs (48.2%) and upper limbs (23.2%). The median length of stay was 34.0 days, and the in-hospital mortality rate was 3.6%. In addition, mortality was negatively correlated with diastolic blood pressure (P = 0.01), SaO2 (P < 0.001), and hemoglobin concentration (P = 0.002).

Conclusion

F&NFFIs cause an enormous burden in the region, and mortality is correlated with some clinical and biological variables. Thus, the study findings will inform F&NFFI referral, triage, and management in low-resource and mass casualty settings.
Examining the association between paramedic transport to the emergency department and hospital admission: a population-based cohort study
Authors: Strum Ryan P. , Mowbray Fabrice I. , Worster Andrew , Tavares Walter , Leyenaar Matthew S. , Correia Rebecca H. , Costa Andrew P.
Published: October 2021

Background

Increasing hospitalization rates present unique challenges to manage limited inpatient bed capacity and services. Transport by paramedics to the emergency department (ED) may influence hospital admission decisions independent of patient need/acuity, though this relationship has not been established. We examined whether mode of transportation to the ED was independently associated with hospital admission.

Methods

We conducted a retrospective cohort study using the National Ambulatory Care Reporting System (NACRS) from April 1, 2015 to March 31, 2020 in Ontario, Canada. We included all adult patients (≥18 years) who received a triage score in the ED and presented via paramedic transport or self-referral (walk-in). Multivariable binary logistic regression was used to determine the association of mode of transportation between hospital admission, after adjusting for important patient and visit characteristics.

Results

During the study period, 21,764,640 ED visits were eligible for study inclusion. Approximately one-fifth (18.5%) of all ED visits were transported by paramedics. All-cause hospital admission incidence was greater when transported by paramedics (35.0% vs. 7.5%) and with each decreasing Canadian Triage and Acuity Scale level. Paramedic transport was independently associated with hospital admission (OR = 3.76; 95%CI = 3.74–3.77), in addition to higher medical acuity, older age, male sex, greater than two comorbidities, treatment in an urban setting and discharge diagnoses specific to the circulatory or digestive systems.

Conclusions

Transport by paramedics to an ED was independently associated with hospital admission as the disposition outcome, when compared against self-referred visits. Our findings highlight patient and visit characteristics associated with hospital admission, and can be used to inform proactive healthcare strategizing for in-patient bed management.
Tuberculosis—Learning the Impact of Nutrition (TB LION): protocol for an interventional study to decrease TB risk in household contacts
Authors: Cintron Chelsie , Narasimhan Prakash Babu , Locks Lindsey , Babu Senbagavalli , Sinha Pranay , Rajkumari Nonika , Kaipilyawar Vaishnavi , Bhargava Anurag , Maloomian Kimberly , Chandrasekaran Padma , Verma Sheetal , Joseph Noyal , Johnson W. Evan , Wanke Christine , Horsburgh C. Robert , Ellner Jerrold J. , Sarkar Sonali , Salgame Padmini , Lakshminarayanan Subitha , Hochberg Natasha S.
Published: October 2021

Background

Comorbidities such as undernutrition and parasitic infections are widespread in India and other tuberculosis (TB)-endemic countries. This study examines how these conditions as well as food supplementation and parasite treatment might alter immune responses to Mycobacterium tuberculosis (Mtb) infection and risk of progression to TB disease.

