bluuebunny/crossref_metadata_2025 huggingface dataset:
Environment and Food Taboos: Breastfeeding, Antenatal, and Postnatal Practices Among Koya Dora of East Godavari District, Andhra Pradesh
Authors: Babu Mopada Nani , Patnaik Rajesh
Published: June 2021

Food taboos are studied from varied perspectives. Breastfeeding, antenatal, and postnatal practices in most of the cultures have a special place: certain taboos are often attached to them. Breastfeeding has a plethora of positive health outcomes for infant and mother alike. Some of these practices are taboos, like abstention from feeding the newborn with mother’s milk immediately after birth or for some stipulated period. Or restrictions placed on would-be or new mothers from consumption of certain food items. This article shows that breastfeeding is natural, and its benefits accrue to the Koya Dora, while “antenatal” and “postnatal” food taboos are from outside. We conclude that Koya Dora breastfeed their children in harmony and as expected, while the food taboos do occur due to outside influences rather than as one expects would occur due to local cultural environmental reasons.
A Kaleckian wealth tax to support a Green New Deal
Authors: Schroeder Susan
Published: June 2021

Green New Deals are being widely discussed as both a means to confront climate change and to improve aspects of social well-being. An important facet of the discussion is how they should be financed. The negative impacts of Covid-19 on national budgets and sovereign debt question whether the implementation of Green New Deals is feasible if austerity needs to be introduced to achieve sustainability. This article assesses whether a wealth tax based upon the work of Michal Kalecki could help avoid austerity measures and facilitate the introduction of Green New Deals. While wealth taxes have traditionally been defined on net worth or assets to reduce wealth inequality, the formulation is meant to be equitable by applying to gross wealth or assets. Estimates are calculated for the United States and turn out to be quite modest. The approach not only generates revenue to cover expected net interest outlays on national debt, but additional revenue to pay down portions of it and/or support green initiatives, such as Biden’s de-carbonisation policy. The article concludes with a discussion of challenges for the tax’s effectiveness.

JEL Codes: H2, H3, B2, B3
Intelligent monitoring of small sized supercapacitor in wind-penetrated power system
Authors: Dar S Zahid Nabi
Published: June 2021

This work pertains to integration of supercapacitor energy storage system with wind-penetrated two-area power system. A small-sized SCES device is incorporated in automatic generation control of each area. For robust and optimum usage of SCES, a customized neuro-adaptive predictive control model is developed using level 1 S-function coding. This model feeds reference power command to the converter of storage system with its voltage used as feedback loop. A step load disturbance reflecting load outage is introduced back to back in the power system. It is seen through simulation studies carried out in MATLAB Simulink Environment that there is significant improvement in frequency response and tie power deviations. SCES converter power limits are fully maintained; besides, SCES voltage and power response is also depicted.
Efficient exascale discretizations: High-order finite element methods
Authors: Kolev Tzanio , Fischer Paul , Min Misun , Dongarra Jack , Brown Jed , Dobrev Veselin , Warburton Tim , Tomov Stanimire , Shephard Mark S , Abdelfattah Ahmad , Barra Valeria , Beams Natalie , Camier Jean-Sylvain , Chalmers Noel , Dudouit Yohann , Karakus Ali , Karlin Ian , Kerkemeier Stefan , Lan Yu-Hsiang , Medina David , Merzari Elia , Obabko Aleksandr , Pazner Will , Rathnayake Thilina , Smith Cameron W , Spies Lukas , Swirydowicz Kasia , Thompson Jeremy , Tomboulides Ananias , Tomov Vladimir
Published: June 2021

Efficient exploitation of exascale architectures requires rethinking of the numerical algorithms used in many large-scale applications. These architectures favor algorithms that expose ultra fine-grain parallelism and maximize the ratio of floating point operations to energy intensive data movement. One of the few viable approaches to achieve high efficiency in the area of PDE discretizations on unstructured grids is to use matrix-free/partially assembled high-order finite element methods, since these methods can increase the accuracy and/or lower the computational time due to reduced data motion. In this paper we provide an overview of the research and development activities in the Center for Efficient Exascale Discretizations (CEED), a co-design center in the Exascale Computing Project that is focused on the development of next-generation discretization software and algorithms to enable a wide range of finite element applications to run efficiently on future hardware. CEED is a research partnership involving more than 30 computational scientists from two US national labs and five universities, including members of the Nek5000, MFEM, MAGMA and PETSc projects. We discuss the CEED co-design activities based on targeted benchmarks, miniapps and discretization libraries and our work on performance optimizations for large-scale GPU architectures. We also provide a broad overview of research and development activities in areas such as unstructured adaptive mesh refinement algorithms, matrix-free linear solvers, high-order data visualization, and list examples of collaborations with several ECP and external applications.
Dancing with Covid: Choreographing examinations in pandemic times
Authors: Alarcón López Cristina , Decuypere Mathias , Dey Joyeeta , Gorur Radhika , Hamilton Mary , Lundahl Christian , Sundström Sjödin Elin
Published: June 2021

