bluuebunny/crossref_metadata_2025 huggingface dataset:
Striking a Balance: Sibling Emotionality and the Negotiation of Power in an Eighteenth-Century Noble Family of the Austrian Netherlands
Authors: Geussens Liesbeth
Published: July 2021

This article examines the emotional dynamics between six siblings of the Merode family in the eighteenth century and the ways in which they used emotional expression as a mechanism to communicate and negotiate existing forms of power within their sibling group. Using the extensive personal correspondence between the siblings, the article explores how the hierarchical nature of their relationship related to expectations of unity, arguing that the siblings had to find a balance between keeping the peace and challenging inequality related to gender, age, and marital status. Sibling emotionality played an important role in negotiating these unequal power dynamics.
Revealing problems, pointing fingers, and creating impact A survey of investigative reporters/editors regarding journalistic impact
Authors: Dahmen Nicole , Walth Brent
Published: July 2021

One measure of success for investigative reporting is impact: Did the story lead to any sort of outcome, from public awareness and dialogue to meaningful policy change? While investigative reporting is historically impact-oriented, there is a dearth of academic scholarship as to what journalists seek and expect when it comes to generating impact. Using data from a national survey of investigative reporters/editors, this research develops a more holistic conceptualization of journalistic impact.
Synthesis of casein-γ-polyglutamic acid hydrogels by microbial transglutaminase-mediated gelation for controlled release of drugs
Authors: Wang Xin , Gou Chenchen , Gao Chunyuan , Song Yazhen , Zhang Jinming , Huang Jihong , Hui Ming
Published: July 2021

Casein-based hydrogels were reported as biodegradability, biocompatibility, and non-toxic materials that had potential in drug delivery. At present, we prepared two kinds of casein/γ-PGA hybrid hydrogels, 1/5 and 1/9, based on the ratio of γ-PGA to casein. The hydrogels were crosslinked by microbial transglutaminase (MTG), the physicochemical properties of the casein/γ-PGA hydrogels were investigated by scanning electron microscopy (SEM) observation, differential scanning calorimetry (DSC) analysis, texture analysis, swelling ratio test, and stability test. The hydrogels showed a well-interconnected sparse and porous structure. The 1/5 casein/γ-PGA hydrogel was much stable, hard, and cohesive than the 1/9 casein/γ-PGA hydrogel, and the 1/5 casein/γ-PGA hydrogel showed a higher swelling ratio and lower degradation rate. To investigate in vitro release behavior, we chose the hydrophilic vitamin B12 and hydrophobic aspirin as the model drugs incorporated into the casein/γ-PGA hydrogels. The 1/5 casein/γ-PGA hydrogel exhibited a good drug release behavior.
The politics of care during COVID-19: The visibility of anti-virus measures in Wuhan
Authors: Sier Willy
Published: July 2021

This article employs the concept of care as a lens through which to examine the anti-COVID-19 measures taken in post-lockdown Wuhan. Based on photographs that depict the Chinese response to COVID-19 at the epicentre of the virus outbreak, the article analyses the visibility of anti-virus measures as a form of government communication inscribed textually and symbolically onto the urban landscape. The state demonstrates its care and capability by implementing highly visible high-tech measures to contain the virus. Bringing care into the literature on crisis management in China sheds light on the Chinese state’s reaction to COVID-19 in eliciting nationalist sentiments and positive feelings of cooperation while stigmatizing critical voices as uncooperative and unpatriotic. It shows that care is central not only to the functioning of liberal democracies: the Chinese state also relies on narratives about care to showcase the superiority of its political system and to distinguish between desirable and unwanted forms of citizens’ political engagement after the COVID-19 outbreak.
Self-Control at 220 Miles per Hour: Steering and Braking to Achieve Optimal Outcomes During Adolescence
Authors: Vohs Kathleen D. , Piquero Alex R.
Published: July 2021

Adolescence is a developmental period characterized by heightened attraction to rewards and risk-taking propensities. Dual-systems models portray the adolescent brain in terms of a maturational mismatch whereby brain systems involved in sensitivity to incentives become potentiated before impulse-control systems have matured. That perspective implies that relying on impulse inhibition to overcome temptation is likely to yield uneven success during adolescence. Using the analogy of practice driving a race car, we propose another process that leads to achieving healthy outcomes: steering aimed at limiting or preventing motivational conflict and thereby lessening reliance on impulse control (termed braking). The focal idea is that the more adolescents can avoid troublesome contexts, the less they will need to depend on their relatively weak impulse-control abilities to avert problems and danger. Recent work links dispositional differences in self-control to indicators of steering, such as situation selection, habit cultivation, and proactive responding. Steering to curb or avoid motivational conflict could be key to promoting healthy outcomes during adolescence, a developmental period characterized by vulnerability to risk, and could have lasting importance given that enduring patterns of unhealthy, dangerous, and self-defeating behaviors often start during this period.
Superior pitch identification ability is associated with better mental rotation performance
Authors: Hou Jiancheng , Chen Chuansheng , Dong Qi , Prabhakaran Vivek , Nair Veena A.
Published: July 2021

