bluuebunny/crossref_metadata_2025 huggingface dataset:
A test device to characterize cold-contact protective performance of fabrics
Authors: Wei Yange , Su Yun , Li Jun , Huang Jianda
Published: May 2021

Workers are exposed to skin frostbite in extremely cold environments, especially in contact with cold surfaces. They must wear cold-resistant clothing/gloves to avoid frostbites. However, there was a lack of an accurate method to evaluate the cold-contact protective performance (CPP) of fabrics. In view of this, a test device was developed to simulate the cold-contact exposure by controlling cold-contact temperature and pressure. Then, a frostbite prediction model was proposed to predict the time to skin-frostbite (TSF) as an index for characterizing the CPP. It was found that the standard deviation of cold-contact temperature fluctuated within 0.03°C to 0.51°C in the same second, and the coefficient of variations of the TSF were from 1.35% to 6.97%, indicating that the device presents good stability, reliability, reproducibility. The TSFs for different fabric systems ranged from 35 s to 419.33 s, mostly depending on the fiber type, the thermal resistance, the thickness of fabric and the air content in the fabric. Finally, it was concluded that the proposed device provides a scientific and realistic measurement of CPP of fabrics.
Anti-HMGB1 auto-Abs influence fatigue in patients with Crohn’s disease
Authors: Kvivik Ingeborg , Grimstad Tore , Jonsson Grete , Kvaløy Jan T. , Omdal Roald
Published: May 2021

Fatigue is common in all chronic inflammatory and autoimmune diseases. A conceptual model for understanding the biological basis of fatigue describes it as being a part of the sickness behaviour response generated by pro-inflammatory cytokines and other mediators. We hypothesised that the pro-inflammatory high mobility group box 1 (HMGB1) protein is a fatigue-inducing molecule and that auto-Abs against HMGB1 reduce fatigue. We measured Abs against disulphide (ds) HMGB1 and fully reduced (fr) HMGB1 in plasma from 57 patients with Crohn’s disease. Fatigue was rated using the fatigue visual analogue scale (fVAS) and disease activity with faecal calprotectin, C-reactive protein and the Simple Endoscopic Score for Crohn’s disease. Multivariable regression models identified anti-dsHMGB1 and anti-frHMGB1 Abs as the strongest contributing factors for fVAS scores ( B = −29.10 ( P = 0.01), R2 = 0.17, and B = −17.77 ( P = 0.01), R2 = 0.17, respectively). Results indicate that anti-HMGB1 auto-Abs alleviate fatigue possibly by down-regulating HMGB1-induced sickness behaviour.
Numerosity representation in a deep convolutional neural network
Authors: Zhou Cihua , Xu Wei , Liu Yujie , Xue Zhichao , Chen Rui , Zhou Ke , Liu Jia
Published: May 2021

Enumerating objects in the environment (i.e., “number sense”) is crucial for survival in many animal species, and foundational for the construction of more abstract and complex mathematical knowledge in humans. Perhaps surprisingly, deep convolutional neural networks (DCNNs) spontaneously emerge a similar number sense even without any explicit training for numerosity estimation. However, little is known about how the number sense emerges, and the extent to which it is comparable with human number sense. Here, we examined whether the numerosity underestimation effect, a phenomenon indicating that numerosity perception acts upon the perceptual number rather than the physical number, can be observed in DCNNs. In a typical DCNN, AlexNet, we found that number-selective units at late layers operated on the perceptual number, like humans do. More importantly, this perceptual number sense did not emerge abruptly, rather developed progressively along the hierarchy in the DCNN, shifting from the physical number sense at early layers to perceptual number sense at late layers. Our finding hence provides important implications for the neural implementation of number sense in the human brain and advocates future research to determine whether the representation of numerosity also develops gradually along the human visual stream from physical number to perceptual number.
Mental Health Outcome Measures in Environmental Design Research: A Critical Review
Authors: Shin Jung-hye , Dennis Samuel , Mohammed Hassnaa
Published: May 2021

Aim:

During the last several decades, researchers have produced abundant evidence of the environmental impacts on stress, attention, and physical activity. More recently, scholars have turned their focus to the influence environments have on mental wellness. Therefore, a critical review of this more recent research is both timely and crucial for setting the future research agenda.

Methods:

In this article, we examined 65 papers published between 2008 and 2019 that examined the environmental correlates of a wide variety of mental health outcomes. We coded each study by type of environment, research design, mental health measurement scale used, and p-value.

Results:

We categorized the research studies into six groups based on mental health outcomes: emotions, moods, vitality, executive function, stress, and general well-being. Our review revealed several trends among the studies, including a heavy focus on nature and outdoor environments with little attention to workplace or residential environments; a lack of consensus on how to operationalize the environment; a heavy reliance on self-reported ratings using a wide variety of scales, many focused on the same outcome; and a disproportionate focus on short-term health effects.