In this paper, we explore the improvisations made in examination practices in higher education during the pandemic of 2020. Drawing on STS, we start from the theoretical assumption that examinations constitute an obligatory passage point in universities and colleges: a sacred point which students need to pass if they want to gain recognized qualifications. We base our analysis of higher education examinations on cases from six countries around the world: Australia, Belgium, Chile, India, Sweden and the UK. We use the analytical heuristic of choreography to follow the movements, tensions and resistance of the ‘emergency examinations’ as well as the re-orderings of actors and stages that have inevitably occurred. In our analytical stories we see the interplay between the maintenance of fixed and sacred aspects of examinations and the fluidity of improvisations aimed at meeting threats of spreading Covid-19. These measures have forced the complex network of examinations both to reinforce some conventional actors and to assemble new actors and stages, thus creating radically new choreographies. Although higher education teaching and didactics are being framed as a playground for pedagogical innovation with digital technologies, it is clear from our data that not all educational activities can be so easily replicated.
Baptism by Wildfire? Wildfire Experiences and Public Support for Wildfire Adaptation Policies
Authors: Hui Iris , Zhao Angela , Cain Bruce E. , Driscoll Anne M.
Published: June 2021

In recent years, wildfires have ravaged the landscape in many Western American states, especially California. But will these horrific wildfire experiences increase public support for wildfire adaptation measures? We conducted an individual-level survey in California in 2019. Combining survey data with geocoded information about a respondent’s proximity to wildfire events and exposure to wildfire smoke, we assess whether respondents’ experiences increased support for several wildfire adaptation policies. We also control for party affiliation. We find that Californians generally oppose restrictive resilience policies and view the decision to take adaptive steps as a matter of personal choice. Republicans are generally more opposed than Democrats to spending public funds to incentivize resilience measures, but proximity to wildfires lessens their opposition to using public funds to encourage homeowners to upgrade their properties for increased protection from wildfires and encourage relocation to safer places. Although exposure to wildfire smoke is extensive and harmful to health, we found that its main impact on policy preferences was statistically insignificant.
Antitumor and Radiosensitizing Effects of Zinc Oxide-Caffeic Acid Nanoparticles against Solid Ehrlich Carcinoma in Female Mice
Authors: Sayed Hayam M. , Said Mahmoud M. , Morcos Nadia Y. S. , El Gawish Mona A. , Ismail Amel F. M.
Published: June 2021

This study aimed to evaluate the anticancer and radio-sensitizing efficacy of Zinc Oxide-Caffeic Acid Nanoparticles (ZnO-CA NPs). ZnO-CA NPs were formulated by the conjugation of Zinc Oxide nanoparticles (ZnO NPs) with caffeic acid (CA) that were characterized by Fourier Transform Infrared Spectra (FT-IR), X-ray Diffractometer (XRD), and Transmission Electron Microscopy (TEM). In vitro anticancer potential of ZnO-CA NPs was evaluated by assessing cell viability in the human breast (MCF-7) and hepatocellular (HepG2) carcinoma cell lines. In vivo anticancer and radio-sensitizing effects of ZnO-CA NPs in solid Ehrlich carcinoma-bearing mice (EC mice) were also assessed. Treatment of EC mice with ZnO-CA NPs resulted in a considerable decline in tumor size and weight, down-regulation of B-cell lymphoma 2 (BCL2) and nuclear factor kappa B (NF-κB) gene expressions, decreased vascular cell adhesion molecule 1 (VCAM-1) level, downregulation of phosphorylated-extracellular-regulated kinase 1 and 2 (p-ERK1/2) protein expression, DNA fragmentation and a recognizable peak at sub-G0/G1 indicating dead cells’ population in cancer tissues. Combined treatment of ZnO-CA NPs with γ-irradiation improved these effects. In conclusion: ZnO-CA NPs exhibit in-vitro as well as in-vivo antitumor activity, which is augmented by exposure of mice to γ-irradiation. Further explorations are warranted previous to clinical application of ZnO-CA NPs.
Results of the Galician registry in the treatment of complex aortoiliac aneurysms with GORE® EXCLUDER® Iliac Branch Endoprosthesis (GALIBER)
Authors: Méndez Fernández Alba , Fernández Noya Jorge , Mosquera Arochena Nilo J , Vidal Rey Jorge , Calvin Álvarez Pablo , Franco Meijide Francisco José , Villardefrancos Gil Rosa
Published: June 2021

Objective

The objective of this study is to report the medium-term results of GORE® EXCLUDER® Iliac Branch Endoprosthesis (IBE, W. L. Gore & Associates, Flagstaff, Ariz) for the treatment of aortoiliac aneurysms by using the GALIBER registry.

Methods

Patients with aortoiliac or isolated common iliac/hypogastric aneurysms treated with Iliac Branch Endoprosthesis device between January 2014 and May 2019 were prospectively collected from 5 centers. Demographic, clinical, and radiologic data were extracted from electronic databases. Technical success was defined as successful implantation of the Iliac Branch Endoprosthesis device with exclusion of aortoiliac aneurysm, as well as patency of Iliac Branch Endoprosthesis in the follow-up. Iliac Branch Endoprosthesis patency was evaluated by Doppler ultrasound and/or computed tomography based on the protocol of each participant center. Follow-up was 731 days +/− 499.