Musicians with absolute pitch ability show better spatial ability, but little is known about whether non-musicians’ pitch identification (PI) ability is associated with their spatial ability. In the present study, a PI test, two mental rotation (MR) tests (Three-Dimensional Mental Rotation [3DMR] and Spatial Relationship [SR]), and eight executive function (EF) tests were administered to a large sample ( N = 525) of Chinese college students who were non-music majors. A subsample with superior PI ability ( n = 42) was identified and compared with a sample with average PI ability matched in age and IQ ( n = 42). Two-way analysis of covariance (ANCOVA) (PI ability x musical training, with gender as a covariate due to a minor difference in matching by gender) revealed that superior PI ability was associated with better performance on MR and various EF tests. Musical training was associated with performance on select visual and EF tests (i.e., visual perception, working memory, and executive attention control), but not with MR performance. Additional ANCOVA showed that PI ability was significantly associated with 3DMR, but not SR, even after scores on EF tests were included as covariates. These results indicate a unique association between PI ability and 3DMR, which helps shed light on the cognitive mechanisms related to PI ability.
Helping Entrepreneurs Help Themselves: A Review and Relational Research Agenda on Entrepreneurial Support Organizations
Authors: Bergman Brian J. , McMullen Jeffery S.
Published: July 2021

Entrepreneurial support organizations (ESOs), such as incubators and accelerators, are now ubiquitous. Despite this proliferation, their impact on entrepreneurs, ventures, and communities remains unclear, while academic research remains disjointed and largely descriptive, limiting understanding of the entrepreneurial support process and the influence of ESOs on it. Conducting a systematic review of 337 peer-reviewed articles involving five ESO forms—incubators, science parks, accelerators, maker spaces, and co-working spaces—we find that the literature’s conception of support is under-socialized such that there is a need for longitudinal, processual, and experimental examination of changes in the rich relationships between entrepreneurs and their ventures, entrepreneurs and other entrepreneurs, entrepreneurs and ESOs, and ESOs and external stakeholders. Conceiving of support as help to become self-sufficient, we offer an alternative, relational approach to research on entrepreneurial support and those organizations seeking to provide it.
Peripheral B cells repress B-cell regeneration in aging through a TNF-α/IGFBP-1/IGF-1 immune-endocrine axis
Authors: Dowery Reem , Benhamou David , Benchetrit Eli , Harel Ofer , Nevelsky Alex , Zisman-Rozen Simona , Braun-Moscovici Yolanda , Balbir-Gurman Alexandra , Avivi Irit , Shechter Arik , Berdnik Daniela , Wyss-Coray Tony , Melamed Doron
Published: July 2021

Loss of B lymphocyte regeneration in the bone marrow (BM) is an immunologic hallmark of advanced age, which impairs the replenishment of peripheral B-cell subsets and results in impaired humoral responses, thereby contributing to immune system dysfunction associated with aging. A better understanding of the mechanism behind this loss may suggest ways to restore immune competence and promote healthy aging. In this study, we uncover an immune-endocrine regulatory circuit that mediates cross-talk between peripheral B cells and progenitors in the BM, to balance B-cell lymphopoiesis in both human and mouse aging. We found that tumor necrosis factor α (TNF-α), which is increasingly produced by peripheral B cells during aging, stimulates the production of insulin-like growth factor-binding protein 1 (IGFBP-1), which binds and sequesters insulin-like growth factor 1 (IGF-1) in the circulation, thereby restraining its activity in promoting B-cell lymphopoiesis in the BM. Upon B-cell depletion in aging humans and mice, circulatory TNF-α decreases, resulting in increased IGF-1 and reactivation of B-cell lymphopoiesis. Perturbation of this circuit by administration of IGF-1 to old mice or anti–TNF-α antibodies to human patients restored B-cell lymphopoiesis in the BM. Thus, we suggest that in both human and mouse aging, peripheral B cells use the TNF-α/IGFBP-1/IGF-1 axis to repress B-cell lymphopoiesis. This trial was registered at www.clinicaltrials.govas#NCT00863187.
Response to upfront azacitidine in juvenile myelomonocytic leukemia in the AZA-JMML-001 trial
Authors: Niemeyer Charlotte M. , Flotho Christian , Lipka Daniel B. , Starý Jan , Rössig Claudia , Baruchel André , Klingebiel Thomas , Micalizzi Concetta , Michel Gérard , Nysom Karsten , Rives Susana , Schmugge Liner Markus , Zecca Marco , Schönung Maximilian , Baumann Irith , Nöllke Peter , Benettaib Bouchra , Biserna Noha , Poon Jennifer , Simcock Mathew , Patturajan Meera , Menezes Daniel , Gaudy Allison , van den Heuvel-Eibrink Marry M. , Locatelli Franco
Published: July 2021

