bluuebunny/crossref_metadata_2025 huggingface dataset:
Ergonomics
Authors: Sluchak Thomas J.
Published: August 2020

Ergonomics is not a panacea. Ergonomics focuses first on fitting the job to the worker, then on fitting the worker into the job. The appropriate application of ergonomic principles, while keeping in mind the individual differences among workers, will lead to improvement in the health and safety of any occupational setting.

Perhaps the real significance of ergonomic programs is best considered in light of the possible alternatives. These words from Weiner (1950), also cited by Christensen (1987), sum up the problem of taking a narrow, short term view of the workplace, and the consequences of failing to actively strive for improved ergonomic working conditions: It is a degradation to a human being to chain him to an oar and use him as a source of power; but it is an almost equal degradation to assign him purely repetitive tasks in a factory, which demand less than a millionth of his brainpower. But it is simpler to organize a factory or galley which uses individual human being for a trivial fraction of their worth than it is to provide a world in which they can grow to their full stature (Weiner, 1950).
Total Quality Management in American Industry
Authors: Widtfeldt Anne Keenan , Widtfeldt James R.
Published: August 2020

Occupational health nurses must apply the universal principles of Total Quality Management so that health services are customer driven, value added, process focused, and statistically measured. They must elicit customer input prior to, along with, and after program implementation. Programs must be directed toward doing the right things and doing things right.

Measurement must be a priority of any program in health services. If occupational health nurses do all this, they will be at the forefront of the American quality movement, especially as it relates to health care.
Stress Related Workers’ Compensation Claims
Authors: Martin Karen J.
Published: August 2020

The occupational health nurse should maintain confidentiality; ethical principles should not have to be compromised for justice to be served. The author has made recommendations to improve safeguarding of records, promote stress reduction, and support legislation to control disclosure. However, because the legislative trend is toward increased use of health data to assure employer compliance with safety and health laws, health data may be increasingly available to all interested parties.
Environmental Hazards in the Workplace: Legal and Safety Considerations
Authors: Yorker Bea , Mistretta Elizabeth F.
Published: August 2020

Both the employer and the employee must work together to provide the best possible work environment. The occupational health nurse can facilitate the interaction and communication between these groups to protect the employer and the employee. The company must follow legal guidelines related to hazardous materials, and the employees must understand and adhere to the established policies and procedures developed for their safety. The nurse can help assure that each is protected.
Implementing a University Campus Wellness Model
Authors: Bruce Glenda M.
Published: August 2020

This university wellness model symbolizes self responsibility and control of one's life while riding toward wellness. The number of concepts it contains makes it reasonably simple to implement. All of the major concepts of the model are well defined, resulting in a clear, descriptive picture of how program development should proceed. The model allows easy visualization of the interaction among concepts.

In view of the broad scope of the model's concepts and its simplicity, the model could be applied to other workplace situations. Minor program component adjustments may be needed to meet the specific needs of the workplace. The model provides a general framework to guide the planning phase, whether that planner be an occupational health nurse, health officer, or exercise physiologist.

This model may apply and be of significance to those who are interested in increasing worker productivity and decreasing employer costs. It may be of particular interest to the nursing profession to generate innovative ideas to help the working populace stay healthy, despite today's crisis of diminishing health care dollars.
Case Management in a Health Maintenance Organization
Authors: Leigh Betsy
Published: August 2020

The planning and implementation of this case management model brought together a mul-tidisciplinary team with a common goal of providing a positive health care experience for the injured worker. The challenge of implementation of a case management model within a large, complex health care system has resulted in successful changes. For example, referral tracking has been improved due to the expected outcome of quality case management.

The difficulties encountered due to the previous lack of consistency in occupational services within the seven occupational health clinics became an immediate concern with the implementation of the model. The formulation of the Standard Operating Procedures became a priority focus. Inconsistencies in service delivery have been identified and corrected by the development and implementation of regionally driven Standard Operating Procedures. Complex group process and interdepartmental communication efforts have resulted in more standardized health care for the clients.

Community outreach with employer groups has been enhanced, providing a close liaison with the occupational health care team. Improved information exchange assists in ongoing monitoring of complicated cases and earlier problem resolution. The projected outcome is improved quality of care for the injured worker and a return to an optimal state of health and productivity.
Idiopathic Granulomatous Mastitis Presenting in a Patient With Hypothyroidism and Recent Hospitalization for Myxedema Coma: A Rare Case Report and Review of Literature
Authors: Bell Stephen , Villasmil Ricardo , Lattanzio Natalia , Abdelal Qassem , King Alan , Farhangi Vida
Published: August 2020

Idiopathic granulomatous mastitis (IGM) is a rare, benign inflammatory disorder of the breast. Clinical features may include painful breasts, erythema, subcutaneous nodules, and ulcerative lesions. It can mimic various other breast pathologies, and it is a diagnosis of exclusion after infection, malignancy, and other inflammatory conditions have been ruled out. In this article, we present a case of IGM developing in a 40-year-old female 3 months after hospitalization for myxedema coma. A contrast-enhanced magnetic resonance imaging of the breasts showed bilateral edema, and a biopsy was negative for malignancy or infection. She was started on prednisone and had noticeable improvement of ulcerations within several weeks. IGM is a rare condition that requires a multimodal treatment approach. Often recalcitrant disease is encountered and requires surgical intervention, immunosuppression, and antimicrobial therapy. The diagnosis should be entertained in patients with bilateral breast inflammation to avoid unnecessary surgical resection early on.
An Exercise for Teaching Employment Termination
Authors: Skowronski Mark S. , Bedi Akanksha
Published: August 2020