Results

Between January 2014 and May 2019, 105 iliac arteries were treated with GORE® IBE device, in 81 patients (79 men, two women; mean age 71, range 52–91). Only seven patients (8.6%) were symptomatic. 60 patients (74%) had aortic and iliac enlargement. Thirty-three patients presented bilateral iliac aneurysms (40.7%): In twenty-four (29.6%) patients, an Iliac Branch Endoprosthesis device was implanted in both sides, and in nine patients (11.1%), one Iliac Branch Endoprosthesis was used with the embolization of the contralateral hypogastric artery. Technical success was achieved in the 99% (104/105 iliac branch device implanted). There were no procedural deaths or type I or III intraoperative endoleaks observed. During the follow-up (range 55–1789 days), 28 (34.5%) type II endoleaks were observed and one (1.2%) type Ia was observed. The patency of the hypogastric arteries treated with the iliac branch device was 98.1% during the follow-up (range 55–1789 days). In 30% of the patients with contralateral hypogastric embolization, some kind of complications was observed in the embolizated side: one developed ischemic colitis and two buttock claudication.

Conclusions

Preservation of internal iliac artery with the Iliac Branch Endoprosthesis device can be performed safely with excellent technical success and good medium-term patency rates. These results support hypogastric preservation whenever possible to prevent ischemic complications.
Retheorising distributed leadership through epistemic injustice
Authors: Tian Meng , Nutbrown Graham
Published: June 2021

Existing distributed leadership (DL) theories tend to focus on distributing financial, material and human resources in order to enhance school performance. However, their impact appears controversial. Critical scholars assert that using DL to promote trust and democracy can be a self-fulfilling prophecy orchestrated by few formal leaders. When being misused as a managerial tool, DL can reinforce epistemic injustice in school. In this conceptual paper, we retheorise DL through the lens of epistemic injustice. Drawing on the concepts of testimonial, hermeneutical and systemic injustice, we analyse how DL practices potentially marginalise, silence, and reject individuals as knowledge contributors due to their deflated credibility, the lack of concepts or language, and systemic discrimination. To build epistemic justice and reciprocity into DL, we propose three moves: building trust and self-trust; re-distributing epistemic resources; and reconfiguring relational justice. This paper makes a theoretical contribution by explicating why and how epistemic injustice is done to disadvantaged individuals in DL. It also serves as the theoretical foundation for future empirical investigations.
Rehabilitation of the face and temporomandibular joint in systemic sclerosis
Authors: Maddali Bongi Susanna , Passalacqua Mauro , Landi Giovanna , Mikhaylova Svetlana , Tofani Lorenzo , Del Rosso Angela , El Aoufy Khadija , Baccini Marco , Matucci-Cerinic Marco , Melchiorre Daniela
Published: June 2021

Background:

Systemic sclerosis (SSc) alterations of the face and of the mouth cause aesthetic modifications and disability, impairing self-esteem and quality of life (QoL). The aim of this study was to verify the effects of two rehabilitation protocols on facial mimic and mouth opening.

Methods:

A total of 47 SSc patients (40 females and 7 males, mean age ± SD 59.08 ± 10.31 years), were consecutively selected: 22 were randomly assigned to protocol 1 [home exercises for temporomandibular joint (TMJ), mimic, masticatory and cervical spine muscles] and 25 to protocol 2 (home exercises and combined physiotherapeutic procedures performed by a physiotherapist). Each treatment had a duration of 12 weeks with a follow up of 8 weeks. TMJ dysfunction, orofacial involvement, disability, QoL, and safety were assessed at enrollment (T0), at the end of the treatment (T1), and at follow up (T2).

Results:

Both Protocol 1 and Protocol 2 induced significant improvements of some clinical and clinimetric parameters, but better results were obtained with Protocol 2. In the comparison between the effects of Protocol 1 and Protocol 2 at T1 and T2, a significant difference was observed only for Mouth Handicap in SSc [MHISS; Total ( p = 0.00178] and for MHISS Mouth opening ( p = 0.0098) at T1. No significant difference of indices of short-form 36 was observed.

Conclusion:

The present data suggest that TMJ involvement in SSc may be managed by rehabilitation treatments. The action of a physiotherapist prescribing and personalizing exercises may induce better therapeutic effects.
The diagnostic certainty levels of junior clinicians: A retrospective cohort study
Authors: Chen Yang , Nagendran Myura , Kilic Yakup , Cavlan Dominic , Feather Adam , Westwood Mark , Rowland Edward , Gutteridge Charles , Lambiase Pier D
Published: June 2021

Background:

Clinical decision-making is influenced by many factors, including clinicians’ perceptions of the certainty around what is the best course of action to pursue.

Objective:

To characterise the documentation of working diagnoses and the associated level of real-time certainty expressed by clinicians and to gauge patient opinion about the importance of research into clinician decision certainty.

Method:

This was a single-centre retrospective cohort study of non-consultant grade clinicians and their assessments of patients admitted from the emergency department between 01 March 2019 and 31 March 2019. De-identified electronic health record proformas were extracted that included the type of diagnosis documented and the certainty adjective used. Patient opinion was canvassed from a focus group.

Results:

During the study period, 850 clerking proformas were analysed; 420 presented a single diagnosis, while 430 presented multiple diagnoses. Of the 420 single diagnoses, 67 (16%) were documented as either a symptom or physical sign and 16 (4%) were laboratory-result-defined diagnoses. No uncertainty was expressed in 309 (74%) of the diagnoses. Of 430 multiple diagnoses, uncertainty was expressed in 346 (80%) compared to 84 (20%) in which no uncertainty was expressed. The patient focus group were unanimous in their support of this research.

