bluuebunny/crossref_metadata_2025 huggingface dataset:
The evolving moral economy of indebtedness in Chile: resignifying credit and debt in the oldest neoliberal society
Authors: Marambio-Tapia Alejandro
Published: June 2022

Credit is ubiquitous in the life of Chilean households, the oldest neoliberal society. It is a key feature in the budgeting, shopping, and consuming practices of families. Consequently, to be indebted is a normal expectation in Chile. Families engage with the ‘necessary evil’ of credit in different ways, representing a massive, regular use of credit as short, medium and long-term leverage tools, with store cards being the main source of credit for lower and moderate income families in general. Moral obligations together with conventional and unconventional financial knowledge accompany the everyday situated economic practices of families.

Addressing both the normalisation and the moralisation of credit, I attempt to make the case for the ongoing resignification of credit and debt and the evolving moral assessments of indebtedness, focusing on moderate and low-income households, namely those who embrace credit during recent decades. This article contributes to the discussion about the meaning of debt, to understand the financialisation of everyday life by looking at situated economic practices, and to recognise the social, moral and relational foundations of the economic practices. From the coming of the expansion of credit, households have learnt to deal with economic rationalities and internal and external moral judgements in order to justify their use of credit. Together with structural factors, this develops indebtedness assessments from detachment to naturalisation, placing credit and debt in the centre of ‘decent life’ expectations.
Evaluation of critical problems of heavy fuel oil separators on ships by best-worst method
Authors: Başhan Veysi , Demirel Hakan , Celik Erkan
Published: June 2022

It is known that trade by ship is a cheaper way than airway, land, and rail trade. One of the most important reasons for this is that ships use heavy fuel oil (HFO), which is cheap but also poor quality fuel. This HFO used in ships needs to be cleaned with machines called separators (purifiers). Therefore, the separator is one of the vital auxiliary machines on the ship. A satisfactory separation should be done in order to get rid of the effects such as water in the fuel, sludge formation, pump ability, mixing of different grades in the tanks, abrasion, and corrosion, which are the most important risks in the burning of fuel oil. Many problems are encountered while trying to make good separation. Therefore, in this article, 20 important problems that are frequently encountered in ship HFO separators are evaluated with the best-worst method (BWM) by consulting marine experts. Results show that dirty separator discs (also fractured or broken), wrong gravity disc choice (or bad interface position), and unsatisfactory bowl work are the most important problems among 20 critical and frequent separator problems. Problems and results are very important in terms of smooth ship machinery operations and we think that this study will close this gap in the literature by ordering and identifying problems and also solution recommendations.
Challenges of Asian international students in the U.S. Public affairs programs: A cross-discipline review
Authors: Zhang Yahong , Warner Lois , Mao Hanjin
Published: June 2022

Scholars have perceived a globalization process in higher education and recognized the influx of international students, especially students from Asia, in the U.S. programs of public affairs as a factual aspect of the globalization of the academic profession. However, the studies that examine international students’ experiences and challenges in the public affairs programs have remained scarce. This article broadens the literature review to multiple disciplines in order to understand the common challenges experienced by Asian international students while it identifies the particular challenges of international students in public affairs programs. Based on the cross-discipline literature review, this article highlights the lessons that American public affairs programs can take in order to provide more accommodating and inclusive educational environments to international students. It also recognizes the missing areas in the literature about the challenges of Asian international students in American public affairs programs that future studies are expected to investigate.
College Freshmen’s Wellness Center Usage, Physical Activity, and Symptoms of Depression
Authors: Leonard Allison , (Stella) Liu Hung-Ling
Published: June 2022

The purpose of the study was to investigate the relationship between wellness center use and depressive symptoms to increase understanding of how campus recreation affects first-year college students’ mental health. A total of 172 first-year college students at a midsize university completed an in-person questionnaire. Based on their Patient Health Questionnaire (PHQ-8) scores, 54% of the students reported some depressive symptoms. A series chi-square analysis indicated: (1) female students tended to report a higher depressive symptom score than male students; (2) freshmen who use the wellness center more often or who go to the center with a friend reported less severe depressive symptoms, and (3) students who have participated in open recreation or intramural sports also reported fewer depressive symptoms than students who never participated in these activities. Our findings showed the importance of social interaction in college freshmen’s recreation participation to reduce depressive symptoms.
Comment: Getting Our Affect Together: Shared Representations as the Core of Empathy
Authors: Marsh Abigail A.
Published: June 2022

Empathy is a construct that is notoriously difficult to define. Murphy and colleagues ( 2022 ) argue for leaning into the construct's inherent fuzziness and reverting to what they term a classical definition informed by the observations of philosophers and clinicians: as a dynamic, “unfolding process of imaginatively experiencing the subjective consciousness of another person, sensing, understanding, and structuring the world as if one were that person.” Although consistent with some historical conceptualizations, this definition risks incorporating so many processes it would make empathy difficult to operationalize or distinguish from any generally socially sensitive interaction. Defining empathy instead as the attempted representation, or simulation, of another's subjective internal experiences (whether sensory, affective, or cognitive) would increase its clarity and empirical utility.
Management of Toxicological Emergencies in the School Setting: An Overview for School Nurses Part 3
Authors: Deitche Amy L. , Burda Anthony M.
Published: June 2022