Teaching students how to terminate an employee in a safe, legal, and humane manner provides them with a valuable management skill. This article describes an exercise for teaching students how to conduct termination meetings, guiding them through the process of creating a termination script that is consistent with best practices from the literature. This exercise also helps students develop confidence and enhance their skills by role-playing the termination meeting and responding to the interpersonal challenges of such meetings.
A Review of Craniofacial Training Programs in North America
Authors: Hush Stefanie , Williams Joseph K.
Published: August 2020

Introduction: The specialty of craniofacial surgery has expanded rapidly since the landmark surgeries of Dr. Paul Tessier. The expansion of fellowship programs over the last 50 years has been seen in both numbers and structure. This growth has been complemented by the continued expansion of skill sets that fellows are experiencing. However, the exposure to these skill sets are varied. The study had 2 objectives: (1) Create a clearer picture of the skill sets that fellows are exposed to during training and (2) provide some threshold of case numbers shared by programs that may be used to establish shared expectations for the fellow’s experience. Method: A comprehensive database was created and placed on the webpage for the American Society of Craniofacial Surgery (ASCFS). Fellows in the year 2017 to 2018 were asked to input their case logs. The cumulative data base was categorized into 9 groupings, capturing surgeries of the facial skeleton, cleft surgeries and specialty surgeries in the area of microsurgery, facial reanimation, and ear reconstruction. These 9 groupings were used to establish 3 tiers that provided an opportunity to discover thresholds of experience that captured consistent skill sets for the majority of the programs. Results: A total of 6018 cases were entered into the cumulative database of which 3469.5 cases were placed into 9 specified groups. Group 1 (craniosynostosis) had 578 cases (mean = 30.4, SD = 22.3). Sixteen of the 19 programs participating (84.2%) were found to be at or above the 20th percentile ranking for this procedure (20th percentile = 10 cases). Group 2 consisted of Mandibular distraction (144 cases), Group 3 midface skeletal surgeries (87), Group 4 facial trauma (641.5), Group 5 orthognathic surgery (506), Group 6 cleft surgeries (1303.5), Group 7 microsurgery (67), Group 8 facial reanimation (40.5), and Group 9 ear reconstruction (113). Percentile rankings were found for each group. Three tiers were created for comparison, Tier 1 (group 1), Tier 2 (groups 2-6), Tier 3 (groups 7-9). When a 20th percentile threshold for case numbers was created for groups 1 to 5, 77.9% of all programs met this criteria (95% CI: 63.7%-92.1%). When group 6 was included 78.9% of programs met the 20th percentile (95% CI: 67.9%-90.0%). Conclusion: Fellows are receiving consistent exposure to areas of training related to manipulation of the facial skeleton with the exception of midface surgeries. The study also demonstrates a significant volume of both cleft surgery and facial trauma. The majority of the participating programs meet a threshold of 20% for skill sets associated with our subspecialty. These thresholds could be used as guides by fellowship programs and the ASCFS to better monitor our training goals.
Ethical Issues in Scarce Resource Allocation in a Global Pandemic: Relevance to Craniofacial Surgery
Authors: Vercler Christian J.
Published: August 2020

The response to the COVID-19 pandemic has necessitated a shift in how we apply the principles of biomedical ethics. The historical foundation of the ethical responsibility of the physician to the patient rests on the of that individual relationship. The patient comes first. However, in a pandemic, a public health ethics takes over, and the focus changes to what each individual member of society’s responsibility is to the collective. The greatest good for the greatest number trumps a given individual’s needs. Ethicists have focused primarily on creating guidelines that apply to allocating scarce life-and-death-determining resources. Very little attention has been paid to scarce resources that are more mundane, such as personal protective equipment (PPE) or operating room (OR) time. I present here a summary of the most recent ethical guidelines for allocation of scarce resources, note some concerns with these approaches, and discuss some of the shortcomings of applying these frameworks to the practice of craniofacial surgeons.
Using a 3D Printed “Phantom of the Opera” Soft Tissue Surgical Guide for Complex Facial Reconstruction
Authors: Sacks Gina , Ulma Raquel M. , Dolphin Samuel D. , Kline Stephanie , Buchman Steven R.
Published: August 2020

Computer aided technology in the form of virtual surgical planning (VSP) and 3D printed surgical guides can allow for a more accurate reconstruction of complex maxillofacial deformities. While this technology is now routinely used for bony reconstruction, it is rarely utilized for soft tissue. In ballistic injuries there is often disfiguring damage to the soft tissue, with destruction of anatomic landmarks making satisfactory soft tissue reconstruction a unique challenge. In this study, the authors present the application of virtual surgical planning and 3D printed guides, in conjunction with anaplastology, for complex soft tissue reconstruction resulting from a gunshot injury. By combining tangible surgical models and aesthetic judgment in a team setting, it is possible to optimize the efficiency and accuracy of soft tissue reconstruction in the setting of complex facial deformities.
Wellington’s earthquake resilience: Lessons from the 2016 Kaikōura earthquake
Authors: Cubrinovski Misko , Bradley Brendon A , Elwood Kenneth J , Johnston David , Orchiston Caroline , Sullivan Timothy , Wotherspoon Liam M
Published: August 2020

