bluuebunny/crossref_metadata_2025 huggingface dataset:
Quality of medical records in public health facilities: A case of Southern Ethiopia, resource limited setting
Authors: Endriyas Misganu , Kawza Aknaw , Alano Abraham , Lemango Fiseha
Published: July 2022

Facility based retrospective study was conducted in three regions in southern Ethiopia to assess quality of medical records. A total of 2,145 medical records were reviewed from 73 public health facilities. Minimum standards of medical records were considered to assess completeness and legibility of records. The completeness of medical records were judged systematically according to national HMIS formats. From total of 2,145 medical cards reviewed, only 394 (18.4%) records had all complete and readable data. Gaps observed include 29.0% missed at least one of identification data, 14.3% lack chief compliant, 20.1% lack diagnosis, 12.5% lack medication and 60.3% records had no date and/or signature. Moreover, 9.5% cards had at least one non-readable component. Records at health centers were 56.8% less likely to be quality record as compared to records in hospitals. Even though completeness of every single record is must, only less than one fifth of records met quality of national medical record standard. Ministry of health should consider rules and regulation to maintain data quality and switching to electronic record, and finally progress in data quality should be monitored routinely.
Earnings generation and strategic alliance-building and as a means of achieving scalability of social enterprises in South Africa
Authors: Urban Boris , Bukula Sanelisiwe
Published: July 2022

While scaling of social impact is a key element in social entrepreneurship (SE), many social enterprises fail to scale-up their impact meaningfully. This is an opportunity to investigate earnings generation (EG) and strategic alliance-building (SAB) as potential predictors of scalability of social enterprises. The study context is South Africa where SE has much relevance due to the many social ills, which plague the country. Initially, the study instrument is tested for validity and reliability, whereupon hypotheses are tested using multiple regression analyses. Results show that EG is a significant and positive predictor of social enterprise scaling. This finding is important considering that many social enterprises in South Africa are challenged by financial resource constraints. This study, conducted in an African emerging market context, allows social entrepreneurs to more deeply understand the relevance of EG and SAB in their scaling efforts. Indeed, developing a strong body of evidence that validates the effectiveness of policy in supporting social enterprise scaling is pivotal for both theory and practice.
The development of theory in comparative and international education: An analysis of doctoral theses at North American universities
Authors: Mukudi Omwami Edith , Shields Robin
Published: July 2022

Comparative and international education (CIE) claims to be an interdisciplinary field embracing a diversity in methodologies and theoretical perspectives. Over the years, there has been an expansion in the range of theoretical perspectives employed in scholarship, as new scholars bring with them interests, expertise and positionalities. Our analysis maps the development of theoretical perspectives in doctoral theses in CIE at North American universities since 1990. We find that theory has changed considerably in this time, with a greater emphasis on critical perspectives and standpoint theories and a declining interest in economically focused perspectives. We also note that the role of doctoral advisors is primarily in terms of theoretical perspective, rather than context or methodology. These findings improve our understanding of the field in North America and potentially hold relevance to scholarship in other parts of the world.
Scenography and the Production of Artworks in Contemporary Art
Authors: Zhang Linzhi
Published: July 2022

This article challenges the assumption in a classical sociology of art that artworks are created in the artist’s studio as independent and self-sufficient objects. Given that artistic production merges with exhibition making in contemporary art, I argue that the production of artworks needs to be situated in the exhibition space. In this institutional and physical environment, a set of scenographic principles dominate. Scenography is an ideology and method for exhibition making that emphasises the audience’s experience of the exhibition as a coherent entity. In the exhibition context, therefore, artworks are produced as an integral part of the scenography. Drawing upon six cases of solo exhibitions in museums and galleries, I reveal how the material, conceptual, and experiential features of artworks are shaped by scenographic considerations. The six cases also demonstrate the variations in the production of contemporary art. This article further develops the sociology of art in three ways. First, I show a middle way between the classical sociology of art and the recent material turn in cultural sociology. While the former explains artworks as social products but often fails to show the direct impact of social factors on features of artworks, the latter prioritises the agency of artworks qua artistic features but take these as given. Through the concept of scenography, I explain the social genesis of artistic features without prioritising human or non-human actors. Second, I call more attention to the dialogue with art history, especially its turns towards exhibitions for apprehending new developments in art. Third, the hybrid practices in visual art extend our understanding of artistic mediation as art itself, which becomes more applicable to different genres of art.
Trump Lies, Truth Dies? Epistemic Crisis and the Effect of False Balance Reporting on Beliefs About Voter Fraud
Authors: Jenkins Matthew David , Gomez Daniel
Published: July 2022

Media scholars have long recognized the potential for falsely balanced reporting to distort public opinion, but existing empirical evidence is inconclusive. In this study, we examine the effect of falsely balanced reporting and explicit journalistic intervention on perceptions of voter fraud in U.S. elections through original internet survey experiments conducted in the United States shortly before and after the 2020 U.S. presidential election held on November 3, 2020. The results show that exposure to falsely balanced reporting largely has a null effect on perceptions of voter fraud, though we also find evidence of partisan-based heterogeneity in its effect. The results of the study also show that explicit journalistic intervention equally decreases belief in voter fraud among both Democrats and Republicans before the election, but among Republicans the corrective effect of intervention disappears in the post-election period, suggesting that there are sharp contextual limits on the effect of explicit journalistic intervention.
Immune complications and their management in inherited and acquired bleeding disorders
Authors: Arruda Valder R. , Lillicrap David , Herzog Roland W.
Published: July 2022