Methods

This is a 5-year prospective clinical trial at Jawaharlal Institute of Post Graduate Medical Education and Research in Puducherry, Tamil Nadu, India. We aim to enroll 760 household contacts (HHC) of adults with active TB in order to identify 120 who are followed prospectively for 2 years: Thirty QuantiFERON-TB Gold Plus (QFT-Plus) positive HHCs ≥ 18 years of age in four proposed groups: (1) undernourished (body mass index [BMI] < 18.5 kg/m2); (2) participants with a BMI ≥ 18.5 kg/m2 who have a parasitic infection (3) undernourished participants with a parasitic infection and (4) controls—participants with BMI ≥ 18.5 kg/m2 and without parasitic infection. We assess immune response at baseline and after food supplementation (for participants with BMI < 18.5 kg/m2) and parasite treatment (for participants with parasites). Detailed nutritional assessments, anthropometry, and parasite testing through polymerase chain reaction (PCR) and microscopy are performed. In addition, at serial time points, these samples will be further analyzed using flow cytometry and whole blood transcriptomics to elucidate the immune mechanisms involved in disease progression.

Conclusions

This study will help determine whether undernutrition and parasite infection are associated with gene signatures that predict risk of TB and whether providing nutritional supplementation and/or treating parasitic infections improves immune response towards this infection. This study transcends individual level care and presents the opportunity to benefit the population at large by analyzing factors that affect disease progression potentially reducing the overall burden of people who progress to TB disease.

Trial registration ClinicalTrials.gov; NCT03598842; Registered on July 26, 2018; https://clinicaltrials.gov/ct2/show/NCT03598842
A multicenter study of short-term changes in mental health emergency services use during lockdown in Kitchener-Waterloo, Ontario during the COVID-19 pandemic
Authors: Dainton Christopher , Donato-Woodger Simon , Chu Charlene H.
Published: October 2021

Background

The COVID-19 pandemic and subsequent lockdown measures have led to increasing mental health concerns in the general population. We aimed to assess the short-term impact of the pandemic lockdown on mental health emergency services use in the Kitchener-Waterloo region of Ontario, Canada.

Methods

We conducted an observational study during the 6-month period between March 5 and September 5, 2020 using National Ambulatory Care Reporting System metadata from mental health visits to three regional Emergency Departments (ED); mental health and substance related police calls; and calls to a regional mental health crisis telephone line, comparing volumes during the pandemic lockdown with the same period in 2019. Quasi-Poisson regressions were used to determine significant differences between numbers of each visit or call type during the lockdown period versus the previous year. Significant changes in ED visits, mental health diagnoses, police responses, and calls to the crisis line from March 5 to September 5, 2020 were examined using changepoint analyses.

Results

Involuntary admissions, substance related visits, mood related visits, situational crisis visits, and self-harm related mental health visits to the EDs were significantly reduced during the lockdown period compared to the year before. Psychosis-related and alcohol-related visits were not significantly reduced. Among police calls, suicide attempts were significantly decreased during the period of lockdown, but intoxication, assault, and domestic disputes were not significantly different. Mental health crisis telephone calls were significantly decreased during the lockdown period. There was a significant increase in weekly mental health diagnoses starting in the week of July 12 – July 18. There was a significant increase in crisis calls starting in the week of May 31 – June 6, the same week that many guidelines, such as gathering restrictions, were eased. There was a significant increase in weekly police responses starting in the week of June 14 – June 20.

Conclusions

Contrary to our hypothesis, the decrease in most types of mental health ED visits, mental health and substance-related police calls, and mental health crisis calls largely mirrored the overall decline in emergency services usage during the lockdown period. This finding is unexpected in the context of increased attention to acutely deteriorating mental health during the COVID-19 pandemic.
Supporting participation in paid work of cancer survivors and their partners in the Netherlands: protocol of the SusTained Employability in cancer Patients and their partnerS (STEPS) multi-centre randomized controlled trial and cohort study
Authors: Zegers Amber D. , Coenen Pieter , Bültmann Ute , Retèl Valesca , Kieffer Jacobien M. , van der Beek Allard J. , Duijts Saskia F. A.
Published: October 2021

Background

Many cancer survivors experience physical and/or psychosocial problems affecting return to work (RTW) and work retention. Current interventions on RTW lack evidence regarding effectiveness, while interventions for work retention are missing. Partners of cancer survivors may also experience work- and health-related outcomes; yet, these consequences are not well understood. Here, the protocol of the STEPS study is described. The study aims are to: 1) evaluate the (cost-)effectiveness of a rehabilitation program for RTW and work retention in cancer survivors, and 2) assess health- and work-related outcomes among cancer survivors’ partners.