Wellington city, the capital of New Zealand, experienced substantial damage and impacts from the 2016 Kaikōura earthquake, despite its relatively large distance of 60 km from the source of the earthquake. This article draws on impact observations from this event to discuss critical issues for Wellington’s earthquake resilience. Ground motion characteristics exhibiting substantial amplifications in native and reclaimed sites, including basin effects, liquefaction of reclaimed land at the port of Wellington, characteristic structural and non-structural damage to mid- and high-rise buildings, and socio-economic impacts on community are explored in detail. The main thrust of the article is to discuss implications of these observations, identify needs, and stimulate actions across a wide range of earthquake science, earthquake engineering, and socio-economic disciplines to achieve adequate resilience levels for Wellington, and other cities facing similar seismic risks.
Hematopoietic recovery in patients receiving chimeric antigen receptor T-cell therapy for hematologic malignancies
Authors: Jain Tania , Knezevic Andrea , Pennisi Martina , Chen Yunxin , Ruiz Josel D. , Purdon Terence J. , Devlin Sean M. , Smith Melody , Shah Gunjan L. , Halton Elizabeth , Diamonte Claudia , Scordo Michael , Sauter Craig S. , Mead Elena , Santomasso Bianca D. , Palomba M. Lia , Batlevi Connie W. , Maloy Molly A. , Giralt Sergio , Smith Eric , Brentjens Renier , Park Jae H. , Perales Miguel-Angel , Mailankody Sham
Published: August 2020

Factors contributing to hematopoietic recovery following chimeric antigen receptor (CAR) T-cell therapy have not been well studied. In an analysis of 83 patients with hematologic malignancies treated with CAR T-cell therapy, we describe patterns of hematopoietic recovery and evaluate potentially associated factors. We included patients who received axicabtagene ciloleucel (n = 30) or tisagenlecleucel (n = 10) for B-cell lymphoma, CD19-28z CAR T therapy for B-cell acute lymphoblastic leukemia (NCT01044069; n = 37), or B-cell maturation antigen targeting CAR T cells for multiple myeloma (NCT03070327; n = 6). Patients treated with CAR T cells who had not progressed, died, or received additional chemotherapy had “recovered” (per definition in Materials and methods section) hemoglobin, platelet, neutrophil, and white blood cell counts at rates of 61%, 51%, 33%, and 28% at month 1 postinfusion and 93%, 90%, 80%, and 59% at month 3 postinfusion, respectively. Univariate analysis showed that increasing grade of immune effector cell–associated neurological syndrome (ICANS), baseline cytopenias, CAR construct, and higher peak C-reactive protein or ferritin levels were statistically significantly associated with a lower likelihood of complete count recovery at 1 month; a similar trend was seen for cytokine release syndrome (CRS). After adjustment for baseline cytopenia and CAR construct, grade ≥3 CRS or ICANS remained significantly associated with the absence of complete count recovery at 1 month. Higher levels of vascular endothelial growth factor and macrophage-derived chemokines, although not statistically significant, were seen patients without complete count recovery at 1 month. This remains to be studied further in larger prospective studies.
Distant hybrids of Heliocidaris crassispina (♀) and Strongylocentrotus intermedius (♂): identification and mtDNA heteroplasmy analysis
Authors: Zhan Yaoyao , Sun Jingxian , Li Yingying , Cui Dongyao , Zhang Weijie , Yang Limeng , Chang Yaqing
Published: August 2020

Background

Distant hybridization between the sea urchin Heliocidaris crassispina (♀) and the sea urchin Strongylocentrotus intermedius (♂) was successfully performed under laboratory conditions. A new variety of hybrid sea urchin (HS hybrid) was obtained. However, the early-development success rates for the HS hybrids were significantly lower than those of purebred H. crassispina or S. intermedius offspring. In addition, it was difficult to distinguish the HS-hybrid adults from the pure H. crassispina adults, which might lead to confusion in subsequent breeding attempts. In this study, we attempted to develop a method to quickly and effectively identify HS hybrids, and to preliminarily investigate the molecular mechanisms underlying the poor early-development success rates in the HS hybrids.

Results

The hybrid sea urchins (HS hybrids) were identified both morphologically and molecularly. There were no significant differences in the test height to test diameter ratios between the HS hybrids and the parents. The number and arrangement of ambulacral pore pairs in the HS hybrids differed from those of the parental lines, which might serve as a useful morphological character for the identification of the HS hybrids. A primer pair that identified the HS hybrids was screened by comparing the mitochondrial genomes of the parental lines. Moreover, paternal leakage induced mitochondrial DNA heteroplasmy in the HS hybrids, which might explain the low rates of early development success in these hybrids.