Disorders of coagulation, resulting in serious risks for bleeding, may be caused by autoantibody formation or by mutations in genes encoding coagulation factors. In the latter case, antidrug antibodies (ADAs) may form against the clotting factor protein drugs used in replacement therapy, as is well documented in the treatment of the X-linked disease hemophilia. Such neutralizing antibodies against factors VIII or IX substantially complicate treatment. Autoantibody formation against factor VIII leads to acquired hemophilia. Although rare, antibody formation may occur in the treatment of other clotting factor deficiencies (eg, against von Willebrand factor [VWF]). The main strategies that have emerged to address these immune responses include (1) clinical immune tolerance induction (ITI) protocols; (2) immune suppression therapies (ISTs); and (3) the development of drugs that can improve hemostasis while bypassing the antibodies against coagulation factors altogether (some of these nonfactor therapies/NFTs are antibody-based, but they are distinct from traditional immunotherapy as they do not target the immune system). Choice of immune or alternative therapy and criteria for selection of a specific regimen for inherited and autoimmune bleeding disorders are explained. ITI serves as an important proof of principle that antigen-specific immune tolerance can be achieved in humans through repeated antigen administration, even in the absence of immune suppression. Finally, novel immunotherapy approaches that are still in the preclinical phase, such as cellular (for instance, regulatory T cell [Treg]) immunotherapies, gene therapy, and oral antigen administration, are discussed.
The double posteromedial portals endoscopy for posterior ankle impingement syndrome in athletes
Authors: Maffulli Nicola , Aicale Rocco , Migliorini Filippo , Wagner Emilio , Saxena Amol , Oliva Francesco
Published: July 2022

Background

Posterior ankle impingement syndrome (PAIS) may result from flexor hallucis longus tendinopathy, compression of the posterior process of the talus from the presence of an os trigonum, soft-tissue impingement, or a combination of these. Posterior extra-articular endoscopy performed with the patient supine through the double posteromedial portals, with excision of adhesions, excision of the posterior process of the talus or an os trigonum, and decompression of the tendon of the flexor hallucis longus (FHL), can be used in athletes with PAIS.

Methods

Thirty-four athletes with PAIS in whom conservative management had failed underwent posterior ankle endoscopy in the supine position using the double posteromedial portals. The patients were assessed pre- and postoperatively using the American Orthopaedic Foot and Ankle Society hindfoot scale score, the Tegner scale, and the simple visual analogue scale. Time of surgery, return to sports, patient satisfaction, and complications were recorded and analysed. The average length of postoperative follow-up was 26.7 ± 12.6 (range 24 to 72) months.

Results

The mean Tegner activity scale score improved to 9 ± 0.2 postoperatively (p < 0.05), while the mean American Orthopaedic Foot and Ankle Society scale score improved to 96 ± 5.1 (range 87 to 100) postoperatively, with 29 of 34 patients (85.3%) achieving a perfect score of 100 (p < 0.05). The mean time to return to sports was 8.7 ± 0.7 (range 8 to 10) weeks. The complication rate was low, with no superficial wound infections or venous thromboembolism events; only two patients (5.9%) reported pain and tenderness by 3 months after the index procedure.

Conclusion

Posterior ankle endoscopy for the resection of a posterior process of the talus or an os trigonum and decompression of the tendon of FHL is safe and allows excellent outcomes with low morbidity in athletes with PAIS.
Design and validation of a deep evolutionary time visual instrument (DET-Vis)
Authors: Stenlund Jörgen I. , Schönborn Konrad J. , Höst Gunnar E.
Published: July 2022

Understanding deep evolutionary time is crucial for biology education and for conceptualizing evolutionary history. Although such knowledge might help citizens contemplate their actions in the context of human existence, understanding deep evolutionary time is a demanding cognitive endeavor for students. The enormous magnitudes of evolutionary time are often visually communicated through phylograms and timelines. Given the importance of understanding evolutionary time in various scientific domains at large, there is a need for tools to gauge students’ knowledge about visually communicated deep evolutionary time. In response, we describe the design and validation of an instrument to measure knowledge about the visual representation of deep evolutionary time. Development, expert panel evaluation, and piloting of an initial 14 questions with 139 respondents resulted in a 10-item multiple-choice questionnaire. Subsequent collection and analysis of 212 responses validated the 10-item Deep Evolutionary Time Visual Instrument (DET-Vis). Identification of a single factor suggests a unidimensional construct that represents knowledge about the visual communication of deep evolutionary time. A Cronbach’s alpha of 0.73 yielded an acceptable internal consistency of the instrument. The items of the instrument discriminate well with discrimination coefficients between 0.25 and 0.53. The instrument is of moderate difficulty with difficulty indices ranging from 0.56 to 0.81. The seven-step methodological design and validation procedure of this study yielded a unidimensional, valid, and reliable ten-item deep evolutionary time visual test instrument. The instrument items probe both procedural and declarative aspects of the construct that could warrant future psychometric exploration. Use of DET-Vis in pedagogical practice could help support the teaching of deep evolutionary time at upper secondary and undergraduate levels.
Identification and genetic characterization of a minor norovirus genotype, GIX.1[GII.P15], from China
Authors: Chen Yanli , Wu Qiongwen , Li Guiman , Li Hongzhe , Li Wenlong , Li Heng , Qin Li , Zheng Huiwen , Liu Changkun , Hou Min , Liu Longding
Published: July 2022