Conclusions:

There is a need for greater consensus on research constructs and health outcome measurements, focused on a wider variety of environmental settings and scales, in order to better inform evidence-based environmental design practice.
Flared non-flow diverting ends of the FRED flow diverter for cerebral aneurysms facilitate device anchoring at the arterial bifurcation
Authors: Burkhardt Jan-Karl , McGuire Laura Stone , Griessenauer Christoph J
Published: May 2021

Introduction

The Flow Redirection Intraluminal Device (FRED) flow diverter has a unique bilayer design, with the outer scaffolding stent extending beyond the inner flow diverting component by about 3 mm at each end. Here, we describe a technique to utilize these unrestrained flared ends for precise flow diverter placement in cases where the aneurysm and an adjacent branch are in close proximity and branch jailing is not desired, such as in posterior communicating artery aneurysms. Technical note: The distal end of the FRED device is pushed out of the microcatheter at the carotid terminus. Once the distal flared ends are fully open and well situated in the terminus, ideally with at least one of the limbs in the A1 segment of the anterior cerebral artery, the device is unsheathed under gentle forward pressure. This technique stabilizes the device at the distal landing zone and prevents unintended foreshortening at the distal end. This is particularly important for aneurysms located adjacent to the carotid terminus in order to assure adequate neck coverage, as well as avoiding jailing one of the branching parent arteries. An illustrative case is provided.

Conclusions

The non-flow diverting unrestrained flared ends of the FRED stabilize the distal end of the device when deployed directly into the branches at the arterial bifurcation. The technique is useful to provide adequate neck coverage of cerebral aneurysm located directly adjacent to the bifurcation as is frequently the case with posterior communicating artery aneurysms.
Branch Pulmonary Artery Jailing During Patent Ductus Arteriosus Stenting: Recruitment and Immediate Outcomes
Authors: Prabhu Sudesh , Joshi Abhijit , Mehra Siddhant , Shetty Riyan , Murthy Keshava , Ramachandra Prakash , Maiya Shreesha
Published: May 2021

Background:

Branch pulmonary artery (PA) occlusion during patent ductus arteriosus (PDA) stenting procedure is the main reason why branch PA origin stenosis was considered as a contraindication for PDA stenting. This study was designed to assess the incidence of branch PA jailing during PDA stenting for cyanotics with duct-dependent pulmonary circulation and its immediate outcome.

Methods:

All the completed PDA stenting patients in our hospital between April 2017 and June 2019 were retrospectively analyzed for branch PA jailing and its outcome.

Results:

Of 63 completed PDA stenting, there was branch PA jailing in 13 (20.6%) patients, all successfully recruited either by strut dilatation or by surgery. The median duration of ventilation was 16 (interquartile range [IQR]: 8-22) hours for jailed patients and 17.5 (IQR: 5.25-34.25) hours for nonjailed patients ( P = .978). Median intensive care unit [ICU] stay was 69 (IQR: 47.75-96) hours for jailed patients and 79.5 (IQR: 66.75-135.25) hours for nonjailed patients ( P = .394). Procedural mortality was 1 (7.6%) for jailed patients and 3 (6%) for nonjailed patients. Since all the jailed pulmonary arteries were recruited, there was proportionate growth of branch PA till the most recent follow-up.

Conclusion:

Jailing of branch PA does not increase the ventilation duration, ICU stay, or mortality risk if recruited immediately. Proportionate growth of branch PAs can be achieved in spite of jailing, if addressed aggressively. Branch PA stenosis should not be considered as a contraindication for PDA stenting.
Cheating on exams: Investigating Reasons, Attitudes, and the Role of Demographic Variables
Authors: Salehi Mohammad , Gholampour Samaneh
Published: May 2021

Cheating is an academically dishonest behavior about which there has been a thrust of research. However, it has not been extensively researched in an Iranian context. Therefore, the current study was conducted with 310 Iranian students. A cheating questionnaire was devised and administered to the participants. Certain demographic variables were investigated. Both descriptive and inferential statistics were employed to analyze the obtained data. The results of the descriptive statistics revealed that cheating was common among participants, and most students did not harbor any negative attitude toward cheating or at least were neutral about it. The most common method of cheating was “letting others look at their papers while taking exams.” The most common reason for cheating was “not being ready for the exam.” As for inferential statistics, one-way analysis of variance, an independent t-test, and correlational analyses were used to test the effect and relationship of demographic variables on and between the cheating behaviors of the participants. It was found that none of the two demographic variables of gender and year level had any effect on students’ cheating behaviors. Furthermore, achievement scores and age were not significantly correlated with cheating behavior scores.
Health and Wellness–Related Travel: A Scoping Study of the Literature in 2010-2018
Authors: Kemppainen Laura , Koskinen Veera , Bergroth Harley , Marttila Eetu , Kemppainen Teemu
Published: May 2021

Health and wellness–related travel, also known as medical tourism, is a topical phenomenon with a wide range of effects in both local and transnational contexts. This scoping study examines the literature on this phenomenon from the perspective of travelers. The literature search was conducted using three databases (EBSCOhost, Web of Science, and SCOPUS) and covered the period from 2010 to 2018. The results show that the literature is divided into two academic fields: social sciences and tourism. Travel from the Global North to the Global South still dominates the field of medical travel research, and studies on South-to-South or intra-regional travel are underrepresented. There is a need for a more in-depth qualitative understanding of travelers’ lived experiences and for studies with more advanced quantitative methods and longitudinal research designs. We call for more interdisciplinary and theoretical approaches to health and wellness–related travel and propose a conceptual model that considers travelers’ intent (medical/wellness) and status (patient/tourist).
The Moderating Effect of Involvement in the Relationship Between Customer Behavioral Intentions and Its Antecedents
Authors: Eskiler Ersin , Altunışık Remzi
Published: May 2021