Conclusions

The distant-hybrid sea urchins were accurately identified using comparative morphological and molecular genetic methods. The first evidence of mtDNA heteroplasmy after the distant hybridization of an echinoderm was also provided.
Cost-effectiveness of the PDSAFE personalised physiotherapy intervention for fall prevention in Parkinson’s: an economic evaluation alongside a randomised controlled trial
Authors: Xin Yiqiao , Ashburn Ann , Pickering Ruth M. , Seymour Kim Chivers , Hulbert Sophia , Fitton Carolyn , Kunkel Dorit , Marian Ioana , Roberts Helen C. , Lamb Sarah E. , Goodwin Victoria A. , Rochester Lynn , McIntosh Emma ,   on behalf of the PDSAFE Collaborative group, Ashburn A. , Seymour K. , Roberts H. C. , Pickering R. M. , Lamb S. , Ballinger C. , Goodwin V. A. , Rochester L. , Nieuwboer A. , McIntosh E. , Kunkel D. , Hulbert S. , Fitton C. , Marian I. , Xin Y. , Rowsell A. , Summer R.
Published: August 2020

Background

PDSAFE is an individually-tailored, physiotherapist-delivered, balance, strength and strategy training programme aimed at preventing falls among people with Parkinson’s. We evaluated the cost-effectiveness of PDSAFE compared with usual care for people with Parkinson’s at higher risk of falling, from a UK National Health Service and Personal Social Service perspective.

Methods

Resource use and quality of life data (EQ-5D-3L) were collected from 238 participants randomised to the PDSAFE intervention and 236 participants randomised to control, at baseline, 3 months, 6 months (primary outcome), and 12 months. Adjusted cost and quality-adjusted life-years (QALYs) were estimated using generalised linear models and uncertainty estimated using a non-parametric bootstrap.

Results

Over 6 months, the PDSAFE intervention was associated with an incremental cost of £925 (95% CI £428 to £1422) and a very small and statistically insignificant QALY gain of 0.008 (95% CI − 0.006 to 0.021). The resulting incremental cost-effectiveness ratio (ICER) was £120,659 per QALY and the probability of the intervention being cost-effective at a UK threshold of £30,000/QALY was less than 1%. The ICER varied substantially across subgroups although no subgroup had an ICER lower than the £30,000 threshold. The result was sensitive to the time horizon with the ICER reducing to £55,176 per QALY when adopting a 12-month time horizon and assuming a sustained treatment effect on QoL, nevertheless, the intervention was still not cost-effective according to the current UK threshold.

Conclusions

Evidence from this trial suggests that the PDSAFE intervention is unlikely to be cost-effective at 6 months. The 12-month analysis suggested that the intervention became closer to being cost-effective if quality of life effects were sustained beyond the intervention period, however this would require confirmation. Further research, including qualitative studies, should be conducted to better understand the treatment effect of physiotherapy and its impact on quality of life in people with Parkinson’s given existing mixed evidence on this topic.

Trial registration

ISRCTN48152791. Registered 17 April 2014.http://www.isrctn.com/ISRCTN48152791
Treatment patterns and comorbid burden of patients newly diagnosed with multiple sclerosis in the United States
Authors: Kern David M. , Cepeda M. Soledad
Published: August 2020

Background

The treatment landscape for multiple sclerosis (MS) is quickly evolving. Understanding real-world treatment patterns of patients is necessary to identifying potential gaps in care.

Methods

Patients with incident MS were identified from a large national claims database during 1/1/2014–6/30/2019. Patients had ≥2 diagnoses for MS or an inpatient hospitalization with a primary diagnosis of MS. Patients were required to have enrollment in the database ≥1 year prior to and ≥ 1 year following their first MS diagnosis. Treatment sequences were captured for all available disease modifying therapies (DMTs) during all available follow-up. Presence of comorbid conditions were captured during the one year prior to and following (and including) the index date; absolute change in prevalence from the pre- to post-index periods was calculated.

Results

We identified 5691 patients with incident MS. Common comorbidities included physical symptoms (e.g., pain, weakness, fatigue), mental health conditions (anxiety, depression), and cardiovascular/metabolic conditions (hypertension, hyperlipidemia, diabetes, obesity). Just 1994 (35.0%) of patients received a DMT at any time during follow-up. Of those receiving a DMT, 28.2% went on to receive a second line of therapy, 5.8% received a third, and just 0.9% went on to a fourth line. Use of more than one DMT concomitantly occurred in just 1.8% of all treated patients. Glatiramer and dimethyl fumarate were by far the most common first-line treatments received accounting for nearly 62% of patients receiving a DMT.

Conclusion

Approximately two-thirds of patients newly diagnosed with MS did not receive a DMT and the disease is accompanied by a significant comorbid burden.
A short course of oral ranitidine as a novel treatment for toddler’s diarrhea: a parallel-group randomized controlled trial
Authors: Uwaezuoke Samuel N. , Ndu Ikenna K. , Eneh Chizoma I. , Anusiem Chikere A. , Ayuk Adaeze C.
Published: August 2020

Background

The current paradigm for treating toddler’s diarrhea comprises dietary modification and fluid restriction. Previous studies show that probiotics and proton-pump inhibitors (PPIs) or H2blockers could control diarrhea associated with functional gastrointestinal disorders (FGIDs). This study aims to determine and compare the efficacy of a short course of oral ranitidine and a probiotic in the treatment of toddler’s diarrhea.

