bluuebunny/crossref_metadata_2025 huggingface dataset:
Predicting the incidence of brucellosis in Western Iran using Markov switching model
Authors: Mohammadian-Khoshnoud Maryam , Sadeghifar Majid , Cheraghi Zahra , Hosseinkhani Zahra
Published: March 2021

Objective

Brucellosis is a zoonosis almost chronic disease. Brucellosis bacteria can remain in the environment for a long time. Thus, climate irregularities could pave the way for the survival of the bacterium brucellosis. Brucellosis is more common in men 25 to 29 years of age, in the western provinces, and in the spring months. The aim of this study is to investigate the effect of climatic factors as well as predicting the incidence of brucellosis in Qazvin province using the Markov switching model (MSM). This study is a secondary study of data collected from 2010 to 2019 in Qazvin province. The data include brucellosis cases and climatic parameters. Two state MSM with time lags of 0, 1 and 2 was fitted to the data. The Bayesian information criterion (BIC) was used to evaluate the models.

Results

According to the BIC, the two-state MSM with a 1-month lag is a suitable model. The month, the average-wind-speed, the minimum-temperature have a positive effect on the number of brucellosis, the age and rainfall have a negative effect. The results show that the probability of an outbreak for the third month of 2019 is 0.30%.
Fe(2)OG: an integrated HMM profile-based web server to predict and analyze putative non-haem iron(II)- and 2-oxoglutarate-dependent dioxygenase function in protein sequences
Authors: Kundu Siddhartha
Published: March 2021

Objective

Non-haem iron(II)- and 2-oxoglutarate-dependent dioxygenases (i2OGdd), are a taxonomically and functionally diverse group of enzymes. The active site comprises ferrous iron in a hexa-coordinated distorted octahedron with the apoenzyme, 2-oxoglutarate and a displaceable water molecule. Current information on novel i2OGdd members is sparse and relies on computationally-derived annotation schema. The dissimilar amino acid composition and variable active site geometry thereof, results in differing reaction chemistries amongst i2OGdd members. An additional need of researchers is a curated list of sequences with putative i2OGdd function which can be probed further for empirical data.

Results

This work reports the implementation of $$Fe\left(2\right)OG$$

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Effects of compound probiotics and aflatoxin-degradation enzyme on alleviating aflatoxin-induced cytotoxicity in chicken embryo primary intestinal epithelium, liver and kidney cells
Authors: Guo Hong-Wei , Chang Juan , Wang Ping , Yin Qing-Qiang , Liu Chao-Qi , Xu Xiao-Xiang , Dang Xiao-Wei , Hu Xiao-Fei , Wang Quan-Liang
Published: March 2021

Aflatoxin B1 (AFB1) is one of the most dangerous mycotoxins for humans and animals. This study aimed to investigate the effects of compound probiotics (CP), CP supernatant (CPS), AFB1-degradation enzyme (ADE) on chicken embryo primary intestinal epithelium, liver and kidney cell viabilities, and to determine the functions of CP + ADE (CPADE) or CPS + ADE (CPSADE) for alleviating cytotoxicity induced by AFB1. The results showed that AFB1 decreased cell viabilities in dose-dependent and time-dependent manners. The optimal AFB1 concentrations and reactive time for establishing cell damage models were 200 µg/L AFB1 and 12 h for intestinal epithelium cells, 40 µg/L and 12 h for liver and kidney cells. Cell viabilities reached 231.58% (p < 0.05) for intestinal epithelium cells with CP addition, 105.29% and 115.84% (p < 0.05) for kidney and liver cells with CPS additions. The further results showed that intestinal epithelium, liver and kidney cell viabilities were significantly decreased to 87.12%, 88.7% and 84.19% (p < 0.05) when the cells were exposed to AFB1; however, they were increased to 93.49% by CPADE addition, 102.33% and 94.71% by CPSADE additions (p < 0.05). The relative mRNA abundances of IL-6, IL-8, TNF-α, iNOS, NF-κB, NOD1 (except liver cell) and TLR2 in three kinds of primary cells were significantly down-regulated by CPADE or CPSADE addition, compared with single AFB1 group (p < 0.05), indicating that CPADE or CPSADE addition could alleviate cell cytotoxicity and inflammation induced by AFB1 exposure through suppressing the activations of NF-κB, iNOS, NOD1 and TLR2 pathways.
On oscillation of higher-order advanced trinomial differential equations
Authors: Luo Demou
Published: March 2021

We study the oscillatory property of the higher-order trinomial differential equation with advanced effects$$ x^{(n)}(t)+p(t)x'(t)+q(t)x \bigl(\sigma (t) \bigr)=0,\quad \sigma (t) \geq t. $$x(n)(t)+p(t)x′(t)+q(t)x(σ(t))=0,σ(t)≥t.Suppose that all solutions of the corresponding ($n-1$n−1)th-order two-term differential equation$$ y^{(n-1)}(t)+p(t)y(t)=0 $$y(n−1)(t)+p(t)y(t)=0are non-oscillatory. In order to supplement the research in the theory of oscillation proposed by (Džurina et al. in Electron. J. Differ. Equ. 2015:70, 2015), two types of clearly confirmable criteria for oscillatory behavior of the investigated equation are obtained. Some examples are offered to describe our main results.
The effect of external factors on industry performance: the case of Lalibela City micro and small enterprises, Ethiopia
Authors: Ebabu Engidaw Abriham
Published: March 2021