Background

Human noroviruses, single-stranded RNA viruses in the family Caliciviridae, are a leading cause of nonbacterial acute gastroenteritis in people of all ages worldwide. Despite three decades of genomic sequencing and epidemiological norovirus studies, full-length genome analyses of the non-epidemic or minor norovirus genotypes are rare and genomic regions other than ORF2 and 3′-end of ORF1 have been largely understudied, which hampers a better understanding of the evolutionary mechanisms of emergence of new strains. In this study, we detected a rare norovirus genotype, GIX.1[GII.P15], in a vomit sample of a 60 year old woman with acute gastroenteritis using Raji cells and sequenced the complete genome.

Results

Using electron microscopy, a morphology of spherical and lace-like appearance of norovirus virus particles with a diameter of approximately 30 nm were observed. Phylogenetic analysis of VP1 and the RdRp region indicated that the KMN1 strain could be genotyped as GIX.1[GII.P15]. In addition, the VP1 region of KMN1 strain had 94.15% ± 3.54% percent nucleotide identity (PNI) compared to 26 genomic sequences available in GenBank, indicating a higher degree similarity between KMN1 and other GIX.1[GII.P15] strains. Further analysis of the full genome sequence of KMN1 strain showed that a total of 96 nucleotide substitutions (63 in ORF1, 25 in ORF2, and 8 in ORF3) were found across the genome compared with the consensus sequence of GIX.1[GII.P15] genome, and 6 substitutions caused amino acid changes (4 in ORF1, 1 in ORF2, and 1 in ORF3). However, only one nucleotide substitution results in the amino acid change (P302S) in the VP1 protein and the site was located near one of the predicted conformational B epitopes on the dimer structure.

Conclusions

The genomic information of the new GIX.1[GII.P15] strain KMN1, which was identified in Kunming, China could provide helpful insights for the study of the genetic evolution of the virus.
Transcriptional landscape of human neuroblastoma cells in response to SARS-CoV-2
Authors: Yang Rui-Cheng , Huang Kun , Zhang Hui-Peng , Li Liang , Tan Chen , Chen Huan-Chun , Jin Mei-Lin , Wang Xiang-Ru
Published: July 2022

Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is highly contagious, and the neurological symptoms of SARS-CoV-2 infection have already been reported. However, the mechanisms underlying the effect of SARS-CoV-2 infection on patients with central nervous system injuries remain unclear.

Methods

The high-throughput RNA sequencing was applied to analyze the transcriptomic changes in SK-N-SH cells after SARS-CoV-2 infection. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses were performed to identify the functions of differentially expressed genes and related pathways.

Results

A total of 820 mRNAs were significantly altered, including 671 upregulated and 149 downregulated mRNAs (showing an increase of ≥ 2-fold or decrease to ≤ 0.5-fold, respectively; p ≤ 0.05). Moreover, we verified the significant induction of cytokines, chemokines, and their receptors, as well as the activation of NF-κB, p38, and Akt signaling pathways, in SK-N-SH by SARS-CoV-2.

Conclusions

To our knowledge, this is the first time the transcriptional profiles of the host mRNAs involved in SARS-CoV-2 infection of SK-N-SH cells have been reported. These findings provide novel insight into the pathogenic mechanism of SARS-CoV-2 and might constitute a new approach for future prevention and treatment of SARS-CoV-2-induced central nervous system infection.
Genome-wide analysis of citrus TCP transcription factors and their responses to abiotic stresses
Authors: Liu Dong-Hai , Luo Yin , Han Han , Liu Yong-Zhong , Alam Shariq Mahmood , Zhao Hui-Xing , Li Yan-Ting
Published: July 2022

Background

Citrus is one of the most important fruit crops in the world, and it is worthy to conduct more research on artificially controlling citrus plant growth and development to adapt to different cultivation patterns and environmental conditions. The plant-specific TEOSINTE BRANCHED1, CYCOLOIDEA, and PROLIFERATING CELL FACTORS (TCP) transcription factors are crucial regulators controlling plant growth and development, as well as responding to abiotic stresses. However, the information about citrus TCP transcription factors remains unclear.