Conclusion:

The documentation of working diagnoses is highly variable among non-consultant grade clinicians. In nearly three quarters of assessments with single diagnoses, no element of uncertainty was implied or quantified. More uncertainty was expressed in multiple diagnoses than single diagnoses.

Implications:

Increased standardisation of documentation will help future studies to better analyse and quantify diagnostic certainty in both single and multiple working diagnoses. This could lead to subsequent examination of their association with important process or clinical outcome measures.
Indonesian General Practitioners’ Experience of Practicing in Primary Care under the Implementation of Universal Health Coverage Scheme (JKN)
Authors: Ekawati Fitriana Murriya , Claramita Mora
Published: June 2021

Introduction

The Indonesian government has been implementing Jaminan Kesehatan Nasional (JKN) as the national universal coverage scheme to help Indonesian citizens affording medical care since 2014. However, after a few years of its implementation, a very limited study has been conducted to explore general practitioners’ (GPs) views and experiences of practicing in primary care under JKN implementation.

Methods

The study applied semi-structured interviews with GPs from January to February 2016, guided by a phenomenology approach in Yogyakarta province, Indonesia. The GPs were recruited using a maximum variation sample design. The interviews were recorded and transcribed, and the data were analyzed thematically.

Result

A total of 19 GPs were interviewed. Three major themes emerged, namely: powerlessness, clinical resources, and administration. Transition to the JKN system has improved patient access to primary care without significant economic barrier, however, GP participants experienced a sense of powerless practice during JKN implementation. They also commented on limited clinical resources and claimed that JKN administration was complicated and burdened their practice.

Conclusion

This study identifies various perspectives from GPs practicing in primary care under JKN implementation. The JKN improves access to primary care practice, but there are limited supports for GPs to practice optimally and maintain their relationships with patients. Extensive improvements are needed to upgrade the GP practice in primary care.
Comparing Perceived and Objective Measures of Bikeability on a University Campus: A Case Study
Authors: Kellstedt Debra K. , Spengler John O. , Maddock Jay E.
Published: June 2021

Using a participatory approach, this multi-method case study compared bicyclists’ perceptions and physical indicators of bikeability on a college campus. Student focus groups discussed campus bikeability and mapped and graded common bicycle routes. Trained students conducted environmental audits with bicycle counts. In discussions, students expressed concerns about safe bicycle riding on campus, especially during peak times. Congestion with pedestrians, other bicyclists, and skateboarders created the potential for crashes. Five major routes were identified with map scores ranging from 21.4% to 70%. Audit scores ranged from 82.5% to 86.7%. Bicycle counts varied by time of day and ranged from 11 to 91 bicycles. Student perceptions of bikeability were poorer than objective assessments of routes. The audit tool did not differentiate enough between routes and did not capture conflict potential accurately. Specification is needed on audit tools to capture the potential for conflict between bicycling and other forms of active transport—especially in unique settings like college campuses. Campuses that have well-marked paths for pedestrians, bicyclists, and motor vehicles and that communicate the importance and ease of bicycling may see the most overall success when promoting active transport options.
Turkish Teacher Candidates’ Self-Efficacies to Use Listening Strategies Scale: A Validity and Reliability Study
Authors: Kurudayıoğlu Mehmet , Yazıcı Emre , Göktentürk Talha
Published: June 2021

This study aimed to develop Turkish Teacher Candidates’ Self-Efficacies to Use Listening Strategies Scale. Therefore, the study was designed in sequential explanatory design, and sequential timing has been followed. First, the interview study was conducted with 40 participants, and the qualitative data were analyzed through content analysis. Subsequently, an item pool was designed via the findings obtained from the qualitative findings and literature review. Afterward, the draft form was applied to Turkish teacher candidates and 345 valid forms were obtained. As a result of the exploratory factor analysis conducted for the data obtained, we determined that the items were collected in four factors in total. The Cronbach’s alpha coefficient was calculated as .927 for the scale. Confirmatory factor analysis was performed in the last stage, and finally, we found that all factors are statistically significant and the obtained model has a good fit. In addition, we determined that the qualitative findings have chronological categorization and the quantitative findings have thematical categorization. This means that thematic categorization to the listening strategies can be more appropriate for listening skills. Consequently, the scale can be used in determining the self-efficacy perceptions of Turkish teacher candidates to use listening strategies. Furthermore, the scale can contribute to similar studies in the literature.
Social Media as an Information Source of Political Learning in Online Education
Authors: Intyaswati Drina , Maryani Eni , Sugiana Dadang , Venus Anter
Published: June 2021

The use of social media as a learning process is inevitable, as students need to be politically inclined. This study wants to contribute to the lack of research on the topic of political material. Complement the literature by evaluating the effects of social media use on political knowledge. The research used a cross-sectional survey method involving 508 undergraduate students of a distance learning program, Open University, Indonesia. They were 218 males (42.9%) and 290 females (57.1%). The study results showed that the use of social media influences political knowledge by mediating online discussions over different social media platforms. The more students use social media and discuss political issues, the higher their level of knowledge. The study implies that instructors can use social media to integrate the instructional design of relevant courses that facilitate political discussion to learn for the acquisition of students’ political knowledge.
Online Education: A Learner’s Perspective During COVID-19
Authors: Garg Adarsh
Published: June 2021