The purpose of this study was to examine the effect of external factors on industry performance: in micro and small-scale enterprises. To achieve its objectives, the study employed a descriptive and explanatory research design and used quantitative research approach. The target population of the study was 395 MSEs owners working in manufacturing, trade, and service sectors. It used stratified and simple random sampling techniques and the required data have been collected from a sample size of 199 MSEs through standardized 5-point Likert-scale questionnaire. The study used both primary and secondary sources of data. For data analysis purpose, it employed descriptive and inferential statistical data analysis methods like correlation and multiple linear regression analysis. The finding of the study discovered the agreement of respondents to the positively significant relationship between external factors and industry performance in the study area. Specifically, marketing factors, financial factors, infrastructure, work premises factors, trade fair factors, and political-legal factors all have a positive effect on enterprises’ performance in the study area. In addition, the study result shows that financial factors, marketing factors, infrastructure, work premises factors, and trade fair factors have a positive significant effect on industry performance but political-legal factors do not significantly affect the dependent variable industry performance. From the predicting variables, infrastructure has more effect on industry performance than the rest of variables in the study area. The study recommends that the government/micro and small enterprises development offices should maintain different supportive trainings, decrease infrastructural problems, facilitate credit services, and create attractive environment to entice or create productive MSEs. In addition, the MSEs owners should design adoptive plans and programs with the external as well as internal environment to increase their performance.
Cascading rupture of patches of high seismic energy release controls the growth process of episodic tremor and slip events
Authors: Nakamoto Keita , Hiramatsu Yoshihiro , Uchide Takahiko , Imanishi Kazutoshi
Published: March 2021

Slip phenomena on plate interfaces reflect the heterogeneous physical properties of the slip plane and, thus, exhibit a wide variety of slip velocities and rupture propagation behaviors. Recent findings on slow earthquakes reveal similarities and differences between slow and regular earthquakes. Episodic tremor and slip (ETS) events, a type of slow earthquake widely observed in subduction zones, likewise show diverse activity. We investigated the growth of 17 ETS events beneath the Kii Peninsula in the Nankai subduction zone, Japan. Analyses of waveform data recorded by a seismic array enabled us to locate tremor hypocenters and estimate the migration patterns and spatial distribution of the energy release of tremor events. Here, we describe three major features in the growth of ETS events. First, independent of their start point and migration pattern, ETS events exhibit patches of high seismic energy release on the up-dip part of the ETS zone, suggesting that the location of these patches is controlled by inherent physical or frictional properties of the plate interface. Second, ETS events usually start outside the high-energy patches, and their final extent depends on whether the patches participate in the rupture. Third, we recognize no size dependence in the initiation phase of ETS events of different sizes with comparable start points. These features demonstrate that the cascading rupture of high-energy patches governs the growth of ETS events, just as the cascading rupture of asperities governs the growth of regular earthquakes.
The surviving sepsis campaign: fluid resuscitation and vasopressor therapy research priorities in adult patients
Authors:   for the Research Committee of the Surviving Sepsis Campaign, Lat Ishaq , Coopersmith Craig M. , De Backer Daniel , Coopersmith Craig M.
Published: March 2021

Objective

To expand upon the priorities of fluid resuscitation and vasopressor therapy research priorities identified by a group of experts assigned by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine.

Data Sources

Original paper and literature search.

Study Selection

Several members of the original task force with expertise specific to the area of fluid resuscitation and vasopressor therapy.

Data Extraction

None.

Data Synthesis

None.

Conclusion

In the second of a series of manuscripts subsequent to the original paper, members with expertise in the subjects expound upon the three identified priorities related to fluid resuscitation and vasopressor therapies. This analysis summarizes what is known and what were identified as ongoing and future research.
Restrictive versus liberal perioperative fluid strategies to prevent post-dural puncture headache after cesarean delivery
Authors: Elsonbaty M. , Agiza Nora A. , Abdelbarr Tarek , Salah Heba
Published: March 2021

Background

Post-dural puncture headache is a common complication after cesarean delivery. The role of fluid therapy in prevention of post-dural puncture headache is not clear. The aim of this work is to compare restrictive versus liberal perioperative fluid protocols in prevention of post-dural puncture headache. A randomized controlled trial was conducted including 100 full-term pregnant women undergoing cesarean delivery under spinal block. After receiving spinal block, all patients received 1.5 mcg/kg phenylephrine and crystalloid co-load at a rate of 10 mL/h. Patients were assigned into either restrictive group (did not receive fluid preload + received postoperative crystalloid therapy at a rate of 2 mL/kg/h till resuming oral fluids) or liberal group (received crystalloid preload 5 mL/kg before spinal block + received postoperative crystalloids at a rate of 6 mL/kg/h till resuming oral fluids. Both groups were compared according to the incidence of post-dural puncture headache, pain scores, systolic blood pressure, heart rate, incidence of post-spinal hypotension, nausea, and vomiting.