Methods

This study was a parallel-group randomized controlled trial (RCT). We sequentially enrolled 40 patients who met the eligibility criteria. We randomly assigned 20 patients to the oral ranitidine group, ten patients to the probiotic group, and ten patients to the placebo group. In the oral ranitidine group, patients received oral ranitidine (3 mg/kg/day) once daily for 10 days; in the probiotic and placebo groups, they were administered 5 to 10 billion colony-forming units (CFUs) per day of lyophilizedLactobacillus rhamnosusand 50 mg of once-daily oral vitamin C tablet respectively for 10 days. Stool frequency and consistency on the 10th day of the interventions were recorded as the primary outcomes. We used the Student’s t-test to determine if there were significant differences in the mean daily stool frequencies in the three intervention groups. Ap-value < 0.05 was adopted as the level of statistical significance.

Results

In the ranitidine group, stool frequency decreased significantly from an average of five per day on the first day to an average of approximately one per day on the 10th day of intervention (t = 10.462,p <  0.001). Additionally, stool consistency normalized on the 10th day of intervention. In the probiotic group, there was a significant reduction in stool frequency from an average of five per day on the first day to four per day on the 10th day (t = 2.586,p = 0.041), although stool consistency remained loose. However, stool consistency and frequency were not significantly affected in the placebo group (t = 1.964,p = 0.072).

Conclusion

Oral ranitidine is more effective than probiotics in reducing stool frequency and normalizing stool consistency in toddler’s diarrhea. We recommend multi-center trials with appropriate study designs to confirm and validate this finding.

Trial registration

ISRCTN,ISRCTN10783996. Registered 8 April 2016-Registered retrospectively.
International time trends in sudden unexpected infant death, 1969–2012
Authors: Müller-Nordhorn Jacqueline , Schneider Alice , Grittner Ulrike , Neumann Konrad , Keil Thomas , Willich Stefan N. , Binting Sylvia
Published: August 2020

Background

Sudden unexpected infant death (SUID) - including sudden infant death syndrome (SIDS) - continues to be a major contributor to infant mortality worldwide. Our objective was to analyse time trends and to identify country-clusters.

Methods

The National Statistical Offices of 52 countries provided the number of deaths and live births (1969–2012). We calculated infant mortality rates per 1000 live births for SUID, SIDS, and all-cause mortality. Overall, 29 countries provided sufficient data for time course analyses of SUID. To sensitively model change over time, we smoothed the curves of mortality rates (1980–2010). We performed a hierarchical cluster analysis to identify clusters of time trends for SUID and SIDS, including all-cause infant mortality.

Results

All-cause infant mortality declined from 28.5 to 4.8 per 1000 live births (mean 12.4; 95% confidence interval 12.0–12.9) between 1969 and 2012. The cluster analysis revealed four country-clusters. Clusters 1 and 2 mostly contained countries showing the typical peak of SUID mortality during the 1980s. Cluster 1 had higher SUID mortality compared to cluster 2. All-cause infant mortality was low in both clusters but higher in cluster 1 compared to cluster 2. Clusters 3 and 4 had low rates of SUID without a peak during the 1980s. Cluster 3 had the highest all-cause infant mortality of all clusters. Cluster 4 had an intermediate all-cause infant mortality. The time trends of SUID and SIDS mortality were similar.

Conclusions

The country-specific time trends in SUID varied considerably. The identification of country-clusters may promote research into how changes in sleep position, smoking, immunisation, or other factors are related to our findings.
Observed trends in the magnitude of socioeconomic and area-based inequalities in use of caesarean section in Ethiopia: a cross-sectional study
Authors: Shibre Gebretsadik , Idriss-Wheeler Dina , Bishwajit Ghose , Yaya Sanni
Published: August 2020

Background

In Ethiopia, there is a paucity of studies on inequality in caesarean section using methodologically rigorous and well-established approaches. In this study, we showed extent and the overtime dynamics of inequality in caesarean section in Ethiopia following rigorous methodologies.

Methods

The data for analysis came from Ethiopia Demographic and Health Surveys (EDHS) conducted between 2000 and 2016. We used the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT) to analyze the data. Caesarean delivery was disaggregated by four equity stratifiers, namely education, wealth, residence and regions. Relative and absolute summary measures were calculated for each equity stratifier to capture inequality from different perspectives. 95% Uncertainty Interval was calculated around a point estimate to measure statistical significance.

Results

We found large socioeconomic and area-based inequalities in use of caesarean section in all study surveys. The inequalities have occurred in favour of socioeconomically advantaged women and those living in urban areas and certain regions such as Addis Ababa. While area-related inequality had generally increased with time, socioeconomic inequality showed fluctuation. Adoption of different measures in the study for the inequality analysis has caused the emergence of mix of patterns in caesarean section inequality over time.

Conclusions

In all the surveys, wealthy and more educated women, and those residing in urban areas had higher chance of obtaining caesarean delivery. Policy makers should work to ensure caesarean section that is in the accepted normal range. More emphasis should be drawn to subpopulation with under use of caesarean section while at the same time, discouraging unjustified use of it.
The impact of injury definitions on measures of injury occurrence in classical music students: a prospective cohort study
Authors: Steemers Suze , van Middelkoop Marienke , de Boks Gideon G. , van Rijn Rogier M. , Bierma-Zeinstra Sita M. A. , Stubbe Janine H.
Published: August 2020

Background

Multiple definitions are used to investigate injuries in musicians, resulting in a wide range of prevalence rates. The aim of this study is to establish the impact of different injury definitions on the prevalence of injuries and disability in classical music students. Moreover, the practical implications of using different injury definitions are considered.