Results

In this study, twenty putative TCP genes (CsTCPs) with the TCP domain were explored from Citrus sinensis genome, of which eleven (CsTCP3, − 4, − 5, − 6, − 10, − 11, − 15, − 16, − 18, − 19, − 20), five (CsTCP1, − 2, − 7, − 9, − 13), and four genes (CsTCP8, − 12, − 14, − 17) were unevenly distributed on chromosomes and divided into three subclades. Cis-acting element analysis indicated that most CsTCPs contained many phytohormone- and environment-responsive elements in promoter regions. All of CsTCPs were predominantly expressed in vegetative tissues or organs (stem, leaf, thorn, and bud) instead of reproductive tissues or organs (flower, fruit, and seed). Combined with collinearity analysis, CsTCP3, CsTCP9, and CsTCP13 may take part in leaf development; CsTCP12 and CsTCP14 may function in shoot branching, leaf development, or thorn development; CsTCP15 may participate in the development of stem, leaf, or thorn. In mature leaf, transcript levels of two CsTCPs (CsTCP19, − 20) were significantly increased while transcript levels of eight CsTCPs (CsTCP2, − 5, − 6, − 7, − 8, − 9, − 10, − 13) were significantly decreased by shading; except for two CsTCPs (CsTCP11, − 19), CsTCPs’ transcript levels were significantly influenced by low temperature; moreover, transcript levels of two CsTCPs (CsTCP11, − 12) were significantly increased while five CsTCPs’ (CsTCP14, − 16, − 18, − 19, − 20) transcript levels were significantly reduced by drought.

Conclusions

This study provides significant clues for research on roles of CsTCPs in regulating citrus plant growth and development, as well as responding to abiotic stresses.
Factors of the childbirth fear among nulliparous women in Iran
Authors: Kananikandeh Safieh , Amin Shokravi Farkhondeh , Mirghafourvand Mojgan , Jahanfar Shayesteh
Published: July 2022

Background

Fear of childbirth is an anxiety associated with childbirth, which manifests itself in physical and concentration problems. It is often associated with requesting a cesarean section, and it is prevalent in nulliparous women. This is a study aimed to summarize the published research on the factors for fear of childbirth in nulliparous women in Iran.

Methods

This study was conducted based on the PRISMA statement. A literature search was performed on nine electronic databases (Web of Sciences, Since Direct, Scopus, PubMed, Cochrane Library, ProQuest, and Persian databases including Scientific Information Database, Irandoc, and Magiran) using keywords related to fear of childbirth, factors, nulliparous, and Iran from 2000 to 2020. This study included cross-sectional studies with full-text in English or Persian in Iran. The quality of the selected studies was evaluated independently by two authors and via the STROBE checklist.

Results

In this study, 93 articles were identified,13 duplicate articles were excluded, 80 articles were screened by title and abstract, 62 were excluded, and the full-text of 18 articles was assessed for analysis. Of these, 12 were excluded, and six articles were reviewed. Six studies were conducted in different provinces of Iran. Based on the study results, factors of the fear of childbirth in nulliparous women were: biological (the process of labor and childbirth and labor pain, concern for the baby (harm to the baby and baby infirmity), psychological (painful injections during labor and suturing in childbirth), and individual (loss of control during labor).

Conclusions

This study identified four main factors that affect fear of childbirth status in nulliparous women, and concern for the baby was a more common factor in this study. In conclusion, these factors can be reduced by increasing their assurance about child health, training during pregnancy, talking about positive experiences, and holding workshops.
HLA class II molecule HLA-DRA identifies immuno-hot tumors and predicts the therapeutic response to anti-PD-1 immunotherapy in NSCLC
Authors: Mei Jie , Jiang Guanyu , Chen Yundi , Xu Yongrui , Wan Yuan , Chen Ruo , Liu Feng , Mao Wenjun , Zheng Mingfeng , Xu Junying
Published: July 2022

Background

Immune checkpoint blockade (ICB) only works well for a certain subset of patients with non-small cell lung cancer (NSCLC). Therefore, biomarkers for patient stratification are desired, which can suggest the most beneficial treatment.

Methods

In this study, three datasets (GSE126044, GSE135222, and GSE136961) of immunotherapy from the Gene Expression Omnibus (GEO) database were analyzed, and seven intersected candidates were extracted as potential biomarkers for ICB followed by validation with The Cancer Genome Atlas (TCGA) dataset and the in-house cohort data.

Results

Among these candidates, we found that human leukocyte antigen-DR alpha (HLA-DRA) was downregulated in NSCLC tissues and both tumor and immune cells expressed HLA-DRA. In addition, HLA-DRA was associated with an inflamed tumor microenvironment (TME) and could predict the response to ICB in NSCLC. Moreover, we validated the predictive value of HLA-DRA in immunotherapy using an in-house cohort. Furthermore, HLA-DRA was related to the features of inflamed TME in not only NSCLC but also in most cancer types.

Conclusion

Overall, HLA-DRA could be a promising biomarker for guiding ICB in NSCLC.
Alterations in ocular microcirculation and oxygen metabolism in patients with lipemia retinalis
Authors: Alsarhani Waleed K. , Al Adel Fadwa F. , Alamri Abdullah , Al Malawi Rahaf M. , AlBloushi Abdulrahman F.
Published: July 2022

Purpose

The study aims to assess the alterations in retinal oxygen saturation and retinal and choroidal blood flow in lipemia retinalis.

Methods

This was a cross-sectional study on 10 eyes (5 patients) with history of lipemia retinalis. The study comprised 10 eyes with documented history of lipemia retinalis and 10 participants as healthy controls. Patients with a confirmed history of lipemia retinalis were grouped into two cohorts based on their most recent fundus examination: untreated lipemia retinalis (abnormal fundus) and resolved lipemia retinalis (normal fundus). Both retinal arteriolar and venular oxygen saturation were measured using the non-invasive spectrophotometric retinal oximeter (Oxymap T1). The mean blur rate (MBR) of the optic nerve and choroidal blood flow were analyzed using a laser speckle flowgraph (LSFG).