Results

The incidence of post-dural puncture headache was lower in the restrictive group compared to the liberal group {10(20%) vs 22(44%), P = 0.018}. All other secondary outcomes were comparable between both groups.

Conclusion

Restrictive fluid therapy was associated with lower incidence of PDPH after cesarean delivery without impacting patient hemodynamic profile.
Endovascular foreign body removal of a MynxGrip polyethylene glycol (PEG) sealant embolus using a cerebral stent retriever
Authors: Shamseldin Mohammed , Bergert Hendrik , Neumeister Axel , Puls Ralf
Published: March 2021

Background

This is a rare case of removing an intra-arterial foreign body represented by MynxGrip polyethylene glycol (PEG) sealant as a rare complication of using the MynxGrip™ Vascular Closure Device (AccessClosure, Inc., Mountain View, CA) using a pRESET stent retriever (Phenox, Bochum, Germany) which is utilized mainly for treatment of endovascular stroke.

Case presentation

A 60-year-old female patient suffering from intermittent claudication in the right lower limb (stage IIb according to Fontaine) due to a peripheral arterial occlusive disease was presented for an elective revascularization using balloon angioplasty of a short chronic occlusion of the right superficial femoral artery. After a successful revascularization of the right superficial femoral artery using a retrograde femoral access from the left common femoral artery, the patient suffered from an acute limb ischemia in the left foot with distal popliteal embolization with involvement of BTK (below the knee) trifurcation. This is believed to be due to an intra-arterial foreign body embolism of MynxGrip polyethylene glycol sealant as a rare complication of using the MynxGrip™ Vascular Closure Device.

Conclusions

Stent retrievers have been used previously in removing dislocated coils especially in the cerebral vessels. This case report however proves a high efficacy and safety of using stent retrievers in removing different and rather unusual intra-arterial foreign bodies such as MynxGrip polyethylene glycol sealant.
Cascading effects of cyber-attacks on interconnected critical infrastructure
Authors: Palleti Venkata Reddy , Adepu Sridhar , Mishra Vishrut Kumar , Mathur Aditya
Published: March 2021

Modern critical infrastructure, such as a water treatment plant, water distribution system, and power grid, are representative of Cyber Physical Systems (CPSs) in which the physical processes are monitored and controlled in real time. One source of complexity in such systems is due to the intra-system interactions and inter-dependencies. Consequently, these systems are a potential target for attackers. When one or more of these infrastructure are attacked, the connected systems may also be affected due to potential cascading effects. In this paper, we report a study to investigate the cascading effects of cyber-attacks on two interdependent critical infrastructure namely, a Secure water treatment plant (SWaT) and a Water Distribution System (WADI).
Can preoperative parameters predict successful sperm retrieval and live birth in couples undergoing testicular sperm extraction and intracytoplasmic sperm injection for azoospermia?
Authors: Lacey L. , Henderson I. , Hassan S. , Hunter H. , Sajjad Y. , Akhtar M. A.
Published: March 2021

Background

We aimed to determine if the success of TESE and live-birth following TESE-ICSI can be predicted from readily available preoperative parameters for couples with azoospermia. Our methodology was as follows, this was a cohort study of couples who attended the fertility service (from 2009-2019) at an NHS hospital in whom the male partner was diagnosed with azoospermia and required conventional TESE with multiple biopsies to obtain sperm. Of 414 men included, 223 had successful TESE and of those 178 have used sperm in ICSI cycle(s). Predictive models were developed using logistic regression. We assessed model performance by internally validated concordance statistics and calibration plots. Successful sperm retrieval was defined as the presence of motile sperm which survived the freeze-thaw process and live-birth defined as delivery after 34 weeks of gestation.

Results

Successful TESE was associated with higher male age and lower FSH. The TESE model discriminated well with a c statistic of 0.81 (0.77-0.85). Live-birth was associated with lower maternal age, earlier ICSI cycle, and lower testicular volume. The live-birth model also discriminated well with a c statistic of 0.70 (0.64-0.76).

Conclusions

These results support the pragmatic counselling of couples diagnosed with azoospermia about the chances of success of the TESE procedure and of biological parenthood prior to surgical intervention. The models help to discriminate between men who have a high or low chance of successful TESE and couples who have a higher chance of achieving a live-birth after successful TESE. This will allow couples to make a better assessment of the balance of risk versus benefit prior to commitment to surgical interventions.
The combined role of NT-proBNP and LV-GLS in the detection of early subtle chemotherapy-induced cardiotoxicity in breast cancer female patients
Authors: Sulaiman Laila , Hesham Dina , Abdel Hamid Magdy , Youssef Ghada
Published: March 2021

Background

Chemotherapeutic agents have many side effects; among them is cardiotoxicity. Ejection fraction fails to detect the subtle alterations of left ventricular (LV) function; that is why there is a need for a more sensitive tool. The aim is to detect subclinical LV systolic dysfunction after chemotherapeutic treatment, using NT-BNP plasma level as well as speckle tracking echo-global longitudinal strain (STE-GLS). Seventy-four asymptomatic, non-metastasizing breast cancer female patients without risk factors were included. They were assessed before and 6 weeks after taking their first chemotherapeutic session. Assessment included clinical characteristics, conventional two-dimensional (2D) and three-dimensional (3D) echocardiography, and 2D STE-GLS. Blood samples for NT-BNP plasma level were collected on both visits and were later analyzed using a Sandwich ELISA technique.