Allogeneic hematopoietic stem cell transplantation (HSCT) is the only curative therapy for most children with juvenile myelomonocytic leukemia (JMML). Novel therapies controlling the disorder prior to HSCT are needed. We conducted a phase 2, multicenter, open-label study to evaluate the safety and antileukemic activity of azacitidine monotherapy prior to HSCT in newly diagnosed JMML patients. Eighteen patients enrolled from September 2015 to November 2017 were treated with azacitidine (75 mg/m2) administered IV once daily on days 1 to 7 of a 28-day cycle. The primary end point was the number of patients with clinical complete remission (cCR) or clinical partial remission (cPR) after 3 cycles of therapy. Pharmacokinetics, genome-wide DNA-methylation levels, and variant allele frequencies of leukemia-specific index mutations were also analyzed. Sixteen patients completed 3 cycles and 5 patients completed 6 cycles. After 3 cycles, 11 patients (61%) were in cPR and 7 (39%) had progressive disease. Six of 16 patients (38%) who needed platelet transfusions were transfusion-free after 3 cycles. All 7 patients with intermediate- or low-methylation signatures in genome-wide DNA-methylation studies achieved cPR. Seventeen patients received HSCT; 14 (82%) were leukemia-free at a median follow-up of 23.8 months (range, 7.0-39.3 months) after HSCT. Azacitidine was well tolerated and plasma concentration-–time profiles were similar to observed profiles in adults. In conclusion, azacitidine monotherapy is a suitable option for children with newly diagnosed JMML. Although long-term safety and efficacy remain to be fully elucidated in this population, these data demonstrate that azacitidine provides valuable clinical benefit to JMML patients prior to HSCT. This trial was registered at www.clinicaltrials.gov as #NCT02447666.
Research on the drought tolerance mechanism of Pennisetum glaucum (L.) in the root during the seedling stage
Authors: Zhang Ailing , Ji Yang , Sun Min , Lin Chuang , Zhou Puding , Ren Juncai , Luo Dan , Wang Xiaoshan , Ma Congyu , Zhang Xinquan , Feng Guangyan , Nie Gang , Huang Linkai
Published: July 2021

Background

Drought is one of the major environmental stresses resulting in a huge reduction in crop growth and biomass production. Pearl millet (Pennisetum glaucum L.) has excellent drought tolerance, and it could be used as a model plant to study drought resistance. The root is a very crucial part of plant that plays important roles in plant growth and development, which makes it a focus of research.

Results

In this study, we explored the mechanism of drought tolerance of pearl millet by comparing physiological and transcriptomic data under normal condition and drought treatment at three time points (1 h, 3 h and 7 h) in the root during the seedling stage. The relative electrical conductivity went up from 1 h to 7 h in both control and drought treatment groups while the content of malondialdehyde decreased. A total of 2004, 1538 and 605 differentially expressed genes were found at 1 h, 3 h and 7 h respectively and 12 genes showed up-regulation at all time points. Some of these differentially expressed genes were significantly enriched into ‘metabolic processes’, ‘MAPK signaling pathway’ and ‘plant hormone signal transduction’ such as the ABA signal transduction pathway in GO and KEGG enrichment analysis.

Conclusions

Pearl millet was found to have a quick drought response, which may occur before 1 h that contributes to its tolerance against drought stress. These results can provide a theoretical basis to enhance the drought resistance in other plant species.
Poor clinical outcomes associated with suboptimal antibiotic treatment among older long-term care facility residents with urinary tract infection: a retrospective cohort study
Authors: Appaneal Haley J. , Shireman Theresa I. , Lopes Vrishali V. , Mor Vincent , Dosa David M. , LaPlante Kerry L. , Caffrey Aisling R.
Published: July 2021

Background

Antibiotic use is associated with several antibiotic-related harms in vulnerable, older long-term care (LTC) residents. Suboptimal antibiotic use may also be associated with harms but has not yet been investigated. The aim of this work was to compare rates of poor clinical outcomes among LTC residents with UTI receiving suboptimal versus optimal antibiotic treatment.

Methods

We conducted a retrospective cohort study among residents with an incident urinary tract infection (UTI) treated in Veterans Affairs LTC units (2013–2018). Potentially suboptimal antibiotic treatment was defined as use of a suboptimal initial antibiotic drug choice, dose frequency, and/or excessive treatment duration. The primary outcome was time to a composite measure of poor clinical outcome, defined as UTI recurrence, acute care hospitalization/emergency department visit, adverse drug event, Clostridioides difficile infection (CDI), or death within 30 days of antibiotic discontinuation. Shared frailty Cox proportional hazard regression models were used to compare the time-to-event between suboptimal and optimal treatment.

Results

Among 19,701 LTC residents with an incident UTI, 64.6% received potentially suboptimal antibiotic treatment and 35.4% experienced a poor clinical outcome. In adjusted analyses, potentially suboptimal antibiotic treatment was associated with a small increased hazard of poor clinical outcome (aHR 1.06, 95% CI 1.01–1.11) as compared with optimal treatment, driven by an increased hazard of CDI (aHR 1.94, 95% CI 1.54–2.44).

Conclusion

In this national cohort study, suboptimal antibiotic treatment was associated with a 6% increased risk of the composite measure of poor clinical outcomes, in particular, a 94% increased risk of CDI. Beyond the decision to use antibiotics, clinicians should also consider the potential harms of suboptimal treatment choices with regards to drug type, dose frequency, and duration used.
Rationale and design to evaluate the PRIME Parkinson care model: a prospective observational evaluation of proactive, integrated and patient-centred Parkinson care in The Netherlands (PRIME-NL)
Authors: Ypinga Jan H. L. , Van Halteren Angelika D. , Henderson Emily J. , Bloem Bastiaan R. , Smink Agnes J. , Tenison Emma , Munneke Marten , Ben-Shlomo Yoav , Darweesh Sirwan K. L.
Published: July 2021

Background

Culminating evidence shows that current care does not optimally meet the needs of persons with parkinsonism, their carers and healthcare professionals. Recently, a new model of care was developed to address the limitations of usual care: Proactive and Integrated Management and Empowerment in Parkinson’s Disease (PRIME Parkinson). From 2021 onwards, PRIME Parkinson care will replace usual care in a well-defined region in The Netherlands. The utility of PRIME Parkinson care will be evaluated on a single primary endpoint (parkinsonism-related complications), which reflects the health of people with parkinsonism. Furthermore, several secondary endpoints will be measured for four dimensions: health, patient and carer experience, healthcare professional experience, and cost of healthcare. The reference will be usual care, which will be continued in other regions in The Netherlands.