School nurses may encounter a variety of poisoning and overdose scenarios in the school setting. Younger students are more likely to experience unintentional exposures that are usually lower in toxicity, with the risk for harm increasing with age for reasons including substance abuse, self-harm, and exposure to more toxic ingestants. Poison Control Centers are uniquely qualified to assist public and health professionals, including school nurses, with poisoning and overdose incidents and are available 24 hours per day. This article is Part 3 of a series of three articles and focuses on poisonings related to environmental hazards that may be found in the school setting. Information includes expected clinical effects, potential for serious injury, and a reasonable approach to manage exposures for the following substances of potential harm: disinfectants and cleaners, lab accidents and other hazardous material incidents, poisonous mushrooms, and plants differentiating between poisonous, minimally toxic, and nontoxic plants.
Impact of Perfectionism and Resilience on Empathy in Medical Students: A Cross-Sectional Study
Authors: Rafaqat Wardah , Sami Ashmal , Ibrahim Muhammad Talal , Ibad Hamza , Awais Sheharbano , Memon Ayesha , Shahbaz Fatima Farrukh , Ahmed Daniyaal , Zindani Shahzaib , Leghari Abdul Lateef , Saleem Sarah
Published: June 2022

Empathy is a cognitive attribute that forms the cornerstone for good doctor–patient encounters. The formative period for the development of empathy toward patients begins with clinical encounters within medical school. An individual medical student's empathy levels may in part be a product of their resilience and perfectionist attitudes. A cross-sectional study with 320 medical students across all years of study was conducted to determine the correlation of perfectionism and resilience with clinical empathy in medical students. The JSE-S, CD-RISC 10, and APS-R scales were used to assess levels of empathy, resilience, and perfectionism, respectively. The study found that a positive correlation exists between resilience ( r = 0.174) and academic year with empathy, and a negative correlation exists between maladaptive perfectionism and empathy ( r = −0.138). The resilience score declined progressively as the year of study progressed with a statistically significant. Mean empathy scores were lowest in fifth-year students (96.8 ± 12.5) and highest in third-year students (107.8 ± 13.2). Further longitudinal studies are necessary to better understand the impact of resilience and perfectionism on empathy.
Normotensive scleroderma renal crisis as the presenting symptom of systemic sclerosis sine scleroderma: A case report
Authors: Hassan Fadi , Sabbah Firas , Naffaa Mohammad E
Published: June 2022

Scleroderma renal crisis is a rare but serious complication of systemic sclerosis. It is usually associated with marked hypertension and carries significant risk for morbidity and mortality. Its occurrence prior to the development of skin sclerosis is exceedingly rare. We report a case of a patient who presented with recurrent pericardial effusion and later tested positive for anti-nuclear and anti-topoisomerase antibodies. He later developed normotensive renal crisis as confirmed by kidney biopsy despite complete absence of skin involvement. To our knowledge, this is the first published case of a patient presenting with normotensive renal crisis without any skin involvement.
Development and use of a checklist for the implementation of medication for opioid use disorder in jails
Authors: Ludwig Ariel , Monico Laura B. , Blue Thomas , Gordon Michael S. , Schwartz Robert P. , Mitchell Shannon Gwin
Published: June 2022

Background:

In light of short lengths of stay and proximity to communities of release, jails are well-positioned to intervene in opioid use disorder (OUD). However, a number of barriers have resulted in a slow and limited implementation.

Methods:

This paper describes the development and testing of a Medication for Opioid Use Disorder (MOUD) Implementation Checklist developed as part of a Building Bridges project, a two-year planning grant which supported 16 US jail systems as they prepared to implement or expand MOUD services.

Results:

Although initially developed to track changes within sites participating in the initiative, participants noted its utility for identifying evidence-based benchmarks through which the successful implementation of MOUDs could be tracked by correctional administrators.

Conclusions:

The findings suggest that this checklist can both help guide and illustrate progress toward vital changes facilitated through established processes and supports.

Plain Language Summary:

People incarcerated in jails are more likely to have opioid use disorder than the general population. Despite this, jails in the United States (U.S.) often offer limited or no access to Medication for Opioid Use Disorder (MOUD). The Building Bridges project was designed to address this gap in 16 U.S. jail systems as they prepared to implement or expand MOUD services. This article addresses the use of a MOUD checklist that was initially designed to help the jails track changes toward evidence-based benchmarks. The findings suggest that this checklist can both help guide and illustrate progress toward vital changes facilitated through established processes and supports.
Biologics in severe asthma: the role of real-world evidence from registries
Authors: Paoletti Giovanni , Pepys Jack , Casini Marta , Di Bona Danilo , Heffler Enrico , Goh Celine Y.Y. , Price David B. , Canonica Giorgio Walter
Published: June 2022

Asthma is one of the most common noncommunicable diseases; in the majority of patients it is well controlled with inhaled bronchodilators and inhaled corticosteroids, but the management of severe asthma has been a significant challenge historically. The introduction of novel biologic drugs in the past few decades has revolutionised the field, presenting physicians with a variety of biologic drugs with different mechanisms for the treatment of severe asthma.