Results

The median NT-proBNP almost doubled after 6 weeks of chemotherapy (73.50 vs 34.4 pg/L, p value <0.001). Only two patients showed significant reduction of LVEF >10% to less <55%. One patient died before her scheduled follow-up visit, and the cause of death is unknown. Fifty patients showed elevated follow-up levels of the NT-BNP. As compared to the baseline visit, 12 patients had a high relative reduction of the LV-GLS (>15%) and all of them had a relatively higher NT-proBNP. A 2.2 relative elevation of the NT-proBNP was able to define a relative reduction of LV-GLS >15% by a 100% sensitivity and 81.8% specificity.

Conclusion

The relative reduction of LV-GLS and the relative elevation of NT-proBNP were successful in defining subclinical, subtle chemotherapy-induced cardiotoxicity after 6 weeks of the first chemotherapeutic agent administration.
Prospectivity of the Triassic successions of the North West Shelf of Australia: New insights from a regional integrated geoscience study
Authors: Grahame Jarrad , Cole Victoria
Published: March 2021

The North West Shelf (NWS) of Australia is a prolific hydrocarbon province hosting significant volumes of hydrocarbons, primarily derived from Jurassic and Cretaceous targets. A new regional, integrated geoscience study has been undertaken to develop insights into the paleogeography and petroleum systems of Late Permian to Triassic successions, which have been underexplored historically in favor of Jurassic to Cretaceous targets. Within the NWS study area, graben and half-graben depocenters developed in response to intracratonic rifting that preceded later fragmentation and northward rifting of small continental blocks. This, coupled with contemporaneous cycles of rising sea levels, brought about the development of large embayments and shallow, epeiric seas between the Australian continental landmass and outlying continental fragments in the early stages of divergence. Key elements of the study results discussed herein include the study methodology, the paleogeographic and gross depositional environment mapping, and the reservoir and source kitchen modeling. The study results highlight the presence of depocenters that developed within oblique rift zones due to regional Permo-Triassic strike-slip tectonics that bear compelling similarities to modern-day analogues. These intracratonic rift zones are well-known and prominent tectonic features resulting from mantle upwelling and weakening of overlying lithospheric crust, initiating the development of divergent intraplate depocenters. The comprehensive analysis of these depocenters from a paleogeographic and petroleum system perspective provides a basin evaluation tool for Triassic prospectivity.
The World Health Organization's QualityRights materials for training, guidance and transformation: preventing coercion but marginalising psychiatry
Authors: Hoare Fiona , Duffy Richard M.
Published: March 2021

The World Health Organization has developed training material to support its QualityRights Initiative. These documents offer excellent strategies to limit coercion. However, the negative portrayal of psychiatry, the absolute prohibition on involuntary treatment and the apparent acceptance of the criminalisation of individuals with mental illness are causes for concern.
Exact discrete spectrum of the Zakharov-Shabat scattering problem for a phase-modulated wave packet
Authors: Korneev N. , Vysloukh V.
Published: March 2021

The simple exact Zakharov-Shabat scattering problem discrete spectrum is presented for the special initial data of the nonlinear Schrödinger equation, having the form

. The salient features of this solution and the issues of its stability are discussed.
Plasma slab expansion into vacuum
Authors: Ivanov S. K. , Kamchatnov A. M.
Published: March 2021

The problem of collisionless plasma slab expansion into vacuum is solved within a two-temperature hydrodynamic approximation in the dispersionless limit of zero Debye radius. In the framework of such an approach, the solution by the Riemann method provides a quite accurate description of the whole process of plasma dynamics. It is shown that the dispersionless approximation agrees very well with exact numerical solution of the full system of plasma hydrodynamic equations.
Post-racial Preoccupations
Authors: McDaneld Jen
Published: March 2021

Using a classroom experience teaching Nella Larsen’s 1929 novel Passing alongside a contemporary controversy over racial identity, this article explores the value of literary study for intervening in student attitudes toward core curriculum requirements. The author argues that literature is uniquely situated to teach the skills colleges most want students to acquire in their general education curricula, in turn providing a crucial method for responding to the “crisis” of the humanities in higher education today.
The Theme Course
Authors: Horton Michal
Published: March 2021

Theme courses are a common practice despite their limited presence in composition scholarship, which contributes to a fractured understanding of the theme course’s purpose and place in the discipline. This article offers an aggregate picture of theme (or topic) based courses based on disparate scholarly publications and affirmed by data collected through an online survey of writing instructors and program administrators. To trace the theme course within our disciplinary tradition and as a continuing practice, this article defines the theme course, distinguishing between writing as subject matter and theme content as a form of reinforcement. It furthermore historicizes the theme course’s limited life in scholarship, synthesizing key features of theme course practice, reinforced by survey responses. Ultimately, this article offers a framework for reflective practice that all theme course practitioners can use for developing, implementing, and evaluating their teaching methods. The underlying argument is that theme courses can support learning about writing, so long as theme selection and implementation work in purposeful support of the course’s learning about writing goals.
Strategic Inessentialism
Authors: Gill-Peterson Jules , Lavery Grace
Published: March 2021