Methods

This is a prospective observational study which will run from January 1, 2020 until December 31, 2023. Before the new model of care will replace the usual care in the PRIME Parkinson care region all baseline assessments will take place. Outcomes will be informed by two data sources. We will use healthcare claims-based data to evaluate the primary endpoint, and costs of healthcare, in all persons with parkinsonism receiving PRIME Parkinson care (estimated number: 2,000) and all persons with parkinsonism receiving usual care in the other parts of The Netherlands (estimated number: 48,000). We will also evaluate secondary endpoints by performing annual questionnaire-based assessments. These assessments will be administered to a subsample across both regions (estimated numbers: 1,200 persons with parkinsonism, 600 carers and 250 healthcare professionals).

Discussion

This prospective cohort study will evaluate the utility of a novel integrated model of care for persons with parkinsonism in The Netherlands. We anticipate that the results of this study will also provide insight for the delivery of care to persons with parkinsonism in other regions and may inform the design of a similar model for other chronic health conditions.
Sepsis scoring systems and use of the Sepsis six care bundle in maternity hospitals
Authors: Abutheraa Nouf , Grant June , Mullen Alexander B.
Published: July 2021

Background

This study aimed to assess the predictive power of three different Sepsis Scoring Systems (SSSs), namely maternity Systematic Inflammatory Response Syndrome (mSIRS), quick Sepsis-related Organ Failure Assessment (qSOFA) and Modified Early Warning System (MEWS) in identifying sepsis by comparing them with positive culture. This study also sought to evaluate compliance with using the Sepsis Six Care Bundle (SSCB) operated in an individual health board.

Methods

A retrospective cohort study was conducted in 3 maternity hospitals of a single Scottish health board that admitted 2690 pregnancies in a 12 weeks period in 2016. Data for study was obtained from medical notes, handheld and electronic health records for women who were prescribed antibiotics with a confirmed or suspected diagnosis of sepsis. Data on clinical parameters was used to classify women according to mSIRS, qSOFA and MEWS as having sepsis or not and this was compared to results of positive culture to obtain sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under Receiver Operating Characteristic curve (AUROC) along with their 95% confidence intervals. Data was also obtained on SSCB compliance.

Results

A total of 89 women were diagnosed with sepsis, of which 14 had missing data, leaving 75 for final analysis. Sensitivity, specificity, PPV, NPV and AUROC of mSIRS and MEWS were almost similar with AUROC of both being around 50%. Only 33 (37.1%) had identifiable sepsis six sticker displayed on medical notes and only 2 (2.2%) had all elements of SSCB delivered within the recommended one-hour post-diagnosis period. Blood culture and full blood count with other lab tests had been performed for most women (97%) followed by intravenous antibiotics and fluids (93.9%).

Conclusions

mSIRS and MEWS were quite similar in detecting sepsis when compared to positive culture, with their ability to detect sepsis being close to chance. This underlines the need for creating a valid SSS with high sensitivity and specificity for clinical use in obstetric settings. Clinical use of SSCB was limited despite it being a health board policy, although there is considerable possibility of improvement following detailed audits and removal of barriers for implementing SSCB.
Development of the Woman-Centred Care Scale- Midwife Self Report (WCCS-MSR)
Authors: Davis Deborah L. , Creedy Debra K. , Bradfield Zoe , Newnham Elizabeth , Atchan Marjorie , Davie Lorna , McAra-Couper Judith , Graham Kristen , Griffiths Christine , Sweet Linda , Stulz Virginia
Published: July 2021

Background

Woman-centred care is recognised as a fundamental construct of midwifery practice yet to date, there has been no validated tool available to measure it. This study aims to develop and test a self-report tool to measure woman-centred care in midwives.

Methods

A staged approach was used for tool development including deductive methods to generate items, testing content validity with a group of experts, and psychometrically testing the instrument with a sample drawn from the target audience. The draft 58 item tool was distributed in an online survey using professional networks in Australia and New Zealand. Testing included item analysis, principal components analysis with direct oblimin rotation and subscale analysis, and internal consistency reliability.

Results

In total, 319 surveys were returned. Analysis revealed five factors explaining 47.6% of variance. Items were reduced to 40. Internal consistency (.92) was high but varied across factors. Factors reflected the extent to which a midwife meets the woman’s unique needs; balances the woman’s needs within the context of the maternity service; ensures midwifery philosophy underpins practice; uses evidence to inform collaborative practice; and works in partnership with the woman.