It is of crucial importance to evaluate the effectiveness of these drugs by following their “real-life” effectiveness rather than relying solely on their efficacy, established in carefully designed clinical trials, which therefore do not necessarily match the profile of the real-life patient. Understanding the actual effectiveness of the specific drugs in real-life patients is a crucial part of tailoring the right drugs to the right patients. Registries serve as an important tool in obtaining real-life evidence, since they are in effect observational studies, following the entire patient population.
Sfcnn: a novel scoring function based on 3D convolutional neural network for accurate and stable protein–ligand affinity prediction
Authors: Wang Yu , Wei Zhengxiao , Xi Lei
Published: June 2022

Background

Computer-aided drug design provides an effective method of identifying lead compounds. However, success rates are significantly bottlenecked by the lack of accurate and reliable scoring functions needed to evaluate binding affinities of protein–ligand complexes. Therefore, many scoring functions based on machine learning or deep learning have been developed to improve prediction accuracies in recent years. In this work, we proposed a novel featurization method, generating a new scoring function model based on 3D convolutional neural network.

Results

This work showed the results from testing four architectures and three featurization methods, and outlined the development of a novel deep 3D convolutional neural network scoring function model. This model simplified feature engineering, and in combination with Grad-CAM made the intermediate layers of the neural network more interpretable. This model was evaluated and compared with other scoring functions on multiple independent datasets. The Pearson correlation coefficients between the predicted binding affinities by our model and the experimental data achieved 0.7928, 0.7946, 0.6758, and 0.6474 on CASF-2016 dataset, CASF-2013 dataset, CSAR_HiQ_NRC_set, and Astex_diverse_set, respectively. Overall, our model performed accurately and stably enough in the scoring power to predict the binding affinity of a protein–ligand complex.

Conclusions

These results indicate our model is an excellent scoring function, and performs well in scoring power for accurately and stably predicting the protein–ligand affinity. Our model will contribute towards improving the success rate of virtual screening, thus will accelerate the development of potential drugs or novel biologically active lead compounds.
Comparisons of the segments of left-sided double-lumen tracheobronchial tubes as industrial products
Authors: Wajima Zen’ichiro , Shiga Toshiya , Imanaga Kazuyuki
Published: June 2022

Background

Although there are at least seven manufacturers producing left-sided double-lumen tubes (DLTs), there have been few reports comparing the segments of these DLTs. In this study, we compared various segments of left-sided DLTs further.

Materials and methods

We examined five manufacturers’ left-sided DLTs: Mallinckrodt, Portex, Rüsch, Sheridan, and Daiken-medical. We conducted the following six trials or measurements, and three supplemental trials or measurements: First, we tried to pass various sizes of steel balls down each lumen in order from the smallest (3 mm) to largest (4.5 mm). If the ball passed on the first attempt, we tried just once; otherwise, we made a second attempt. Second, we measured the external diameter of tracheal and bronchial cuff using a profile projector. Third, we measured the length of the cuff and tip of the bronchial segment of the tubes using the profile projector. Fourth, we measured various lengths of the tubes. Fifth, we measured the external diameter of both lumens and the tubules for tracheal and bronchial cuff inflation. Finally, we measured various cross-sectional areas including the tracheal lumen, bronchial lumen, and tubules for cuff inflation. We also conducted three supplemental studies. First, we measured air volume in the cuff when intracuff pressure equaled 2 or 3 kPa. Second, we defined the configuration of the tracheal and bronchial cuffs. Third, we defined the presence or absence of bevels and also measured the angle of the bevels using the profile projector.

Results

We performed nine trials and measurements and found large disparities between each manufacturer’s tubes.

Conclusions

The large disparities found between the measurements of the five manufacturers’ tubes may be due to different lots or changes in specifications made by each manufacturer. We found tubes exhibiting lower quality, such as deformations, and non-universal and inconsistent sizing, in the comparison of the manufacturers’ tubes. Practitioners should be aware of the features and aspects of these tubes.
Risk of thrombotic events and other complications in anticoagulant users infected with SARS-CoV-2: an observational cohort study in primary health care in SIDIAP (Catalonia, Spain)
Authors: Giner-Soriano Maria , Gomez-Lumbreras Ainhoa , Vedia Cristina , Ouchi Dan , Morros Rosa
Published: June 2022

Background

The risk of thromboembolic events and COVID-19 complications in anticoagulated patients once hospitalized has been widely analyzed. We aim to assess these outcomes in primary health care (PHC) patients chronically treated with oral anticoagulants (OAC) in comparison with non-treated.

Methods

Cohort study including adults with COVID-19 diagnosis in the PHC records in Catalonia, Spain; from March to June 2020. Patients were matched between exposed and non-exposed to OAC based on age and gender in a 1:2 design. Data source is the Information System for Research in Primary Care (SIDIAP).

Results

We included 311,542 individuals with COVID-19. After propensity score matching, we obtained a cohort of 20,360 people, 10,180 exposed and 10,180 non-exposed to OAC. Their mean age was 79.9 and 52.1% were women. Patients exposed to OAC had a higher frequency of comorbidities than non-exposed. Anticoagulated patients had a higher risk of hospital admission (IRR 1.16, 95% CI 1.03–1.29), and of stroke and pulmonary embolism than non-anticoagulated (IRR 1,80, 95% CI 1.06–3.06). The risk of pneumonia was not different between groups (IRR 1.04, 95% CI 0.84–1.30). We found a lower risk of death in patients exposed to OAC (IRR 0.60, 95% CI 0.55–0.65).