Results

Patients with untreated lipemia retinalis had a significantly higher retinal arteriolar and venular oxygen saturation than that of the other two groups (p < 0.001). Moreover, patients with untreated lipemia retinalis had significantly smaller retinal arteriolar and venular diameters (p < 0.001). On LSFG, there was a significant difference in the overall MBR (p = 0.007) and vessel MBR of the optic nerve between the groups (p = 0.011). The patients with history of lipemia retinalis (untreated and resolved) exhibited a high overall MBR and vessel MBR of the optic nerve than that of the control group. There was a significant elevation of the optic nerve (p = 0.002) and choroidal blowout score (p < 0.001), while the resistivity index of the optic nerve (p = 0.001) and choroids (p = 0.002) was significantly lower in patients with resolved and untreated lipemia retinalis.

Conclusions

There was a significant alteration in retinal oximetry, in untreated lipemia retinalis, and in retinal blood flow, in both the resolved and untreated groups. The increase in retinal blood flow and oxygen saturation may elucidate the preservation of visual acuity and function despite the fundus changes observed in lipemia retinalis.
A qualitative study on multisector activities to prevent childhood obesity in the municipality of Seinäjoki, Finland
Authors: Koivusilta Leena , Alanne Soili , Kamila Marjo , Ståhl Timo
Published: July 2022

Background

Multisector activities are needed to prevent childhood obesity due to its multifactorial background. The first aim was to identify the activities that had been undertaken for obesity prevention and deduce their main targets. Second, we analyzed the public health policy approaches (upstream, midstream, and downstream) which were followed. Finally, we studied the perception of interviewees regarding their sectors’ roles in implementing the local obesity program.

Methods

Deductive content analysis was used to analyze semi-structured interviews with 34 key professionals (from seven administrative sectors) who had participated in multisector health promotion during 2009–2016 and five representatives of other core parties.

Results

Several midstream and upstream activities were targeted at making physical activity (PA) and healthy eating (HE) integral parts of children’s lifestyle. One long-term strategy was to create environments for PA accessible to every inhabitant and build and renovate the interiors and yards of schools and day-care centers. The healthiness of meals was increased progressively. In addition to midstream and upstream activities, as a downstream activity, an intervention targeting children at risk of obesity was implemented. The impact of management on the activities was considerable; childhood obesity prevention was included in the city strategy and systematically coordinated at the highest managerial level. Altogether, various sectors operated efficiently to promote obesity-preventing lifestyles; however, not all (important) sectors recognized their role in the multisector process.

Conclusion

Most of the activities to guide children towards obesity-preventing lifestyles were either at the midstream or upstream level. Among the latter, considerable work is aimed at creating opportunities to practice PA and making it a natural part of the daily life. The aim of familiarizing children with lifestyles that include PA and HE was shared across sectors, including sectors that had not yet acknowledged their role in obesity prevention. Strong support from city management and systematic coordination of the activity are important factors that contribute to the engagement of several administrative sectors in working towards a shared aim, such as the prevention of childhood obesity.
The development and feasibility study of Multidisciplinary Timely Undertaken Advance Care Planning conversations at the outpatient clinic: the MUTUAL intervention
Authors: van Lummel Eline V. T. J. , Savelkoul Claudia , Stemerdink Eva L. E. , Tjan Dave H. T. , van Delden Johannes J. M.
Published: July 2022

Background

Patients still receive non-beneficial treatments when nearing the end of life. Advance care planning (ACP) interventions have shown to positively influence compliance with end of life wishes. Hospital physicians seem to miss opportunities to engage in ACP, whereas patients visiting the outpatient clinic usually have one or more chronic conditions and are at risk for medical emergencies. So far, implemented ACP interventions have had limited impact. Structural implementation of ACP may be beneficial. We hypothesize that having ACP conversations more towards the end of life and involving the treating physician in the ACP conversation may help patient wishes and goals to become more concrete and more often documented, thus facilitating goal-concordant care.

Aim

To facilitate timely shared decision making and increase patient autonomy we aim to develop an ACP intervention at the outpatient clinic for frail patients and determine the feasibility of the intervention.

Methods

The United Kingdom’s Medical Research Council framework was used to structure the development of the ACP intervention. Key elements of the ACP intervention were determined by reviewing existing literature and an iterative process with stakeholders. The feasibility of the developed intervention was evaluated by a feasibility study of 20 ACP conversations at the geriatrics and pulmonology department of a non-academic hospital. Feasibility was assessed by analysing evaluation forms by patients, nurses and physicians and by evaluating with stakeholders. A general inductive approach was used for analysing comments. The developed intervention was described using the template for intervention description and replication (TIDieR).

Results

We developed a multidisciplinary timely undertaken ACP intervention at the outpatient clinic. Key components of the developed intervention consist of 1) timely patient selection 2) preparation of patient and healthcare professional 3) a scripted ACP conversation in a multidisciplinary setting and 4) documentation. 94.7% of the patients, 60.0% of the nurses and 68.8% of the physicians agreed that the benefits of the ACP conversation outweighed the potential burdens.

