bluuebunny/crossref_metadata_2025 huggingface dataset:
Simultaneous Elections and the Rise of Female Representation in Indonesia
Authors: Amalia Luky Sandra , Budiatri Aisah Putri , Sweinstani Mouliza KD. , Kusumaningtyas Atika Nur , Ekawati Esty
Published: May 2021

In the 2019 election, the proportion of women elected to Indonesia’s People’s Representative Assembly ( Dewan Perwakilan Rakyat, DPR) increased significantly to almost 21 per cent. In this article, we ask whether an institutional innovation – the introduction of simultaneous presidential and legislative elections – contributed to this change. We examine the election results, demonstrating that, overall, women candidates did particularly well in provinces where the presidential candidate nominated by their party won a majority of the vote. Having established quantitatively a connection between results of the presidential elections and outcomes for women legislative candidates, we turn to our qualitative findings to seek a mechanism explaining this outcome. We argue that the simultaneous elections helped women candidates by easing their access to voters who supported one of the presidential candidates, but who were undecided on the legislative election. Rather than imposing additional burdens on female candidates, simultaneous elections assisted them.
Engels’ ‘proletarisation’ and ‘great towns’ vis-à-vis dispossession, and gendered work in an informal economy
Authors: Chaudhary Tanya
Published: May 2021

Through a powerful investigation of Engels’ The Condition of the Working Class in England (1845), this paper aims to study the conditions of the working-class population in an Indian metropolis in present times. The paper borrows from an empirical case study of working-class population in Narela, a peripheral region in Delhi, to assess the relationship among labour, capital and state. With deepening inequality, changing labour market relations and spatial restructuring in cities, it becomes essential to understand this relationship in light of existing scholarships on South Asian cities focussing on everyday state, urban informality, social reproduction and periphery. The spatial reorganisation of Delhi was premised on aesthetic improvisation of the city, which aimed at driving the polluting/hazardous industries and working-class population to the peripheral area of Narela in the late 1990s and early 2000s. Drawing from the lived experiences of the displaced workers and new migrant workers, this study addresses concerns around housing and employment, therefore looking at a larger relationship among labour, state and capital. Explaining the process of peopling and industrialisation of this peripheral region, the paper critically analyses the contributions as well as limitations of Engels’ work in Indian urban studies.
There Is No Evidence That Associations Between Adolescents’ Digital Technology Engagement and Mental Health Problems Have Increased
Authors: Vuorre Matti , Orben Amy , Przybylski Andrew K.
Published: May 2021

Digital technology is ubiquitous in modern adolescence, and researchers are concerned that it has negative impacts on mental health that, furthermore, increase over time. To investigate whether technology is becoming more harmful, we examined changes in associations between technology engagement and mental health in three nationally representative samples. Results were mixed across types of technology and mental health outcomes: Technology engagement had become less strongly associated with depression in the past decade, but social-media use had become more strongly associated with emotional problems. We detected no changes in five other associations or differential associations by sex. There is therefore little evidence for increases in the associations between adolescents’ technology engagement and mental health. Information about new digital media has been collected for a relatively short time; drawing firm conclusions about changes in their associations with mental health may be premature. We urge transparent and credible collaborations between scientists and technology companies.
Effect of interleukin-17A inhibitor in Japanese patients with psoriatic arthritis compared with tumor necrosis factor-alpha inhibitor
Authors: Izumiyama Takuya , Mori Yu , Oizumi Itsuki , Hamada Soshi , Kurishima Hiroaki , Terui Hitoshi , Omori-Shimada Ryoko , Yamasaki Kenshi , Itoi Eiji
Published: May 2021

Objectives:

The patient of severe psoriatic arthritis (PsA) is mainly treated with oral methotrexate, ciclosporin, and anti-tumor necrosis factor-alpha inhibitors (TNFi). Recently, anti-interleukin-17A inhibitors (IL-17Ai) have been used in the treatment of PsA. This study aimed to evaluate the efficacy and safety of IL-17Ai in Japanese patients with PsA compared with those of TNFi.