Future trends in customers’ postpurchasing habits and the identification of the structures that affect the formation of these trends are key determinants of long-term financial performance and competitive advantage for businesses. In the field of marketing, service quality, perceived value and customer satisfaction, and the relationship between these structures are the main factors for the determination of customer loyalty. However, empirical findings have proven to be inadequate in revealing relationships between related structures in low- and high-involvement levels of consumer groups. Therefore, the aim of this study was to examine the moderating effect of involvement in the relationship between the behavioral intentions of members of a sports-fitness center and their antecedents. For the research, face-to-face questionnaires were administered to 842 subjects who had been selected by convenience sampling performed at sports and fitness centers operating in Istanbul, and the collected data were analyzed using the structural equation modeling technique. Our results showed that there were differences in the effects of service quality, perceived value, and customer satisfaction on behavioral intentions among consumer groups in terms of low- or high-involvement levels. This article discussed the theoretical and managerial effects of the obtained results.
Theory, explanation, and understanding in management research
Authors: Joullié Jean-Etienne , Gould Anthony M.
Published: May 2021

Theory production has been a central focus of management research for decades, mostly because theory legitimizes both management research and, through its application, management practice as professional endeavors. However, such an emphasis on theory glosses over one of its constraining and particularized roles in scientific explanation, namely that theory codifies predictive knowledge. Committing to a ‘traditional’ or ‘critical’ understanding of theory thus amounts to embracing the view that prediction is achievable within a circumscribed field of study. Such an embrace is non-controversial in natural science. However, within the realm of management studies, it necessitates and smuggles in a strawman view of human existence, one which does not accommodate freedom and responsibility. This limitation of management theory explains its inadequate utility. This article argues that alternative avenues for management research exist.

JEL CLASSIFICATION: M10
A continuum hypothesis of psychotomimetic rapid antidepressants
Authors: Haarsma Joost , Harmer Catherine J , Tamm Sandra
Published: May 2021

Ketamine, classical psychedelics and sleep deprivation are associated with rapid effects on depression. Interestingly, these interventions also have common psychotomimetic actions, mirroring aspects of psychosis such as an altered sense of self, perceptual distortions and distorted thinking. This raises the question whether these interventions might be acute antidepressants through the same mechanisms that underlie some of their psychotomimetic effects. That is, perhaps some symptoms of depression can be understood as occupying the opposite end of a spectrum where elements of psychosis can be found on the other side. This review aims at reviewing the evidence underlying a proposed continuum hypothesis of psychotomimetic rapid antidepressants, suggesting that a range of psychotomimetic interventions are also acute antidepressants as well as trying to explain these common features in a hierarchical predictive coding framework, where we hypothesise that these interventions share a common mechanism by increasing the flexibility of prior expectations. Neurobiological mechanisms at play and the role of different neuromodulatory systems affected by these interventions and their role in controlling the precision of prior expectations and new sensory evidence will be reviewed. The proposed hypothesis will also be discussed in relation to other existing theories of antidepressants. We also suggest a number of novel experiments to test the hypothesis and highlight research areas that could provide further insights, in the hope to better understand the acute antidepressant properties of these interventions.
A new method for exploring gene–gene and gene–environment interactions in GWAS with tree ensemble methods and SHAP values
Authors: Johnsen Pål V. , Riemer-Sørensen Signe , DeWan Andrew Thomas , Cahill Megan E. , Langaas Mette
Published: May 2021

Background

The identification of gene–gene and gene–environment interactions in genome-wide association studies is challenging due to the unknown nature of the interactions and the overwhelmingly large number of possible combinations. Parametric regression models are suitable to look for prespecified interactions. Nonparametric models such as tree ensemble models, with the ability to detect any unspecified interaction, have previously been difficult to interpret. However, with the development of methods for model explainability, it is now possible to interpret tree ensemble models efficiently and with a strong theoretical basis.

Results

We propose a tree ensemble- and SHAP-based method for identifying as well as interpreting potential gene–gene and gene–environment interactions on large-scale biobank data. A set of independent cross-validation runs are used to implicitly investigate the whole genome. We apply and evaluate the method using data from the UK Biobank with obesity as the phenotype. The results are in line with previous research on obesity as we identify top SNPs previously associated with obesity. We further demonstrate how to interpret and visualize interaction candidates.

Conclusions

The new method identifies interaction candidates otherwise not detected with parametric regression models. However, further research is needed to evaluate the uncertainties of these candidates. The method can be applied to large-scale biobanks with high-dimensional data.
The Glypican proteoglycans show intrinsic interactions with Wnt-3a in human prostate cancer cells that are not always associated with cascade activation
Authors: de Moraes Gabrielle Ferrante Alves , Listik Eduardo , Justo Giselle Zenker , Vicente Carolina Meloni , Toma Leny
Published: May 2021

Background

Prostate cancer occurs through multiple steps until advanced metastasis. Signaling pathways studies can result in the identification of targets to interrupt cancer progression. Glypicans are cell surface proteoglycans linked to the membrane through glycosylphosphatidylinositol. Their interaction with specific ligands has been reported to trigger diverse signaling, including Wnt. In this study, prostate cancer cell lines PC-3, DU-145, and LNCaP were compared to normal prostate RWPE-1 cell line to investigate glypican family members and the activation of the Wnt signaling pathway.

