bluuebunny/crossref_metadata_2025 huggingface dataset:
Canadian Radiology Gender Pay Gap-Reality or Myth?
Authors: Yap Wan W. , Hodgson Carol S. , Spalluto Lucy , Lebel Kiana , Trop Isabelle , Hillier Elizabeth , Darras Kathryn , Hillier Tracey , Yong-Hing Charlotte J.
Published: October 2022

Introduction: Prior studies on Canadian physicians’ income have demonstrated a gender pay gap (GPG); however, there is a paucity of data in the Radiology specialty. A cross-sectional study was conducted to determine if practicing Canadian radiologists’ self-reported income is related to gender, controlling for demographic and work variables. Methods: English and French online surveys were distributed by email and social media to radiologists and trainees (May–July 2021). The association between Gender (controlling for Ethnicity variables, Region, having Children, Full-/Part-Time work, and Academic position) and Self-Reported Income was examined using chi-square tests. Pearson correlations examined relationships between opinion variables. Analyses were conducted using SPSS V28.0. A priori significance was P < .05. Study had ethics approval. Results: Four hundred and fifty-four practicing Canadian radiologists responded. Majority were women (51.2%, n = 227), a non-visible Minority (71.7%, n = 317), and from Western Provinces (67.8%, n = 308). Significant relationship was established between Self-Reported Income and Gender (χ2 = 10.44, df = 2, P < .05). More men (70.6%, n = 120) than women (56.4%, n = 110), reported income “greater than $500 000”; fewer men (20.6%, n = 35) than women (35.9%, n = 70) reported “$300 000-$500 000”; a similar percent of men (8.8%, n = 15) and women (7.7%, n = 15) reported “less than $300 000.” No relationship was found between self-reported income and gender for ethnicity variables, those without children, part-time, or non-academic radiologists. The opinion “Addressing the GPG is important” correlated to “Canadian Association of Radiologists should collect demographic data” (r = 0.63). Responses were low for ethnic minorities and non-western provinces. Conclusion: Our results suggest a GPG exists in Canadian radiology and is an important first step for future studies.
A design-oriented method for response prediction of light-weight timber floors under bouncing excitation
Authors: Wang Haoqi , Zeng Dongjun , Cheng Yao , Wang Pengcheng , Chen Jun
Published: October 2022

Owing to the light weight and high fundamental frequency, timber floors exhibit impulse-like responses under human-induced excitation, which is different with the resonance-like responses for heavy concrete structures. The vibration serviceability of timber floors thus needs to be considered in a different manner. Many design codes for timber structures have required that the static displacement or dynamic response under human excitation should be limited within a threshold for the purpose of serviceability, while failing to provide appropriate method for predicting structural responses considering various affecting factors. Inspired by the idea of response spectrum, this paper proposed a design-oriented method for the peak acceleration prediction of high-frequency floors under human bouncing excitation. The prediction can be obtained for any desired confidence level. Statistical analysis shows that the acceleration responses are mostly dependent on structural fundamental frequency, structural damping ratio, and excitation frequency, which are considered in the proposed mathematical model. The application procedure and the experimental assessment of the proposed model are provided, showing the decent applicability of the proposed method.
Adolescent displaced lateral-end clavicle fractures are not comparable to the adult variant. Epidemiology, fracture patterns and outcome of non-operative management
Authors: Baxendale-Smith LD , Teed R , Nicholson JA
Published: October 2022

Background

The primary aim of this study was to determine the epidemiology of lateral-end clavicle fractures in adolescents. The secondary aim was to assess the outcome following non-operative management.

Methods

A retrospective review of all adolescent clavicle fractures over a 10-year period was undertaken. Fracture classification, demographics, management, and complications were analysed. Functional outcomes were undertaken with the Quick Disabilities of Arm, Shoulder and Hand and EuroQol five-dimension at mean 8.8 years post-injury.

Results

In total, 677 clavicle fractures were analysed, 8.7% were lateral-end fractures ( n = 59/677). The median age was 14.6 (range: 13–17) and 92% were male ( n = 54/59). The incidence was 0.17 per 100,000 per year. All displaced physeal fractures (Neer IV n = 14) were managed non-operatively and of the six followed-up, all united with good outcomes. The adult type displaced fracture (Neer II) occurred in fifteen fractures, five underwent operative fixation and ten were managed non-operatively with one subsequent nonunion ( n = 1/10). Those patients that underwent non-operative management (response n = 5/10, 50%) reported a median Quick Disabilities of Arm, Shoulder and Hand of 2.3 but approximately 40% reported cosmetic and outcome dissatisfaction at long-term follow-up.