Conclusions

OAC users in our study had more comorbidities and were older than non-users, well known risks for hospitalization being confirmed with our results. We also found in our study that OAC exposure was not associated to an increased risk in the mortality rate, and it was associated with higher risks of hospital admission and thromboembolic events, although we cannot assess the effect of the interventions applied during hospital admission on the outcomes studied, as our database is a PHC database.

Trial registration

EUPAS register: EUPAS37205.
Carers using assistive technology in dementia care at home: a mixed methods study
Authors: Sriram Vimal , Jenkinson Crispin , Peters Michele
Published: June 2022

Introduction

Informal carers support persons with dementia to live at home, even with deteriorating physical, social and cognitive issues. This study aims to examine the experiences and impact of Assistive Technology (AT) on carers, providing care for a person with dementia.

Methods

This is an explanatory sequential mixed methods study. The quantitative phase was an online and postal survey using the Carers Assistive Technology Experience Questionnaire and Short Form-12 (SF-12) questionnaire, with carers of persons with dementia in the UK, who used AT. The qualitative phase involved in-depth telephone interviews with a purposive sample of survey respondents and was analysed using hermeneutic phenomenology to develop, compare and explain the findings of the survey.

Results

The survey included data from 201 carers. Smartphones (45.5%) and tablet computers (45.0%) were the most frequently used AT. Multiple AT were used in the care of persons with dementia predominantly for safety (78.5%), communication (66.0%), and reminders (62.5%). The SF-12 indicated that carers in the 46–65 age group and carers who were not extremely satisfied with AT had lower mental component scores whilst carers who lived with the person with dementia and older carers had lower physical component scores. Twenty-three carers participated in the interviews, and 5 themes with 14 sub-themes were identified. The interviews helped confirm data from the survey on the impact of AT on the physical, mental and social wellbeing of the carers. It helped describe reasons for satisfaction with AT; how AT was used in daily life and strengthened caring relationships and how wider support systems enhanced the care of a person with dementia using AT.

Conclusions

This study describes the use of AT in the real-world context. AT supplements the care provided to people with dementia in the community. Appropriate use, access to AT and abilities of the carer can enhance the support provided through AT to both carers and the person with dementia.
Midwives’ experiences of reducing maternal morbidity and mortality from postpartum haemorrhage (PPH) in Eastern Nigeria
Authors: Kalu Felicity Agwu , Chukwurah Joan N.
Published: June 2022

Background

Postpartum haemorrhage (PPH) is one of the major complications of childbirth which may result in maternal morbidity and mortality, especially in low and middle-income countries like Nigeria. Midwives play a vital role in preventing and managing PPH in Nigerian rural communities. The aim of this study is to understand the experiences of midwives in rural maternity care settings in order to provide appropriate support and improve practice.

Methods

An exploratory, qualitative study of a purposive sample of 15 practicing midwives was carried out using semi-structured interviews from November 2018 to February 2019. Data were transcribed verbatim and analyzed using content analysis.

Results

Four themes were identified: 1. interventions for preventing PPH; 2. approaches to managing PPH; 3. challenges of preventing and managing PPH and 4. ways of supporting midwives to overcome these challenges in rural health care settings. Midwives employed various strategies, such as antenatal education, diagnosis and treatment of anaemia to counteract complications from possible PPH. Understanding PPH as a life-threatening condition enabled the midwives to provide holistic and effective management that sometimes involved a multidisciplinary team approach. Inadequate resources and delay in seeking health care, however, militate against their efforts. The midwives also identified the need for continuing education and training to enhance their standards of care.

Conclusion

These midwives in Nigerian rural health care settings engage in preventive practices and active management of PPH though not without barriers, such as inadequate resources. There is a need for midwives in rural areas to have cultural competence, be provided with adequate resources and participate in ongoing education in order to be more effective.
Synergistic anti-proliferative activity of JQ1 and GSK2801 in triple-negative breast cancer
Authors: Yellapu Nanda Kumar , Ly Thuc , Sardiu Mihaela E. , Pei Dong , Welch Danny R. , Thompson Jeffery A. , Koestler Devin C.
Published: June 2022

Background

Triple-negative breast cancer (TNBC) constitutes 10–20% of breast cancers and is challenging to treat due to a lack of effective targeted therapies. Previous studies in TNBC cell lines showed in vitro growth inhibition when JQ1 or GSK2801 were administered alone, and enhanced activity when co-administered. Given their respective mechanisms of actions, we hypothesized the combinatorial effect could be due to the target genes affected. Hence the target genes were characterized for their expression in the TNBC cell lines to prove the combinatorial effect of JQ1 and GSK2801.

Methods

RNASeq data sets of TNBC cell lines (MDA-MB-231, HCC-1806 and SUM-159) were analyzed to identify the differentially expressed genes in single and combined treatments. The topmost downregulated genes were characterized for their downregulated expression in the TNBC cell lines treated with JQ1 and GSK2801 under different dose concentrations and combinations. The optimal lethal doses were determined by cytotoxicity assays. The inhibitory activity of the drugs was further characterized by molecular modelling studies.