The global health disaster COVID-19 has imposed a self-refrainment from social gathering to contain the disease, because social distancing is the only shield from community spread. Home and work places are altogether giving an unanticipated, unpredicted and unpleasant milieu due to global spread of COVID-19. The teaching–learning process is no exception, with the closure of all educational institutions as a protective step to save lives. The teaching–learning process has been reflecting a very wide and deep impact of COVID-19. With all teachers and learners confined to their places of stay, learning has been impacted to a large extent, with a sense of uncertainty, insecurity and dilemma around effective learning. In fact, the COVID-19 pandemic has thrown the mission and rigour of teaching–learning out of gear. With all classrooms shut, the pandemic has exposed teachers and learners more towards the online learning mode, with no other option perceptible at this point of time. Though online education has always been embraced by academics as a supporting tool, switching over completely to the online mode of learning has raised some serious concerns pertaining to its efficacy and the reluctance of learners in embracing it as a substitute of the regular mode of learning. This study reveals the perception of 2,895 learners on the efficiency of online learning as a substitute of the regular mode of learning. The results show the acceptance of online learning only as a supporting tool to regular learning instead of as a substitute of the regular learning mode on the basis of various factors of effective learning, such as content, pedagogy, assessment and rigour.
Biomechanical Comparison of Panda Rope Bridge Technique and Other Minimally Invasive Achilles Tendon Repair Techniques In Vitro
Authors: Wang Ting , Mu Yuan , Diao Yulei , Liu Wenke , Wu Yahong , Wang Zhuoqun , Luo Yanfeng , Xie Yangli , Yin Liangjun
Published: June 2021

Background:

Although nonoperative management of acute Achilles tendon rupture (ATR) is a reasonable option, surgical repair has attracted attention for young and active patients. More reliable Achilles tendon repair techniques are needed to enhance recovery after ATR in this population.

Purpose/Hypothesis:

To biomechanically analyze the panda rope bridge technique (PRBT) and compare it with other minimally invasive repair techniques over a simulated, progressive rehabilitation program. It was hypothesized that PRBT would result in better biomechanical properties and enhanced recovery after ATR.

Study Design:

Controlled laboratory study.

Methods:

An Achilles tendon rupture was created 4 cm from the distal tendon insertion site in 40 bovine lower extremities, and specimens were then randomly allocated to 5 Achilles tendon repair techniques: (1) Achillon, (2) modified Achillon, (3) Percutaneous Achilles Repair System (PARS), (4) modified PARS, and (5) PRBT. Each group was subjected to a cyclic loading protocol that was representative of progressive postoperative rehabilitation for ATR (250 cycles at 1 Hz for each loading stage: 20-100 N, 20-200 N, 20-300 N, and 20-400 N).

Results:

The PRBT technique demonstrated significantly less elongation (1.62 ± 0.25 mm) than the 4 other repair techniques after the first loading stage of 20 to 100 N ( P < .05). All specimens in the 4 other groups developed a large gap (elongation ≥5 mm) at the 20- to 200-N loading stage. When overall biomechanical performance was examined, the PRBT group exhibited higher strength (20-400 N) and more mean loading cycles (984 ± 10) compared with the 4 other groups ( P < .05).

Conclusion:

In this bovine model, PRBT biomechanically outperformed the other minimally invasive Achilles tendon repair techniques that were tested and could therefore meet the requirements of accelerated rehabilitation.

Clinical Relevance:

The reduced tendency for premature rerupture and the overall improved biomechanical properties of PRBT suggest that ATR patients treated with PRBT may more readily complete early and aggressive postoperative rehabilitation protocols. In addition, they may have a lower risk of early irreversible suture failure.
Home-Care Nurses’ Experiences of Caring for Older Adults With Type 2 Diabetes Mellitus and Urinary Incontinence: An Interpretive Description Study
Authors: Northwood Melissa , Ploeg Jenny , Markle-Reid Maureen , Sherifali Diana
Published: June 2021

Introduction

A third of older adults with diabetes receiving home-care services have daily urinary incontinence. Despite this high prevalence of urinary incontinence, the condition is typically not recognized as a complication and thereby not detected or treated. Diabetes and urinary incontinence in older adults are associated with poorer functional status and lower quality of life. Home-care nurses have the potential to play an important role in supporting older adults in the management of these conditions. However, very little is known about home-care nurses’ care of this population.

Objective

The objective of this study was to explore how nurses care for older home-care clients with diabetes and incontinence.

Methods

This was an interpretive description study informed by a model of clinical complexity, and part of a convergent, mixed methods research study. Fifteen nurse participants were recruited from home-care programs in southern Ontario, Canada to participate in qualitative interviews. An interpretive description analytical process was used that involved constant comparative analysis and attention to commonalities and variance.

Results

The experiences of home-care nurses caring for this population is described in three themes and associated subthemes: (a) conducting a comprehensive nursing assessment with client and caregiver, (b) providing holistic treatment for multiple chronic conditions, and (c) collaborating with the interprofessional team. The provision of this care was hampered by a task-focused home-care system, limited opportunities to collaborate and communicate with other health-care providers, and the lack of health-care system integration between home care, primary care, and acute care.