Results

Glypican-1 (GPC1) was highly expressed in all the examined cell lines, except for LNCaP, which expressed glypican-5 (GPC5). The subcellular localization of GPC1 was detected on the cell surface of RWPE-1, PC-3, and DU-145 cell lines, while GPC5 suggested cytoplasm localization in LNCaP cells. Besides glypican, flow cytometry analysis in these prostate cell lines confirmed the expression of Wnt-3a and unphosphorylated β-catenin. The co-immunoprecipitation assay revealed increased levels of binding between Wnt-3a and glypicans in cancer cells, suggesting a relationship between these proteoglycans in this pathway. A marked increase in nuclear β-catenin was observed in tumor cells. However, only PC-3 cells demonstrated activation of canonical Wnt signaling, according to the TOPFLASH assay.

Conclusions

GPC1 was the majorly expressed gene in all the studied cell lines, except for LNCaP, which expressed GPC5. We assessed by co-immunoprecipitation that these GPCs could interact with Wnt-3a. However, even though nuclear β-catenin was found increased in the prostate cancer cells (i.e., PC-3, DU-145 and LNCaP), activation of Wnt pathway was only found in PC-3 cells. In these PC-3 cells, GPC1 and Wnt-3a revealed high levels of colocalization, as assessed by confocal microscopy studies. This suggests a localization at the cellular surface, where Frizzled receptor is required for downstream activation. The interaction of Wnt-3a with GPCs in DU-145 and LNCaP cells, which occurs in absence of Wnt signaling activation, requires further studies. Once non-TCF-LEF proteins can also bind β-catenin, another signaling pathway may be involved in these cells with regulatory function.
Detection and characterization of carbapenem resistant Gram‐negative bacilli isolates recovered from hospitalized patients at Soba University Hospital, Sudan
Authors: Elbadawi Hana S. , Elhag Kamal M. , Mahgoub Elsheikh , Altayb Hisham N. , Ntoumi Francine , Elton Linzy , McHugh Timothy D. , Tembo John , Ippolito Giuseppe , Osman Abdinasir Yusuf , Zumla Alimuddin , Hamid Muzamil M. Abdel
Published: May 2021

Background

Antimicrobial resistance (AMR) poses a complex threat to global health security and universal health coverage. Recently, nosocomial infections with carbapenemase-producing Gram-negative bacilli (GNB) is increasing worldwide. We report the molecular characterization and detection of genes associated with carbapenemase producing Gram negative bacteria isolated from hospitalized patients at Soba University Hospital (SUH) in Khartoum State, Sudan.

Results

Between October 2016 and February 2017, a total of 206 GNB clinical specimens were collected from hospitalized patients in SUH. Of 206 carbapenem resistance isolates, 171 (83 %) were confirmed as phenotypically resistant and 121 (58.7 %) isolates harboured one or more carbapenemase genes. New Delhi metallo-β-lactamase (NDM) types were the most predominant genes, blaNDM 107(52 %), followed by blaIMP 7 (3.4 %), blaOXA-48 5(2.4 %) and blaVIM 2 (0.9 %). Co-resistance genes with NDM producing GNB were detected in 87 (81.3 %) of all blaNDM producing isolates. NDM-1 was the most frequent subtype observed in 75 (70 %) blaNDM producing isolates. The highest percentage of resistance was recorded in ampicillin (98 %), cephalexin (93.5 %) amoxicillin clavulanic acid (90 %), cefotaxime (89.7 %), ceftriaxone (88.4 %), ceftazidime (84.2 %), sulfamethoxazole-trimethoprim (78.4 %) and nitrofurantoin (75.2 %), aztreonam (66 %) and temocillin (64 %). A close correlation between phenotypic and carbapenemase genes detection in all GNB was observed.

Conclusions

The frequency of carbapenemase producing bacilli was found to be high in SUH. NDM was found to be the most prevalent carbapenemase gene among clinical isolates. Close surveillance across all hospitals in Sudan is required. The relative distribution of carbapenemase genes among GNB in nosocomial infections in Africa needs to be defined.
Comparison of remifentanil concentrations with and without dexmedetomidine for the prevention of emergence cough after nasal surgery: a randomized double-blinded trial
Authors: Kim Ha Yeon , Kwak Hyun Jeong , Lee Dongchul , Lee Ji Hyea , Min Sang Kee , Kim Jong Yeop
Published: May 2021

Background

Preventing emergence cough after nasal surgery is critical. Emergence cough can provoke immediate postoperative bleeding, which leads to upper airway obstruction. In the present study, we compared the effect-site concentration (Ce) of remifentanil to prevent emergence cough after propofol anesthesia for nasal surgery when remifentanil was or was not combined with dexmedetomidine.

Methods

Forty-seven patients with propofol-remifentanil anesthesia for nasal surgery were randomly assigned to a dexmedetomidine group (Group D, n = 23) or a saline group (Group S, n = 24). Group D and Group S were infused with dexmedetomidine (0.5 μg/kg) and saline, respectively, for 10 min before the completion of surgery. A predetermined Ce of remifentanil was infused until extubation. Remifentanil Ce to prevent cough in 50 and 95% of patients (EC50 and EC95) was estimated using modified Dixon’s up-and-down method and isotonic regression. Hemodynamic and recovery parameters were recorded.