Conclusion

Displaced Neer II lateral-end clavicle fractures are rare in the adolescent population. Although nonunion is rare, some dissatisfaction with cosmesis persists at long-term follow-up despite good functional outcomes with non-operative management.
Beyond the decolonial: Critical Muslim geographies
Authors: Sidaway James D.
Published: October 2022

This paper considers selected decolonial moves in geography, building on engagements with postcolonial theory since the 1990s and earlier currents of radical geography. Whilst the paper charts their interactions, including the impacts of selective intellectual influences from Latin America, it foregrounds Muslim geographies. The decolonization of Muslim geographies questions concepts and upgrades terminology, and speaks to crucial interfaces of circuits of capital, economic and political geographies and area studies. Such moves entail relearning from epistemological, social and spatial ‘peripheries’ and establish connections, notably with Black geographies. The conclusions consider how such links transcend decolonial geographies.
Factors Effecting Private Consumption in India: An ARDL Approach
Authors: Banerji Amit , Chandravanshi Anand Gaurav
Published: October 2022

Various macroeconomic and microeconomic factors influence household expenditure. This study thus attempts to establish long-run and short-run relationships among consumption, credit, capital formation, and current account deficit (CAD). By applying autoregressive distributed lag (ARDL) and Granger causality models, results of the study suggest that capital formation is the primary factor influencing consumption in the long run. It must be noted that consumption-led growth post 2000 was financed by rise in credit. Imports will rise in response to rising GDP and rising exports, and the main cause of CAD has been a persistent trade account deficit. In this article, pre-COVID-19 macroeconomic conditions have been studied.
Caste, Social Inequalities and Maternal Healthcare Services in India: Evidence from the National Family and Health Survey
Authors: Das Bikash , Hossain Moslem , Roy Piyal Basu
Published: October 2022

This study examines the level of access and utilization of maternal care health services among different socially disadvantaged groups in India. The study uses the data from the National Family Health Survey conducted in 2015–2016. We have used descriptive statistics and bivariate analysis to assess the trends and prevalence of maternal healthcare services among different social groups. Using logistic regression, we have estimated the association of different socio-economic variables on maternal healthcare services among different socially disadvantaged groups in India. The results suggest tremendous inequality in access to maternal healthcare services among socially disadvantaged groups in India. It was found that several factors such as women’s education, working status, household wealth quintile and mass media exposure significantly impact access and utilization of maternal healthcare services among various socially disadvantaged groups. In addition, the Scheduled Caste and Scheduled Tribe women are subjected to socio-economic discrimination at multiple levels, and their maternal healthcare situation remains highly fragile. The social identity and caste-based socio-economic inequalities remain a major challenge in India to assure universal access to maternal healthcare services.
Evaluation of Risk Factors of Premature Coronary Artery Disease in Patients From North India: A Rising Epidemic
Authors: Bunker Gautam Kumar , Patidar Manoj , Atal Devendra , Meena Ratti Lal
Published: October 2022

Background:

The incidence of premature coronary artery disease (PCAD) is on rising trend in low- and middle-income countries. Considering the limited reports, the current study was conducted to evaluate the prevalence, various predisposing factors, and coronary angiographic findings of PCAD in North India.

Methods:

Study design—hospital-based analytical cross-sectional study.

Setting:

Outpatient and inpatient units of a tertiary cardiac center in North India. Two hundred sequential patients (170 males and 30 females) with acute coronary syndrome were evaluated for history of risk factors, measurement of anthropometric parameters, biochemical blood examination, electrocardiogram, complete dental examination, and angiographic assessment of coronary artery lesion. Patients with acute infection or chronic inflammatory disorders were excluded. Patients were divided into PCAD (age ≤45 years) and mature CAD.

Results:

The prevalence of PCAD was 15% (N = 30). PCAD had higher rates of family history of CAD ( P < 0.001), tobacco consumption ( P = 0.01), smoking ( P = 0.004), and single-vessel disease (SVD) ( P < 0.001). Premature CAD group had significantly lower mean fasting blood glucose (105 ± 41 mg/dL vs 127 ± 45 mg/dL) levels.

Conclusion:

Family history of CAD, smoking, and tobacco consumption are important risk factors of PCAD. SVD is more common in PCAD. Screening the susceptible population at risk and controlling the cardiovascular risk factors will help reduce the epidemic and consequences of PCAD.
Genome-edited allogeneic donor “universal” chimeric antigen receptor T cells
Authors: Qasim Waseem
Published: October 2022

αβ T cell receptor (TCRαβ) T cells modified to express chimeric antigen receptors (CAR), are now available as authorized therapies for certain B-cell malignancies. However the process of autologous harvest and generation of patient-specific products is costly, with complex logistics and infrastructure requirements. Premanufactured banks of allogeneic donor–derived CAR T cells could help widen applicability if the challenges of HLA-mismatched T-cell therapy can be addressed. Genome editing is being applied to overcome allogeneic barriers, most notably, by disrupting TCRαβ to prevent graft-versus-host disease, and multiple competing editing technologies, including CRISPR/Cas9 and base editing, have reached clinical phase testing. Improvements in accuracy and efficiency have unlocked applications for a wider range of blood malignancies, with multiplexed editing incorporated to target HLA molecules, shared antigens and checkpoint pathways. Clinical trials will help establish safety profiles and determine the durability of responses as well as the role of consolidation with allogeneic transplantation.
Human genetic defects in SRP19 and SRPRA cause severe congenital neutropenia with distinctive proteome changes
Authors: Linder Monika I. , Mizoguchi Yoko , Hesse Sebastian , Csaba Gergely , Tatematsu Megumi , Łyszkiewicz Marcin , Ziȩtara Natalia , Jeske Tim , Hastreiter Maximilian , Rohlfs Meino , Liu Yanshan , Grabowski Piotr , Ahomaa Kaarin , Maier-Begandt Daniela , Schwestka Marko , Pazhakh Vahid , Isiaku Abdulsalam I. , Briones Miranda Brenda , Blombery Piers , Saito Megumu K. , Rusha Ejona , Alizadeh Zahra , Pourpak Zahra , Kobayashi Masao , Rezaei Nima , Unal Ekrem , Hauck Fabian , Drukker Micha , Walzog Barbara , Rappsilber Juri , Zimmer Ralf , Lieschke Graham J. , Klein Christoph
Published: October 2022