Conclusion

The Woman-Centred Care Scale-Midwife Self Report is the first step in developing a valid and reliable tool to enable midwives to self-assess their woman-centredness. Further research in alternate populations and refinement is warranted.
A Phase 2a cohort expansion study to assess the safety, tolerability, and preliminary efficacy of CXD101 in patients with advanced solid-organ cancer expressing HR23B or lymphoma
Authors: Booth Stephen W. , Eyre Toby A. , Whittaker John , Campo Leticia , Wang Lai Mun , Soilleux Elizabeth , Royston Daniel , Rees Gabrielle , Kesavan Murali , Hildyard Catherine , Kazmi Farasat , La Thangue Nick , Kerr David , Middleton Mark R. , Collins Graham P.
Published: July 2021

Background

This Phase 2a dose expansion study was performed to assess the safety, tolerability and preliminary efficacy of the maximum tolerated dose of the oral histone de-acetylase (HDAC) inhibitor CXD101 in patients with relapsed / refractory lymphoma or advanced solid organ cancers and to assess HR23B protein expression by immunohistochemistry as a biomarker of HDAC inhibitor sensitivity.

Methods

Patients with advanced solid-organ cancers with high HR23B expression or lymphomas received CXD101 at the recommended phase 2 dose (RP2D). Key exclusions: corrected QT > 450 ms, neutrophils < 1.5 × 109/L, platelets < 75 × 109/L, ECOG > 1. Baseline HR23B expression was assessed by immunohistochemistry.

Results

Fifty-one patients enrolled between March 2014 and September 2019, 47 received CXD101 (19 solid-organ cancer, 28 lymphoma). Thirty-four patients received ≥80% RP2D. Baseline characteristics: median age 57.4 years, median prior lines 3, male sex 57%. The most common grade 3–4 adverse events were neutropenia (32%), thrombocytopenia (17%), anaemia (13%), and fatigue (9%) with no deaths on CXD101. No responses were seen in solid-organ cancers, with disease stabilisation in 36% or patients; the overall response rate in lymphoma was 17% with disease stabilisation in 52% of patients. Median progression-free survival was 1.2 months (95% confidence interval (CI) 1.2–5.4) in solid-organ cancers and 2.6 months (95%CI 1.2–5.6) in lymphomas. HR23B status did not predict response.

Conclusions

CXD101 showed acceptable tolerability with efficacy seen in Hodgkin lymphoma, T-cell lymphoma and follicular lymphoma. Further studies assessing combination approaches are warranted.

Trial registration

ClinicalTrials.gov identifier NCT01977638. Registered 07 November 2013.
Detailed corneal and genetic characteristics of a pediatric patient with macular corneal dystrophy - case report
Authors: Nowińska Anna , Chlasta-Twardzik Edyta , Dembski Michał , Wróblewska-Czajka Ewa , Ulfik-Dembska Klaudia , Wylęgała Edward
Published: July 2021

Background

Corneal dystrophies are a group of rare, inherited disorders that are usually bilateral, symmetric, slowly progressive, and not related to environmental or systemic factors. The majority of publications present the advanced form of the disease with a typical clinical demonstration. The initial signs and symptoms of different epithelial and stromal corneal dystrophies are not specific; therefore, it is very important to establish the early characteristic corneal features of these disorders that could guide the diagnostic process.

Case presentation

The main purpose of this study was to report the differential diagnosis of a pediatric patient with bilateral anterior corneal involvement suspected of corneal dystrophy. An 8-year-old male patient presented with asymptomatic, persistent, superficial, bilateral, diffuse, anterior corneal opacities. Slit lamp examination results were not specific. Despite the lack of visible stromal involvement on the slit lamp examination, corneal analysis based on confocal microscopy and optical coherence tomography revealed characteristic features of macular corneal dystrophy (MCD). The diagnosis of MCD was confirmed by CHST6 gene sequencing. The early corneal characteristic features of MCD, established based on the findings of this case report, include corneal astigmatism (not specific), diffuse corneal thinning without a pattern of corneal ectasia (specific), and characteristic features on confocal microscopy (specific), including multiple, dark, oriented striae at different corneal depths.

Conclusions

The clinical examination should be complemented with corneal imaging techniques, such as confocal microscopy and optical coherence tomography. In patients suspected of corneal dystrophy, genetic testing plays an important role in establishing the final diagnosis.
Topography-guided corneal surface laser ablation combined with simultaneous accelerated corneal collagen cross-linking for treatment of keratoconus
Authors: Zhang Yu , Chen Yueguo
Published: July 2021

Background

to study the outcomes of topography-guided customized excimer laser subepithelial ablation combined with accelerated CXL for progressive keratoconus.

Methods

Thirty-one eyes of 30 patients with progressive keratoconus were included in this prospective study. Topography-guided excimer laser ablation without refractive correction was performed. Simultaneous accelerated collagen cross-linking with ultraviolet light of 30 mW/cm2 for 4 min was followed. Uncorrected distance visual acuity (UCVA), manifest refraction, corrected distance visual acuity (CDVA), tomograghy were examined at postoperative 1, 6, and 12 months.