Methods:

This was a longitudinal and retrospective study. The study population included 31 Japanese patients with PsA. All enrolled patients fulfilled the Classification Criteria for Psoriatic Arthritis. All patients were treated with TNFi or IL-17Ai. The assessed clinical manifestations were C-reactive protein (CRP)-based Disease Activity Score in 28 Joints (DAS28-CRP), disease activity in psoriatic arthritis (DAPSA), 20% achievement of American College of Rheumatology core set, swollen joint count (SJC), tender joint count (TJC), and visual analog scale (VAS). Functional ability of patients with PsA was analyzed using the modified health assessment questionnaire (mHAQ) score. We evaluated the parameters at baseline and weeks 12, 24, and 52.

Results:

The change in SJC, TJC, VAS, mHAQ, and DAPSA had no significant difference at weeks 12, 24, and 52. The improvements of CRP and DAS28-CRP were significantly higher in TNFi group only at week 12. The biologics retention rate was significantly higher in TNFi group by the log-rank test. No critical adverse events occurred.

Conclusions:

Our study presented that IL-17Ai had treatment effects comparable to TNFi. IL-17Ai might have the potential to become an alternative to the previous drug, but more large-scale studies are expected.
Return to Play After Patellar Tendon Autograft for Primary Anterior Cruciate Ligament Reconstruction in Rugby Players
Authors: Hurley Eoghan T. , Withers Dan , King Enda , Franklyn-Miller Andrew , Jackson Mark , Moran Ray
Published: May 2021

Background:

There is scant literature on outcomes after anterior cruciate ligament (ACL) reconstruction in rugby players, and no prior study has evaluated the outcomes of bone–patellar tendon–bone (BTB) autograft ACL reconstruction.

Purpose:

To assess the rate of return to play, the timing of that return, and the subsequent graft reinjury rate among rugby players after ACL reconstruction with BTB autograft.

Methods:

The ACL registry at a single hospital was screened for professional and amateur rugby players who had undergone a primary ACL reconstruction with BTB autograft. Professional rugby players were those playing for one of the professional provincial teams in Ireland. Outcomes were analyzed for the rate and timing of return to play, functional outcomes, and subsequent graft ruptures. Additionally, outcomes were compared between professional and amateur athletes.

Study Design:

Case series; Level of evidence, 4.

Results:

A total of 126 patients with 24 months of follow-up were enrolled. The overall rate of return to play was 84.9%, with 75.4% returning to the same level of play; 8.7% of patients did not return to play secondary to non–knee-related issues. The mean time to return was 10.9 ± 4.9 months. Among professional rugby players, 93.3% were able to return at a mean time of 9.7 ± 4.4 months; 80% returned to the same level. The mean Anterior Cruciate Ligament–Return to Sport after Injury score was 78.4 ± 20.2, the Cincinnati knee score was 92.5 ± 8.0, the International Knee Documentation Committee score was 88.2 ± 8.1, and the Marx score was 9.7 ± 5.3. Two patients sustained a subsequent rerupture of the reconstructed ACL, and 4 players sustained a contralateral ACL injury within the follow-up interval of 2 years.

Conclusion:

Rugby players receiving BTB ACL reconstruction demonstrated good clinical outcomes with a high rate of return to sport, with the majority returning before 12 months. The rate of a subsequent ACL injury was low among the authors’ cohort at short-term follow-up.
Mitigating injection-induced seismicity to reduce seismic risk
Authors: Johnson Eric G , Haagenson Ryan , Liel Abbie B , Rajaram Harihar
Published: May 2021

Over the past decade, parts of the central United States have experienced elevated number of earthquakes and seismic damage to buildings and infrastructure. These earthquakes are caused by underground injection of wastewater from oil and gas operations, which increases pore pressures, in some cases leading to slip on faults in the geologic basement. Mitigation strategies have been proposed or implemented to reduce these earthquakes, while minimizing impact on operations, but the effectiveness of these strategies in terms of seismic risk is not well understood. Here, we show that the most effective strategies for reducing earthquake occurrence may not be the best for reducing regional seismic risk in terms of economic loss. Well locations have a large impact on seismic risk, and increasing the distance between wells typically reduces risks, with the least interruption to injection operations. Results also quantify the dramatic decrease in risk achieved by locating injection operations farther from population centers. Decreasing injected volume reduces both earthquake occurrence and risk, but large reductions in volumes are needed to achieve significant reductions in risk. These findings can be used to inform design and selection of mitigation strategies that most reduce seismic risk.
Adoption of seismic-resistant techniques in reconstructed housing in the aftermath of Nepal’s 2015 Gorkha earthquake
Authors: Hendriks Eefje , Opdyke Aaron
Published: May 2021