The mechanisms of coordinated changes in proteome composition and their relevance for the differentiation of neutrophil granulocytes are not well studied. Here, we discover 2 novel human genetic defects in signal recognition particle receptor alpha (SRPRA) and SRP19, constituents of the mammalian cotranslational targeting machinery, and characterize their roles in neutrophil granulocyte differentiation. We systematically study the proteome of neutrophil granulocytes from patients with variants in the SRP genes, HAX1, and ELANE, and identify global as well as specific proteome aberrations. Using in vitro differentiation of human induced pluripotent stem cells and in vivo zebrafish models, we study the effects of SRP deficiency on neutrophil granulocyte development. In a heterologous cell–based inducible protein expression system, we validate the effects conferred by SRP dysfunction for selected proteins that we identified in our proteome screen. Thus, SRP-dependent protein processing, intracellular trafficking, and homeostasis are critically important for the differentiation of neutrophil granulocytes.
Design and Analysis of a Novel Compliant Mechanism with RPR Degrees of Freedom
Authors: Zhang Shuang , Liu Jingfang , Ding Huafeng
Published: October 2022

A novel compliant mechanism with RPR degrees of freedom (DOF) is proposed where R and P represent rotation and translation DOFs, respectively. The proposed compliant mechanism is obtained from dimension synthesizing a 2-RPU-UPR rigid parallel mechanism with the method of optimization of motion/force transfer characteristic. R, P and U represent rotation, translation and universal pairs, respectively. Firstly, inverse kinematics and Jacobian matrix are analyzed for the dimensional synthesis. Then, output transmission indexes of branches in the parallel mechanism are given. Dimensional synthesis is completed based on the normalized design parameter. And optimization of flexure joints based on constrained energy is carried out. Afterwards, the novel compliant mechanism is obtained by direct replacing method. Mechanical model of the compliant mechanism including static stiffness and input stiffness is built based on the pseudo-rigid body modeling method and virtual work principle. Finally, FEA simulation by Ansys Workbench is carried out to verify DOF, effectiveness of the dimension synthesis, and compliant model. Optimization of motion/force transfer characteristic is first applied for the design of compliant mechanisms to suppress drift of rotation axis in the paper.
VEBA: a modular end-to-end suite for in silico recovery, clustering, and analysis of prokaryotic, microeukaryotic, and viral genomes from metagenomes
Authors: Espinoza Josh L. , Dupont Chris L.
Published: October 2022

Background

With the advent of metagenomics, the importance of microorganisms and how their interactions are relevant to ecosystem resilience, sustainability, and human health has become evident. Cataloging and preserving biodiversity is paramount not only for the Earth’s natural systems but also for discovering solutions to challenges that we face as a growing civilization. Metagenomics pertains to the in silico study of all microorganisms within an ecological community in situ,however, many software suites recover only prokaryotes and have limited to no support for viruses and eukaryotes.

Results

In this study, we introduce theViral Eukaryotic Bacterial Archaeal(VEBA) open-source software suite developed to recover genomes from all domains. To our knowledge,VEBAis the first end-to-end metagenomics suite that can directly recover, quality assess, and classify prokaryotic, eukaryotic, and viral genomes from metagenomes.VEBAimplements a novel iterative binning procedure and hybrid sample-specific/multi-sample framework that yields more genomes than any existing methodology alone.VEBAincludes a consensus microeukaryotic database containing proteins from existing databases to optimize microeukaryotic gene modeling and taxonomic classification.VEBAalso provides a unique clustering-based dereplication strategy allowing for sample-specific genomes and genes to be directly compared across non-overlapping biological samples. Finally,VEBAis the only pipeline that automates the detection of candidate phyla radiation bacteria and implements the appropriate genome quality assessments.VEBA’s capabilities are demonstrated by reanalyzing 3 existing public datasets which recovered a total of 948 MAGs (458 prokaryotic, 8 eukaryotic, and 482 viral) including several uncharacterized organisms and organisms with no public genome representatives.