Results

Global expression profiling of TNBC cell lines using RNASeq revealed different expression patterns when JQ1 and GSK2801 were co-administered. Functional enrichment analyses identified several metabolic pathways (i.e., systemic lupus erythematosus, PI3K-Akt, TNF, JAK-STAT, IL-17, MAPK, Rap1 and signaling pathways) enriched with upregulated and downregulated genes when combined JQ1 and GSK2801 treatment was administered. RNASeq identified downregulation of PTPRC, MUC19, RNA5-8S5, KCNB1, RMRP, KISS1 and TAGLN (validated by RT-qPCR) and upregulation of GPR146, SCARA5, HIST2H4A, CDRT4, AQP3, MSH5-SAPCD1, SENP3-EIF4A1, CTAGE4 and RNASEK-C17orf49 when cells received both drugs. In addition to differential gene regulation, molecular modelling predicted binding of JQ1 and GSK2801 with PTPRC, MUC19, KCNB1, TAGLN and KISS1 proteins, adding another mechanism by which JQ1 and GSK2801 could elicit changes in metabolism and proliferation.

Conclusion

JQ1-GSK2801 synergistically inhibits proliferation and results in selective gene regulation. Besides suggesting that combinatorial use could be useful therapeutics for the treatment of TNBC, the findings provide a glimpse into potential mechanisms of action for this combination therapy approach.
Interfering with the expression of EEF1D gene enhances the sensitivity of ovarian cancer cells to cisplatin
Authors: Xu Qia , Liu Yun , Wang Shenyi , Wang Jing , Liu Liwei , Xu Yin , Qin Yide
Published: June 2022

Background

Eukaryotic translation elongation factors 1 δ (EEF1D), has garnered much attention with regards to their role in the drug resistance of cancers. In this paper, we investigated the effects and mechanisms of increasing the sensitivity of ovarian cancer cells to cisplatin or cis-dichlorodiammine platinum (DDP) by knockdown and knockout of EEF1D gene in cellular and animal models.

Methods

The EEF1D gene was knocked-down or -out by siRNA or CRISPR/Cas9 respectively in human ovarian cancer cell SKOV3, DDP-resistant subline SKOV3/DDP, and EEF1D gene in human primary ovarian cancer cell from 5 ovarian cancer patients with progressive disease/stable disease (PD/SD) was transiently knocked down by siRNA interference. The mice model bearing xenografted tumor was established with subcutaneous inoculation of SKOV3/DDP.

Results

The results show that reducing or removing EEF1D gene expression significantly increased the sensitivity of human ovarian cancer cells to DDP in inhibiting viability and inducing apoptosis in vitro and in vivo, and also boosted DDP to inhibit xenografted tumor growth. Interfering with EEF1D gene expression in mice xenografted tumor significantly affected the levels of OPTN, p-Akt, Bcl-2, Bax, cleaved caspase-3 and ERCC1 compared to DDP treated mice alone, and had less effect on PI3K, Akt and caspase-3.

Conclusions

The knocking down or out EEF1D gene expression could enhance the sensitivity of ovarian cancer cells to DDP partially, which may be achieved via inactivating the PI3K/AKT signaling pathway, thus inducing cell apoptosis and decreasing repairment of DNA damage. Our study provides a novel therapeutic strategy for the treatment of ovarian cancer.
Clinical determinants of recurrence in pTa bladder cancer following transurethral resection of bladder tumor
Authors: Jeong Seung-hwan , Han Jang Hee , Jeong Chang Wook , Kim Hyeon Hoe , Kwak Cheol , Yuk Hyeong Dong , Ku Ja Hyeon
Published: June 2022

Background

Non-muscle invasive bladder cancer can be controlled by transurethral resection of bladder (TURB), but suffers from frequent recurrences in 60–70% of cases. Although, recurrence interval after TURB influences treatment course and prognosis, its implication and risk factors have not been fully elucidated. We evaluated the risk factors of early (within 1 yr) and late (after 1 yr) recurrence of pTa bladder cancer and clinical significance of recurrence interval on disease progression and overall survival.

Methods

In this study, pTa bladder cancer patients enrolled in prospective patient registry system of Seoul National University, SUPER-UC, were retrospectively examined to determine the clinical risk factors for recurrence and its significance regarding to recurrence interval. A total of 1067 bladder cancer patients who underwent TURB between March 20 and June 2021 were included and classified into three groups of no recurrence, early, or late recurrence to be comparatively analyzed.

Results

Early recurrence was associated with poorer cystectomy-free survival and overall survival than late recurrence. Risk factors for early recurrence included a high number of previous TURB, tumor multiplicity, tumor location, tumor shape, incompleteness of TURB, and high tumor grade. Otherwise, late recurrence was associated with low-grade tumors with insufficient TURB depth.