The following introduction provides an overview to the Dossier on COVID-19, curated by Jules Gill-Peterson and Grace Lavery. This introduction explores how the pandemic has intensified the inessential denotation grafted onto trans people's material lives through health care, policing, incarceration, immigration, and racism. The ongoing crisis in academic labor and its uncertain pandemic futures are, similarly, an important place for trans studies to attend in this moment.
Viral Capital and the Limits of Freedom
Authors: Sharron Kelly
Published: March 2021

This article considers the strained conditions of freedom under capitalism that are further inflected by COVID-19. Taking seriously the calls to reopen the economy as necessary steps to survival, the larger relationships of production must be called into question. Just as capitalism can ensure basic needs for some, it has always ensured the death of many. When spaces of production become both necessary for the working class and rampant with risk, Marx's “double bind of freedom,” as well as the cyclical crises and contradictions of capital warrant heightened attention and contextualization.
Tumor microenvironment acidity modulates ROR1 to promote epithelial–mesenchymal transition and hepatocarcinoma metastasis
Authors: Meng Xia , Xu Yurui , Ning Xinghai
Published: March 2021

The tendency of hepatocarcinoma to metastasize results in a high rate of mortality, making it a hot research topic in cancer studies. Although an acidic tumor microenvironment has been proven to promote cancer metastasis, the underlying regulatory mechanisms remain poorly defined. Here, we found that acidic conditions significantly enhanced cell migration and invasion ability in hepatocellular carcinoma, and the expression of receptor tyrosine kinase-like orphan receptor 1 (ROR1) was distinctly upregulated in acid-treated cells. In addition, siRNA-mediated knockdown of ROR1 could effectively inhibit acid-induced cell migration, invasion and epithelial–mesenchymal transition (EMT). Importantly, neutralization of acidic environments with NaHCO3 could downregulate acid-stimulated ROR1 expression, thereby retarding cell metastatic potential. Notably, the formation of metastatic nodules was significantly increased after intrapulmonary injection of acid-stimulated cancer cells, and this was inhibited by pretreating with NaHCO3. In summary, we reveal that an acidic tumor microenvironment modulates ROR1 expression to promote tumor metastasis, providing not only a better understanding of molecular mechanisms related to metastasis, but also a promising target for tumor management.
Evaluation of Alnus subcordata for urban environments through assessment of drought and flooding tolerance
Authors: Sjöman Henrik , Levinsson Anna , Emilsson Tobias , Ibrahimova Aida , Alizade Valida , Douglas Philip , Wiström Björn
Published: March 2021

The urban environment is stressful and trees experience multiple stresses, including drought, flooding, and extreme heat, all of which are likely to increase under future climate warming and increasing urbanisation. In the selection of tree species to maximise ecosystem services, tolerance to site characteristics such as flooding and severe drought is of critical importance. This study evaluated the suitability of a rare species, Alnus subcordata C.A. Mey (Caucasian alder) from the Hyrcanian forests of southern Azerbaijan,for its functionality as an urban tree. A total of 48 pot-grown, two-year-old saplings of A. subcordata were tested in a greenhouse experiment using a complete randomised block design. Each block contained four replicates of three treatments (waterlogging, drought, control), with 16 plants per treatment. Height differences between treatments were measured, and water status was estimated by determination of midday leaf water potential (ΨL) and stomatal conductance (gs). To estimate drought tolerance reaction in the treatments, leaf water potential at turgor loss (ΨP0) was used together with broken-stick modelling of water status over time. There was a significant difference in tree height between the different treatments. In the drought treatment, A. subcordata plants showed no height increase, while plants in both the waterlogged and control treatments increased in height during the nine-week experiment. Over 63 days of flooding, plant water status was slightly more negative in the waterlogging treatment, but did not deviate essentially from the control. In the drought treatment, plant water status rapidly deviated from the control. There was a significant differencein ΨP0 between treatments, with drought-treated plants showing the lowest value (−2.31 MPa).This study demonstrated that A. subcordata has limited tolerance to drought and seems to rely more on waterloss-avoiding strategies. However, the species may be usable at periodically waterlogged sites, due to its high tolerance to flooding. It could therefore be recommended for wet urban environments and stormwater management facilities, for which reliable guidance on suitable trees is currently lacking.
H3S28P Antibody Staining of Okinawan Oikopleura dioica Suggests the Presence of Three Chromosomes
Authors: Liu Andrew W. , Tan Yongkai , Masunaga Aki , Bliznina Aleksandra , West Charlotte , Plessy Charles , Luscombe Nicholas M.
Published: March 2021