Conclusion

This study showed that the developed ACP intervention is feasible and considered valuable by patients and healthcare professionals.
Super-additive associations between parity and education level on mortality from cardiovascular disease and other causes: the Japan Collaborative Cohort Study
Authors: Yasukawa Sumiyo , Eguchi Eri , Tamakoshi Akiko , Iso Hiroyasu ,   for JACC Study Group, Tamakoshi Akiko , Iso Hiroyasu , Mori Mitsuru , Kaneko Yoshihiro , Tsuji Ichiro , Nakamura Yosikazu , Yamagishi Kazumasa , Mikami Haruo , Kurosawa Michiko , Hoshiyama Yoshiharu , Tanabe Naohito , Tamakoshi Koji , Wakai Kenji , Ando Masahiko , Suzuki Koji , Hashimoto Shuji , Yatsuya Hiroshi , Kikuchi Shogo , Wada Yasuhiko , Okabayashi Satoe , Ozasa Kotaro , Mikami Kazuya , Sakata Kiyomi , Kurozawa Yoichi , Fujino Yoshihisa
Published: July 2022

Background

While women’s parity status and education level have independent associations with cardiovascular and other diseases, no studies have evaluated the additive interaction of these two factors. Therefore, we examined the additive interaction between parity and education level on mortality from stroke, coronary heart disease, total cardiovascular disease, cancer, non-cardiovascular disease, and non-cancer causes, and all causes in Japanese women.

Methods

This study followed 41,242 women aged 40–79 years without a history of cardiovascular disease or cancer from 1988 to 1990 until 2009. Baseline parity and education level were classified into four categories, with highly educated parous women as the reference group. Cox proportional hazards regression analyses were performed to calculate the risk of mortality. We also assessed the additive interactions between parity and education level on mortality from cardiovascular disease and other causes using the relative excess risk due to interaction obtained using Cox models.

Results

During the median follow-up period of 19.1 years, we identified 6299 deaths. In a multivariable model adjusted for cardiovascular disease and other disease risk factors, nulliparous women with low education levels had increased multivariable-adjusted hazard ratios of 1.67 (95% confidence interval [CI] 1.13, 2.47) for stroke, 1.98 (95% CI 1.15, 3.39) for coronary heart disease, 1.71 (95% CI 1.34,2.18) for total cardiovascular disease, 1.69 (95% CI 1.33, 2.14) for non-cardiovascular and non-cancer, and 1.51 (95% CI 1.30, 1.75) for all-cause mortality when compared with highly educated parous women. Moreover, we observed significant additive interactions between parity and education level on total cardiovascular disease mortality (P = 0.04), non-cardiovascular disease and non-cancer mortality (P = 0.01), and all-cause mortality (P = 0.005).

Conclusions

Nulliparity and low education levels are super-additively associated with total cardiovascular disease, non-cardiovascular and non-cancer, and all-cause mortality risks, suggesting that nulliparous women with low education levels need specific support for preventing mortality related to cardiovascular and other diseases.
The determinants of staff retention after Emergency Obstetrics and Newborn Care training in Kenya: a cross-sectional study
Authors: Shikuku Duncan N. , Nyaoke Irene , Maina Onesmus , Eyinda Martin , Gichuru Sylvia , Nyaga Lucy , Iman Fatuma , Tallam Edna , Wako Ibrahim , Bashir Issak , Allott Helen , Ameh Charles
Published: July 2022

Introduction

Kenya’s maternal mortality ratio is relatively high at 342/100,000 live births. Confidential enquiry into maternal deaths showed that 90% of the maternal deaths received substandard care with health workforce related factors identified in 75% of 2015/2016 maternal deaths. Competent Skilled Health Personnel (SHP) providing emergency obstetric and newborn care (EmONC) in an enabling environment reduces the risk of adverse maternal and newborn outcomes. The study objective was to identify factors that determine the retention of SHP 1 – 5 years after EmONC training in Kenya.

Methods

A cross-sectional review of EmONC SHP in five counties (Kilifi, Taita Taveta, Garissa, Vihiga and Uasin Gishu) was conducted between January–February 2020. Data was extracted from a training database. Verification of current health facilities where trained SHP were deployed and reasons for non-retention were collected. Descriptive data analysis, transfer rate by county and logistic regression for SHP retention determinants was performed.

Results

A total of 927 SHP were trained from 2014–2019. Most SHP trained were nurse/midwives (677, 73%) followed by clinical officers (151, 16%) and doctors (99, 11%). Half (500, 54%) of trained SHP were retained in the same facility. Average trained staff transfer rate was 43%, with Uasin Gishu lowest at 24% and Garissa highest at 50%. Considering a subset of trained staff from level 4/5 facilities with distinct hospital departments, only a third (36%) of them are still working in relevant maternity/newborn/gynaecology departments. There was a statistically significant difference in transfer rate by gender in Garissa, Vihiga and the combined 5 counties (p < 0.05). Interval from training in years (1 year, AOR = 4.2 (2.1–8.4); cadre (nurse/midwives, AOR = 2.5 (1.4–4.5); and county (Uasin Gishu AOR = 9.5 (4.6- 19.5), Kilifi AOR = 4.0 (2.1–7.7) and Taita Taveta AOR = 1.9 (1.1–3.5), p < 0.05, were significant determinants of staff retention in the maternity departments.