Conclusion

Patients with risk factors for early recurrence should be closely followed up with special cautions.
Correction: Using the Goal Attainment Scale adapted for depression to better understand treatment outcomes in patients with major depressive disorder switching to vortioxetine: a phase 4, single-arm, open-label, multicenter study
Authors: McCue Maggie , Sarkey Sara , Eramo Anna , François Clement , Parikh Sagar V.
Published: June 2022

Graphical Abstract
Relationship between rural self-efficacy and rural career intent after rural clinical training: a study on medical students in Japan
Authors: Kawamoto Ryuichi , Ninomiya Daisuke , Kikuchi Asuka , Tokumoto Yoshio , Kumagi Teru
Published: June 2022

Background

In Japan, community medicine clerkships facilitate positive attitudes toward rural medical practice and encourage rural recruitment. Rural self-efficacy has been shown to influence rural career intent following a rural clinical placement. However, the impact of subjective difficulties of living in a rural area on future rural career intent is also important. This study aims to explore whether rural self-efficacy influences the relationship between difficulty with living in a rural area and rural career intent. 

Methods

The subjects included 308 male and 255 female participants aged 20–41 [median (interquartile range): 22 (21–22)] years. Rural self-efficacy was based on a validated scale consisting of 15 questions. Difficulty with living in a rural area was measured asking students. A cohort survey was conducted to evaluate the effect of the rural self-efficacy score on the rural career intent of Japanese medical students after they completed their rural clinical training.

Results

The following variables were significantly associated with a higher rural self-efficacy score: female sex (p = 0.003), age < 21 years (p = 0.013), having a doctor as a role model (p < 0.001), gaining admission through a school recommendation (p = 0.016), living in a rural or remote area until the age of 18 years (p = 0.018), and orientation towards general medicine (p < 0.001). In addition, baseline difficulty with living in a rural area was significantly associated with a lower self-efficacy score (p < 0.001). Participants with a stronger intent to practice in a rural area before rural clinical training had higher rural self-efficacy and showed a stronger positive rural career intent after rural clinical training (p < 0.001). A multivariable logistic regression analysis demonstrated that difficulty with living in a rural area [odds ratio (OR): 0.61; 95% confidence interval (CI), 0.39–0.84] was still associated with lower rural career intent after rural clinical training, independent of all confounders such as gender, age, scholarship for regional duty, rural background, and orientation towards general medicine. However, when rural self-efficacy (OR, 1.12; 95% CI, 1.07–1.16) was added as a factor for rural career intent, difficulty with living in a rural area (OR, 0.68; 95% CI, 0.43–1.06) was no longer observed as an associated factor.

Conclusion

Subjective difficulty with living in a rural area was shown to reduce future rural career intent, but high rural self-efficacy ameliorated this decline.
Under careful construction: combining findings, arguments, and values into robust health care coverage decisions
Authors: Kleinhout-Vliek T.H. , De Bont A.A. , Boer A.
Published: June 2022

Background

Health care coverage decisions deal with health care technology provision or reimbursement at a national level. The coverage decision report, i.e., the publicly available document giving reasons for the decision, may contain various elements: quantitative calculations like cost and clinical effectiveness analyses and formalised and non-formalised qualitative considerations. We know little about the process of combining these heterogeneous elements into robust decisions.

Methods

This study describes a model for combining different elements in coverage decisions. We build on two qualitative cases of coverage appraisals at the Dutch National Health Care Institute, for which we analysed observations at committee meetings (n = 2, with field notes taken) and the corresponding audio files (n = 3), interviews with appraisal committee members (n = 10 in seven interviews) and with Institute employees (n = 5 in three interviews), and relevant documents (n = 4).

Results

We conceptualise decisions as combinations of elements, specifically (quantitative) findings and (qualitative) arguments and values. Our model contains three steps: 1) identifying elements; 2) designing the combinations of elements, which entails articulating links, broadening the scope of designed combinations, and black-boxing links; and 3) testing these combinations and choosing one as the final decision.

Conclusions

Based on the proposed model, we suggest actively identifying a wider variety of elements and stepping up in terms of engaging patients and the public, including facilitating appeals. Future research could explore how different actors perceive the robustness of decisions and how this relates to their perceived legitimacy.
The impact of Raynaud’s phenomenon on work ability – a longitudinal study
Authors: Stjernbrandt Albin , Wahlström Jens
Published: June 2022

Objective

To determine if having Raynaud’s phenomenon (RP) affects the work ability, job retainment, or occurrence of sick leave.

Methods

Surveys on the working-age general population of northern Sweden were conducted in 2015 and 2021, gathering data on RP, occupation and sick leave. Work ability was assessed using the Work Ability Score.

Results

The study population consisted of 2,703 women and 2,314 men, among which 390 women and 290 men reported RP at follow-up. For women, the mean [standard deviation (SD)] Work Ability Score was 8.02 (2.24) for subjects reporting RP and 7.68 (2.46) for those without RP. For men, the corresponding numbers were 7.37 (2.03) and 7.61 (2.14), respectively. Multiple linear regression did not show an association between RP status and work ability (p = 0.459 for women andp = 0.254 for men), after adjusting for age, body mass index, physical workload, cardiovascular disease, and perceived stress. Having retained the same main livelihood since baseline was reported by 227 (58.5%) women with RP, 1,163 (51.2%) women without RP, 152 (52.6%) men with RP, and 1,075 (54.1%) men without RP (p = 0.002 for women andp = 0.127 for men). At follow-up, any occurrence of sick leave during the last year was reported by 80 (21.4%) women with RP, 410 (18.6%) women without RP, 48 (17.1%) men with RP, and 268 (13.7%) men without RP (p = 0.208 for women andp = 0.133 for men). Among those reporting sick leave, the mean (SD) duration in months was 2.93 (3.76) for women with RP, 3.00 (4.64) for women without RP, 2.77 (3.79) for men with RP, and 2.91 (12.45) for men without RP (p = 0.849 for women andp = 0.367 for men).