Results

The EC50 of remifentanil Ce was significantly lower in Group D than in Group S (2.15 ± 0.40 ng/mL vs. 2.66 ± 0.36 ng/mL, p = 0.023). The EC95 (95% CI) of remifentanil Ce was also significantly lower in Group D [2.75 (2.67–2.78) ng/mL] than in Group S [3.16 (3.06–3.18) ng/mL]. Emergence and recovery variables did not differ between the two groups.

Conclusion

The remifentanil EC50 to prevent cough after propofol-remifentanil anesthesia was significantly lower (approximately 19%) when a combination of remifentanil and 0.5 μg/kg dexmedetomidine was used than when remifentanil infusion alone was used in patients undergoing nasal surgery. Therefore, the Ce of remifentanil may be adjusted to prevent emergence cough when used in combination with dexmedetomidine.

Trial registration

ClinicalTrials.gov (NCT03622502, August 9, 2018).
A new scoring system for predicting short‐term outcomes in Chinese patients with critically‐ill acute decompensated heart failure
Authors: Mo Ran , Yu Li-tian , Tan Hui-qiong , Wang Yang , Yang Yan-min , Liang Yan , Zhu Jun
Published: May 2021

Background

Acute decompensated heart failure (ADHF) contributes millions of emergency department (ED) visits and it is associated with high in-hospital mortality. The aim of this study was to develop and validate a multiparametric score for critically-ill ADHF patients.

Methods

In this single-center, retrospective study, a total of 1268 ADHF patients in China were enrolled and divided into derivation (n = 1014) and validation (n = 254) cohorts. The primary endpoint was any in-hospital death, cardiac arrest or utilization of mechanical support devices. Logistic regression model was preformed to identify risk factors and build the new scoring system. The assigning point of each parameter was determined according to its β coefficient. The discrimination was validated internally using C statistic and calibration was evaluated by the Hosmer-Lemeshow goodness-of-fit test.

Results

We constructed a predictive score based on six significant risk factors [systolic blood pressure (SBP), white blood cell (WBC) count, hematocrit (HCT), total bilirubin (TBIL), estimated glomerular filtration rate (eGFR) and NT-proBNP]. This new model was computed as (1 × SBP < 90 mmHg) + (2 × WBC > 9.2 × 109/L) + (1 × HCT ≤ 0.407) + (2 × TBIL > 34.2 μmol/L) + (2 × eGFR < 15 ml/min/1.73 m2) + (1 × NTproBNP ≥ 10728.9 ng/ml). The C statistic for the new score was 0.758 (95% CI 0.667–0.838) higher than APACHE II, AHEAD and ADHERE score. It also demonstrated good calibration for detecting high-risk patients in the validation cohort (χ2 = 6.681, p = 0.463).

Conclusions

The new score including SBP, WBC, HCT, TBIL, eGFR and NT-proBNP might be used to predict short-term prognosis of Chinese critically-ill ADHF patients.
Factors Related to Self-Confidence to Live Alone in Community-Dwelling Older Adults: A Cross-Sectional Study
Authors: Ryu So Im , Cho BeLong , Chang Sun Ju , Ko Hana , Yi Yu Mi , Noh Eun-Young , Cho Hye Ryung , Park Yeon-Hwan
Published: May 2021

Background

Many older adults prefer to live alone in their own homes, with age-related issues in physical movement, regardless of their cultural background. Importantly, however, to identify the features of successfully ageing in place (AIP), and foster independent living among these individuals, this study explored their level of self-confidence to live alone and its related factors.

Methods

We conducted a cross-sectional study using secondary data from an earlier study with older adults living alone in South Korea recruited by convenience sampling methods (N = 936, mean age = 77.1 years, 76.1% female). Data regarding the general, health-related, and social characteristics as well as self-confidence to live alone were collected via face-to-face interviews in 2019. Self-confidence to live alone was measured with a numeric rating scale of 0 to 10.

Results

The average self-confidence score to live alone was 6.59. A regression analysis showed that mould exposure at home, depression, emergency department visits, and loneliness hinder self-confidence to live alone. Meanwhile, such self-confidence was facilitated by independency in instrumental activities of daily living (IADL), interactions with family members, social service utilisation, and social support.

Conclusions

This study suggests that healthcare providers need to consider the importance of self-confidence to live alone and influencing functional, mental, social, and environmental factors to promote quality of life as well as successful AIP for older adults living alone. Further, self-confidence to live alone could be a new practical index in the field of health and ageing to screen the successful AIP of older adults living alone.
Healthcare professionals’ experiences of being observed regarding hygiene routines: the Hawthorne effect in vascular surgery
Authors: Rezk Francis , Stenmarker Margaretha , Acosta Stefan , Johansson Karoline , Bengnér Malin , Åstrand Håkan , Andersson Ann-Christine
Published: May 2021

Background

The Hawthorne Effect is the change in behaviour by subjects due to their awareness of being observed and is evident in both research and clinical settings as a result of various forms of observation. When the Hawthorne effect exists, it is short-lived, and likely leads to increased productivity, compliance, or adherence to standard protocols. This study is a qualitative component of an ongoing multicentre study, examining the role of Incisional Negative Pressure Wound Therapy after vascular surgery (INVIPS Trial). Here we examine the factors that influence hygiene and the role of the Hawthorne effect on the adherence of healthcare professionals to standard hygiene precautions.