Earthquake affected households too often insufficiently apply seismic construction knowledge during reconstruction. This study aims to assess to what degree safety guidelines have found their way to practice in Nepal. Differences are explored between communities in the Gorkha and Okhaldhunga districts, which received differing levels of technical assistance following the 2015 earthquakes. Seismic resistance of houses was assessed 3 years after the earthquakes. Findings from 955 houses in 25 communities show high degrees of adoption of earthquake-resistant construction knowledge in all selected communities. Variation in safer construction across communities differs only slightly for different intensities of humanitarian technical assistance. This finding points toward the need to more closely examine the communication methods employed and motivations of households to build back safer.
Maternal karyogene and cytoplasmic genotype affect the induction efficiency of doubled haploid inducer in Brassica napus
Authors: Zhang Wei , Ma Yongting , Zhu Zhendong , Huang Liangjun , Ali Asif , Luo Xuan , Zhou Ying , Li Yun , Xu Peizhou , Yang Jin , Li Zhuang , Shi Haoran , Wang Jisheng , Gong Wanzhuo , Zou Qiong , Tao Lanrong , Kang Zeming , Tang Rong , Zhao Zhangjie , Li Zhi , Guo Shixing , Fu Shaohong
Published: May 2021

Background

Artificial synthesis of octoploid rapeseed double haploid (DH) induction lines Y3380 and Y3560 was made possible by interspecific hybridization and genome doubling techniques. Production of pure lines by DH induction provides a new way to achieve homozygosity earlier in B.napus. Previously, the mechanism of induction, and whether the induction has obvious maternal genotypic differences or not, are not known so far.

Results

In this study, different karyogene and cytoplasmic genotype of B.napus were pollinated with the previously reported DH inducers e.g. Y3380 and Y3560. Our study presents a fine comparison of different cytoplasmic genotypes hybridization to unravel the mechanism of DH induction. Ploidy identification, fertility and SSR marker analysis of induced F1 generation, revealed that ploidy and phenotype of the induced F1 plants were consistent with that type of maternal, rather than paternal parent. The SNP chip analysis revealed that induction efficiency of DH inducers were affected by the karyogene when the maternal cytoplasmic genotypes were the same. However, DH induction efficiency was also affected by cytoplasmic genotype when the karyogenes were same, and the offspring of the ogura cytoplasm showed high frequency inducer gene hybridization or low-frequency infiltration.

Conclusion

The induction effect is influenced by the interaction between maternal karyogene and cytoplasmic genotype, and the results from the partial hybridization of progeny chromosomes indicate that the induction process may be attributed to the selective elimination of paternal chromosome. This study provides a basis for exploring the mechanism of DH inducer in B.napus, and provides new insights for utilization of inducers in molecular breeding.
Prevalence of chronic hepatitis B phases in Eritrean patients: a laboratory-based cross-sectional study
Authors: Hamida Mohammed Elfatih , Raja Saud Mohammed , Seyoum Yemane , Elkhidir Isam Mohammed , Tekle Freweini
Published: May 2021

Background

Understanding the natural history of chronic hepatitis B (CHB) virus infection is important for determining optimal management and predicting prognosis in patients. The aim of this study was to determine the prevalence of different phases of CHB infection among Eritrean patients and to identify the proportion of patients who are eligible for treatment according to the latest American Association for the Study of Liver Diseases (AASLD) guidelines.

Methods

This cross-sectional study enrolled 293 CHB patients (213 males and 80 females) between Jan 2017 and Feb 2019. The patients were classified into immune-tolerant, immune-active, and inactive CHB phases of the infection, which is based on the results of Hepatitis B virus (HBV) serological panel (HBsAg, anti-HBc total, HBeAg, and anti-HBe), ALT levels, and HBV DNA viral load. The 2018 AASLD guidelines were also used to identify patients who needed treatment.

Results

The mean age of the patients was 41.66 ± 13.84 years. Of these, 3 (1.0%) were at the immune tolerant phase, 58 (19.8%) at the immune-active CHB phase, and 232 (79.2%) at the inactive CHB phase. As most subjects (93%) were HBeAg-negative, based on AASLD guidelines, only 5 (1.7%) were currently eligible for treatment.