Conclusion

For neither women nor men was there a significant effect of having RP on work ability. Women with RP reported a slightly higher job retainment compared to those without the condition, while there was no difference in job retainment among men. For neither gender did the presence of RP influence the occurrence of recent sick leave, nor did it affect the length of time away from work.
Historical overview and update on relapsing fever group Borrelia in Latin America
Authors: Faccini-Martínez Álvaro A. , Silva-Ramos Carlos Ramiro , Santodomingo Adriana M. , Ramírez-Hernández Alejandro , Costa Francisco B. , Labruna Marcelo B. , Muñoz-Leal Sebastián
Published: June 2022

Relapsing fever group Borrelia(RFGB) are motile spirochetes transmitted to mammalian or avian hosts through the bite of hematophagous arthropods, such as soft ticks (Argasidae), hard ticks (Ixodidae) and the human clothing lice. RFGB can infect pets such as dogs and cats, as well as birds, cattle and humans.Borrelia recurrentis,B. anserinaandB. theileriare considered to have worldwide distribution, affecting humans, domestic birds and ruminants, respectively.Borreliaspp. associated with soft ticks are transmitted mainly byOrnithodorosticks and thrive in endemic foci in tropical and subtropical latitudes. Nowadays, human cases of soft tick-borne relapsing fever remain neglected diseases in several countries, and the impact these spirochetes have on the health of wild and domestic animals is largely understudied. Human infection with RFGB is difficult to diagnose, given the lack of distinguishing clinical features (undifferentiated febrile illness). Clinically, soft tick or louse-borne relapsing fever is often confused with other etiologies, such as malaria, typhoid or dengue. In Latin America, during the first half of the twentieth century historical documents elaborated by enlightened physicians were seminal, and resulted in the identification of RFGB and their associated vectors in countries such as Mexico, Panama, Colombia, Venezuela, Peru and Argentina. Almost 80 years later, research on relapsing fever spirochetes is emerging once again in Latin America, with molecular characterizations and isolations of novel RFGB members in Panama, Bolivia, Brazil and Chile. In this review we summarize historical aspects of RFGB in Latin America and provide an update on the current scenario regarding these pathogens in the region. To accomplish this, we conducted an exhaustive search of all the published literature for the region, including old medical theses deposited in libraries of medical academies. RFGB were once common pathogens in Latin America, and although unnoticed for many years, they are currently the focus of interest among the scientific community. A One Health perspective should be adopted to tackle the diseases caused by RFGB, since these spirochetes have never disappeared and the maladies they cause may be confused with etiologies with similar symptoms that prevail in the region.

Graphical Abstract
Lameness prevalence and management practices on Irish pasture-based dairy farms
Authors: Browne N. , Hudson C. D. , Crossley R. E. , Sugrue K. , Kennedy E. , Huxley J. N. , Conneely M.
Published: June 2022

Background

Lameness is a painful disease, which negatively impacts dairy cow production and welfare. The aim of this observational study was to determine herd lameness prevalence, describe current lameness management practices and identify the presence of established risk factors for lameness on Irish pasture-based dairy farms. Farms were visited once during grazing (99 farms) and again during housing (85 farms). Lameness scoring was carried out at each visit (AHDB 0–3 scale); cows were classified as lame if they scored two or three. Farm management practices and infrastructure characteristics were evaluated via farmer questionnaires and direct measurements of farm infrastructure.

Results

Median herd-level lameness prevalence was 7.9% (interquartile range = 5.6 – 13.0) during grazing and 9.1% (interquartile range = 4.9 – 12.0) during housing; 10.9% of cows were lame at a single visit and 3.5% were lame at both visits (chronically lame or had a repeat episode of lameness). Fifty-seven percent of farmers were not familiar with lameness scoring and only one farm carried out lameness scoring. Only 22% of farmers kept records of lame cows detected, and 15% had a lameness herd health plan. Twenty-eight percent of farmers waited more than 48 h to treat a lame cow, and 21% waited for more than one cow to be identified as lame before treating. Six percent of farmers carried out routine trimming and 31% regularly footbathed (> 12 times per year). Twelve percent put severely lame cows in a closer paddock and 8% stated that they used pain relief to treat severely lame cows. Over 50% of farms had at least one cow track measurement that was classified as rough or very rough, and cow tracks were commonly narrow for the herd size. On 6% of farms, all cubicle beds were bare concrete (no matting or bedding) and on a further 6% of farms, there was a combination of cubicles with and without matting or bedding. On 56% of farms, all pens contained less than 1.1 cubicles per cow and on 28% of farms, a proportion of pens contained less than 1.1 cubicles per cow.