Methods

In a multicentre Randomized Controlled Trial (RCT), 236 working-age cancer survivors with an employment contract will be randomly allocated to a usual care group or an intervention group receiving a multidisciplinary rehabilitation program, combining occupational therapy facilitating work retention (e.g., energy management and self-efficacy training) and reintegration consultation addressing work-related issues (e.g., RTW planning and discussing workplace or task modifications with the supervisor). Alongside the RCT, a prospective cohort study will be conducted among cancer survivors’ partners (n = 267). Participants in the RCT and cohort study will be asked to complete questionnaires at baseline, and after six and 12 months, assessing work- and health-related outcomes. Generalized estimating equations will be used to assess intervention’s effectiveness, compared to usual care, regarding primary (i.e., working hours per week) and secondary outcomes. Also economic and process evaluations will be performed. For the cohort study, logistic or linear regression modelling will be applied assessing work- and health-related outcomes (primary outcome: working hours) of cancer survivors’ partners, and what factors predict these outcomes.

Results

The study is planned to start in September 2021; results are expected in 2023.

Conclusion

Compared to usual care, the STEPS intervention is hypothesized to be (cost-)effective and the intervention could be a valuable addition to standard care helping cancer survivors to sustain employment. Further, it is expected that living with a cancer survivor has a substantial impact on work and health of partners, while specific groups of partners that are at particular risk for this impact are likely to be identified.

Trial registration

Dutch Trial Register (NTR;NL9094; 15-12-2020).
Achieving a “step change” in the tuberculosis epidemic through comprehensive community-wide intervention: a model-based analysis
Authors: Shrestha Sourya , Kendall Emily A. , Chang Rebekah , Joseph Roy , Kasaie Parastu , Gillini Laura , Fojo Anthony Todd , Campbell Michael , Arinaminpathy Nimalan , Dowdy David W.
Published: October 2021

Background

Global progress towards reducing tuberculosis (TB) incidence and mortality has consistently lagged behind the World Health Organization targets leading to a perception that large reductions in TB burden cannot be achieved. However, several recent and historical trials suggest that intervention efforts that are comprehensive and intensive can have a substantial epidemiological impact. We aimed to quantify the potential epidemiological impact of an intensive but realistic, community-wide campaign utilizing existing tools and designed to achieve a “step change” in the TB burden.

Methods

We developed a compartmental model that resembled TB transmission and epidemiology of a mid-sized city in India, the country with the greatest absolute TB burden worldwide. We modeled the impact of a one-time, community-wide screening campaign, with treatment for TB disease and preventive therapy for latent TB infection (LTBI). This one-time intervention was followed by the strengthening of the tuberculosis-related health system, potentially facilitated by leveraging the one-time campaign. We estimated the tuberculosis cases and deaths that could be averted over 10 years using this comprehensive approach and assessed the contributions of individual components of the intervention.

Results

A campaign that successfully screened 70% of the adult population for active and latent tuberculosis and subsequently reduced diagnostic and treatment delays and unsuccessful treatment outcomes by 50% was projected to avert 7800 (95% range 5450–10,200) cases and 1710 (1290–2180) tuberculosis-related deaths per 1 million population over 10 years. Of the total averted deaths, 33.5% (28.2–38.3) were attributable to the inclusion of preventive therapy and 52.9% (48.4–56.9) to health system strengthening.

Conclusions

A one-time, community-wide mass campaign, comprehensively designed to detect, treat, and prevent tuberculosis with currently existing tools can have a meaningful and long-lasting epidemiological impact. Successful treatment of LTBI is critical to achieving this result. Health system strengthening is essential to any effort to transform the TB response.