Conclusions

Our data show that CHB patients in Eritrea were predominantly in the inactive CHB phase. Although initiating antiviral therapy is not recommended in these patients, periodic assessment of liver function and disease severity should be considered in patients older than 40 years. The immune-tolerant phase had the fewest patients, most of whom were aged above 20 years, attesting to the success of incorporating HBV vaccine in the national childhood immunization program since 2002. Our study shows that adopting AASLD treatment guidelines with adjustments to suit the local setting is a suitable option in the management of Eritrean CHB patients.
The effect of care provided by paediatric critical care transport teams on mortality of children transported to paediatric intensive care units in England and Wales: a retrospective cohort study
Authors:   on behalf of the DEPICT Study Team, Seaton Sarah E. , Draper Elizabeth S. , Pagel Christina , Rajah Fatemah , Wray Jo , Ramnarayan Padmanabhan
Published: May 2021

Background

Centralisation of paediatric intensive care units (PICUs) has the increased the need for specialist paediatric critical care transport teams (PCCT) to transport critically ill children to PICU. We investigated the impact of care provided by PCCTs for children on mortality and other clinically important outcomes.

Methods

We analysed linked national data from the Paediatric Intensive Care Audit Network (PICANet) from children admitted to PICUs in England and Wales (2014–2016) to assess the impact of who led the child’s transport, whether prolonged stabilisation by the PCCT was detrimental and the impact of critical incidents during transport on patient outcome. We used logistic regression models to estimate the adjusted odds and probability of mortality within 30 days of admission to PICU (primary outcome) and negative binomial models to investigate length of stay (LOS) and length of invasive ventilation (LOV).

Results

The study included 9112 children transported to PICU. The most common diagnosis was respiratory problems; junior doctors led the PCCT in just over half of all transports; and the 30-day mortality was 7.1%. Transports led by Advanced Nurse Practitioners and Junior Doctors had similar outcomes (adjusted mortality ANP: 0.035 versus Junior Doctor: 0.038). Prolonged stabilisation by the PCCT was possibly associated with increased mortality (0.059, 95% CI: 0.040 to 0.079 versus short stabilisation 0.044, 95% CI: 0.039 to 0.048). Critical incidents involving the child increased the adjusted odds of mortality within 30 days (odds ratio: 3.07).

Conclusions

Variations in team composition between PCCTs appear to have little effect on patient outcomes. We believe differences in stabilisation approaches are due to residual confounding. Our finding that critical incidents were associated with worse outcomes indicates that safety during critical care transport is an important area for future quality improvement work.
The psychological impact of the COVID-19 pandemic on adults and children in the United Arab Emirates: a nationwide cross-sectional study
Authors: Saddik Basema , Hussein Amal , Albanna Ammar , Elbarazi Iffat , Al-Shujairi Arwa , Temsah Mohamad-Hani , Saheb Sharif-Askari Fatemeh , Stip Emmanuel , Hamid Qutayba , Halwani Rabih
Published: May 2021

Background

The psychosocial impact of previous infectious disease outbreaks in adults has been well documented, however, there is limited information on the mental health impact of the COVID-19 pandemic on adults and children in the United Arab Emirate (UAE) community. The aim of this study was to explore anxiety levels among adults and children in the UAE and to identify potential risk and protective factors for well-being during the COVID-19 pandemic.

Methods

Using a web-based cross-sectional survey we collected data from 2200 self-selected, assessed volunteers and their children. Demographic information, knowledge and beliefs about COVID-19, generalized anxiety disorder (GAD) using the (GAD-7) scale, emotional problems in children using the strengths and difficulties questionnaire (SDQ), worry and fear about COVID-19, coping mechanisms and general health information were collected. Descriptive analysis was carried out to summarize demographic and participant characteristics, Chi-square analysis to explore associations between categorical variables and anxiety levels and multivariable binary logistic regression analysis to determine predictors of anxiety levels in adults and emotional problems in children.

Results

The overall prevalence of GAD in the general population was 71% with younger people (59.8%) and females (51.7%) reporting highest levels of anxiety. Parents who were teachers reported the highest percentage of emotional problems in children (26.7%). Adjusted multivariable logistic regression for GAD-7 scores showed that being female, high levels of worry associated with COVID-19, intention to take the COVID-19 vaccine and smoking were associated with higher levels of anxiety. Adjusted multivariable logistic regression for SDQ showed that higher emotional problems were reported for children in lower and higher secondary education, and parents who had severe anxiety were seven times more likely to report emotional problems in their children.