Conclusion

Retention of EmONC trained SHP in the relevant maternity departments was low at 36 percent. SHP were more likely to be retained by 1-year after training compared to the subsequent years and this varied from county to county. County policies and guidelines on SHP deployment, transfers and retention should be strengthened to optimise the benefits of EmONC training.
Emerging role of human microbiome in cancer development and response to therapy: special focus on intestinal microflora
Authors: Sadrekarimi Hourieh , Gardanova Zhanna R. , Bakhshesh Morteza , Ebrahimzadeh Farnoosh , Yaseri Amirhossein Fakhre , Thangavelu Lakshmi , Hasanpoor Zahra , Zadeh Firoozeh Abolhasani , Kahrizi Mohammad Saeed
Published: July 2022

In recent years, there has been a greater emphasis on the impact of microbial populations inhabiting the gastrointestinal tract on human health and disease. According to the involvement of microbiota in modulating physiological processes (such as immune system development, vitamins synthesis, pathogen displacement, and nutrient uptake), any alteration in its composition and diversity (i.e., dysbiosis) has been linked to a variety of pathologies, including cancer. In this bidirectional relationship, colonization with various bacterial species is correlated with a reduced or elevated risk of certain cancers. Notably, the gut microflora could potentially play a direct or indirect role in tumor initiation and progression by inducing chronic inflammation and producing toxins and metabolites. Therefore, identifying the bacterial species involved and their mechanism of action could be beneficial in preventing the onset of tumors or controlling their advancement. Likewise, the microbial community affects anti-cancer approaches’ therapeutic potential and adverse effects (such as immunotherapy and chemotherapy). Hence, their efficiency should be evaluated in the context of the microbiome, underlining the importance of personalized medicine. In this review, we summarized the evidence revealing the microbiota's involvement in cancer and its mechanism. We also delineated how microbiota could predict colon carcinoma development or response to current treatments to improve clinical outcomes.
The importance of mineralogical composition for the cytotoxic and pro-inflammatory effects of mineral dust
Authors: Grytting Vegard Sæter , Refsnes Magne , Låg Marit , Erichsen Eyolf , Røhr Torkil Sørlie , Snilsberg Brynhild , White Richard Aubrey , Øvrevik Johan
Published: July 2022

Background

Respirable mineral particles represent a potential health hazard in occupational settings and ambient air. Previous studies show that mineral particles may induce cytotoxicity and inflammatory reactions in vitro and in vivo and that the potency varies between samples of different composition. However, the reason for these differences is largely unknown and the impact of mineralogical composition on the biological effects of mineral dust remains to be determined.

Methods

We have assessed the cytotoxic and pro-inflammatory effects of ten mineral particle samples of different composition in human bronchial epithelial cells (HBEC3-KT) and THP-1-derived macrophages, as well as their membranolytic properties in erythrocytes. Moreover, the results were compiled with the results of recently published experiments on the effects of stone particle exposure and analysed using linear regression models to elucidate which mineral components contribute most to the toxicity of mineral dust.

Results

While all mineral particle samples were more cytotoxic to HBEC3-KT cells than THP-1 macrophages, biotite and quartz were among the most cytotoxic in both cell models. In HBEC3-KT cells, biotite and quartz also appeared to be the most potent inducers of pro-inflammatory cytokines, while the quartz, Ca-feldspar, Na-feldspar and biotite samples were the most potent in THP-1 macrophages. All particle samples except quartz induced low levels of membranolysis. The regression analyses revealed associations between particle bioactivity and the content of quartz, muscovite, plagioclase, biotite, anorthite, albite, microcline, calcite, chlorite, orthopyroxene, actinolite and epidote, depending on the cell model and endpoint. However, muscovite was the only mineral consistently associated with increased cytotoxicity and cytokine release in both cell models.

Conclusions

The present study provides further evidence that mineral particles may induce cytotoxicity and inflammation in cells of the human airways and that particle samples of different mineralogical composition differ in potency. The results show that quartz, while being among the most potent samples, does not fully predict the toxicity of mineral dust, highlighting the importance of other particle constituents. Moreover, the results indicate that the phyllosilicates muscovite and biotite may be more potent than other minerals assessed in the study, suggesting that this group of sheet-like minerals may warrant further attention.
Aseptic femoral nonunion treated with exchange locked nailing with intramedullary augmentation cancellous bone graft
Authors: Wu Chi-Chuan
Published: July 2022

Background

Closed reamed locked intramedullary nailing has been the treatment of choice for most of femoral shaft fractures. A high union rate with a low complication rate is generally predictable. For an aseptic femoral shaft nonunion with a prior inserted intramedullary nail, exchange nailing is one of favored surgical techniques for treatment. However, a greatly varied success rate of 72–100% has been reported. To improve the success rate of exchange femur nailing, a modified bone grafting technique was developed. The purpose of this retrospective study intended to evaluate outcomes of such a revised technique.

