bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Ozone on Corrosion Behavior of a Cobalt–Chromium Alloy Used in Removable Partial Denture Framework: An In Vitro Study
Authors: Rangrazi Abdolrasoul , Mirmortazavi Amirtaher , Imani Reyhaneh , Nodehi Davood
Published: May 2021

Aim:

The aim of this study was to evaluate the effect of the ozonated water on corrosion of a cobalt–chromium (Co-Cr)-based alloy, which is applied for the fabrication of metal frameworks of removable partial dentures.

Materials and Methods:

In this in vitro study, a total of 30 disk-shaped samples of a Co-Cr alloy were papered and randomly divided into two groups of 15 specimens. In group 1 (control), the specimens were stored in distilled water (DW), and in group 2, the specimens were stored in ozonated water. Around 90 immersions were performed, and the weight change of each specimen was determined. The ion release was analyzed using an inductively coupled plasma-optical emission spectrophotometer. The potentiodynamic polarization test was performed for each group to assess the corrosion resistance of the Co-Cr alloy. The statistical analysis was performed using SPSS version 22. Data were analyzed by independent samples’ t-test.

Results:

The results showed no significant difference between the weight changes of the two groups. The test using an inductively coupled plasma-optical emission spectrophotometer demonstrated no significant difference between the groups in Co and Cr ions release. In the potentiodynamic polarization test, both groups present similar corrosion behavior, and ozonated water has no deleterious effect on the corrosion resistance and passive range of the Co-Cr alloy compared to DW.

Conclusion:

As compared to DW, ozonated water has no significant deleterious effect on the corrosion resistance of the Co-Cr frameworks and can be used for cleaning the removable partial dentures.
Fat Embolism Syndrome in Sickle Cell β-Thalassemia Patient With Osteonecrosis: An Uncommon Presentation in a Young Adult
Authors: Sangani Vikram , Pokal Mytri , Balla Mamtha , Merugu Ganesh Prasad , Khokher Waleed , Gayam Vijay , Konala Venu Madhav
Published: May 2021

Fat embolism syndrome is a relatively infrequent presentation in sickle cell thalassemia patients. It most commonly occurs in long bone fractures in the setting of trauma. However, nonorthopedic trauma and nontraumatic cases have been reported to contribute to fat embolism. The fat embolic syndrome is an underdiagnosed, life-threatening, and debilitating complication of sickle-β-thalassemia–related hemoglobinopathies. It is primarily seen in milder versions of sickle cell disease, including HbSC and sickle cell β-thalassemia, with the mild prior clinical course without complications; hence, diagnosis can be easily missed. Pathogenesis of fat embolic syndrome is a combination of mechanical obstruction from fat globules released into systemic circulation at the time of bone marrow necrosis and direct tissue toxicity from fatty acids and inflammatory cytokines released from fat globules. Prompt diagnosis and early initiation of treatment can reduce morbidity and mortality and result in better outcomes and prognosis. Red cell exchange transfusion is the mainstay of therapy with mortality benefits. Overall mortality and neurological sequelae continue to be high despite increased red cell exchange transfusion in the last few years. In this article, we discussed a case of a 34-year-old male patient with a history of sickle cell thalassemia and avascular necrosis of the hip, who presented with fever, hypoxia, encephalopathy, and generalized body aches, found to have thrombocytopenia and punctate lesions on magnetic resonance imaging brain, which led to the diagnosis of the fat embolism syndrome. Only a few sickle cell β-thalassemia with fat embolic syndrome cases have been reported.
Time Poverty and Parenthood: Who Has Time for College?
Authors: Conway Katherine M. , Wladis Claire , Hachey Alyse C.
Published: May 2021

Student parents are among the least likely student groups to complete college. Regression models were run using 2003–2019 American Time Use Survey data to explore time poverty among college students. Results indicate that students with children under 13 years had significantly less discretionary time and free time, spent significantly less time on their education, enrolled part-time at significantly higher rates, and spent significantly more time studying while simultaneously caring for children, compared with students without children under 13 years. The strength of these relationships was strongest when children were younger. Parents with children under 6 years, and mothers of children of all age-groups, had significantly higher time poverty than other groups, yet spent significantly more time on education after controlling for discretionary time, at the cost of significantly less free time for themselves. Results suggest that improving college outcomes for student parents may require consideration of time poverty.
Mobile Learning During School Disruptions in Sub-Saharan Africa
Authors: Kizilcec René F. , Chen Maximillian , Jasińska Kaja K. , Madaio Michael , Ogan Amy
Published: May 2021

School closures due to teacher strikes or political unrest in low-resource contexts can adversely affect children’s educational outcomes and career opportunities. Phone-based educational technologies could help bridge these gaps in formal schooling, but it is unclear whether or how children and their families will use such systems during periods of disruption. We investigate two mobile learning technologies deployed in sub-Saharan Africa: a text-message-based application with lessons and quizzes adhering to the national curriculum in Kenya (N = 1.3 million), and a voice-based platform for supporting early literacy in Côte d’Ivoire (N = 236). We examine the usage and beliefs surrounding unexpected school closures in each context via system log data and interviews with families about their motivations and methods for learning during the disruption. We find that mobile learning is used as a supplement for formal and informal schooling during disruptions with equivalent or higher intensity, as parents feel responsible to ensure continuity in schooling.
Cracks to Craters: College Advising During COVID-19
Authors: Naughton Meredith R.
Published: May 2021