Results

UDVA improved slightly after surgery (P > 0.05). BSCDVA improved significantly from 0.32 ± 0.20 logMAR to 0.15 ± 0.14 logMAR at postoperative 12 months (P < 0.05). During 12-month follow-ups, there were no significant differences in manifest refraction and corneal keratometry except for maximal keratometry value of the anterior surface (Kapex), which decreased significantly from 57.23 ± 5.09D to 53.13 ± 4.47D (P < 0.05). Even though the thinnest corneal thickness decreased from 465 ± 24 μm to 414 ± 35 μm (P < 0.05), curvature asymmetry index front (SIf), keratoconus vertex front (KVf) and Baiocchi Calossi Versaci index front (BCVf) decreased significantly till postoperative 12 months (P < 0.05). Corneal higher-order aberrations and coma also decreased significantly till 12 months after surgery (P < 0.05).

Conclusions

Topography-guided surface ablation without refractive correction combined with simultaneous accelerated collagen cross-linking provided good stability in refraction and corneal curvature, and also showed significant improvement in BSCDVA, corneal regularity and corneal optical quality.
The role of mental health symptomology and quality of life in predicting referrals to special child and adolescent mental health services
Authors: Yoon Yeosun , Deighton Jessica , Wickersham Alice , Edbrooke-Childs Julian , Osborn David , Viding Essi , Downs Johnny
Published: July 2021

Background

Children and adolescents’ mental health problems have been largely assessed with conventional symptom scales, for example, Strengths and Difficulties Questionnaire (SDQ) given that it is one of the mostly widely used measures in specialist Child and Adolescent Mental Health Services (CAMHS). However, this emphasis on symptom scales might have missed some important features of the mental health challenges that children and young people experience including day to day functioning and life satisfaction aspect (i.e. qualify of life).

Method

The study examined longitudinal association between a young person’s self-perceptions of quality of life and mental health difficulties and referral to specialist CAMHS service using a population cohort study (Targeted Mental Health in Schools service data) nested within a large-scale linkage between school (National Pupil Data base) and child mental health service administrative data (South London and Maudsley NHS Foundation Trust children and adolescent mental health services health records). Cox proportional hazard regression to estimate crude and adjusted hazard ratios (HRs) for the association between participant psychopathology, and incidence of CAMHS referral.

Results

Pupils experiencing more behavioural difficulties, had an increased incidence of CAMHS referral (adjusted hazard ratio 1.1, 95% confidence interval 1.0–1.2). However, pupils who reported higher health related quality of life had a lower incidence of CAMHS referral over the follow-up period (adjusted hazard hario 0.94, 95% confidence interval 0.9–0.98).

Conclusion

Children and young people’s perception of their quality of life should be considered at the stages of a clinical needs assessment.
Association between sleep quality and depression among institutionalized and community older people - Brazilian Western Amazonia
Authors: de Paula Rebouças Cleide Maria , Ribeiro Maura Regina , Zangilorami-Raimundo Juliana , de Lima Bezerra Polyana Caroline , das Chagas de Souza Júnior Angelo Márcio , da Silva Souza Nair , Pereira Janaina Ribeiro , Soares Júnior José Maria , de Paula Rebouças da Costa Larissa Maria , de Abreu Luiz Carlos , Raimundo Rodrigo Daminello
Published: July 2021

Background

The transition in the population pyramid is a reality in several locations around the world and projections of an increase in the older population in Brazil demonstrate the relevance of studies on factors that may interfere in the functionality and quality of life in this age group. Thus, the present study aims to assess depression levels and their relationship with sleep quality in institutionalized and community older adults.

Methods

This cross-sectional study included 220 older people of both sexes, divided into two groups, institutionalized older adults, and community older adults. The older adults were monitored by Community Health Agents (CHA), through identification of everyone in their micro area using a method of random name generation, based on geographic location. Due to the small number of institutionalized older adults, all residents in the institutions were recruited, according to the inclusion and exclusion criteria. The Geriatric Depression Scale (GDS-15) and Pittsburgh Sleep Quality Index (PSQI) were used to assess depression and sleep quality.

Results

Among the 220 older adults, 175 were community members and 45 were institutionalized. The survey revealed that institutionalized older adults had a higher percentage of severe depression compared to community dwelling older adults (p <  0.039).

Conclusion

Older adults in the community present greater symptoms of depression and better sleep than institutionalized older adults. There was a direct association between sleep quality and depression. In our sample, being institutionalized and female positively influenced and feeling alone negatively influenced depressive symptoms.
Reported sources of health inequities in Indigenous Peoples with chronic kidney disease: a systematic review of quantitative studies
Authors: Huria Tania , Pitama Suzanne G. , Beckert Lutz , Hughes Jaquelyne , Monk Nathan , Lacey Cameron , Palmer Suetonia C.
Published: July 2021

Background

To summarise the evidentiary basis related to causes of inequities in chronic kidney disease among Indigenous Peoples.

Methods

We conducted a Kaupapa Māori meta-synthesis evaluating the epidemiology of chronic kidney diseases in Indigenous Peoples. Systematic searching of MEDLINE, Google Scholar, OVID Nursing, CENTRAL and Embase was conducted to 31 December 2019. Eligible studies were quantitative analyses (case series, case-control, cross-sectional or cohort study) including the following Indigenous Peoples: Māori, Aboriginal and Torres Strait Islander, Métis, First Nations Peoples of Canada, First Nations Peoples of the United States of America, Native Hawaiian and Indigenous Peoples of Taiwan. In the first cycle of coding, a descriptive synthesis of the study research aims, methods and outcomes was used to categorise findings inductively based on similarity in meaning using the David R Williams framework headings and subheadings. In the second cycle of analysis, the numbers of studies contributing to each category were summarised by frequency analysis.