Conclusions

This study reports the psychological impact of COVID-19 among adults and children in the UAE and highlights the significant association between parental and child anxiety. Findings suggest the urgency for policy makers to develop effective screening and coping strategies for parents and especially children.
Prevalence of criminal convictions in Norwegian adult ADHD outpatients and associations with ADHD symptom severity and emotional dysregulation
Authors: Anker Espen , Ginsberg Ylva , Heir Trond
Published: May 2021

Objectives

Attention deficit hyperactivity disorder (ADHD) often co-occurs with antisocial behaviour. Several studies have shown high rates of ADHD among prisoners. However, the prevalence of crime among individuals with ADHD is less known. The aim of the present study was to estimate the prevalence of lifetime criminal conviction (CC) in a clinical sample of adults with ADHD, and the associations with the severity of ADHD and emotional dysregulation (ED).

Methods

Patients were admitted to a private psychiatric outpatient clinic in Oslo between 2014 and 2018. Of the 656 patients diagnosed with ADHD, 629 (95.9%) agreed to participate in the study. CC was determined based on self-reporting of the lifetime history of criminal behaviour. ADHD was diagnosed according to the DSM-5 criteria, and ADHD severity was measured using the Adult ADHD Self-Report Scale (ASRS). ED was assessed by the eight-item version of Barkley’s Current Behaviour Scale - Self-Report (CBS-SR).

Results

The prevalence of self-reported CC in this clinical sample was 11.7% among women and 24.5% among men. CC was associated with hyperactive-impulsive severity (p < 0.001) and ED (p = 0.006).

Conclusions

The prevalence of self-reported lifetime criminal conviction was high for both genders. CC was associated with symptom severity of hyperactivity-impulsivity and emotional dysregulation. The findings suggest the need for greater research efforts on the avoidance of criminal activity in people with ADHD and targeted intervention for ADHD treatment and CC prevention.
Association between severe acute malnutrition during childhood and blood pressure during adulthood in the eastern Democratic Republic of the Congo: the Lwiro cohort study
Authors: Mwene-Batu Pacifique , Lemogoum Daniel , de le Hoye Laurène , Bisimwa Ghislain , Hermans Michel P. , Minani Jimmy , Amani Gaylord , Mateso Guy-Quesney , Cikomola Justin Cirhuza , Dramaix Michelle , Donnen Philippe
Published: May 2021

Introduction

Little is known about the long-term outcomes of Severe Acute Malnutrition (SAM) during childhood. As such, this study aims to explore the association between childhood SAM and blood pressure (BP) in adulthood in a context without nutrition transition.

Methodology

We identified 524 adults (Median age: 22 years) who were treated for SAM during childhood in Eastern DRC between 1988 and 2007. They were compared with 407 age-and-sex matched subjects with no history of SAM in the community. The variables examined for this study were the systolic (SBP), diastolic (DBP), mean (MBP) blood pressure (BP) and pulse pressure (PP), as well as high blood pressure (HBP) defined as BP ≥ 140/90 mmHg and/or use of BP-lowering drug(s) in adulthood. For comparison, linear and logistic regression models were used for analysing continuous and dichotomous variables, respectively.

Results

Of the 524 exposed located, 145 were selected according to age. A total of 97 unexposed were recruited. Compared to unexposed, exposed had slightly higher SBP and PP after adjusting for occupation, body mass index (BMI) and food consumption [SBP = 1.4 mmHg (− 2.2, 4.8) and PP = 2.6 mmHg (− 0.3, 6.0)]. However, their DBP was lower than that of the unexposed [− 1.6 mmHg (− 4.6, 1.5)]. MBP and creatinine levels were similar between the two groups. The prevalence of HBP adjusted for age was higher among exposed than unexposed (9.7% vs 5.3%). In addition, the odds of having HBP was higher among exposed than unexposed, however the observed difference was not statistically significant [Odds Ratio (OR) 1.9 (0.7, 5.6)]. Finally, using multiple regression analysis, although the effect was not significant, SAM was a major contributor to HBP [adjusted OR 3.1 (0.9,10.9), p = 0.064], while only male gender and higher BMI (overweight/obesity) emerged as independent predictors of HBP among this young study population.