The COVID-19 (coronavirus disease–2019) pandemic disrupted the education of students across the globe in the spring of 2020. Students who were previously at most risk for falling behind their peers and through the cracks because of academic, financial, racial, and/or generational disadvantage faced a wide range of additional obstacles in the pursuit of their college goals. This qualitative study sought to uncover postsecondary advising implications for students through the perspectives of near-peer college advisers (n = 23) serving in high-need schools in two different states as intensive, in-person advising was forced to adapt to virtual formats. Two key thematic findings reveal that advisers faced new communication challenges and existing systemic barriers for marginalized students became even larger. For seniors who had not yet made final postsecondary decisions or who had remaining to-dos, the impact of school closures and distanced advising may have fatally widened existing cracks in the path to college.
Lack of Progression of Intraventricular Hemorrhage in Premature Infants: Implications for Head Ultrasound Screening
Authors: Daigneault Jaclyn , White Heather , Dube Alexandra , Shi Qiming , Gauguet Jean-Marc , Rhein Lawrence
Published: May 2021

Very preterm infants are at risk for germinal matrix hemorrhage- intraventricular hemorrhage (GH-IVH). Severe GH-IVH may cause death or severe neurodevelopmental disability while mild GH-IVH is considered a static, non-progressive disease. This retrospective study aimed to determine if infants with no GH-IVH or mild GH-IVH on initial screening head ultrasound (HUS) advanced to severe GH-IVH. A total of 353 eligible infants with birth gestational age ≤32 0/7 weeks who received a HUS during hospitalization were identified. Of the 343 (97%) infants who had mild GH-IVH (grade II or less) on initial screening, only 4 (1.2%) progressed to severe (grade III or IV). Each of these infants required mechanical ventilation for at least 40 days. Therefore, premature infants who have no GH-IVH or mild GH-IVH on initial routine screening HUS without other risk factors may not require follow-up HUSs. Infants with prolonged mechanical ventilation may require further screening despite reassuring initial HUS findings.
Experiences of Outpatient Clinics and Opinions of Telehealth by Caucasian and South Asian Patients’ With Celiac Disease
Authors: Muhammad Humayun , Reeves Sue , Ishaq Sauid , Jeanes Yvonne
Published: May 2021

Outpatient clinics are an important part of chronic disease management, including that of celiac disease. During the coronavirus disease 2019 (COVID-19) global pandemic, telephone and online video consultations with health care professionals have substantially increased. This study aimed to explore the experience and opinions of adults, with celiac disease, toward face-to-face clinic appointments and alternatives, such as telehealth. Semistructured qualitative interviews with 37 patients were undertaken (75% White Caucasians, 25% South Asians; 29 patients were not adhering to the gluten-free diet). Interviews were recorded, transcribed, and analyzed by NVivo. Frequently reported issues with face-to-face appointments included travel and car parking costs, needing to take time off work, and frequent changes to appointment time. In addition, South Asian patients highlighted issues with linguistics barriers. Telephone consultations were considered acceptable and practical by the majority of patients based on ease and convenience. Online video consultations were favored by just 9 patients, however it is acknowledged that since the COVID-19 pandemic, there has been a greater exposure to this type of technology. These patient experiences can inform health care service development and are not biased by external health concerns connected with in-person visits during the pandemic.
Caregiver Burden: Caregiving Workshops Have a Positive Impact on Those Caring for Individuals With Dementia in Arkansas
Authors: McAtee Robin E. , Spradley Laura , Tobey Leah , Thomasson Whitney , Azhar Gohar , Mercado Cynthia
Published: May 2021

Millions of Americans live with dementia. Caregivers of this population provide countless hours of multifaceted, complex care that frequently cause unrelenting stress which can result in immense burden. However, it is not fully understood what efforts can be made to reduce the stress among caregivers of persons with dementia (PWD). Therefore, the aim of this pretest–posttest designed study was to evaluate changes in caregiver burden after providing an educational intervention to those caring for PWD in Arkansas. Forty-one participants completed the Zarit Caregiver Burden Scale before and after attending a 4-hour dementia-focused caregiving workshop. The analysis of the means, standard deviations, and paired t tests showed that there was an increase in the confidence and competence in caring for PWD 30 to 45 days after attending the workshop. Health care providers need to understand both the vital role caregivers provide in managing a PWD and the importance of the caregiver receiving education about their role as a caregiver. Utilizing caregiver educational programs is a first step.
Scleroderma associated with renal cell carcinoma: A case report and literature review
Authors: Patel Hiral S. , Aggarwal Vanya , Thapa Rupak
Published: May 2021

Introduction:

Systemic sclerosis (aka scleroderma) is an autoimmune disease with no known definitive etiology, but genetic, infectious, and non-infectious exposures have been associated with its occurrence. Previous studies have shown that systemic sclerosis can be a paraneoplastic phenomenon and may be associated with increased risk of malignancy, most commonly lung, skin, and breast cancers. The association of renal cell carcinoma with systemic sclerosis is rare.