Completeness of reporting related to health research involving Indigenous Peoples was evaluated using the CONSIDER checklist.

Results

Four thousand three hundred seventy-two unique study reports were screened and 180 studies proved eligible. The key finding was that epidemiological investigators most frequently reported biological processes of chronic kidney disease, particularly type 2 diabetes and cardiovascular disease as the principal causes of inequities in the burden of chronic kidney disease for colonised Indigenous Peoples. Social and basic causes of unequal health including the influences of economic, political and legal structures on chronic kidney disease burden were infrequently reported or absent in existing literature.

Conclusions

In this systematic review with meta-synthesis, a Kaupapa Māori methodology and the David R Williams framework was used to evaluate reported causes of health differences in chronic kidney disease in Indigenous Peoples. Current epidemiological practice is focussed on biological processes and surface causes of inequity, with limited reporting of the basic and social causes of disparities such as racism, economic and political/legal structures and socioeconomic status as sources of inequities.
Exploring differences in perceptions of child feeding practices between parents and health care professionals: a qualitative study
Authors: Rohit Athira , Kirkham Renae , McCarthy Leisa , Puruntatameri Valentina , Maple-Brown Louise , Brimblecombe Julie
Published: July 2021

Background

Evidence on child feeding practice is often based on the perspectives and experiences of parents and less that of health practitioners. In this study, we explored child feeding practice in Aboriginal communities in northern Australia from both the parents and health practitioners’ perspectives with the aim of informing nutrition improvement programs.

Methods

Qualitative research methods were employed. Using semi-structured interviews, parents (n = 30) of children aged 2–5 years, and 29 service providers who were involved in the delivery of child health and nutrition programs in the same communities, were asked about child feeding attitudes and practices. Responses were analyzed through inductive and deductive analysis, recognizing that worldviews influence child feeding practices.

Results

Sharing food was a central practice within families. Parents highly valued development of child independence in food behavior but were conflicted with the easy access to unhealthy food in their communities. This easy access to unhealthy food and inadequate food storage and kitchen facilities for some families were major challenges to achieving optimal diets for children identified by Aboriginal families and service providers. The responsive style of parenting described by parents was often misunderstood by service providers as sub-optimal parenting when viewed through a dominant western lens.

Conclusions

Approaches to support healthy feeding practices and optimal child nutrition require health-enabling food environments. Along with a community-based Aboriginal health workforce, it is paramount that the non-Aboriginal workforce be supported to be reflective of the impact of worldview on their practice, to ensure a culturally safe environment for families where parenting styles are understood and appropriately supported.
Amyand’s hernia: a 10-year experience with 6 cases
Authors: Gao Yijie , Zhang Taotao , Zhang Min , Hu Zhengxu , Li Qiao , Zhang Xiangwen
Published: July 2021

Purpose

Amyand’s hernia is a rare hernia defined as an inguinal hernia that contains the appendix within the hernia sac. Current treatment of Amyand’s hernia remains controversial. Our study retrospectively reviewed 6 cases of Amyand’s hernia, aiming to provide a reference for the surgical treatment of Amyand's hernia.

Methods

Six patients diagnosed with Amyand’s hernia from September 2010 to May 2020 were retrospectively enrolled in our study. We summarized clinical data of six patients including the chief complaint, physical examinations, laboratory examinations, imaging examinations, surgical methods, and postoperative treatments and outcomes.

Results

The diagnosis of six cases with Amyand’s hernia was made during surgery. Two patients had normal appendixes whereas the remaining four patients had appendicitis. Two patients with normal appendix received tension-free mesh repair through the inguinal incision. Among those with inflamed or perforated appendixes, two received mesh repair and the other two did not. The discharge time after surgery of six patients was 9.8 ± 6.1 days. One patient suffered from a wound infection. No additional postoperative complications were detected.

Conclusions

Computed tomography and ultrasonography are helpful but limited in the definite diagnosis of Amyand’s hernia. The presence of a normal appendix does not require to be resected, but appendicectomy is necessary if the appendix is inflamed. The treatment of Amyand's hernia should be tailored based on the patient's condition and the type of Amyand's hernia.
Reporting stAndards for research in PedIatric Dentistry (RAPID): an expert consensus-based statement
Authors: Jayaraman Jayakumar , Dhar Vineet , Donly Kevin J. , Priya Ekta , Raggio Daniela P. , Childers Noel K. , Wright Timothy J. , Nagendrababu Venkateshbabu , Clarke Mike , King Nigel , Clarkson Jan , Innes Nicola P. T.
Published: July 2021

Background

Reporting guidelines for different study designs are currently available to report studies with accuracy and transparency. There is a need to develop supplementary guideline items that are specific to areas within Pediatric Dentistry. This study aims to develop Reporting stAndards for research in PedIatric Dentistry (RAPID) guidelines using a pre-defined expert consensus-based Delphi process.