Conclusions

TheVEBAsoftware suite allows for the in silico recovery of microorganisms from all domains of life by integrating cutting edge algorithms in novel ways.VEBAfully integrates both end-to-end and task-specific metagenomic analysis in a modular architecture that minimizes dependencies and maximizes productivity. The contributions ofVEBAto the metagenomics community includes seamless end-to-end metagenomics analysis but also provides users with the flexibility to perform specific analytical tasks.VEBAallows for the automation of several metagenomics steps and shows that new information can be recovered from existing datasets.
Comparison of meiotic transcriptomes of three maize inbreds with different origins reveals differences in cell cycle and recombination
Authors: Garcia Nelson , Yin Lu , Dukowic-Schulze Stefanie , Milsted Claire , Kianian Penny M. A. , Kianian Shahryar , Pawlowski Wojciech P. , Chen Changbin
Published: October 2022

Background

Cellular events during meiosis can differ between inbred lines in maize. Substantial differences in the average numbers of chiasmata and double-strand breaks (DSBs) per meiotic cell have been documented among diverse inbred lines of maize: CML228, a tropical maize inbred line, B73 and Mo17, temperate maize lines. To determine if gene expression might explain these observed differences, an RNA-Seq experiment was performed on CML228 male meiocytes which was compared to B73 and Mo17 male meiocytes, where plants were grown in the same controlled environment.

Results

We found that a few DSB-repair/meiotic genes which promote class I crossovers (COs) and the Zyp1 gene which limits newly formed class I COs were up-regulated, whereas Mus81 homolog 2 which promotes class II COs was down-regulated in CML228. Although we did not find enriched gene ontology (GO) categories directly related to meiosis, we found that GO categories in membrane, localization, proteolysis, energy processes were up-regulated in CML228, while chromatin remodeling, epigenetic regulation, and cell cycle related processes including meiosis related cell cycle processes were down-regulated in CML228. The degree of similarity in expression patterns between the three maize lines reflect their genetic relatedness: B73 and Mo17 had similar meiotic expressions and CML228 had a more distinct expression profile.

Conclusions

We found that meiotic related genes were mostly conserved among the three maize inbreds except for a few DSB-repair/meiotic genes. The findings that the molecular players in limiting class I CO formation (once CO assurance is achieved) were up-regulated and those involved in promoting class II CO formation were down-regulated in CML228 agree with the lower chiasmata number observed in CML228 previously. In addition, epigenetics such as chromatin remodeling and histone modification might play a role. Transport and energy-related processes was up-regulated and Cyclin13 was down-regulated in CML228. The direction of gene expression of these processes agree with that previously found in meiotic tissues compared with vegetative tissues. In summary, we used different natural maize inbred lines from different climatic conditions and have shown their differences in expression landscape in male meiocytes.
Analysis of antibiotic use and clinical outcomes in adults with known and suspected pleural empyema
Authors: Avner Benjamin S. , Ginosyan Anush , Le James , Mak Justin , Qiryaqoz Zeena , Huffman Cuyler
Published: October 2022

Background

There is not a prevailing consensus on appropriate antibiotic choice, route, and duration in the treatment of bacterial pleural empyema after appropriate source control. Professional society guidelines note the lack of comparative trials with which to guide recommendations. We assessed clinical outcomes in the treatment of known and suspected empyema based upon three aspects of antibiotic use: (1) total duration, (2) duration of intravenous (IV) antibiotics, and (3) duration of anti-anaerobic antibiotics.

Methods

We performed a hypothesis-generating retrospective chart review analysis of 355 adult inpatients who had pleural drainage, via either chest tube or surgical intervention, for known or suspected empyema. The primary outcome variable was clinician assessment of resolution or lack thereof. The secondary outcomes were death within 90 days, hospital readmission within 30 days for empyema, and all-cause hospital readmission within 30 days. Mann-Whitney U test was used to compare outcomes with regard to these variables.

Results

None of the independent variables was significantly associated with a difference in clinical resolution rate despite trends for total antibiotic duration and anti-anaerobic antibiotic duration. None of the independent variables was associated with mortality. Longer total antibiotic duration was associated with lower readmission rate for empyema (median 17 [interquartile range 11–28] antibiotic days in non-readmission group vs. 13 [6-15] days in readmission group), with a non-significant trend for all-cause readmission rate (17 [11–28] days vs. 14 [9–21] days). IV antibiotic duration was not associated with a difference in any of the defined outcomes. Longer duration of anti-anaerobic antibiotics was associated with both lower all-cause readmission (8.5 [0–17] vs. 2 [0–11]) and lower readmission rate for empyema (8 [0–17] vs. 2 [0–3]).

Conclusion

Our data support the premise that routine use of anti-anaerobic antibiotics is indicated in the treatment of pleural empyema. However, our study casts doubt on the benefits of extended IV rather than oral antibiotics in the treatment of empyema. This represents a target for future investigation that could potentially limit complications associated with the excessive use of IV antibiotics.
Sex differences in determinants of COVID-19 severe outcomes – findings from the National COVID Cohort Collaborative (N3C)
Authors: Yoshida Yilin , Chu San , Fox Sarah , Zu Yuanhao , Lovre Dragana , Denson Joshua L. , Miele Lucio , Mauvais-Jarvis Franck
Published: October 2022

Objective

The impact of comorbidities and biomarkers on COVID-19 severity vary by sex but have not yet been verified in population-based studies. We examined the association of comorbidities, inflammatory biomarkers, and severe outcomes in men and women hospitalized for COVID-19.

Design

This is a retrospective cohort analysis based on the National COVID Cohort Collaborative (N3C). We included 574,391 adult patients admitted for COVID-19 at hospitals or emergency rooms between 01/01/2020 and 12/31/2021.