Conclusions

Overall, this study identified infrastructure and management practices which could be improved upon. The comparatively low lameness prevalence demonstrated, compared to fully housed systems, also highlights the benefits of a pasture-based system for animal welfare; however, there remains scope for improvement.
Effects of exercise habituation and aging on the intersegmental coordination of lower limbs during walking with sinusoidal speed change
Authors: Abe Daijiro , Motoyama Kiyotaka , Tashiro Takehiro , Saito Akira , Horiuchi Masahiro
Published: June 2022

Background

The time courses of the joint elevation angles of the thigh, shank, and foot in one stride during walking can be well approximated by a “plane” in a triaxial space. This intersegmental coordination (IC) of the lower limb elevation angles is referred to as the planar covariation law. We examined the effects of exercise habituation and aging on the thickness of the IC plane of the lower limbs under sinusoidal speed changing conditions.

Methods

Seventeen sedentary young (SY), 16 active young (AY), and 16 active elderly (AE) adults walked on a treadmill in accordance with a sinusoidal speed changing protocol at 120, 60, and 30 s periods with an amplitude of ± 0.56 m·s−1. Motion of the lower limbs from the sagittal direction was recorded to calculate the elevation angles of the lower limbs. When the best-fit IC plane was determined, the smallest standard deviation of the IC plane was considered as the anteroposterior gait variability of the lower limbs. The coefficient of variance of the step width was also quantified to evaluate the lateral step variability (CVSW).

Results

The standard deviation of the IC plane was significantly greater in the order of SY, AY, and AE, regardless of the sinusoidal wave periods of the changing speed. The CVSW was not significantly different among the three groups.

Conclusions

Exercise habituation influences anteroposterior gait variability of the lower limbs, but not lateral step variability, even in young adults. Given these, gait adaptability for sinusoidal speed changes does not always decline with aging.

Trial registration

UMIN000031456 (R000035911; registered February 23, 2018).
The role of disconnection in explaining disability in multiple sclerosis
Authors: Lapucci Caterina , Schiavi Simona , Signori Alessio , Sbragia Elvira , Bommarito Giulia , Cellerino Maria , Uccelli Antonio , Inglese Matilde , Roccatagliata Luca , Pardini Matteo
Published: June 2022

Background

In multiple sclerosis, the correlation between white matter lesion volumes (LV) and expanded disability status scale (EDSS) is at best moderate, leading to the “clinico-radiological paradox”, influenced by many factors, including the lack of information on the spatial localisation of each lesion on synthetic metrics such as LV. We used a probabilistic approach to provide the volume of WM tracts that may be disconnected by lesions and to evaluate its correlation with EDSS.

Methods

Forty-five patients (aged 37.4 ± 6.8 years, mean ± standard deviation; 30 females; 29 relapsing-remitting, 16 progressive) underwent 3-T magnetic resonance imaging. Both LV and the volume of the tracts crossing the lesioned regions (disconnectome volume, DV) were calculated using BCBtoolkit and correlated with EDSS.

Results

T1-weighted LV and DV significantly correlated with EDSS (p ≤ 0.006 r ≥ 0.413) as it was for T2-weighted LV and T2-weighted DV (p ≤ 0.004 r ≥ 0.430), but only T1-weighetd and T2-weighted DVs were EDSS significant predictors (p ≤ 0.001). The correlations of T1-weighted and T2-weighted LV with EDSS were significantly mediated by DV, while no effect of LV on the EDSS-DV correlation was observed.

Conclusion

The volume of disconnected WM bundles mediates the LV-EDSS correlation, representing the lonely EDSS predictor.
Validity between self-report and biochemical testing of cannabis and drugs among patients with traumatic injury: brief report
Authors: Salottolo Kristin , McGuire Emmett , Madayag Robert , Tanner Allen H. , Carrick Matthew M. , Bar-Or David
Published: June 2022

Background

The relationship between drug use and traumatic injury is well documented, yet only a small proportion of patients are biochemically tested for cannabis and other substances. The study objective was to determine whether patient self-report can be used as a proxy for biochemical drug testing following traumatic injury.

Methods

This study was a secondary analysis that included 320 patients admitted to four level I trauma centers in Colorado and Texas, primarily involved in motor vehicle crash (89%). If performed, biochemical testing was collected via urine toxicology screen (“tox screen”) for cannabis, amphetamines, barbiturates, cocaine, opiates, PCP, and benzodiazepines. All patients were screened for self-reported current drug use, which was evaluated for any drug and specifically for cannabis use. Analyses used to compare results of self-reported drug use and tox screen included sensitivity, specificity, positive, and negative predictive values, and percent agreement.

Results

Among 320 patients, 23% (n = 75) self-reported drug use; cannabis was the most frequently reported drug (n = 63). A tox screen was performed in 59% of patients (n = 190); the proportion of patients who had a tox screen was similar for those self-reporting drug use (60.0%) to those who denied using drugs (59.2%), p = 0.90. Among patients who had a tox screen performed, 18% (n = 35) tested positive for any drug, 12% (n = 22) tested positive for THC, and 7% (n = 13) tested positive for opiates. The percent agreement was 80% for any drug and 81% for cannabis. The specificity was 84–85%, indicating a high likelihood that a patient will not have a positive tox screen if they do not report using drugs. Negative predictive values were 90–95%, indicating a negative self-report correctly identified nearly all patients testing negative on tox screen. Sensitivity was only 60% and positive predictive values were 30–47% for cannabis and drugs, respectively.

Conclusion

These findings may negate the need for biochemical drug testing in this population, particularly as a “rule out” based on self-reporting. Future studies are needed to confirm these findings and should address risk of selection bias.