Methods

From July 2011 to March 2019, 48 consecutive adult patients (average, 38 years; range, 19–67 years) with aseptic femoral shaft nonunions after intramedullary nailing treatment were studied. All femoral shaft fractures were initially caused by traffic accidents, which were treated by a closed or open intramedullary nailing technique at various hospitals. The current revision treatment was performed after an average of 2.2 years (range 1.1–6.2 years) from initial injuries. In the surgery, the prior nail was removed and the marrow cavity was reamed widely (at least 2 mm as possible). Sufficient cancellous bone grafts harvested on the trochanteric marrow wall from the inside were placed in the marrow cavity of the junction of nonunion fragments. A new 1-mm smaller size locked intramedullary nail was inserted. Whether the dynamic or static mode of nails were used mainly depended on the nonunion level. Postoperatively, protected weight bearing with crutches was allowed for all patients.

Results

Forty-one patients were followed for an average of 2.8 years (85.4%; range, 1.9–4.5 years) and all fractures healed. The union rate was 100% (41/41, p < 0.001) with a union time of an average of 3.4 months (range, 2.5–5.0 months). There were no complications of deep infection, nonunions, malunions, implant failures or an avulsed trochanter tip fracture. The satisfactory knee function improved from 73.2% (30/41) preoperatively to 92.7% (38/41) at the latest follow-up (p = 0.019).

Conclusions

The described modified bone grafting technique may effectively improve a union rate of exchange femur nailing while the surgical procedure is not complicated. It may therefore be used concomitantly in all aseptic femoral shaft nonunions when exchange nailing is performed.
Etiology of trauma-related acute compartment syndrome of the forearm: a systematic review
Authors: Khoshhal Khalid I. , Alsaygh Ehab F. , Alsaedi Obaid F. , Alshahir Alwaleed A. , Alzahim Ammar F. , Al Fehaid Mohammad S.
Published: July 2022

Objectives

Acute compartment syndrome (ACS) can be caused by multiple causes that affect people of different ages. It is considered an orthopedic emergency condition that requires immediate diagnosis and surgical intervention to avoid devastating complications and irreversible damages. This systematic review aimed to present the etiology of trauma-related forearm ACS.

Methods

A systematic review was performed on four different databases: Embase, Medline, Cochrane Central Register of Controlled Trials (CENTRAL) and Cochrane Database of systematic review register databases via Ovid, with no restriction on dates (last date was June 30, 2021). It included all the studies containing data about the etiology of trauma-related forearm ACS.

Results

A total of 4893 articles were retrieved: 122 met the inclusion criteria, 39 were excluded, 25 were out of scope and 14 had insufficient details. Hence, this review constituted 83 articles and 684 patients. The etiology of ACS causing forearm ACS was classified into three groups: fracture-related, soft tissue injury-related and vascular injury-related. The fracture-related group was the most common group (65.4%), followed by soft tissue injury (30.7%), then vascular injuries (3.9%). Furthermore, supracondylar humerus fractures were the most common cause of fractures related to forearm ACS. Blunt traumas were the most common cause of soft tissue injuries-related forearm ACS, and brachial artery injuries were the most common cause of vascular-related forearm ACS.

Conclusion

Frequent assessment of patients with the most prevalent etiologies of forearm ACS is recommended for early detection of forearm ACS and to save limbs.
Barriers and facilitators to chemotherapy initiation and adherence for patients with HIV-associated Kaposi’s sarcoma in Kenya: a qualitative study
Authors: McMahon Devon E. , Singh Rhea , Chemtai Linda , Semeere Aggrey , Byakwaga Helen , Grant Merridy , Laker-Oketta Miriam , Lagat Celestine , Collier Sigrid , Maurer Toby , Martin Jeffrey , Bassett Ingrid V. , Butler Lisa , Kiprono Samson , Busakhala Naftali , Freeman Esther E.
Published: July 2022

Background

Kaposi sarcoma is one of the most prevalent HIV-associated malignancies in sub-Saharan Africa and is often diagnosed at advanced stage of disease. Only 50% of KS patients who qualify for chemotherapy receive it and adherence is sub-optimal.

Methods

57 patients > 18 years with newly diagnosed KS within the AMPATH clinic network in Western Kenya were purposively selected to participate in semi-structured interviews stratified by whether they had completed, partially completed, or not completed chemotherapy for advanced stage KS. We based the interview guide and coding framework on the situated Information, Motivation, Behavioral Skills (sIMB) framework, in which the core patient centered IMB constructs are situated into the socioecological context of receiving care.

Results

Of the 57 participants, the median age was 37 (IQR 32–41) and the majority were male (68%). Notable barriers to chemotherapy initiation and adherence included lack of financial means, difficulty with convenience of appointments such as distance to facility, appointment times, long lines, limited appointments, intrapersonal barriers such as fear or hopelessness, and lack of proper or sufficient information about chemotherapy. Factors that facilitated chemotherapy initiation and adherence included health literacy, motivation to treat symptoms, improvement on chemotherapy, prioritization of self-care, resilience while experiencing side effects, ability to carry out behavioral skills, obtaining national health insurance, and free chemotherapy.

Conclusion

Our findings about the barriers and facilitators to chemotherapy initiation and adherence for KS in Western Kenya support further work that promotes public health campaigns with reliable cancer and chemotherapy information, improves education about the chemotherapy process and side effects, increases oncology service ability, supports enrollment in national health insurance, and increases incorporation of chronic disease care into existing HIV treatment networks.