Conclusion

The results suggest that nursing interventions for older adults with diabetes and incontinence should not only consider disease management of the individual conditions but pay attention to the broader social determinants of health in the context of multiple chronic conditions. Efforts to enhance health-care system integration would facilitate the provision of person-centred home care.
Somatic uniparental disomy mitigates the most damaging EFL1 allele combination in Shwachman-Diamond syndrome
Authors: Lee Sangmoon , Shin Chang Hoon , Lee Jawon , Jeong Seong Dong , Hong Che Ry , Kim Jun-Dae , Kim Ah-Ra , Park Boryeong , Son Soo Jin , Kokhan Oleksandr , Yoo Taekyeong , Ko Jae Sung , Sohn Young Bae , Kim Ok-Hwa , Ko Jung Min , Cho Tae-Joon , Wright Nathan T. , Seong Je Kyung , Jin Suk-Won , Kang Hyoung Jin , Kim Hyeon Ho , Choi Murim
Published: June 2021

Shwachman-Diamond syndrome (SDS; OMIM #260400) is caused by variants in SBDS (Shwachman-Bodian-Diamond syndrome gene), which encodes a protein that plays an important role in ribosome assembly. Recent reports suggest that recessive variants in EFL1 are also responsible for SDS. However, the precise genetic mechanism that leads to EFL1-induced SDS remains incompletely understood. Here we present 3 unrelated Korean SDS patients who carry biallelic pathogenic variants in EFL1 with biased allele frequencies, resulting from a bone marrow–specific somatic uniparental disomy in chromosome 15. The recombination events generated cells that were homozygous for the relatively milder variant, allowing for the evasion of catastrophic physiologic consequences. However, the milder EFL1 variant was still solely able to impair 80S ribosome assembly and induce SDS features in cell line and animal models. The loss of EFL1 resulted in a pronounced inhibition of terminal oligopyrimidine element–containing ribosomal protein transcript 80S assembly. Therefore, we propose a more accurate pathogenesis mechanism of EFL1 dysfunction that eventually leads to aberrant translational control and ribosomopathy.
International BEAT-PCD consensus statement for infection prevention and control for primary ciliary dyskinesia in collaboration with ERN-LUNG PCD Core Network and patient representatives
Authors: Marthin June K. , Lucas Jane S. , Boon Mieke , Casaulta Carmen , Crowley Suzanne , Destouches Damien M.S. , Eber Ernst , Escribano Amparo , Haarman Eric , Hogg Claire , Maitre Bernard , Marsh Gemma , Martinu Vendula , Moreno-Galdó Antonio , Mussaffi Huda , Omran Heymut , Pohunek Petr , Rindlisbacher Bernhard , Robinson Phil , Snijders Deborah , Walker Woolf T. , Yiallouros Panayiotis , Johansen Helle Krogh , Nielsen Kim G.
Published: June 2021

Introduction

In primary ciliary dyskinesia (PCD) impaired mucociliary clearance leads to recurrent airway infections and progressive lung destruction, and concern over chronic airway infection and patient-to-patient transmission is considerable. So far, there has been no defined consensus on how to control infection across centres caring for patients with PCD. Within the BEAT-PCD network, COST Action and ERS CRC together with the ERN-Lung PCD core a first initiative has now been taken towards creating such a consensus statement.

Methods

A multidisciplinary international PCD expert panel was set up to create a consensus statement for infection prevention and control (IP&C) for PCD, covering diagnostic microbiology, infection prevention for specific pathogens considered indicated for treatment and segregation aspects. Using a modified Delphi process, consensus to a statement demanded at least 80% agreement within the PCD expert panel group. Patient organisation representatives were involved throughout the process.

Results

We present a consensus statement on 20 IP&C statements for PCD including suggested actions for microbiological identification, indications for treatment ofPseudomonas aeruginosa,Burkholderia cepaciaand nontuberculous mycobacteria and suggested segregation aspects aimed to minimise patient-to-patient transmission of infections whether in-hospital, in PCD clinics or wards, or out of hospital at meetings between people with PCD. The statement also includes segregation aspects adapted to the current coronavirus disease 2019 (COVID-19) pandemic.

Conclusion

The first ever international consensus statement on IP&C intended specifically for PCD is presented and is targeted at clinicians managing paediatric and adult patients with PCD, microbiologists, patient organisations and not least the patients and their families.
Endogenous bacteria inhabiting the Ophiocordyceps highlandensis during fruiting body development
Authors: Li Chengpeng , Tang Dexiang , Wang Yuanbing , Fan Qi , Zhang Xiaomei , Cui Xiaolong , Yu Hong
Published: June 2021

Background

The genus Ophiocordyceps, which includes Ophiocordyceps sinensis, has been demonstrated to be one of the most valuable medicinal taxa. The low rate of larval infection and slow development that characterize the cultivation of this genus should be urgently addressed. To identify potential bioinoculants that stimulate the growth of Ophiocordyceps, O. highlandensis was selected as a model system, and a total of 72 samples were collected to systematically compare the microbial communities present during fruiting body development. By applying high-throughput 16S and ITS2 amplicon sequencing technology, the bacterial and fungal communities were identified in O. highlandensis and its surrounding soil, and the functional dynamics of the bacteria were explored.

Results

The results indicate that the most abundant bacteria across all the samples from O. highlandensis were Proteobacteria, Firmicutes and Bacteroidetes, while members of Ascomycota were detected among the fungi. The pathways enriched in the developmental stages were associated with carbohydrate degradation, nucleotides and pyridoxal biosynthesis, and the TCA cycle. Compared with that in the fungal community, an unexpectedly high taxonomic and functional fluctuation was discovered in the bacterial community during the maturation of O. highlandensis. Furthermore, bipartite network analysis identified four potential supercore OTUs associated with O. highlandensis growth.