Methods

We defined comorbidities at or before the first admission for COVID-19 by Charlson Comorbidity Index (CCI) and CCI components. We used the averaged lab values taken within 15 days before or after the admission date to measure biomarkers including c-reactive protein (CRP), ferritin, procalcitonin, N-terminal pro b-type natriuretic peptide (NT proBNP), d-dimer, absolute lymphocyte counts, absolute neutrophil counts, and platelets. Our primary outcome was all-cause mortality; secondary outcomes were invasive mechanical ventilation (IMV) and hospital length of stay (LOS). We used logistic regression adjusted for age, race, ethnicity, visit type, and medications to assess the association of comorbidities, biomarkers, and mortality disaggregating by sex.

Results

Moderate to severe liver disease, renal disease, metastatic solid tumor, and myocardial infarction were the top four fatal comorbidities among patients who were hospitalized for COVID-19 (adjusted odds ratio [aOR] > 2). These four comorbid conditions remained the most lethal in both sexes, with a higher magnitude of risk in women than in men (p-interaction < 0.05). Abnormal elevations of CRP, ferritin, procalcitonin, NT proBNP, neutrophil, and platelet counts, and lymphocytopenia were significantly associated with the risk of death, with procalcitonin and NT proBNP as the strongest predictors (aOR > 2). The association between the abnormal biomarkers and death was stronger in women than in men (p-interaction < 0.05).

Conclusion

There are sex differences in inpatient mortality associated with comorbidities and biomarkers. The significant impact of these clinical determinants in women with COVID-19 may be underappreciated as previous studies stressed the increased death rate in male patients that is related to comorbidities or inflammation. Our study highlights the importance and the need for sex-disaggregated research to understand the risk factors of poor outcomes and health disparities in COVID-19.
Correlation study between multiplanar reconstruction trigeminal nerve angulation and trigeminal neuralgia
Authors: Sun Tao , Huang Qinghao , Li Chuangfeng , Yang Wensheng , Wang Wentao , He Longshuang , Liu Jinlong , Yang Chao
Published: October 2022

Objectives

Neurovascular compression (NVC) produces morphological changes on the trigeminal nerve root is considered the cause of trigeminal neuralgia (TN), but there were some patients with TN found no NVC, and also NVC was found in asymptomatic individuals. Many studies found tight relationships of TN and morphological structures of trigeminal nerve. We designed this study to explore the correlation between multiplanar reconstruction (MPR) trigeminal nerve angulation (TNA) and TN.

Methods

Patients with classical symptoms of TN were recruited as observation group (OG) in this study, 50 healthy controls were enrolled as control group (CG), the OG was further subtyped into young patients (YP), middle-aged patients (MP) and old patients (OP) based to the onset age of symptoms, and also divided into patients with or without trigger maneuvers (TM) based on the presence of TM or not. All the participants underwent magnetic resonance (MR) examinations in same device, bilateral TNA measurements were carried out in OG and CG, then TNA was compared between different groups or subgroups. All images were interpreted by two radiologists who were blinded to the study, diagnosis of TN was made by two senior neurosurgery professors.

Result

Ultimately, 95 patients with primary TN were recruited in OG, aged from 25 to 84 (61.15 ± 12.70) years with a course of 0.5 to 30 (5.03 ± 5.41) years, their onset age ranged from 24 to 82 (56.13 ± 11.98) years. There were 34 males and 61 females in OG, and 58 cases involved right side. The CG aged from 22 to 85 (61.86 ± 13.03) years. No statistical difference was found between the age of OG and CG(p = 0.76), and also the bilateral TNA of CG (154.92 ± 16.90° vs 155.55 ± 17.03°, p > 0.05), while TNA of OG was significantly smaller than CG (150.78 ± 11.29° vs 155.24 ± 16.88°, p = 0.019). In OG, TNA on the affected side was significantly smaller than the unaffected side (149.29 ± 12.44° vs 152.27 ± 9.85°, p = 0.014). TNA showed a positive correlation with onset age of patients with TN, as TNA on the affected side of YP was significantly smaller than MP and OP (139.00 ± 11.64° vs 148.86 ± 11.54°, 139.00 ± 11.64° vs 152.18 ± 12.61°, p = 0.004 and 0.026). Furthermore, patients with TM showed smaller TNA than those without TM (147.05 ± 11.30° vs 164.75 ± 8.39°, p < 0.001).

Conclusions

This study suggested that TNA might play a role in TN, small TNA could be a risk factor of TN. Furthermore, patients with small TNA are more likely to combine with TM, but more studies are needed to explore the exact role of TNA in TN.
Doula support among brazilian women who attended the senses of birth health education intervention – a cross sectional analysis
Authors: Fernandes Luísa M M , Mishkin Kathryn E , Lansky Sônia
Published: October 2022

Background

While maternal health is a priority in international goals, maternal health outcomes remain poor in many regions of the world. In Brazil, maternal mortality has decreased over the past decades, but the country’s maternal mortality ratio is higher than over half of all countries at 59 deaths per 100,000 live births. The Brazilian maternal health care model facilitates high rates of medical interventions during labor and childbirth; 56% of births are by cesarean birth. Doula support is considered a potential strategy to reduce medically unnecessary interventions during childbirth that contribute to maternal mortality.