Methods

This is a qualitative interview study, investigating how healthcare professionals perceive the observation regarding hygiene routines and their compliance with them. Seven semi-structured focus group interviews were conducted, each interview included a different staff category and one individual interview with a nurse from the Department for Communicable Disease Control. Additionally, a structured questionnaire interview was performed with environmental services staff. The results were analysed based on the inductive qualitative content analysis approach.

Results

The analysis revealed four themes and 12 subthemes. Communication and hindering hierarchy were found to be crucial. Healthcare professionals sought more personal and direct feedback. All participants believed that there were routines that should be adhered to but did not know where to find information on them. Staff in the operating theatre were most meticulous in adhering to standard hygiene precautions. The need to give observers a clear mandate and support their work was identified. The staff had different opinions concerning the patient’s awareness of the importance of hygiene following surgery. The INVIPS Trial had mediated the Hawthorne effect.

Conclusion

The results of this study indicate that the themes identified, encompassing communication, behaviour, rules and routines, and work environment, influence the adherence of healthcare professionals to standard precautions to a considerable extent of which many factors could be mediated by a Hawthorne effect. It is important that managers within the healthcare system put into place an improved and sustainable hygiene care to reduce the rate of surgical site infections after vascular surgery.
A case report of atypical Kawasaki disease presented with severe elevated transaminases and literature review
Authors: Ren Yifan , Zhang Chuanxin , Xu Xiaoqin , Yin Yu
Published: May 2021

Background

Kawasaki disease (KD) is the most common cause of acquired heart disease among children in developed countries, in which the resulting coronary artery (CA) abnormalities cause myocardial ischemia, infarction, and death. Prompt diagnosis was essential, and supplemental information should be used to assist the diagnosis when classical clinical criteria are incomplete. The elevated levels of serum transaminases in most KD patients are mild. Herein, a case of atypical KD child with severely elevated transaminase was reported.

Case presentation

A child with clinical manifestations of fever, high C-reactive protein (CRP) and severely elevated transaminases was reported. The treatment effect of antibiotic and liver-protecting drugs was not satisfactory. A bilateral diffuse dilation of the CA was detected on echocardiography on day 5 of the illness; thus, atypical KD was diagnosed. Elevated transaminases declined rapidly to normal after the treatment of intravenous immunoglobulin (IVIG). A 1-month follow-up revealed that CA returned to normal, and 2-month, 6-months, and 1-year follow-up revealed the child was in good general health.

Conclusions

This case highlighted that atypical KD clinical symptoms were diverse, and severely elevated transaminases might provide a clue to healthcare providers for the diagnosis and management of atypical KD.
Lower birth weight-for-age and length-for-age z-scores in infants with in-utero HIV and ART exposure: a prospective study in Cape Town, South Africa
Authors: Nyemba Dorothy C. , Kalk Emma , Madlala Hlengiwe P. , Malaba Thokozile R. , Slogrove Amy L. , Davies Mary-Ann , Boulle Andrew , Myer Landon , Powis Kathleen M.
Published: May 2021

Background

Successful scale-up of antiretroviral therapy (ART) during pregnancy has minimized infant HIV acquisition, and over 1 million infants are born HIV-exposed but uninfected (HEU), with an increasing proportion also exposed in utero to maternal ART. While benefits of ART in pregnancy outweigh risks, some studies have reported associations between in utero ART exposure and impaired fetal growth, highlighting the need to identify the safest ART regimens for use in pregnancy.

Methods

We compared birth anthropometrics of infants who were HEU with those HIV-unexposed (HU) in Cape Town, South Africa. Pregnant women had gestational age assessed by ultrasound at enrolment. Women living with HIV were on ART (predominately tenofovir-emtricitabine-efavirenz) either prior to conception or initiated during pregnancy. Birth weights and lengths were converted to weight-for-age (WAZ) and length-for-age (LAZ) z-scores using Intergrowth-21st software. Linear regression was used to compare mean z-scores adjusting for maternal and pregnancy characteristics.

Results

Among 888 infants, 49% (n = 431) were HEU and 51% (n = 457) HU. Of 431 HEU infants, 62% (n = 268) were exposed to HIV and antiretrovirals (ARVs) from conception and 38% (n = 163) were exposed to ARVs during gestation but after conception (median fetal ARV exposure of 21 weeks [IQR; 17–26]). In univariable analysis, infants who were HEU had lower mean WAZ compared with HU [β = − 0.15 (95% Confidence Interval (CI): − 0.28, − 0.020)]. After adjustment for maternal age, gravidity, alcohol use, marital and employment status the effect remained [adjusted β − 0.14 (95%CI: − 0.28, − 0.01]. Similar differences were noted for mean LAZ in univariable [β − 0.20 (95%CI: − 0.42, − 0.01] but not multivariable analyses [adjusted β − 0.18 (95%CI: − 0.41, + 0.04] after adjusting for the same variables. Mean WAZ and LAZ did not vary by in utero ARV exposure duration among infants who were HEU.