Oikopleura dioica is a ubiquitous marine zooplankton of biological interest owing to features that include dioecious reproduction, a short life cycle, conserved chordate body plan, and a compact genome. It is an important tunicate model for evolutionary and developmental research, as well as investigations into marine ecosystems. The genome of north Atlantic O. dioica comprises three chromosomes. However, comparisons with the genomes of O. dioica sampled from mainland and southern Japan revealed extensive sequence differences. Moreover, historical studies have reported widely varying chromosome counts. We recently initiated a project to study the genomes of O. dioica individuals collected from the coastline of the Ryukyu (Okinawa) Islands in southern Japan. Given the potentially large extent of genomic diversity, we employed karyological techniques to count individual animals’ chromosomes in situ using centromere-specific antibodies directed against H3S28P, a prophase-metaphase cell cycle-specific marker of histone H3. Epifluorescence and confocal images were obtained of embryos and oocytes stained with two commercial anti-H3S28P antibodies (Abcam ab10543 and Thermo Fisher 07-145). The data lead us to conclude that diploid cells from Okinawan O. dioica contain three pairs of chromosomes, in line with the north Atlantic populations. The finding facilitates the telomere-to-telomere assembly of Okinawan O. dioica genome sequences and gives insight into the genomic diversity of O. dioica from different geographical locations. The data deposited in the EBI BioImage Archive provide representative images of the antibodies’ staining properties for use in epifluorescent and confocal based fluorescent microscopy.
Minimally invasive (flapless) crown lengthening by erbium:YAG laser in aesthetic zone
Authors: Capodiferro Saverio , Tempesta Angela , Limongelli Luisa , Barile Giuseppe , Di Venere Daniela , Corsalini Massimo
Published: March 2021

Crown lengthening is a surgical procedure aimed at exposure of a larger tooth surface by gingivectomy alone or with cortical bone remodelling for aesthetic purposes in the anterior zone of the maxilla or for reconstruction of teeth affected by subgingival caries. We report two cases of crown lengthening in the anterior maxilla for aesthetic purposes by gingival and bone re-contouring performed by erbium-doped yttrium aluminium garnet (erbium:YAG) laser. As highlighted in this report, the erbium:YAG laser-assisted crown lengthening is less invasive and also leads to faster clinical outcomes in contrast to the conventional surgical technique by scalpel incision, flap elevation and osteoplastic.
Estimating epidemiological and economic burden and community derived disability weights for snake bite in Kerala: a study protocol
Authors: Menon Jaideep C. , John Denny , Menon Geeta R. , Joseph Joseph K. , Suseela P. Rakesh , Pillay VV
Published: March 2021

Background: In India, geographical variation, lack of data and underreporting on cases and deaths due to snakebite makes it difficult to estimate socio-economic burden of snakebites. Previous studies measuring economic burden of snakebite in low-and-middle-income countries (LMICs) using different approaches have been conducted, but none so far in India. The proposed study aims to provide evidence on disability weights, epidemiological and economic burden due to snakebites in Kerala state, India.

Protocol: A cross-sectional community based study for estimating epidemiological and economic burden of snakebite, recruiting victims of snakebite occurring over a nine month period prior to start and over the three month period of the study, across Ernakulam district, Kerala state, India. For the community derived disability weights, 60 adult patients admitted and treated at Amrita Institute of Medical Sciences, Kochi or Little Flower Hospital, Angamaly would be interviewed. The sample size to determine the mortality rate is calculated at 108,458 persons in Ernakulam.The study will measure annual incidence, mortality, treatment cost of snakebites along with community-derived disability weights for snakebites. Standard methods for analysis and reporting of mortality, morbidity, years of lives lost, years lived with disability, disability weights, and costs of treatment will be calculated and presented. The study will be started in March 2021 and is expected to be completed by June 2021.

Discussion: This protocol is the first published for estimating epidemiological, economic burden and community derived disability weights for snakebites in India. Besides, the Global Burden of Disease has not attached a particular disability weight to snakebite and this would be an attempt to do so.The protocol has been developed using guidelines for both cross-sectional studies and  for conducting community derived disability weights. The evidence generated will contribute to knowledge regarding epidemiology, economic burden and community-derived disability weights for snakebites in India and other LMICs.
A cross-sectional study on the pursuit of happiness among healthcare workers in the context of health systems strengthening: The case of Meru County, Kenya.
Authors: Muthuri Rose Nabi Deborah Karimi , Senkubuge Flavia , Hongoro Charles
Published: March 2021

Background: Happiness is one of the ultimate goals of every human being. Happiness is a significant factor of health system efficiency. Healthcare workers are at the core of every health system. However, up-to-date literature on happiness among healthcare workers is limited. The purpose of this study is to investigate the factors influencing the self-assessed happiness among healthcare workers in public and mission hospitals, Meru County, Kenya. 

Methods: Using a cross-sectional design, a total of 553 healthcare workers in 24 hospitals completed the Orientations to Happiness questionnaire between June and July 2020.  

Results: Healthcare workers’ overall happiness was significantly different between hospitals of public and mission ownership (p<0.05). The orientations to happiness mean scores of both pursuits of pleasure and meaning were significantly different between public and mission hospitals  (p<0.05). However, there were no statistically significant differences in the pursuit of engagement among the healthcare workers between public and mission hospitals (p<0.05).  