Methods

The cross-sectional study analyses associations with use of doula support and normal birth among Brazilian women who participated in a health education intervention named the Senses of Birth (SoB). The SoB intervention, implemented in five cities from 2015 to 2017, was developed to educate about normal birth and to evidence-based practices (EBP) reduce medically in childbirth. Chi-Square tests were performed to identify the relationship between doula support during childbirth and sociodemographic characteristics, childbirth information, perceived knowledge, and use of EBPs during labor. Logistic regression was performed to identify associations in adjusted analysis.

Results

Controlling for covariates, doula support was associated with vaginal delivery (OR 2.47, 95% CI: 1.37–4.45.) Findings also suggest that women who had doula support were more likely to use non-pharmacological pain relief methods during labor (OR 9.68, 95% CI: 2.67–34.61), deliver in a public hospital (OR 2.02, 95% CI: 1.09–3.72), and be low and mid-level income compared to women with high income.

Conclusion

This study’s findings suggest that doula support is significantly associated with vaginal birth. The results may be useful for advocating for changes to the childbirth care model in Brazil. Incorporating EBPs, such as doula support, for all women who desire may improve maternal and child outcomes.
Umbilical cord blood concentration of connecting peptide (C-peptide) and pregnancy outcomes
Authors: Niknam Atrin , Ramezani Tehrani Fahimeh , Behboudi-Gandevani Samira , Rahmati Maryam , Hedayati Mehdi , Abedini Mehrandokht , Firouzi Faegheh , Torkestani Farahnaz , Zokaee Mehdi , Azizi Fereidoun
Published: October 2022

Background

C-peptide offers potential as a marker to indicate childhood metabolic outcomes. Measuring C-peptide concentration might have better future utility in the risk stratification of neonates born to overweight or diabetic mothers. Prior research has tried to bring this matter into the light; however, the clinical significance of these associations is still far from reach. Here we sought to investigate the associations between fetomaternal metabolic variables and umbilical cord blood C-peptide concentration.

Methods

For the present study, 858 pregnant women were randomly selected from among a sub-group of 35,430 Iranian pregnant women who participated in a randomized community non-inferiority trial of gestational diabetes mellitus (GDM) screening. Their umbilical cord (UC) blood C-peptide concentrations were measured, and the pregnancy variables of macrosomia/large for gestational age (LGA) and primary cesarean section (CS) delivery were assessed. The variation of C-peptide concentrations among GDM and macrosomia status was plotted. Due to the skewed distribution of C-peptide concentration in the sample, median regression analysis was used to identify potential factors related to UC C-peptide concentration.

Results

In the univariate model, positive GDM status was associated with a 0.3 (95% CI: 0.06 − 0.54, p = 0.01) increase in the median coefficient of UC blood C-peptide concentration. Moreover, one unit (kg) increase in the birth weight was associated with a 0.25 (95% CI: 0.03 − 0.47, p = 0.03) increase in the median coefficient of UC blood C-peptide concentration. In the multivariate model, after adjusting for maternal age, maternal BMI, and macrosomia status, the positive status of GDM and macrosomia were significantly associated with an increase in the median coefficient of UC blood C-peptide concentration (Coef.= 0.27, 95% CI: 0.13 − 0.42, p < 0.001; and Coef.= 0.34, 95% CI: 0.06 − 0.63, p = 0.02, respectively).

Conclusion

UC blood concentration of C-peptide is significantly associated with the incidence of maternal GDM and neonatal macrosomia. Using stratification for maternal BMI and gestational weight gain (GWG) and investigating molecular markers like Leptin and IGF-1 in the future might lay the ground to better understand the link between metabolic disturbances of pregnancy and UC blood C-peptide concentration.
Identification of actions to be taken by managers to facilitate the return to work of cancer survivors: Consensus between managers and cancer survivors
Authors: Porro B. , Tamminga S. J. , de Boer A. G.E.M. , Petit A. , Roquelaure Y. , Greidanus M. A.
Published: October 2022

Background

Managers are considered to be main stakeholders in the return to work (RTW) of cancer survivors. However, the perspectives of cancer survivors and managers differ on what managerial actions should be taken during the RTW of cancer survivors. This difference might put effective collaboration and successful RTW at risk. Therefore, this study aims to reach consensus among managers and cancer survivors on the managerial actions to be taken during the four different RTW phases of cancer survivors (i.e., Disclosure, Treatment, RTW plan, Actual RTW).

Methods

The Technique for Research of Information by Animation of a Group of Experts (TRIAGE) was implemented with managers and cancer survivors (hereafter referred to as “experts”). An initial list of 24 actions was derived from a previous study. Firstly, for each action, fifteen experts were asked to indicate individually how important this action is per RTW phase (Likert scale from 1 – “Not important at all” to 6 – “Very important”). Consensus was reached when ≥ 80% (i.e., ≥ twelve experts) of the experts rated that action ≥5. Secondly, for each phase of the RTW process, the 15 actions with the highest percentage were discussed with eight experts during the collective consultation, except for the actions that already reached consensus. After discussion, the experts voted whether each action was important (“yes” / “no”) and consensus required ≥ 87.5% (i.e., ≥ seven experts) of the experts to consider an action as important.