Conclusions

This study suggests that an episode of SAM in childhood has a weak impact on BP variability in young Congolese adults (from DRC) living in an environment without nutrition transition. However, people who experienced a period of SAM tended to have a higher prevalence of HBP and a much higher risk of developing HBP than unexposed. Additional multicentre studies involving a larger cohort would provide greater understanding of the impact of SAM on the overall risk of BP disorders during adulthood.
The incidence of construction site injuries to women in Delhi: capture-recapture study
Authors: Yadav Sajjan S. , Edwards Phil , Porter John
Published: May 2021

Background

In India, the construction sector provides the main alternative to agricultural work - seasonal migration to and from construction work is widespread and construction work remains the second-largest employer of women in the country behind agriculture. Occupational injuries, which kill over 300,000 people annually, are a serious public health concern. However, data on construction site injuries to women are lacking, as India does not publish statistics on occupational injuries and illnesses. Our objectives were to: Estimate the number of women injured in construction site accidents in Delhi; and to estimate and compare the annual construction site injury rates per 100,000 workers of males and females in Delhi.

Methods

We conducted a two-sample capture-recapture study using data for accidents reported to the Delhi Police, Employee State Insurance Corporation (ESIC), and Commissioners of Workmen Compensation (CWC) of Delhi Government. The capture-recapture method has been used in epidemiology, to estimate morbidity and mortality using multiple, overlapping, but incomplete data sources. This study is based on the injuries reported from construction site accidents in Delhi in 2017. We linked the data from each of the data sources using the name, gender, and age of each injured person, the date and place of the accident, and the name of the employer. We used the Chapman estimator to estimate the total incidence of construction injuries in Delhi.

Results

We estimated that there was a total of 37 female construction site workers injured (17 fatal and 20 non-fatal) in Delhi in 2017. There was a total of 1043 male construction site workers injured (236 fatal and 807 non-fatal). FIRs ascertained two-thirds (68%) of all injuries to females but only one third (34%) of those to males. The annual construction site injury rate per 100,000 workers of females was 82.26 (95%CI: 57.92 to 113.39). The annual construction site injury rate per 100,000 workers of males was 146.5 (95%CI: 137.7 to 155.6). There was strong evidence (p = 0.001) that the overall construction site injury rate per 100,000 workers of females was about one half the rate of males [rate ratio 0.56 (95%CI: 0.40 to 0.78)]. There was no evidence (p = 0.601) that the rates of fatal injuries differed in males and females (rate ratio 1.14 (95%CI: 0.70 to 1.87).

Conclusions

This study is the first to estimate the incidence of injuries to female construction site workers in India. The overall injury rate of female construction workers was over half as great as the rate of males. This implies that female construction workers face a not insignificant risk. Hence, safety measures (e.g., personal protective equipment) that are appropriate and culturally acceptable to Indian women are needed.
Appendiceal adenocarcinoma found by surgery for acute appendicitis is associated with older age
Authors: Skendelas John P. , Alemany Victor S. , Au Vincent , Rao Devika , McNelis John , Kim Peter K.
Published: May 2021

Background

Appendectomy for acute appendicitis is the most common procedure performed emergently by general surgeons in the United States. The current management of acute appendicitis is increasingly controversial as non-operative management gains favor. Although rare, appendiceal neoplasms are often found as an incidental finding in the setting of appendectomy. Criteria and screening for appendiceal neoplasms are not standardized among surgical societies.

Methods

The National Surgical Quality Improvement Program (NSQIP) database was queried for all patients who underwent appendectomy over a 9-year period (2010–2018). Over the same time period, patients who underwent appendectomy in two municipal hospitals in The Bronx, New York City, USA were reviewed.

Results

We found a 1.7% incidence of appendiceal neoplasms locally and a 0.53% incidence of appendiceal tumors in a national population sample. Both groups demonstrated an increased incidence of appendiceal carcinoma by age. This finding was most pronounced after the age of 40 in both local and national populations. In our study, the incidence of appendiceal tumors increased with each decade interval up to the age of 80 and peaked at 2.1% in patients between 70 and 79 years.