Conclusion: Our results may have policy and practical implications related to healthcare workers’ happiness policies and programs in future, aimed at health workforce strengthening. Future studies should replicate this study across the remaining 46 counties in Kenya.
Physical functioning limitations and physical activity of people experiencing homelessness: A scoping review
Authors: Kiernan Sinéad , Mockler David , Ní Cheallaigh Clíona , Broderick Julie
Published: March 2021

Background: Adults who are experiencing homelessness suffer higher levels of premature mortality and age-related medical conditions compared to the general population, but little is known about physical factors that influence their health experience. The aim of this scoping review was to evaluate what is known about physical functional limitations and physical activity levels and how they are measured in adults experiencing homelessness.

Methods: This review was conducted in accordance with the Joanna Briggs Institute’s methodology for scoping reviews. Suitable quantitative and qualitative articles were searched using PubMed, CINAHL, EMBASE, PsychInfo, Web of Science and SCOPUS databases using a combination of keywords and a gray literature search was performed. Two reviewers independently screened articles for inclusion. Inclusion criteria were studies that examined physical functional limitations and/or physical activity among homeless adults (with/without co-occurring mental illness, infectious disease, substance use disorder), as a primary or secondary outcome measure.

Results: We identified 15 studies for inclusion including 2,018 participants. Studies were primarily quantitative (n=13) and there were 2 qualitative studies. The following outcomes related to physical functioning were reported; mobility levels (n=3), frailty (n=1), flexibility (n=2), strength (n=1), physical symptom burden (n=3), and exercise capacity (n=3). Eight studies reported outcomes related to physical activity. The majority of studies reported high levels of functional limitations among participants and low physical activity levels although a spectrum of abilities was noted.

Conclusion: This review showed that many adults who are homeless appear to show a high burden of physical functional limitations and low physical activity levels but more objective and consistent measures should be applied to examine these factors in future studies. This will help address and plan future care, physical rehabilitation and housing needs for this vulnerable cohort. This scoping review will help direct research and future systematic reviews in this emerging area.
Active septic arthritis of the hip in adults: what’s new in the treatment? A systematic review
Authors: D’Angelo Fabio , Monestier Luca , Zagra Luigi
Published: March 2021

Treatment of bacterial septic arthritis in the native adult hip joint can be challenging. Prompt diagnosis and treatment decisions can reduce the associated morbidity and mortality. For this systematic review of the literature, we asked: (1) What are the treatment options? (2) What are the success rates and the outcomes after treatment? (3) Which antibiotic and duration of therapy are optimal? We searched the electronic databases PubMed, Scopus, and Embase using the search terms “hip” or “native hip” and “septic arthritis” or “coxitis”. Studies were included if they reported on: (1) bacterial infection of the hip, (2) treatment, (3) success rate/outcomes, (4) follow-up. The final review included 19 studies. The quality of study reporting was evaluated with the Methodological Index for Non-randomized Studies (MINORS) questionnaire. Three treatment options are: arthroscopy, single open surgery, and two-stage total hip arthroplasty (THA). A high success rate in infection eradication was reported for all three. Intravenous antibiotic therapy should be promptly initiated to eradicate septic arthritis and minimize potential sequelae and complications. Arthroscopy, single open or two-stage THA were reported to be effective in treating bacterial septic arthritis of the native hip. The key to optimal outcome is early diagnosis and timely treatment.

Cite this article: EFORT Open Rev 2021;6:164-172. DOI: 10.1302/2058-5241.6.200082
An update on reverse total shoulder arthroplasty: current indications, new designs, same old problems
Authors: Kozak Thomas , Bauer Stefan , Walch Gilles , Al-karawi Saad , Blakeney William
Published: March 2021

Reverse total shoulder arthroplasty (RTSA) was originally developed because of unsatisfactory results with anatomic shoulder arthroplasty options for the majority of degenerative shoulder conditions and fractures. After initial concerns about RTSA longevity, indications were extended to primary osteoarthritis with glenoid deficiency, massive cuff tears in younger patients, fracture, tumour and failed anatomic total shoulder replacement. Traditional RTSA by Grammont has undergone a number of iterations such as glenoid lateralization, reduced neck-shaft angle, modular, stemless components and onlay systems. The incidence of complications such as dislocation, notching and acromial fractures has also evolved. Computer navigation, 3D planning and patient-specific implantation have been in use for several years and mixed-reality guided implantation is currently being trialled. Controversies in RTSA include lateralization, stemless humeral components, subscapularis repair and treatment of acromial fractures.

Cite this article: EFORT Open Rev 2021;6:189-201. DOI: 10.1302/2058-5241.6.200085
Defining mechanical instability in tuberculosis of the spine: a systematic review
Authors: Ahuja Kaustubh , Ifthekar Syed , Mittal Samarth , Yadav Gagandeep , Sarkar Bhaskar , Kandwal Pankaj
Published: March 2021

Over the years, a number of authors have used different working definitions of instability in tuberculosis of the spine (TB spine). However, no clear consensus exists to define instability in TB spine. The current systematic review addresses the question ‘What defines instability in TB spine’? A comprehensive medical literature search was carried out to identify all the studies which defined instability in the setting of spinal TB. The extracted data included the clinical, X-ray and CT or MRI-based definitions. The current review identified lesser age, junctional region of the spine, mechanical pain and ‘instability catch’, kyphotic deformity above 40 degrees, pan-vertebral or bilateral facetal involvement and multifocal contiguous disease involving more than three vertebrae as predictors for spinal instability in the dorso-lumbar spine. Cervical kyphosis more than 30 degrees and facetal or pan-vertebral involvement were found to be the factors used to define instability in subaxial cervical spine. With respect to C1–C2 TB spine, migration of the tip of the odontoid above the McRae or McGregor line or anterior translation of C1 over C2 were considered as determinants for instability. Although definitive conclusions could not be drawn due to lack of adequate evidence, the authors identified factors which may contribute towards instability in TB spine.