Results

Twenty-five managerial actions were finally retained for at least one of the RTW phases, e.g., Disclosure: “respect privacy” and “radiate a positive attitude”, Treatment: “show appreciation” and “allow sufficient sick leave”, RTW Plan: “tailor” and “communicate”, and Actual RTW: “support practically” and “balance interest”.

Conclusion

Cancer survivors and managers reached consensus on the importance of 25 managerial actions, distributed into each phase of the RTW process. These actions should be considered an interplay of managerial actions by different stakeholders on the part of the employer (e.g., direct supervisor, HR-manager), and should be a responsibility that is shared by these stakeholders. The collective implementation of these actions within the company will help cancer survivors feel fully supported.
Factors associated with men’s health facility attendance as clients and caregivers in Malawi: a community-representative survey
Authors: Thorp Marguerite , Balakasi Kelvin T. , Mphande Misheck , Robson Isabella , Khan Shaukat , Stillson Christian , Doi Naoko , Nichols Brooke E. , Dovel Kathryn
Published: October 2022

Introduction

Men have higher rates of morbidity and mortality across nearly all top ten causes of mortality worldwide. Much of this disparity is attributed to men’s lower utilization of routine health services; however, little is known about men’s general healthcare utilization in sub-Saharan Africa.

Methods

We analyze the responses of 1,116 men in a community-representative survey of men drawn from a multi-staged sample of residents of 36 villages in Malawi to identify factors associated with men’s facility attendance in the last 12 months, either for men’s own health (client visit) or to support the health care of someone else (caregiver visit). We conducted single-variable tests of association and multivariable logistic regression with random effects to account for clustering at the village level.

Results

Median age of participants was 34, 74% were married, and 82% attended a health facility in the last year (63% as client, 47% as caregiver). Neither gender norm beliefs nor socioeconomic factors were independently associated with attending a client visit. Only problems with quality of health services (adjusted odds ratio [aOR] 0.294, 95% confidence interval [CI] 0.10—0.823) and good health (aOR 0.668, 95% CI 0.462–0.967) were independently associated with client visit attendance. Stronger beliefs in gender norms were associated with caregiver visits (beliefs about acceptability of violence [aOR = 0.661, 95% CI 0.488–0.896], male sexual dominance [aOR = 0.703, 95% CI 0.505–0.978], and traditional women’s roles [aOR = 0.718, 95% CI 0.533–0.966]). Older age (aOR 0.542, 95% CI 0.401–0.731) and being married (aOR 2.380, 95% CI 1.196–4.737) were also independently associated with caregiver visits.

Conclusion

Quality of services offered at local health facilities and men’s health status were the only variables associated with client facility visits among men, while harmful gender norms, not being married, and being younger were negatively associated with caregiver visits.
Digital adaptation of teaching disaster and deployment medicine under COVID-19 conditions: a comparative evaluation over 5 years
Authors: Henze SM , Fellmer F , Wittenberg S , Höppner S , Märdian S , Willy C , Back DA
Published: October 2022

Background

The COVID-19 pandemic has not only brought many aspects of disaster medicine into everyday awareness but also led to a massive change in medical teaching due to the necessity of contact restrictions. This study aimed to evaluate student acceptance of a curricular elective module on disaster and deployment medicine over a 5-year period and to present content adjustments due to COVID-19 restrictions.

Methods

Since 2016, 8 semesters of the curricular elective module took place in face-to-face teaching (pre-COVID-19 group). From the summer semester of 2020 to the summer semester of 2021, 3 semesters took place as online and hybrid courses (mid-COVID-19 group). Student attitudes and knowledge gains were measured using pretests, posttests, and final evaluations. These data were statistically compared across years, and new forms of teaching under COVID-19 conditions were examined in more detail.

Results

A total of 189 students participated in the module from the summer semester of 2016 through the summer semester of 2021 (pre-COVID-19: n = 138; mid-COVID-19: n = 51). There was a high level of satisfaction with the module across all semesters, with no significant differences between the groups. There was also no significant difference between the two cohorts in terms of knowledge gain, which was always significant (p < 0.05). COVID-19 adaptations included online seminars using Microsoft Teams or Zoom, the interactive live-streaming of practical training components, and digital simulation games.

Conclusion

The high level of satisfaction and knowledge gained during the module did not change even under a digital redesign of the content offered. The curricular elective module was consistently evaluated positively by the students, and the adaptation to online teaching was well accepted. Experiences with digital forms of teaching should also be used after the COVID-19 pandemic to create digitally supported blended learning concepts in the field of deployment and disaster medicine and thus further promote the expansion of teaching in this important medical field.
The FUS/circEZH2/KLF5/ feedback loop contributes to CXCR4-induced liver metastasis of breast cancer by enhancing epithelial-mesenchymal transition
Authors: Liu Peng , Wang Zehao , Ou Xueqi , Wu Peng , Zhang Yue , Wu Song , Xiao Xiangsheng , Li Yuehua , Ye Feng , Tang Hailin
Published: October 2022

Background

Metastasis of breast cancer have caused the majority of cancer-related death worldwide. The circRNAs are associated with tumorigenesis and metastasis in breast cancer according to recent research. However, the biological mechanism of circRNAs in liver metastatic breast cancer remains ambiguous yet.