Conclusion

In a cohort with high prevalence of ART exposure in pregnancy, infants who were HEU had lower birth WAZ compared with those HU. Studies designed to identify the mechanisms and clinical significance of these disparities, and to establish the safest ART for use in pregnancy are urgently needed.
Genetic alterations and their therapeutic implications in epithelial ovarian cancer
Authors: Lapke Nina , Chen Chien-Hung , Chang Ting-Chang , Chao Angel , Lu Yen-Jung , Lai Chyong-Huey , Tan Kien Thiam , Chen Hua-Chien , Lu Hsiao-Yun , Chen Shu-Jen
Published: May 2021

Background

Genetic alterations for epithelial ovarian cancer are insufficiently characterized. Previous studies are limited regarding included histologies, gene numbers, copy number variant (CNV) detection, and interpretation of pathway alteration patterns of individual patients.

Methods

We sequenced 410 genes to analyze mutations and CNV of 82 ovarian carcinomas, including high-grade serous (n = 37), endometrioid (n = 22) and clear cell (n = 23) histologies. Eligibility for targeted therapy was determined for each patient by a pathway-based approach. The analysis covered DNA repair, receptor tyrosine kinase, PI3K/AKT/MTOR, RAS/MAPK, cell cycle, and hedgehog pathways, and included 14 drug targets.

Results

Postulated PARP, MTOR, and CDK4/6 inhibition sensitivity were most common. BRCA1/2 alterations, PTEN loss, and gain of PIK3CA and CCND1 were characteristic for high-grade serous carcinomas. Mutations of ARID1A, PIK3CA, and KRAS, and ERBB2 gain were enriched in the other histologies. PTEN mutations and high tumor mutational burden were characteristic for endometrioid carcinomas. Drug target downstream alterations impaired actionability in all histologies, and many alterations would not have been discovered by key gene mutational analysis. Individual patients often had more than one actionable drug target.

Conclusions

Genetic alterations in ovarian carcinomas are complex and differ among histologies. Our results aid the personalization of therapy and biomarker analysis for clinical studies, and indicate a high potential for combinations of targeted therapies.
The D*Phase-study: study protocol for a pragmatic two-phased, randomised controlled (non-inferiority) trial that addresses treatment non-response and compares cognitive behavioural therapy and short-term psychodynamic supportive psychotherapy for major depression
Authors: Miggiels M. F. , ten Klooster P. M. , Bremer-Hoeve S. , Dekker J. J. M. , Huibers M. J. H. , Reefhuis E. , Van H. L. , van Dijk M. K.
Published: May 2021

Background

Several evidence-based psychotherapeutic treatment options are available for depression, but the treatment results could be improved. The D*Phase study directly compares short-term psychodynamic supportive psychotherapy (SPSP) and cognitive behavioural therapy (CBT) for Major Depressive Disorder (MDD). The objectives are 1. to investigate if, from a group level perspective, SPSP is not inferior to CBT in the treatment of major depressive disorder, 2. to build a model that may help predict the optimal type of treatment for a specific individual; and 3. to determine whether a change of therapist or a change of therapist and treatment method are effective strategies to deal with non-response. Furthermore (4.), the effect of the therapeutic alliance, treatment integrity and therapist allegiance on treatment outcome will be investigated.

Method

In this pragmatic randomised controlled trial, 308 patients with a primary diagnosis of MDD are being recruited from a specialised mental health care institution in the Netherlands. In the first phase, patients are randomised 1:1 to either SPSP or CBT. In case of treatment non-response, a second phase follows in which non-responders from treatment phase one are randomised 1:1:1 to one of three groups: continuing the initial treatment with the same therapist, continuing the initial treatment with another therapist or continuing the other type of treatment with another therapist. In both treatment phases, patients are offered sixteen twice-weekly psychotherapy sessions. The primary outcome is an improvement in depressive symptoms. Process variables, working alliance and depressive symptoms, are frequently measured. Comprehensive assessments take place before the start of the first phase (at baseline), in week one, two and four during the treatment, and directly after the treatment (week eight).

Discussion

While the naturalistic setting of the study involves several challenges, we expect, by focusing on a large and diverse number of research variables, to generate important knowledge that may help enhance the effect of psychotherapeutic treatment for MDD.

Trial registration

The study was registered on 26 August 2016 with the Netherlands Trial Register, part of the Dutch Cochrane Centre (NL5753),https://www.trialregister.nl/trial/5753
The Eating Disorders Genetics Initiative (EDGI): study protocol
Authors: Bulik Cynthia M. , Thornton Laura M. , Parker Richard , Kennedy Hannah , Baker Jessica H. , MacDermod Casey , Guintivano Jerry , Cleland Lana , Miller Allison L. , Harper Lauren , Larsen Janne T. , Yilmaz Zeynep , Grove Jakob , Sullivan Patrick F. , Petersen Liselotte V. , Jordan Jennifer , Kennedy Martin A. , Martin Nicholas G.
Published: May 2021

Background

The Eating Disorders Genetics Initiative (EDGI) is an international investigation exploring the role of genes and environment in anorexia nervosa, bulimia nervosa, and binge-eating disorder.