Case Description:

Here, we present a case of a 75-year-old male patient with a rapidly progressive scleroderma despite the initial treatment with methotrexate and prednisone 5 mg daily. Shortly after the diagnosis of scleroderma, the patient was found to have a renal mass. The patient underwent a right partial nephrectomy revealing papillary renal cell carcinoma. The surgical margin was negative indicating complete removal of the cancer. The patient, later, developed scleroderma renal crisis and progressed to end-stage renal disease despite treatment with captopril, mycophenolate mofetil, plasmapheresis, and intravenous immunoglobulin.

Conclusions:

The purpose of this case report and literature review is to highlight that diffuse scleroderma can potentially be paraneoplastic from a renal cell carcinoma and to add more data to the literature given there are only a handful of reported cases. Our patient is unique in the sense that he was discovered to have renal cell carcinoma shortly after being diagnosed with scleroderma suggesting a paraneoplastic etiology yet continued to worsen despite full resection of the renal cell carcinoma. This is in contrast to the other reported cases of renal cell carcinoma associated scleroderma where scleroderma worsened around the time of the diagnosis of renal cell carcinoma and improved after nephrectomy. There also are case reports of the patients with renal cell carcinoma associated scleroderma where the patient had scleroderma for several years before the diagnosis of renal cell carcinoma, which raises the question, if scleroderma could also represent a risk factor for developing renal cell carcinoma.
Fibroblast Growth Factor Receptor Inhibitor–Associated Multifocal Serous Retinal Detachments: A Case Report
Authors: Kim Diana H. , Xia Tian , Bracha Peter , VanderBeek Brian L.
Published: May 2021

Purpose:

This report aims to describe a case of bilateral, multifocal neurosensory retinal detachments that developed during erdafitinib therapy for metastatic urothelial carcinoma.

Methods:

A case report with color fundus imaging and spectral-domain optical coherence tomography imaging is presented.

Results:

A 50-year-old man with metastatic urothelial carcinoma had an unremarkable baseline ophthalmic examination prior to starting erdafitinib. At 3-month follow up, an examination revealed bilateral, multifocal retinal detachments. Because the patient was asymptomatic and erdafitinib was the only drug to which his tumor had responded, he was kept on the medication with close ophthalmic monitoring.

Conclusions:

Erdafitinib, a fibroblast growth factor receptor inhibitor, can cause bilateral, multifocal retinal detachments. Continuation of erdafitinib may be considered in patients without significant visual impairment when the overall benefit of the medication appears to outweigh the risks.
Effects of Project Leader Workplace Anxiety on Project Team Member Organizational Citizenship Behavior: A Moderated Mediation Model
Authors: Wang Linlin , Lin Han , Jiang Wan
Published: May 2021

This study investigates how and when project leader workplace anxiety influences project team member organizational citizenship behavior (OCB). Drawing from social information processing theory and the dual process model, we propose that project leader workplace anxiety negatively affects project team member OCB via job frustration and career adaptability. We also propose that project team member core self-evaluation moderates these hypothesized relationships. We test our hypotheses using multisource and time-lagged data from a sample of 269 matched project leader-member dyads. Theoretical and practical implications and future research directions are discussed.
Post-annealing Effect on Optical and Electronic Properties of Thermally Evaporated MoOX Thin Films as Hole-Selective Contacts for p-Si Solar Cells
Authors: Jiang Yuanwei , Cao Shuangying , Lu Linfeng , Du Guanlin , Lin Yinyue , Wang Jilei , Yang Liyou , Zhu Wenqing , Li Dongdong
Published: May 2021

Owing to its large work function, MoOX has been widely used for hole-selective contact in both thin film and crystalline silicon solar cells. In this work, thermally evaporated MoOX films are employed on the rear sides of p-type crystalline silicon (p-Si) solar cells, where the optical and electronic properties of the MoOX films as well as the corresponding device performances are investigated as a function of post-annealing treatment. The MoOX film annealed at 100 °C shows the highest work function and proves the best hole selectivity based on the results of energy band simulation and contact resistivity measurements. The full rear p-Si/MoOX/Ag-contacted solar cells demonstrate the best performance with an efficiency of 19.19%, which is the result of the combined influence of MoOX’s hole selectivity and passivation ability.
Calibrating a chief complaint list for low resource settings: a methodologic case study
Authors: Hansoti B. , Hahn E. , Rao A. , Harris J. , Jenson A. , Markadakis N. , Moonat S. , Osula V. , Pousson A.
Published: May 2021

Background

The chief or presenting complaint is the reason for seeking health care, often in the patient’s own words. In limited resource settings, a diagnosis-based approach to quantifying burden of disease is not possible, partly due to limited availability of an established lexicon or coding system. Our group worked with colleagues from the African Federation of Emergency Medicine building on the existing literature to create a pilot symptom list representing an attempt to standardize undifferentiated chief complaints in emergency and acute care settings. An ideal list for any setting is one that strikes a balance between ease of use and length, while covering the vast majority of diseases with enough detail to permit epidemiologic surveillance and make informed decisions about resource needs.

Methods

This study was incorporated as a part of a larger prospective observational study on human immunodeficiency virus testing in Emergency Departments in South Africa. The pilot symptom list was used for chief complaint coding in three Emergency Departments. Data was collected on 3357 patients using paper case report forms. Chief complaint terms were reviewed by two study team members to determine the frequency of concordance between the coded chief complaint term and the selected symptom(s) from the pilot symptom list.