Conclusions

All the findings of this study suggest unexpectedly high taxonomic and functional fluctuations in the bacterial community of O. highlandensis during its maturation. O. highlandensis may recruit different endogenous bacteria across its life cycle to enhance growth and support rapid infection. These results may facilitate Ophiocordyceps cultivation and improve the development of strategies for the identification of potential bioinoculant resources.
Management of chronic non-communicable diseases in Ghana: a qualitative study using the chronic care model
Authors: Amu Hubert , Darteh Eugene Kofuor Maafo , Tarkang Elvis Enowbeyang , Kumi-Kyereme Akwasi
Published: June 2021

Background

While the burden and mortality from chronic non-communicable diseases (CNCDs) have reached epidemic proportions in sub-Saharan Africa (SSA), decision-makers and individuals still consider CNCDs to be infrequent and, therefore, do not pay the needed attention to their management. We, therefore, explored the practices and challenges associated with the management of CNCDs by patients and health professionals.

Methods

This was a qualitative study among 82 CNCD patients and 30 health professionals. Face-to-face in-depth interviews were used in collecting data from the participants. Data collected were analysed using thematic analysis.

Results

Experiences of health professionals regarding CNCD management practices involved general assessments such as education of patients, and specific practices based on type and stage of CNCDs presented. Patients’ experiences mainly centred on self-management practices which comprised self-restrictions, exercise, and the use of anthropometric equipment to monitor health status at home. Inadequate logistics, work-related stress due to heavy workload, poor utility supply, and financial incapability of patients to afford the cost of managing their conditions were challenges that militated against the effective management of CNCDs.

Conclusions

A myriad of challenges inhibits the effective management of CNCDs. To accelerate progress towards meeting the Sustainable Development Goal 3 on reducing premature mortality from CNCDs, the Ghana Health Service and management of the respective hospitals should ensure improved utility supply, adequate staff motivation, and regular in-service training. A chronic care management policy should also be implemented in addition to the review of the country’s National Health Insurance Scheme (NHIS) by the Ministry of Health and the National Health Insurance Authority to cover the management of all CNCDs.
Correction to: Diabetes, cardiovascular disease and the microcirculation
Authors: Strain W. David , Paldánius P. M.
Published: June 2021

An amendment to this paper has been published and can be accessed via the original article.
Preterm birth and PM2.5 in Puerto Rico: evidence from the PROTECT birth cohort
Authors: Kirwa Kipruto , Feric Zlatan , Manjourides Justin , Alshawabekeh Akram , Vega Carmen Milagros Velez , Cordero José F. , Meeker John D. , Suh Helen H.
Published: June 2021

Background

Preterm birth (PTB, birth before 37 weeks of gestation) has been associated with adverse health outcomes across the lifespan. Evidence on the association between PTB and prenatal exposure to air pollutants is inconsistent, and is especially lacking for ethnic/racial minority populations.

Methods

We obtained data on maternal characteristics and behaviors and PTB and other birth outcomes for women participating in the Puerto Rico Testsite for Exploring Contamination Threats (PROTECT) cohort, who lived in municipalities located along the North Coast of Puerto Rico. We assessed pre-natal PM2.5 exposures for each infant based on the nearest US Environmental Protection Agency monitor. We estimated prenatal phthalate exposures as the geometric mean of urinary measurements obtained during pregnancy. We then examined the association between PM2.5 and PTB using modified Poisson regression and assessed modification of the association by phthalate exposure levels and sociodemographic factors such as maternal age and infant gender.

Results

Among 1092 singleton births, 9.1% of infants were born preterm and 92.9% of mothers had at least a high school education. Mothers had a mean (standard deviation) age of 26.9 (5.5) years and a median (range) of 2.0 (1.0–8.0) pregnancies. Nearly all women were Hispanic white, black, or mixed race. Median (range) prenatal PM2.5 concentrations were 6.0 (3.1–19.8) μ g/m3. Median (interquartile range) prenatal phthalate levels were 14.9 (8.9–26.0) and 14.5 (8.4–26.0), respectively, for di-n-butyl phthalate (DBP) and di-isobutyl phthalate (DiBP). An interquartile range increase in PM2.5 was associated with a 1.2% (95% CI 0.4, 2.1%) higher risk of PTB. There was little difference in PTB risk in strata of infant sex, mother’s age, family income, history of adverse birth outcome, parity, and pre-pregnancy body mass index. Pregnancy urinary phthalate metabolite levels did not modify the PM2.5-PTB association.

Conclusion

Among ethnic minority women in Puerto Rico, prenatal PM2.5 exposure is associated with a small but significant increase in risk of PTB.
Identification of lymphocyte cell-specific protein-tyrosine kinase (LCK) as a driver for invasion and migration of oral cancer by tumor heterogeneity exploitation
Authors: Weiße Jonas , Rosemann Julia , Müller Lisa , Kappler Matthias , Eckert Alexander W. , Glaß Markus , Misiak Danny , Hüttelmaier Stefan , Ballhausen Wolfgang G. , Hatzfeld Mechthild , Haemmerle Monika , Gutschner Tony
Published: June 2021

Background

Cancer metastases are the main cause of lethality. The five-year survival rate for patients diagnosed with advanced stage oral cancer is 30%. Hence, the identification of novel therapeutic targets is an urgent need. However, tumors are comprised of a heterogeneous collection of cells with distinct genetic and molecular profiles that can differentially promote metastasis making therapy development a challenging task. Here, we leveraged intratumoral heterogeneity in order to identify drivers of cancer cell motility that might be druggable targets for anti-metastasis therapy.