Methods

The development of the RAPID guidelines was based on the Guidance for Developers of Health Research Reporting Guidelines. Following a comprehensive search of the literature, the Executive Group identified ten themes in Pediatric Dentistry and compiled a draft checklist of items under each theme. The themes were categorized as: General, Oral Medicine, Pathology and Radiology, Children with Special Health Care Needs, Sedation and Hospital Dentistry, Behavior Guidance, Dental Caries, Preventive and Restorative Dentistry, Pulp Therapy, Traumatology, and Interceptive Orthodontics. A RAPID Delphi Group (RDG) was formed comprising of 69 members from 15 countries across six continents. Items were scored using a 9-point rating Likert scale. Items achieving a score of seven and above, marked by at least 70% of RDG members were accepted into the RAPID checklist items. Weighted mean scores were calculated for each item. Statistical significance was set at p < 0.05 and one-way ANOVA was used to calculate the difference in the weighted mean scores between the themes.

Results

The final RAPID checklist comprised of 128 items that were finalized and approved by the RDG members in the online consensus meeting. The percentage for high scores (scores 7 to 9) ranged from 69.57 to 100% for individual items. The overall weighted mean score of the final items ranged from 7.51 to 8.28 (out of 9) and the difference was statistically significant between the themes (p < 0.05).

Conclusions

The RAPID statement provides guidance to researchers, authors, reviewers and editors, to ensure that all elements relevant to particular studies are adequately reported.
Gurus and Griots: Revisiting the research informed consent process in rural African contexts
Authors: Appiah Richard
Published: July 2021

Background

Researchers conducting community-based participatory action research (CBPAR) in highly collectivistic and socioeconomically disadvantaged community settings in sub-Saharan Africa are confronted with the distinctive challenge of balancing universal ethical standards with local standards, where traditional customs or beliefs may conflict with regulatory requirements and ethical guidelines underlying the informed consent (IC) process. The unique ethnic, socioeconomic, and cultural diversities in these settings have important implications for the IC process, such as individual decisional autonomy, beneficence, confidentiality, and signing the IC document.

Main text

Drawing on insights and field observations from conducting CBPARs across several rural, highly communal, low literate, and low-income communities in Ghana, we discuss some theoretical, ethico-cultural, and methodological challenges associated with applying the universal, Western individualistic cultural value-laden IC process in sub-Saharan Africa. By citing field situations, we discuss how local cultural customs and the socioeconomic adversities prevalent in these settings can influence (and disrupt) the information disclosure process, individual decisional authority for consent, and voluntariness. We review the theoretical assumptions of the Declaration of Helsinki’s statement on IC and discuss its limitations as an ultimate guide for the conduct of social science research in the highly communal African context. We argue that the IC process in these settings should include strategies directed at preventing deception and coercion, in addition to ensuring respect for individual autonomy. We urge Universities, research institutions, and institutional review boards in Africa to design and promote the use of context-appropriate ethical IC guidelines that take into consideration both the local customs and traditional practices of the people as well as the scientific principles underpinning the universal IC standards.

Conclusion

We recommend that, rather than adopt a universal one-size-fits-all IC approach, researchers working in the rural, highly collectivistic, low literate, socioeconomically disadvantaged settings of sub-Saharan Africa should deeply consider the roles and influence of cultural values and traditional practices on the IC and the research process. We encourage researchers to collaborate with target communities and stakeholders in the design and implementation of context-appropriate IC to prevent ethics dumping and safeguard the integrity of the research process.
Population health management in France: specifying population groups through the DRG system
Authors: Malone A. , Gomez S. , Finkel S. , Chourchoulis D. , Morcos E. , Loko M. A. , Gaches T. , Laplanche D. , Sanchez S.
Published: July 2021

Background

Population health management (PHM) by hospital groups is not yet defined nor implemented in France. However, in 2019, the French Hospitals Federation launched a pilot program to experiment PHM in five territories around five Territorial Hospital Groups (GHT’s). In order to implement PHM, it is necessary to firstly define the population which healthcare facilities (hospitals) have responsibility for. In the French healthcare system, mapping of health territories however relies mainly on administrative data criteria which do not fit with the actual implementation of GHT’s. Mapping for the creation of territorial hospital groups (GHTs) also did not include medical criteria nor all healthcare offers particularly in private hospitals and primary care services, who are not legally part of GHT’s but are major healthcare providers. The objective of this study was to define the French population groups for PHM per hospital group.

Methods

A database study based on DRG (acute care, post-acute and rehabilitation, psychiatry and home care) from the French National Hospitals Database was conducted. Data included all hospital stays from 1 January 2016 to 31 December 2017. The main outcome of this study was to create mutually exclusive territories that would reflect an accurate national healthcare service consumption. A six-step method was implemented using automated analysis reviewed manually by national experts.

Results

In total, 2840 healthcare facilities, 5571 geographical zones and 31,441,506 hospital stays were identified and collated from the database. In total, 132 GHTs were included and there were 72 zones (1.3%) allocated to a different GHTs. Furthermore, 200 zones were manually reviewed with 33 zones allocated to another GHT. Only one area did not have a population superior to 50,000 inhabitants. Three were shown to have a population superior to 2 million.

Conclusions

Our study demonstrated a feasible methodology to define the French population under the responsibility of 132 hospital groups validated by a national group of experts.