Methods

A prospective cohort study among first-year classical music students was performed using bi-monthly questionnaires focusing on injuries. Three injury definitions were used: 1) all MSK complaints injury (any MSK complaint resulting in a VAS pain score > 0 in the past eight weeks), 2) medical attention injury (any MSK complaint that resulted in a student consulting a health provider in the past eight weeks), 3) time-loss injury (any MSK complaint that resulted in partly/completely missing music classes or activities in the past eight weeks). For all injury definitions prevalences were calculated and compared. Furthermore, the Disabilities of the Arm, Shoulder and Hand performing arts module (DASH-pa) was used to calculate disability scores for all three injury definitions.

Results

Twenty-nine classical music students participated in the current study. The total response rate over one academic year was 85.3%. One year prevalences of all MSK complaints, medical attention and time-loss were 96.6, 17.2 and 13.8% respectively. The bi-monthly prevalences ranged from 74.1 to 96.0% for all MSK complaints, from 5.6 to 11.5% for medical attention injuries and from 0 to 11.5% for time loss injuries. Scores on the DASH-pa ranged from 15.6 to 26.9 for MSK complaints, 33.3 to 50 for medical attention and 47.9 to 62.5 for time-loss injuries.

Conclusion

The choice of injury definition is a critical factor affecting the outcome of music injury surveillance studies. To reach a consensus, it is therefore important to consider the different injury definitions depending on the goal of the injury surveillance and the practical implications.
Concurrent validity and reliability of measuring range of motion during the cervical flexion rotation test with a novel digital goniometer
Authors: Luedtke Kerstin , Schoettker-Königer Thomas , Hall Toby , Reimer Christine , Grassold Maike , Hasselhoff-Styhler Petra , Neulinger Christian , Obrocki Max , Przyhoda Philipp , Schäfer Axel
Published: August 2020

Background

Headache is a common and costly health problem. Although the pathogenesis of headache is heterogeneous, reported contributing factors are dysfunctions of the upper cervical spine. The flexion rotation test (FRT) is a commonly used diagnostic test to detect upper cervical movement impairment. A digital goniometer may support precise measurement of movement impairment in the upper cervical spine. However, its reliability and validity is not assessed, yet. The aim of this study was to investigate the reliability and validity of the digital goniometer compared to an ultrasound-based movement analysis system.

Methods

Two separate cross-sectional studies were conducted using the digital goniometer EasyAngle (Meloq AB, Stockholm, Sweden) for a) investigating the concurrent validity of upper cervical range of motion (ROM) during the FRT and b) determining the inter- and intra-rater reliability in the target population of patients with head and neck pain. Sixty-two participants, 39 with and 23 without head and neck pain, were recruited for the concurrent validity study. For the reliability study, a total of 50 participants were recruited. Intraclass correlation coefficients (ICC) and Bland Altmann plots were used to assess validity and ICC values, Bland Altmann plots as well as Kappa coefficients were used for estimating intra-rater and inter-rater reliability.

Results

Concurrent validity was strong with an ICC (2,1) of 0.97 for ROM to either side (95%CI = 0.95–0.98). Bland Altman Plots revealed a mean difference between measurement systems of 0.5° for the left and 0.11° for the right side.

The inter-rater ICC (2,1) was 0.66 (95%CI 0.47–0.79, p <  0.001, SEM 6.6°), indicating good reliability. The limits of agreement were between 10.25° and − 11.89°, the mean difference between both raters was − 0.82°. Intra-rater reliability for the measurement of ROM during the FRT was between 0.96 (ICC 3,1) for rater 1 and 0.94 (ICC 3,1) for rater 2.

Conclusions

The digital goniometer demonstrated strong concurrent validity and good to strong reliability and can be used in clinical practice to accurately determine movement impairment in the upper cervical spine.

Trial registration

German Registry of Clinical Trials DRKS00013051.
Modelling the suppression of a malaria vector using a CRISPR-Cas9 gene drive to reduce female fertility
Authors: North Ace R. , Burt Austin , Godfray H. Charles J.
Published: August 2020

Background

Gene drives based on CRISPR-Cas9 technology are increasingly being considered as tools for reducing the capacity of mosquito populations to transmit malaria, and one of the most promising options is driving endonuclease genes that reduce the fertility of female mosquitoes. In particular, there is much interest in constructs that target the conserved mosquito doublesex (dsx) gene such that the emergence of functional drive-resistant alleles is unlikely. Proof of principle that these constructs can lead to substantial population suppression has been obtained in population cages, and they are being evaluated for use in sub-Saharan Africa. Here, we use simulation modelling to understand the factors affecting the spread of this type of gene drive over a one million-square kilometre area of West Africa containing substantial environmental and social heterogeneity.