Methods

We used 2D migration and 3D matrigel-based invasion assays to characterize the invasive heterogeneity among and within four human oral cancer cell lines in vitro. Subsequently, we applied mRNA-sequencing to map the transcriptomes of poorly and strongly invasive subclones as well as primary tumors and matched metastasis.

Results

We identified SAS cells as a highly invasive oral cancer cell line. Clonal analysis of SAS yielded a panel of 20 subclones with different invasive capacities. Integrative gene expression analysis identified the Lymphocyte cell-specific protein-tyrosine kinase (LCK) as a druggable target gene associated with cancer cell invasion and metastasis. Inhibition of LCK using A-770041 or dasatinib blocked invasion of highly aggressive SAS cells. Interestingly, reduction of LCK activity increased the formation of adherens junctions and induced cell differentiation.

Conclusion

Analysis of invasive heterogeneity led to the discovery of LCK as an important regulator of motility in oral cancer cells. Hence, small molecule mediated inhibition of LCK could be a promising anti-metastasis therapy option for oral cancer patients.
Rutin prevents tau pathology and neuroinflammation in a mouse model of Alzheimer’s disease
Authors: Sun Xiao-ying , Li Ling-jie , Dong Quan-Xiu , Zhu Jie , Huang Ya-ru , Hou Sheng-jie , Yu Xiao-lin , Liu Rui-tian
Published: June 2021

Background

Tau pathology is a hallmark of Alzheimer’s disease (AD) and other tauopathies. During disease progression, abnormally phosphorylated forms of tau aggregate and accumulate into neurofibrillary tangles, leading to synapse loss, neuroinflammation, and neurodegeneration. Thus, targeting of tau pathology is expected to be a promising strategy for AD treatment.

Methods

The effect of rutin on tau aggregation was detected by thioflavin T fluorescence and transmission electron microscope imaging. The effect of rutin on tau oligomer-induced cytotoxicity was assessed by MTT assay. The effect of rutin on tau oligomer-mediated the production of IL-1β and TNF-α in vitro was measured by ELISA. The uptake of extracellular tau by microglia was determined by immunocytochemistry. Six-month-old male Tau-P301S mice were treated with rutin or vehicle by oral administration daily for 30 days. The cognitive performance was determined using the Morris water maze test, Y-maze test, and novel object recognition test. The levels of pathological tau, gliosis, NF-kB activation, proinflammatory cytokines such as IL-1β and TNF-α, and synaptic proteins including synaptophysin and PSD95 in the brains of the mice were evaluated by immunolabeling, immunoblotting, or ELISA.

Results

We showed that rutin, a natural flavonoid glycoside, inhibited tau aggregation and tau oligomer-induced cytotoxicity, lowered the production of proinflammatory cytokines, protected neuronal morphology from toxic tau oligomers, and promoted microglial uptake of extracellular tau oligomers in vitro. When applied to Tau-P301S mouse model of tauopathy, rutin reduced pathological tau levels, regulated tau hyperphosphorylation by increasing PP2A level, suppressed gliosis and neuroinflammation by downregulating NF-kB pathway, prevented microglial synapse engulfment, and rescued synapse loss in mouse brains, resulting in a significant improvement of cognition.

Conclusion

In combination with the previously reported therapeutic effects of rutin on Aβ pathology, rutin is a promising drug candidate for AD treatment based its combinatorial targeting of tau and Aβ.
Long-term outcomes of cementless femoral stem revision with the Wagner cone prosthesis
Authors: Park Kyung-Soon , Jin Sheng-Yu , Lim Jun-Hyuk , Yoon Taek-Rim
Published: June 2021

Background

The procedure of femoral stem revision is challenging, and bone conservation with less stress shielding is a mandatory effort in these cases. Although there are several reports of stem revision with stems designed for primary total hip arthroplasty (THA), there is no report on stem revision with the Wagner cone prosthesis.

Methods

Between 1996 and 2008, 41 hips of 41 consecutive patients were subjected to femoral revision THA using the Wagner cone prosthesis. The mean age during revision surgery was 56.1 years, and the mean follow-up period was 14.8 years. The clinical results were evaluated, and the femoral component was assessed radiologically.

Results

The results showed that the average period from the first operation to revision THA was 8.0 years. Additionally, the mean Harris hip score improved from 52 points preoperatively to 83 points at the final follow-up. All stems showed bone integration in the radiological evaluation. A subsidence of more than 5 mm was observed in 3 out of 28 (10.7%) femoral stems. Two patients needed an acetabular revision for acetabular cup loosening during the follow-up period. Furthermore, one patient had recurrent dislocation and had to undergo revision surgery for soft tissue augmentation.

Conclusions

We achieved favorable clinical and radiological long-term outcomes in femoral stem revision using the Wagner cone prosthesis. This cementless femoral stem could be an option for femoral stem revision in cases with relatively good bone stock.