Results

Overall, 3537 patients’ chief complaints were reviewed, of which 640 were identified as ‘potential mismatches.’ When considering the 191 confirmed mismatches (29.8%), the Delphi process identified 6 (3.1%) false mismatches and 185 (96.9%) true mismatches. Significant chief-complaint clustering was identified with 9 sets of complaints frequently selected together for the same patient. “Pain” was used 2076 times for 58.7% of all patients. A combination of user feedback and expert-panel modified Delphi analysis of mismatched complaints and clustered complaints resulted in several substantial changes to the pilot symptom list.

Conclusions

This study presented a systematic methodology for calibrating a chief complaint list for the local context. Our revised list removed/reworded symptoms that frequently clustered together or were misinterpreted by health professionals. Recommendations for additions, modifications, and/or deletions from the pilot chief complaint list we believe will improve the functionality of the list in low resource environments.
Diversity of plant assemblages dampens the variability of the growing season phenology in wetland landscapes
Authors: Rheault Guillaume , Lévesque Esther , Proulx Raphaël
Published: May 2021

Background

The functioning of ecosystems is highly variable through space and time. Climatic and edaphic factors are forcing ecological communities to converge, whereas the diversity of plant assemblages dampens these effects by allowing communities’ dynamics to diverge. This study evaluated whether the growing season phenology of wetland plant communities within landscapes is determined by the climatic/edaphic factors of contrasted regions, by the species richness of plant communities, or by the diversity of plant assemblages. From 2013 to 2016, we monitored the phenology and floristic composition of 118 wetland plant communities across five landscapes distributed along a gradient of edaphic and climatic conditions in the Province of Québec, Canada.

Results

The growing season phenology of wetlands was driven by differences among plant assemblage within landscapes, and not by the species richness of each individual community (< 1% of the explained variation). Variation in the growing season length of wetlands reflected the destabilizing effect of climatic and edaphic factors on green-up dates, which is opposed to the dampening effect of plant assemblage diversity on green-down dates.

Conclusions

The latter dampening effect may be particularly important in the context of increasing anthropogenic activities, which are predicted to impair the ability of wetlands to adapt to fluctuating environmental conditions. Our findings suggest that stakeholders should not necessarily consider local species-poor plant communities of lower conservation value to the global functioning of wetland ecosystems.
Investigating the impact of reference assembly choice on genomic analyses in a cattle breed
Authors: Lloret-Villas Audald , Bhati Meenu , Kadri Naveen Kumar , Fries Ruedi , Pausch Hubert
Published: May 2021

Background

Reference-guided read alignment and variant genotyping are prone to reference allele bias, particularly for samples that are greatly divergent from the reference genome. A Hereford-based assembly is the widely accepted bovine reference genome. Haplotype-resolved genomes that exceed the current bovine reference genome in quality and continuity have been assembled for different breeds of cattle. Using whole genome sequencing data of 161 Brown Swiss cattle, we compared the accuracy of read mapping and sequence variant genotyping as well as downstream genomic analyses between the bovine reference genome (ARS-UCD1.2) and a highly continuous Angus-based assembly (UOA_Angus_1).

Results

Read mapping accuracy did not differ notably between the ARS-UCD1.2 and UOA_Angus_1 assemblies. We discovered 22,744,517 and 22,559,675 high-quality variants from ARS-UCD1.2 and UOA_Angus_1, respectively. The concordance between sequence- and array-called genotypes was high and the number of variants deviating from Hardy-Weinberg proportions was low at segregating sites for both assemblies. More artefactual INDELs were genotyped from UOA_Angus_1 than ARS-UCD1.2 alignments. Using the composite likelihood ratio test, we detected 40 and 33 signatures of selection from ARS-UCD1.2 and UOA_Angus_1, respectively, but the overlap between both assemblies was low. Using the 161 sequenced Brown Swiss cattle as a reference panel, we imputed sequence variant genotypes into a mapping cohort of 30,499 cattle that had microarray-derived genotypes using a two-step imputation approach. The accuracy of imputation (Beagle R2) was very high (0.87) for both assemblies. Genome-wide association studies between imputed sequence variant genotypes and six dairy traits as well as stature produced almost identical results from both assemblies.

Conclusions

The ARS-UCD1.2 and UOA_Angus_1 assemblies are suitable for reference-guided genome analyses in Brown Swiss cattle. Although differences in read mapping and genotyping accuracy between both assemblies are negligible, the choice of the reference genome has a large impact on detecting signatures of selection that already reached fixation using the composite likelihood ratio test. We developed a workflow that can be adapted and reused to compare the impact of reference genomes on genome analyses in various breeds, populations and species.
The potential and effects of saline-alkali alfalfa microbiota under salt stress on the fermentation quality and microbial
Authors: Sa Duo Wen , Lu Qiang , Wang Zhen , Ge Gentu , Sun Lin , Jia Yushan
Published: May 2021

Background

The objective of this study was to evaluate the chemical compositions and microbial communities of salt-tolerant alfalfa silage. Salt-tolerant alfalfa was ensiled with no additive control, and cellulase for 30 and 60 to 90 days. In this study, the dry matter (DM) content of the raw material was 29.9% DM, and the crude protein (CP) content of the alfalfa was 21.9% CP.