Results

We found that a driving endonuclease gene targeting female fertility could lead to substantial reductions in malaria vector populations on a regional scale. The exact level of suppression is influenced by additional fitness costs of the transgene such as the somatic expression of Cas9, and its deposition in sperm or eggs leading to damage to the zygote. In the absence of these costs, or of emergent drive-resistant alleles that restore female fertility, population suppression across the study area is predicted to stabilise at ~ 95% 4 years after releases commence. Small additional fitness costs do not greatly affect levels of suppression, though if the fertility of females whose offspring transmit the construct drops by more than ~ 40%, then population suppression is much less efficient. We show the suppression potential of a drive allele with high fitness costs can be enhanced by engineering it also to express male bias in the progeny of transgenic males. Irrespective of the strength of the drive allele, the spatial model predicts somewhat less suppression than equivalent non-spatial models, in particular in highly seasonal regions where dry season stochasticity reduces drive efficiency. We explored the robustness of these results to uncertainties in mosquito ecology, in particular their method of surviving the dry season and their dispersal rates.

Conclusions

The modelling presented here indicates that considerable suppression of vector populations can be achieved within a few years of using a female sterility gene drive, though the impact is likely to be heterogeneous in space and time.
The role of vegetative cell fusions in the development and asexual reproduction of the wheat fungal pathogen Zymoseptoria tritici
Authors: Francisco Carolina Sardinha , Zwyssig Maria Manuela , Palma-Guerrero Javier
Published: August 2020

Background

The ability of fungal cells to undergo cell-to-cell communication and anastomosis, the process of vegetative hyphal fusion, allows them to maximize their overall fitness. Previous studies in a number of fungal species have identified the requirement of several signaling pathways for anastomosis, including the so far best characterized soft (So) gene, and the MAPK pathway components MAK-1 and MAK-2 of Neurospora crassa. Despite the observations of hyphal fusions’ involvement in pathogenicity and host adhesion, the connection between cell fusion and fungal lifestyles is still unclear. Here, we address the role of anastomosis in fungal development and asexual reproduction in Zymoseptoria tritici, the most important fungal pathogen of wheat in Europe.

Results

We show that Z. tritici undergoes self-fusion between distinct cellular structures, and its mechanism is dependent on the initial cell density. Contrary to other fungi, cell fusion in Z. tritici only resulted in cytoplasmic mixing but not in multinucleated cell formation. The deletion of the So orthologous ZtSof1 disrupted cell-to-cell communication affecting both hyphal and germling fusion. We show that Z. tritici mutants for MAPK-encoding ZtSlt2 (orthologous to MAK-1) and ZtFus3 (orthologous to MAK-2) genes also failed to undergo anastomosis, demonstrating the functional conservation of this signaling mechanism across species. Additionally, the ΔZtSof1 mutant was severely impaired in melanization, suggesting that the So gene function is related to melanization. Finally, we demonstrated that anastomosis is dispensable for pathogenicity, but essential for the pycnidium development, and its absence abolishes the asexual reproduction of Z. tritici.

Conclusions

We demonstrate the role for ZtSof1, ZtSlt2, and ZtFus3 in cell fusions of Z. tritici. Cell fusions are essential for different aspects of the Z. tritici biology, and the ZtSof1 gene is a potential target to control septoria tritici blotch (STB) disease.
Neoadjuvant concurrent chemoradiotherapy followed by transanal total mesorectal excision assisted by single-port laparoscopic surgery for low-lying rectal adenocarcinoma: a single center study
Authors: Lu Yen-Jung , Chen Chien-Hsin , Lin En-Kwang , Wu Szu-Yuan
Published: August 2020

Purpose

To assess the feasibility and short-term outcomes of neoadjuvant chemoradiotherapy (CCRT) followed by transanal total mesorectal excision assisted by single-port laparoscopic surgery (TaTME-SPLS) for low-lying rectal adenocarcinoma.

Methods and materials

A total of 23 patients with clinical stage II-III low-lying (from anal verge 0-8 cm) rectal adenocarcinoma who underwent neoadjuvant CCRT followed by TaTME-SPLS consecutively from December 2015 to December 2018, were enrolled into our study. Chi-squared testing and Student’s t testing were used to make parametric comparisons, and Fisher’s exact test or the Mann–Whitney U test were used to make nonparametric comparisons.

Results

Conversion rate in patients who underwent neoadjuvant CCRT followed by TaTME-SPLS was only 4%. The mean operation time was 366 min and the inter-sphincter resection (ISR) was done for 14 patients (60%). The mean number of lymph nodes harvested was 15. There was no surgical mortality, but the 30-day morbidity rate was 21% (5 patients were Clavien-Dindo I-II). Pathological complete response was 21.74% with 100% organ preservation and 100% clear distal margin after neoadjuvant CCRT followed by TaTME-SPLS.

Conclusion

TaTME-SPLS would be highly successful in lymph node negative and low T stage of low-lying rectal cancer patients who had pathological complete remission or high percentage of partial remission after neoadjuvant CCRT.
Radiation exposure and fluoroscopically-guided interventional procedures among orthopedic surgeons in South Korea
Authors: Kang Seonghoon , Cha Eun Shil , Bang Ye Jin , Na Teresa W. , Lee Dalnim , Song Sang Youn , Lee Won Jin
Published: August 2020

Background

The use of fluoroscopically-guided interventional (FGI) procedures by orthopedic surgeons has been increasing. This study aimed to investigate the occupational radiation exposure among orthopedic surgeons in South Korea.