Cite this article: EFORT Open Rev 2021;6:202-210. DOI: 10.1302/2058-5241.6.200113
Anal cancer survival: a socioeconomic analysis
Authors: Ali F , Ghareeb AE , Jha A , Van der Voet H , Garg D , Jha M
Published: March 2021

Introduction

Squamous cell carcinoma is the most common variant of anal malignancy. Certain disease-related factors have been established in determining survival. These include tumour size, differentiation and nodal involvement. Other factors such as HIV status, human papillomavirus infection, smoking and socioeconomic disparity may have important roles, however few data are available on the UK population. We aim to correlate social deprivation and survival of anal cancer patients at a tertiary centre.

Materials and methods

All consecutive cases diagnosed with anal squamous cell carcinoma and treated as per local protocol between July 2010 and April 2017 were included. The pathological and demographical details were collected from a prospectively maintained database. Socioeconomic deprivation was defined for each postcode using the Index of Multiple Deprivation decile compiled by local governments in England. Survival was estimated using Kaplan–Meier analysis and Cox regression was used to investigate the effect of different factors on overall survival.

Results

A total of 129 patients with anal squamous cell carcinoma over a median follow-up of 43 months were included. Overall survival for the entire patient cohort was 87.7% (95% confidence interval, CI, 82.0–93.7%), 75.5% (95% CI 67.5–84.5%) and 68.9% (95% CI 59.7–79.6%) at one year, three years and five years, respectively. On multivariate analysis, Index of Multiple Deprivation and income do not significantly influence overall survival (p = 0.79, hazard ratio, HR, 1.07; 95% CI 0.61–1.63), (p = 0.99, HR=1.00; 95% CI 0.61–1.63), respectively. Increased risk of death was observed for male sex (p = 0.02, HR=2.80; 95% CI 1.02–5.50) and larger tumour size (p = 0.01, HR=1.64; 95% CI 1.12–2.41).

Conclusion

In contrast to US studies, there is little difference in survival between the least deprived and most deprived groups. We attribute this to equal access to intensity-modulated radiation therapy-based chemoradiotherapy. Thus, a highly effective treatment made available to all mitigates any survival difference between socioeconomic groups.
Isolated brachial artery aneurysm: a rare presentation of paediatric Behçet’s disease
Authors: Naik AL , Savlania A , Gupta A , Rastogi P , Singh A
Published: March 2021

Behçet’s disease is a rare disease characterised by recurrent oral ulcers, with systemic manifestations including genital ulcers, ocular disease, skin lesions, gastrointestinal disease, neurologic disease, vascular disease and arthritis. Most clinical manifestations of Behçet’s disease are believed to be due to vasculitis. The heterogeneous clinical spectrum is influenced by sex, ethnicity and country of residence. Vascular manifestation in the form of isolated large brachial artery aneurysm is rare in children. Treatment involves aneurysmorrhaphy to avoid rupture or ischaemic sequelae in addition to lifelong medical management to control vasculitis.
Orthopaedic assessment unit: a service model for the delivery of orthopaedic trauma care in a major trauma centre during the global pandemic (COVID-19)
Authors: Lim JW , Rehman H , Gaba S , Sargeant H , Stevenson IM , Boddie DE
Published: March 2021

Introduction

We describe a new service model, the Orthopaedic Assessment Unit (OAU), designed to provide care for trauma patients during the COVID-19 pandemic. Patients without COVID-19 symptoms and isolated musculoskeletal injuries were redirected to the OAU.

Methods

We prospectively reviewed patients throughput during the peak of the global pandemic (7 May 2020 to 7 June 2020) and compared with our historic service provision (7 May 2019 to 7 June 2019). The Mann–Whitney and Fisher Exact tests were used to test the statistical significance of data.

Results

A total of 1,147 patients were seen, with peak attendances between 11am and 2pm; 96% of all referrals were seen within 4h. The majority of patients were seen by orthopaedic registrars (52%) and nurse practitioners (44%). The majority of patients suffered from sprains and strains (39%), followed by fractures (22%) and wounds (20%); 73% of patients were discharged on the same day, 15% given follow up, 8% underwent surgery and 3% were admitted but did not undergo surgery. Our volume of trauma admissions and theatre cases decreased by 22% and 17%, respectively (p=0.058; 0.139). There was a significant reduction of virtual fracture clinic referrals after reconfiguration of services (p<0.001).

Conclusions

Rapid implementation of a specialist OAU during a pandemic can provide early definitive trauma care while exceeding national waiting time standards. The fall in trauma attendances was lower than anticipated. The retention of orthopaedic staff in the department to staff the unit and maintain a high standard of care is imperative.