Results

After 30 days of fermentation, the DM content with the cellulase treatment was reduced by 3.6%, and the CP content was reduced by 12.7%. After 60 days of fermentation, compared with alfalfa raw material, the DM content in the control group (CK) was reduced by 1%, the CP content was reduced by 9.5%, and the WSC (water-soluble carbohydrates) content was reduced by 22.6%. With the cellulase, the lactic acid content of the 30- and 60-day silages was 2.66% DM and 3.48% DM. The content of Firmicutes in salinized alfalfa raw material was less than 0.1% of the total bacterial content. Before and after ensiling, the microbes had similar composition at the phylum level, and were composed of Firmicutes, Actinobacteria, Bacteroidetes, and Proteobacteria. The abundance of Pantoea was dominant in fresh alfalfa. In the absence of additives, after 30 days and 60 days of silage, the dominant lactic acid bacteria species became Lactococcus and Enterococcus.

Conclusions

The results showed that LAB (Lactobacillus, Lactococcus, Enterococcus, and Pediococcus) played a major role in the fermentation of saline alfalfa silage. It also can better preserve the nutrients of saline alfalfa silage. The use of cellulase enhances the reproduction of Lactobacillus. The fermentation time would also change the microbial community of silage fermentation.
Association between fatality rate of COVID-19 and selenium deficiency in China
Authors: Zhang Hai-Yang , Zhang An-Ran , Lu Qing-Bin , Zhang Xiao-Ai , Zhang Zhi-Jie , Guan Xiu-Gang , Che Tian-Le , Yang Yang , Li Hao , Liu Wei , Fang Li-Qun
Published: May 2021

Background

COVID-19 has impacted populations around the world, with the fatality rate varying dramatically across countries. Selenium, as one of the important micronutrients implicated in viral infections, was suggested to play roles.

Methods

An ecological study was performed to assess the association between the COVID-19 related fatality and the selenium content both from crops and topsoil, in China.

Results

Totally, 14,045 COVID-19 cases were reported from 147 cities during 8 December 2019–13 December 2020 were included. Based on selenium content in crops, the case fatality rates (CFRs) gradually increased from 1.17% in non-selenium-deficient areas, to 1.28% in moderate-selenium-deficient areas, and further to 3.16% in severe-selenium-deficient areas (P = 0.002). Based on selenium content in topsoil, the CFRs gradually increased from 0.76% in non-selenium-deficient areas, to 1.70% in moderate-selenium-deficient areas, and further to 1.85% in severe-selenium-deficient areas (P < 0.001). The zero-inflated negative binomial regression model showed a significantly higher fatality risk in cities with severe-selenium-deficient selenium content in crops than non-selenium-deficient cities, with incidence rate ratio (IRR) of 3.88 (95% CIs: 1.21–12.52), which was further confirmed by regression fitting the association between CFR of COVID-19 and selenium content in topsoil, with the IRR of 2.38 (95% CIs: 1.14–4.98) for moderate-selenium-deficient cities and 3.06 (1.49–6.27) for severe-selenium-deficient cities.

Conclusions

Regional selenium deficiency might be related to an increased CFR of COVID-19. Future studies are needed to explore the associations between selenium status and disease outcome at individual-level.
Two-stage prediction model for in-hospital mortality of patients with influenza infection
Authors: Cheong Chan-Wa , Chen Chien-Lin , Li Chih-Huang , Seak Chen-June , Tseng Hsiao-Jung , Hsu Kuang-Hung , Ng Chip-Jin , Chien Cheng-Yu
Published: May 2021

Background

Infleunza is a challenging issue in public health. The mortality and morbidity associated with epidemic and pandemic influenza puts a heavy burden on health care system. Most patients with influenza can be treated on an outpatient basis but some required critical care. It is crucial for frontline physicians to stratify influenza patients by level of risk. Therefore, this study aimed to create a prediction model for critical care and in-hospital mortality.

Methods

This retrospective cohort study extracted data from the Chang Gung Research Database. This study included the patients who were diagnosed with influenza between 2010 and 2016. The primary outcome of this study was critical illness. The secondary analysis was to predict in-hospital mortality. A two-stage-modeling method was developed to predict hospital mortality. We constructed a multiple logistic regression model to predict the outcome of critical illness in the first stage, then S1 score were calculated. In the second stage, we used the S1 score and other data to construct a backward multiple logistic regression model. The area under the receiver operating curve was used to assess the predictive value of the model.

Results

In the present study, 1680 patients met the inclusion criteria. The overall ICU admission and in-hospital mortality was 10.36% (174 patients) and 4.29% (72 patients), respectively. In stage I analysis, hypothermia (OR = 1.92), tachypnea (OR = 4.94), lower systolic blood pressure (OR = 2.35), diabetes mellitus (OR = 1.87), leukocytosis (OR = 2.22), leukopenia (OR = 2.70), and a high percentage of segmented neutrophils (OR = 2.10) were associated with ICU admission. Bandemia had the highest odds ratio in the Stage I model (OR = 5.43). In stage II analysis, C-reactive protein (OR = 1.01), blood urea nitrogen (OR = 1.02) and stage I model’s S1 score were assocaited with in-hospital mortality. The area under the curve for the stage I and II model was 0.889 and 0.766, respectively.