Conclusions

Appendiceal adenocarcinomas were identified in patients with acute appendicitis that seem to be associated with increasing age. The presence of an appendiceal malignancy should be considered in the management of older patients with acute appendicitis before a decision to embark on non-operative therapy.
Comparison of suturing models: the effect on perception of basic surgical skills
Authors: Gonzalez-Navarro Alejandro Rafael , Quiroga-Garza Alejandro , Acosta-Luna Adriana Sharai , Salinas-Alvarez Yolanda , Martinez-Garza Javier Humberto , de la Garza-Castro Oscar , Gutierrez-de la O Jorge , de la Fuente-Villarreal David , Elizondo-Omaña Rodrigo Enrique , Guzman-Lopez Santos
Published: May 2021

Background

Acquisition of Basic Surgical Skills (BSS) are essential for medical students. The objective was to determine it’s fidelity impact.

Methods

Using four suturing models (SM) (pigskin, sponge, commercial pad, and orange), SM-quality and student-SM interaction were evaluated. After a 1-h class, participants were divided into groups and randomly assigned exercises in SM in 15-min intervals. The experiment included completing three individual simple stitches and a 3-stitch continuous suture in each SM.

Results

Eighty-two medical students participated. Suturing quality was better in pigskin and sponge, which were also the preferred models (p < 0.001). Significant differences in quality between the insertion and exit point, and firmness of knots (p < 0.05) in both simple and continuous sutures, as well as between length and distance in continuous ones (p < 0.001) were identified.

Conclusions

Acquisition and quality of BSS are influenced by the intrinsic characteristics of SM. An adequate degree of resistance, consistency, and elasticity are necessary.
Patient participation in electronic nursing documentation: an interview study among community nurses
Authors: De Groot Kim , Sneep Elisah B. , Paans Wolter , Francke Anneke L.
Published: May 2021

Background

Patient participation in nursing documentation has several benefits like including patients’ personal wishes in tailor-made care plans and facilitating shared decision-making. However, the rise of electronic health records may not automatically lead to greater patient participation in nursing documentation. This study aims to gain insight into community nurses’ experiences regarding patient participation in electronic nursing documentation, and to explore the challenges nurses face and the strategies they use for dealing with challenges regarding patient participation in electronic nursing documentation.

Methods

A qualitative descriptive design was used, based on the principles of reflexive thematic analysis. Nineteen community nurses working in home care and using electronic health records were recruited using purposive sampling. Interviews guided by an interview guide were conducted face-to-face or by phone in 2019. The interviews were inductively analysed in an iterative process of data collection–data analysis–more data collection until data saturation was achieved. The steps of thematic analysis were followed, namely familiarization with data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and reporting.

Results

Community nurses believed patient participation in nursing documentation has to be tailored to each patient. Actual participation depended on the phase of the nursing process that was being documented and was facilitated by patients’ trust in the accuracy of the documentation. Nurses came across challenges in three domains: those related to electronic health records (i.e. technical problems), to work (e.g. time pressure) and to the patients (e.g. the medical condition). Because of these challenges, nurses frequently did the documentation outside the patient’s home. Nurses still tried to achieve patient participation by verbally discussing patients’ views on the nursing care provided and then documenting those views at a later moment.

Conclusions

Although community nurses consider patient participation in electronic nursing documentation important, they perceive various challenges relating to electronic health records, work and the patients to realize patient participation. In dealing with these challenges, nurses often fall back on verbal communication about the documentation. These insights can help nurses and policy makers improve electronic health records and develop efficient strategies for improving patient participation in electronic nursing documentation.
A practical technique for subacute hemorrhagic pericarditis, a case report
Authors: Zhao Long , Hong Ruofeng , Fei Jianbin , Yang Wenyu
Published: May 2021

Background

We used pericardioscope operation for a patient who suffered from subacute hemorrhagic pericarditis which usually have to had a sternotomy.

Case presentation

A pericardioscope was used in the operation rather than sternotomy on a 66-year-old male who was diagnosed with subacute hemorrhagic pericarditis after PCI(Percutaneous Coronary Intervention). He was discharged 7 days after the operation with an uneventfull postoperative course.