Methods

A nationwide survey of orthopedic surgeons was conducted in South Korea in October 2017. The dosimetry data of the participants were obtained from the National Dosimetry Registry. The orthopedic surgeons were categorized by job specialty [spine or trauma specialists, other orthopedic specialists, and residents], and descriptive statistics for the demographics and work-related characteristics were presented. Multivariable logistic regression analysis was used to evaluate the risk factors for the orthopedic surgeons who were not linked with the dosimetry data.

Results

Among the total participants (n = 513), 40.5% of the orthopedic surgeons spent more than 50% of their time working with the FGI procedures when compared with their overall work. The average frequency of the FGI procedures among the orthopedic surgeons was 12.3 days per month. Less than 30% of the participants were regularly provided with radiation monitoring badges. The proportion of subjects who always wore lead aprons and thyroid shields were 52 and 29%, respectively. The residents group experienced more unfavorable working conditions of radiation exposure than the other specialists. The dosimetry data were not significantly linked among the residents (odds ratio [OR] 2.10, 95% confidence interval [CI] 1.11–3.95) and orthopedic surgeons working at small hospitals (OR 4.76, 95% CI 1.05–21.51).

Conclusions

Although orthopedic surgeons often performed FGI procedures, they wore protective gear less frequently, and a large proportion of orthopedic surgeons were not monitored by the national radiation dosimetry system. As the number of radiation procedures performed by the orthopedic surgeons increases, more intensive approaches are needed to reduce radiation exposure, especially for spine and trauma surgeons.
Spatial patterns of CTCF sites define the anatomy of TADs and their boundaries
Authors: Nanni Luca , Ceri Stefano , Logie Colin
Published: August 2020

Background

Topologically associating domains (TADs) are genomic regions of self-interaction. Additionally, it is known that TAD boundaries are enriched in CTCF binding sites. In turn, CTCF sites are known to be asymmetric, whereby the convergent configuration of a pair of CTCF sites leads to the formation of a chromatin loop in vivo. However, to date, it has been unclear how to reconcile TAD structure with CTCF-based chromatin loops.

Results

We approach this problem by analysing CTCF binding site strengths and classifying clusters of CTCF sites along the genome on the basis of their relative orientation. Analysis of CTCF site orientation classes as a function of their spatial distribution along the human genome reveals that convergent CTCF site clusters are depleted while divergent CTCF clusters are enriched in the 5- to 100-kb range. We then analyse the distribution of CTCF binding sites as a function of TAD boundary conservation across seven primary human blood cell types. This reveals divergent CTCF site enrichment at TAD boundaries. Furthermore, convergent arrays of CTCF sites separate the left and right sections of TADs that harbour internal CTCF sites, resulting in unequal TAD ‘halves’.

Conclusions

The orientation-based CTCF binding site cluster classification that we present reconciles TAD boundaries and CTCF site clusters in a mechanistically elegant fashion. This model suggests that the emergent structure of nuclear chromatin in the form of TADs relies on the obligate alternation of divergent and convergent CTCF site clusters that occur at different length scales along the genome.

Graphical abstract
Molecular identification of head lice collected in Franceville (Gabon) and their associated bacteria
Authors: Boumbanda-Koyo Celia Scherelle , Mediannikov Oleg , Amanzougaghene Nadia , Oyegue-Liabagui Sandrine Lydie , Imboumi-Limoukou Roméo Karl , Raoult Didier , Lekana-Douki Jean Bernard , Fenollar Florence
Published: August 2020

Background

Pediculus humanus, which includes two ecotypes (body and head lice), is an obligate bloodsucking parasite that co-evolved with their human hosts over thousands of years, thus providing a valuable source of information to reconstruct the human migration. Pediculosis due to head lice occurred each year throughout the world and several pathogenic bacteria, which are usually associated with body lice, are increasingly detected in them. In Gabon, where this pediculosis is still widespread, there is a lack of data on genetic diversity of head lice and their associated bacteria.

Methods

This study aimed to investigate the phylogeny of head lice collected in Gabon and their associated bacteria, using molecular tools. Between 26 March and 11 April 2018, 691 head lice were collected from 86 women in Franceville. We studied the genetic diversity of these lice based on the cytochrome b gene, then we screened them for DNA of Bartonella quintana, Borrelia spp., Acinetobacter spp., Yersinia pestis, Rickettsia spp., R. prowazekii, Anaplasma spp. and C. burnetii, using real time or standard PCR and sequencing.

Results

Overall 74.6% of studied lice belonged to Clade A, 25.3% to Clade C and 0.1% to Clade E. The phylogenetic analysis of 344 head lice yielded 45 variable positions defining 13 different haplotypes from which 8 were novel. Bacterial screening revealed the presence of Borrelia spp. DNA in 3 (0.4%) of 691 head lice belonging to Clade A and infesting one individual. This Borrelia is close to B. theileri (GenBank: MN621894). Acinetobacter spp. DNA has been detected in 39 (25%) of the 156 screened lice; of these 13 (8.3%) corresponded to A. baumannii. Acinetobacter nosocomialis (n = 2) and A. pittii (n = 1) were also recorded.

Conclusions

To of our knowledge, this study is the first to investigate the genetic diversity of head lice from Gabon. It appears that Clade C is the second most important clade in Gabon, after Clade A which is known to have a global distribution. The detection of Borrelia spp. DNA in these lice highlight the potential circulation of these bacteria in Gabon.