Conclusions

The two-stage model is a efficient risk-stratification tool for predicting critical illness and mortailty. The model may be an optional tool other than qSOFA and SIRS criteria.
Association between time to stent dysfunction and the anti-tumour effect of systemic chemotherapy following stent placement in patients with pancreaticobiliary cancers and malignant gastric outlet obstruction: a retrospective cohort study
Authors: Kobayashi Satoshi , Ueno Makoto , Nagashima Shuhei , Sano Yusuke , Kawano Kuniyuki , Fukushima Taito , Asama Hiroyuki , Tezuka Shun , Morimoto Manabu
Published: May 2021

Background

Malignant gastric outlet obstruction (MGOO) occasionally occurs due to pancreaticobiliary cancer. Endoscopic duodenal stenting (DS) is a common treatment for MGOO. However, it has been reported that DS does not have sufficient patency time for it to be used in patients who have a potentially increased lifespan. Nowadays, systemic chemotherapy for pancreaticobiliary cancer has developed, and its anti-tumour effect would make time to stent dysfunction longer.

Therefore, we retrospectively evaluated the association between objective response to systemic chemotherapy, followed by DS and time to stent dysfunction in patients with advanced pancreaticobiliary cancer.

Methods

This retrospective study included 109 patients with advanced pancreaticobiliary cancer who received systemic chemotherapy after DS. Patients who showed complete or partial response were defined as responders. The rest were defined as non-responders. Time to stent dysfunction was compared between responders and non-responders using the landmark analysis at 2 months after DS. Death without recurrence of MGOO was considered as a competing risk for time to stent dysfunction.

Results

Combination and monotherapy regimens were adopted for 46 and 63 patients, respectively. Median progression-free survival and overall survival were 3.2 months (95% confidence interval [CI], 2.4–4.0) and 6.0 months (95% CI, 4.6–7.3). Objective response was observed in 21 patients (19.3%). Median time to stent dysfunction was 12.5 months (95% CI, 8.4–16.5) in the entire cohort. In 89 patients, responders had a lower cumulative incidence of stent dysfunction than non-responders: 9.5 and 19.1% at 6 months, and 19.0 and 27.9% at 1-year, respectively. There was difference of time to stent dysfunction between responders and non-responders among patients who received combination regimen as the first-line treatment with p-value of 0.009: cumulative incidence was 0 and 42.9% at 6 months, and 9.3 and 57.1% at 1-year, respectively.

Conclusions

Longer time to stent dysfunction is expected when systemic chemotherapy following DS suppresses tumour progression; DS is slated to be a standard treatment for MGOO even in patients with pancreaticobiliary cancer and a long lifespan.
Pediatric dentists’ perspectives of children with special health care needs in Japan: developmental disabilities, phobia, maltreatment, and multidisciplinary collaboration
Authors: Ide-Okochi Ayako , Funayama Hiromi , Asada Yoshinobu
Published: May 2021

Background

The number of children diagnosed with developmental disabilities (DDs) or other chronic difficulties has risen. However, each professional’s awareness of children with developmental, emotional and behavioural difficulties may differ, allowing their special needs to be overlooked at child health checkups until secondary difficulties appear. Therefore, it is necessary to explore the multi-professional views of children with such chronic difficulties. This study investigates pediatric dentists’ perception of children with potential chronic difficulties.

Methods

Interviews were conducted with 21 pediatric dentists, and the transcripts were analyzed using grounded theory to develop categories for the theoretical assessment.

Results

Four themes emerged regarding the children with potential chronic difficulties: children exhibiting possible DDs with awkward social communication and interaction; severe rampant caries possibly derived from maltreatment; dental phobia possibly derived from mental health problems; a complicated home environment where their mothers exhibit poor oral health literacy.

Conclusions

This study’s findings imply that participants’ concept of children of concern included the risks of poor oral health and mental health problems that other healthcare professionals might overlook. It is recommended that multidisciplinary professionals engaging in child health checkups be aware of children’s oral and mental health status as well as potential DDs and child maltreatment.
Minimum acceptable diet among children aged 6–23 months in South Kivu, Democratic Republic of Congo: a community-based cross-sectional study
Authors: Kambale Richard Mbusa , Ngaboyeka Gaylord Amani , Kasengi Joe Bwija , Niyitegeka Sarah , Cinkenye Boss Rutakaza , Baruti Armand , Mutuga Kizito Chentwali , Van der Linden Dimitri
Published: May 2021

Background

Suboptimal child nutrition remains the main factor underlying child undernutrition in Democratic Republic of Congo (DRC). This study aimed to assess the prevalence of minimum acceptable diet and associated factors among children aged 6–23 months old.

Methods

Community-based cross-sectional study including 742 mothers with children aged 6–23 months old was conducted in 2 Health Zones of South Kivu, Eastern DRC. WHO indicators of Infant and Young Child Feeding (IYCF) regarding complementary feeding practices were used. Logistic regression analysis was used to quantify the association between sociodemographic indicators and adequate minimum acceptable diet for both univariate and multivariate analysis.

Results

Overall, 33% of infants had minimum acceptable diet. After controlling for a wide range of covariates, residence urban area (AOR 2.39; 95% CI 1.43, 3.85), attendance postnatal care (AOR 1.68; 95% CI 1.12, 2.97), education status of mother (AOR 1.83; 95% CI 1.20, 2.77) and household socioeconomic status (AOR 1.72; 95% CI 1.14, 2.59) were factors positively associated with minimum acceptable diet.