Methods

Microarray analysis of three pairs of primary BC tissues and matched hepatic metastatic specimens identified circEZH2. We used RT-qPCR and FISH assays to confirm circEZH2 existence, characteristics, and expression. Both in vivo and in vitro, circEZH2 played an oncogenic role which promoted metastasis as well. A range of bioinformatic analysis, Western blot, RNA pull-down, RIP, ChIP, and animal experiments were used to define the feedback loop involving FUS, circEZH2, miR-217-5p, KLF5, FUS, CXCR4 as well as epithelial and mesenchymal transition.

Results

In our research, circEZH2 was proved to be upregulated in liver metastases in BC and predicted the worse prognosis in breast cancer patients. Overexpression of circEZH2 notably accentuated the vitality and invasion of BC cells, whereas knockdown of circEZH2 elicited the literally opposite effects. Besides, overexpressed circEZH2 promoted tumorigenesis and liver metastasis in vivo. Moreover, circEZH2 could adsorb miR-217-5p to upregulate KLF5 thus leading to activate FUS transcription which would facilitate the back-splicing program of circEZH2. Meanwhile, KLF5 could upregulated CXCR4 transcriptionally to accelerate epithelial and mesenchymal transition of breast cancer.

Conclusions

Consequently, a novel feedback loop FUS/circEZH2/KLF5/CXCR4 was established while circEZH2 could be novel biomarker and potential target for BC patients’ therapy.
Clinical significance of neutrophil extracellular traps biomarkers in thrombosis
Authors: Xu Xiangbo , Wu Yuting , Xu Shixue , Yin Yue , Ageno Walter , De Stefano Valerio , Zhao Qingchun , Qi Xingshun
Published: October 2022

Neutrophil extracellular traps (NETs) may be associated with the development of thrombosis. Experimental studies have confirmed the presence of NETs in thrombi specimens and potential role of NETs in the mechanisms of thrombosis. Clinical studies also have demonstrated significant changes in the levels of serum or plasma NETs biomarkers, such as citrullinated histones, myeloperoxidase, neutrophil elastase, nucleosomes, DNA, and their complexes in patients with thrombosis. This paper aims to comprehensively review the currently available evidence regarding the change in the levels of NETs biomarkers in patients with thrombosis, summarize the role of NETs and its biomarkers in the development and prognostic assessment of venous thromboembolism, coronary artery diseases, ischemic stroke, cancer-associated thromboembolism, and coronavirus disease 2019-associated thromboembolism, explore the potential therapeutic implications of NETs, and further discuss the shortcomings of existing NETs biomarkers in serum and plasma and their detection methods.
Informing investment in health workforce in Bangladesh: a health labour market analysis
Authors: Nuruzzaman Md , Zapata Tomas , McIsaac Michelle , Wangmo Sangay , Islam Md Joynul , Almamun Md , Alam Sabina , Talukder Md Humayun Kabir , Dussault Gilles
Published: October 2022

Background

As the 2016 Global Strategy on Human Resources for Health: Workforce 2030 (GSHRH) outlines, health systems can only function with health workforce (HWF). Bangladesh is committed to achieving universal health coverage (UHC) hence a comprehensive understanding of the existing HWF was deemed necessary informing policy and funding decisions to the health system.

Methods

The health labour market analysis (HLMA) framework for UHC cited in the GSHRH was adopted to analyse the supply, need and demand of all health workers in Bangladesh. Government’s information systems provided data to document the public sector HWF. A national-level assessment (2019) based on a country representative sample of 133 geographical units, served to estimate the composition and distribution of the private sector HWF. Descriptive statistics served to characterize the formal and informal HWF.

Results

The density of doctors, nurses and midwives in Bangladesh was only 9.9 per 10 000 population, well below the indicative sustainable development goals index threshold of 44.5 outlined in the GSHRH. Considering all HWFs in Bangladesh, the estimated total density was 49 per 10 000 population. However, one-third of all HWFs did not hold recognized roles and their competencies were unknown, taking only qualified and recognized HWFs into account results in an estimated density 33.2. With an estimate 75 nurses per 100 doctors in Bangladesh, the second area, where policy attention appears to be warranted is on the competencies and skill-mix. Thirdly, an estimated 82% of all HWFs work in the private sector necessitates adequate oversight for patient safety. Finally, a high proportion of unfilled positions in the public sector, especially in rural areas where 67% of the population lives, account only 11% of doctors and nurses.

Conclusion

Bangladesh is making progress on many of the milestones of the GSHRH, notably, the establishment of the HWF unit and reporting through the national health workforce accounts. However, particular investment on strengthening the intersectoral HWF coordination across sectors; regulation for assurance of patient safety and adequate oversight of the private sector; establishing accreditation mechanisms for training institutions; and halving inequalities in access to a qualified HWF are important towards advancing UHC in Bangladesh.