Methods

A total of 14,500 individuals with eating disorders and 1500 controls will be included from the United States (US), Australia (AU), New Zealand (NZ), and Denmark (DK). In the US, AU, and NZ, participants will complete comprehensive online phenotyping and will submit a saliva sample for genotyping. In DK, individuals with eating disorders will be identified by the National Patient Register, and genotyping will occur using bloodspots archived from birth. A genome-wide association study will be conducted within EDGI and via meta-analysis with other data from the Eating Disorders Working Group of the Psychiatric Genomics Consortium (PGC-ED).

Discussion

EDGI represents the largest genetic study of eating disorders ever to be conducted and is designed to rapidly advance the study of the genetics of the three major eating disorders (anorexia nervosa, bulimia nervosa, and binge-eating disorder). We will explicate the genetic architecture of eating disorders relative to each other and to other psychiatric and metabolic disorders and traits. Our goal is for EDGI to deliver “actionable” findings that can be transformed into clinically meaningful insights.

Trial registration

EDGI is a registered clinical trial: clinicaltrials.govNCT04378101.
Fluoride in the drinking water and dental caries experience by tooth surface susceptibility among adults
Authors: Stangvaltaite-Mouhat Lina , Puriene Alina , Stankeviciene Indre , Aleksejuniene Jolanta
Published: May 2021

Background

Dental caries is the most prevalent non-communicable health condition globally. The surface-based susceptibility hierarchy indicates that surfaces in the same group have similar susceptibility to caries, where the most susceptible group consists of occlusal surfaces of first molars and buccal surfaces of lower first molars, and the least susceptible surfaces are smooth and proximal surfaces of first premolars, canines and incisors. Therefore, fluoride in the drinking water could impact one group more than the other group. The present study examined the association between fluoride levels in the drinking water and dental caries experience in adults in the context of varying tooth surface susceptibility.

Methods

Data from the cross-sectional National Lithuanian Oral Health Survey conducted in 2017–2019 included a stratified random sample of 1398 35–74-year-olds (52% response rate). Dental caries experience in dentine was measured at a surface level. The surfaces were grouped according to their caries susceptibility (group 1 being the most and group 4 the least susceptible), and dental caries experience was calculated separately for each susceptibility group, creating four outcomes. Information about explanatory variable, fluoride levels in the drinking water, was provided by the water suppliers. The questionnaire inquired about potential determinants: sociodemographic characteristics and oral health-related behaviors. Chi-square, Mann–Whitney U and Kruskal Wallis tests were used for descriptive statistics, and linear regression analyses to examine the association between fluoride levels and four outcomes.

Results

The proportions of median decayed, missing, filled surfaces decreased following the surface-based susceptibility hierarchy (group 1–33%, group 2–28%, group 3–24%, group 4–15%). When adjusted for potential determinants, higher-level fluoride (≥ 0.7 ppm vs < 0.7 ppm) in the drinking water associated with lower dental caries experience in all surface-based susceptibility hierarchy groups; Group 1: β = − 0.23 (95 %CI − 0.44; − 0.001), Group 2: β = − 0.44 (95 %CI − 0.82; − 0.07), Group 3: β = − 1.14 (95 %CI − 1.88; − 0.41) and Group 4: β = − 6.28 (95 %CI − 9.29; − 3.30).

Conclusions

The higher-level fluoride in the drinking water associated with lower dental caries experience in adults and this was observed in all surface-based susceptibility groups. However, there is a need to validate the surface-based susceptibility hierarchy in longitudinal adult studies.
Student and educator perspectives on virtual institutional introductory pharmacy practice experience (IPPE)
Authors: Almohammed Omar A. , Alotaibi Lama H. , Ibn Malik Shatha A.
Published: May 2021

Background

The COVID-19 pandemic has required governments around the world to suspend face-to-face learning for school and university students. Colleges of pharmacy are faced with the challenge of training students in hospitals that are under considerable pressure at this time. The government of Saudi Arabia has moved all classes and training online to limit the spread of the virus. This study describes the experience of the Introductory and Advanced Pharmacy Practice Experience (IPPE and APPE) students and preceptors engaged in the virtual IPPE training.

Methods

A cross-sectional study was conducted to describe and appraise the implemented virtual IPPE training from the experiences of IPPE and APPE students, and their preceptor. The IPPE students described their experiences in close-ended questionnaires, while APPE students in open-ended questionnaires, and the preceptor described the experiences in narrative. The study focused on highlighting the advantages, opportunities, challenges, and shortcomings of the virtual training.

Results

Two preceptors and seven APPE students participated in the preparation and administration of the virtual training. The IPPE students’ experiences, based on 87 respondents, were mostly positive. Although IPPE students enjoyed the time flexibility that allowed the learning of new skills and reflection on previous experiences, 15% experienced difficulty finding quiet places with a reliable internet connection or had difficulty working on team-based activities. Moreover, some were anxious about the lack of adequate patient-care experience. On the other hand, the APPE students found the experience enriching as they gained experience and understanding of academic workflow, gained skills, and overcame the challenges they faced during this virtual training experience.

Conclusions

Future training programs should be organized to overcome the challenges and to maximize the benefits of training experiences. Schools of pharmacy may benefit from the training materials constructed, prepared, and administered by APPE students to improve IPPE students’ learning experiences and outcomes.