Conclusion

Actions targeting these factors are expected to improve infant feeding practices in South Kivu.
Awareness and acceptability of HIV pre-exposure prophylaxis (PrEP) among students at two historically Black universities (HBCU): a cross-sectional survey
Authors: Okeke Nwora Lance , McLaurin Tony , Gilliam-Phillips Ruth , Wagner David H. , Barnwell Valerie J. , Johnson Yolanda M. , James Osaffo , Webb Padonda B. , Parker Sharon D. , Hill Bendu , McKellar Mehri S. , Mitchell John T.
Published: May 2021

Background

Despite young African American adults (ages 18–24) being among the highest risk groups for HIV infection, little is known about their awareness of HIV pre-exposure prophylaxis (PrEP) – a once daily pill shown to be > 90% effective in preventing HIV. To explore awareness and acceptability of PrEP among college students in this demographic, we conducted a survey of attendees at two large historically Black universities (HBCU) in North Carolina.

Methods

We administered a 14-item questionnaire to students at two HBCUs in North Carolina between February and April 2018. Questions were formatted in a yes/no or multiple choice format. Questionnaire items specifically addressed PrEP awareness and acceptability. Surveys were administered to students at a campus health fair and while transiting the campus student union via iPad. Response to all questions was optional. We fit a logistic regression model to determine association of key demographic determinants with PrEP acceptability and awareness. Statistical analyses were conducted using SAS 9.4 (SAS, Cary, NC).

Results

Overall, 210 students participated in the survey, of which 60 completed all survey items as presented. The survey cohort was 75% female, 89% heterosexual and 39% freshmen. The mean age of respondents was 19.8 years (SD: 1.8). Fifty-two percent of survey respondents reported that they were aware of PrEP prior to the time of survey administration. Only 3% of respondents reported that they were on PrEP. The most common sources of information on PrEP were campus health services (24%) and non-social media advertising (15%). Of respondents who were aware of PrEP, 61% reported that they had heard about in the 6 months prior to survey administration, while only 19% say they were aware of it for more than a year. Regarding acceptability of PrEP, 58% of respondents reported that they would take a once a day pill for HIV if they were at risk. Our logistic regression analysis found no statistically significant associations between key demographic factors and PrEP awareness. However, persons who perceived themselves to be at risk for HIV acquisition were more likely to find once daily oral PrEP (relative risk 2.66 (95% CI 1.31–5.42)) as an acceptable prevention strategy than the rest of the survey cohort.

Conclusions

African American HBCU students are becoming aware of PrEP, and generally perceive the intervention as acceptable and worth consideration.
The risk factors and care measures of surgical site infection after cesarean section in China: a retrospective analysis
Authors: Li Lijun , Cui Hongyan
Published: May 2021

Background

Surgical site infections after cesarean section are very common clinically, it is necessary to evaluate the risk factors of surgical site infections after cesarean section, to provide evidences for the treatment and nursing care of cesarean section.

Methods

This study was a retrospective cohort study design. Patients undergone cesarean section in a tertiary hospital of China from May 2017 to May 2020 were identified, we collected the clinical data of the included patients, and we analyzed the infection rate, etiological characteristics and related risk factors of surgical site infection after caesarean section.

Results

A total of 206 patients with cesarean section were included, and the incidence of surgical site infection in patients with cesarean section was 23.30%. A total of 62 cases of pathogens were identified, Enterococcus faecalis (33.87%) and Escherichia coli (29.03%) were the most common pathogens. Both Enterococcus faecalis and Escherichia coli were highly sensitive to Cefoperazone, Meropenem, and Levofloxacin. Logistic regression analyses indicated that Age ≥ 30y (OR 4.18, 95%CI: 1.23–7.09), BMI ≥ 24 (OR 2.39, 95%CI: 1.02–4.55), duration of cesarean section ≥ 1.5 h (OR 3.90, 95%CI: 1.28–5.42), estimated blood loss ≥ 400 ml (OR 2.35, 95%CI: 1.10–4.37) and the duration of urinary catheter ≥ 24 h (OR 3.18, 95% CI: 1.21–5.71) were the independent risk factors of surgical site infection after cesarean section (all p < 0.05).

Conclusions

Age, BMI, duration of surgery, blood loss and urinary catheter use were associated with higher risk of the surgical site infection after cesarean section. Clinical preventions and interventions are warranted for those population to reduce the occurrence of surgical site infection.
Qualitative exploration of medical student experiences during the Covid-19 pandemic: implications for medical education
Authors: Nolan Helen , Owen Katherine
Published: May 2021

Background

During the Covid-19 pandemic medical students were offered paid roles as medical student healthcare assistants. Anecdotal reports suggested that students found this experience rich for learning. Previous studies have explored alternative models of student service, however this defined medical student support role is novel.

Methods

Individual semi-structured interviews were recorded with 20 medical students at a UK medical school exploring their experiences of placement learning and experiences of working as healthcare assistants. Responses were analysed qualitatively using a framework approach. The framework was developed into a model describing key findings and their relationships.

Results

Interviews yielded data that broadly covered aspects of (1) Medical students’ experiences of clinical placement learning (2) Medical students’ experiences of working as medical student healthcare assistants (3) Learning resulting from working as a healthcare assistant (4) Hierarchies and professional barriers in the clinical environment (5) Influences on professional identity.

Participants described barriers and facilitators of clinical learning and how assuming a healthcare assistant role impacted on learning and socialisation within the multidisciplinary team. Students became increasingly socialised within the healthcare team, contributing directly to patient care; the resulting social capital opened new opportunities for learning, team working and enhanced students’ interprofessional identity. Students described the impact of these experiences on their aspirations for their future practice.

Conclusions

Changes to work patterns in healthcare and delivery models of medical education have eroded opportunities for students to contribute to healthcare delivery and be embedded within a team. This is impacting negatively on student learning and socialisation and we suggest that medical curricula have much to learn from nursing and allied health professional training. Longitudinal embedment with a multidisciplinary team, where students have a defined role and work directly with patients may not only add value to clinical service, but also overcome current barriers to effective placement learning and interprofessional identity formation for medical students.
Esomeprazole attenuates inflammatory and fibrotic response in lung cells through the MAPK/Nrf2/HO1 pathway
Authors: Ebrahimpour Afshin , Wang Min , Li Li , Jegga Anil G. , Bonnen Mark D. , Eissa N. Tony , Raghu Ganesh , Jyothula Soma , Kheradmand Farrah , Hanania Nicola A. , Rosas Ivan O. , Ghebre Yohannes T.
Published: May 2021

Introduction

Idiopathic pulmonary fibrosis (IPF) is an orphan disease characterized by progressive loss of lung function resulting in shortness of breath and often death within 3–4 years of diagnosis. Repetitive lung injury in susceptible individuals is believed to promote chronic oxidative stress, inflammation, and uncontrolled collagen deposition. Several preclinical and retrospective clinical studies in IPF have reported beneficial outcomes associated with the use of proton pump inhibitors (PPIs) such as esomeprazole. Accordingly, we sought to investigate molecular mechanism(s) by which PPIs favorably regulate the disease process.

Methods

We stimulated oxidative stress, pro-inflammatory and profibrotic phenotypes in primary human lung epithelial cells and fibroblasts upon treatment with bleomycin or transforming growth factor β (TGFβ) and assessed the effect of a prototype PPI, esomeprazole, in regulating these processes.

Results

Our study shows that esomeprazole controls pro-inflammatory and profibrotic molecules through nuclear translocation of the transcription factor nuclear factor-like 2 (Nrf2) and induction of the cytoprotective molecule heme oxygenase 1 (HO1). Genetic deletion of Nrf2 or pharmacological inhibition of HO1 impaired esomeprazole-mediated regulation of proinflammatory and profibrotic molecules. Additional studies indicate that activation of Mitogen Activated Protein Kinase (MAPK) pathway is involved in the process. Our experimental data was corroborated by bioinformatics studies of an NIH chemical library which hosts gene expression profiles of IPF lung fibroblasts treated with over 20,000 compounds including esomeprazole. Intriguingly, we found 45 genes that are upregulated in IPF but downregulated by esomeprazole. Pathway analysis showed that these genes are enriched for profibrotic processes. Unbiased high throughput RNA-seq study supported antifibrotic effect of esomeprazole and revealed several novel targets.

Conclusions

Taken together, PPIs may play antifibrotic role in IPF through direct regulation of the MAPK/Nrf2/HO1 pathway to favorably influence the disease process in IPF.
Prevalence and risk factors of thrombotic events on patients with COVID-19: a systematic review and meta‐analysis
Authors: Xiong Xiaoming , Chi Jianhua , Gao Qinglei
Published: May 2021

Background

Coagulation abnormalities in COVID-19 patients accompanied with poor prognosis. This study aimed to determine the prevalence and risk factors of thrombotic events on COVID-19 patients.

Methods.

We systematically reviewed all the studies about thrombotic events on COVID-19 patients in PubMed, Embase, Web of Science, MedRxiv, bioRxiv, from Dec 1, 2019 to July 5, 2020. The weighted mean difference (MD) or odds ratio (OR) or relative risk (RR) with 95 % confidence intervals (CI) for clinical data in COVID-19 patients with or without thrombotic events was calculated.

Results

12 articles contained 1083 patients were included for meta-analysis. The prevalence of thrombosis was 22 % (95 % CI 0.08–0.40) in COVID-19 patients and increased to 43 % (95 % CI 0.29–0.65) after admission to the intensive care unit (ICU). Compared with non-thrombotic patients, thrombotic patients had higher levels of D-dimer (MD = 2.79 μg/ml, 95 % CI 2.27–3.31 μg/ml), lactate dehydrogenase (LDH) (MD = 112.71 U/L, 95 % CI 62.40–163.02 U/L), and white blood cells (WBC) (MD = 1.14 *109/L, 95 % CI 0.47–1.81*109/L) while decreased lymphocytes (MD= -0.20*109/L, 95 % CI -0.38 – -0.02*109/L). Age, platelet counts, and male sex tended to be risks while diabetes tended to be a protection for thrombosis for COVID-19 patients, although no statistical difference was achieved. Finally, patients with thrombosis were at a higher risk of death (OR = 2.39, 95 % CI 1.36–4.20).

Conclusions

Prevalence of thrombosis in COVID-19 patients was high, especially in ICU, though pharmacologic thromboembolism prophylaxis was applied. Therefore, higher levels of D-dimer, LDH, WBC, and decreased lymphocytes needed to be paid close attention to in patients with COVID-19.