Conclusions

We believe that this technique is a safe procedure without any major complications.
Validated green spectrophotometric kinetic method for determination of Clindamycin Hydrochloride in capsules
Authors: Affas Shaza , Sakur Amir Alhaj
Published: May 2021

Background

Simple, sensitive, free of organic solvents, kinetic spectrophotometric method has been developed for the determination of Clindamycin Hydrochloride, both in pure form and Capsules. Method is based on reaction of Clindamycin with potassium iodide and potassium iodate in an aqueous medium at (25 ± 2 °C) to produce yellow-coloured tri iodide ions (I3−). The reaction is followed spectrophotometrically by measuring the absorbance at wavelength 350 nm during 40 min.

Results

The effects of analytical parameters on reported kinetic methods were investigated. Under the optimized conditions, the initial rate and fixed time (at 10 min) methods were used for constructing the calibration graphs. The graphs were linear in concentration ranges 1–20 μg ml−1 with limit of detection of 0.12 and 0.22 μg ml−1for the initial rate and fixed time methods, respectively. The results were satisfactory and the analytical performance for both methods was validated.

Conclusion

The proposed methods have been applied to determine the components in capsules with an average recovery of 98.25–102.00% and the results are in good agreement with those found by the reference method.
Assessment of differentially methylated loci in individuals with end-stage kidney disease attributed to diabetic kidney disease: an exploratory study
Authors: Smyth L. J. , Kilner J. , Nair V. , Liu H. , Brennan E. , Kerr K. , Sandholm N. , Cole J. , Dahlström E. , Syreeni A. , Salem R. M. , Nelson R. G. , Looker H. C. , Wooster C. , Anderson K. , McKay G. J. , Kee F. , Young I. , Andrews D. , Forsblom C. , Hirschhorn J. N. , Godson C. , Groop P. H. , Maxwell A. P. , Susztak K. , Kretzler M. , Florez J. C. , McKnight A. J.
Published: May 2021

Background

A subset of individuals with type 1 diabetes mellitus (T1DM) are predisposed to developing diabetic kidney disease (DKD), the most common cause globally of end-stage kidney disease (ESKD). Emerging evidence suggests epigenetic changes in DNA methylation may have a causal role in both T1DM and DKD. The aim of this exploratory investigation was to assess differences in blood-derived DNA methylation patterns between individuals with T1DM-ESKD and individuals with long-duration T1DM but no evidence of kidney disease upon repeated testing to identify potential blood-based biomarkers. Blood-derived DNA from individuals (107 cases, 253 controls and 14 experimental controls) were bisulphite treated before DNA methylation patterns from both groups were generated and analysed using Illumina’s Infinium MethylationEPIC BeadChip arrays (n = 862,927 sites). Differentially methylated CpG sites (dmCpGs) were identified (false discovery rate adjusted p ≤ × 10–8 and fold change ± 2) by comparing methylation levels between ESKD cases and T1DM controls at single site resolution. Gene annotation and functionality was investigated to enrich and rank methylated regions associated with ESKD in T1DM.

Results

Top-ranked genes within which several dmCpGs were located and supported by functional data with methylation look-ups in other cohorts include: AFF3, ARID5B, CUX1, ELMO1, FKBP5, HDAC4, ITGAL, LY9, PIM1, RUNX3, SEPTIN9 and UPF3A. Top-ranked enrichment pathways included pathways in cancer, TGF-β signalling and Th17 cell differentiation.

Conclusions

Epigenetic alterations provide a dynamic link between an individual’s genetic background and their environmental exposures. This robust evaluation of DNA methylation in carefully phenotyped individuals has identified biomarkers associated with ESKD, revealing several genes and implicated key pathways associated with ESKD in individuals with T1DM.
Weight loss after Roux-En-Y gastric bypass surgery reveals skeletal muscle DNA methylation changes
Authors: Garcia Luis A. , Day Samantha E. , Coletta Richard L. , Campos Baltazar , Benjamin Tonya R. , De Filippis Eleanna , Madura James A. , Mandarino Lawrence J. , Roust Lori R. , Coletta Dawn K.
Published: May 2021

Background

The mechanisms of weight loss and metabolic improvements following bariatric surgery in skeletal muscle are not well known; however, epigenetic modifications are likely to contribute. The aim of our study was to investigate skeletal muscle DNA methylation after weight loss induced by Roux-en-Y gastric bypass (RYGB) surgery. Muscle biopsies were obtained basally from seven insulin-resistant obese (BMI > 40 kg/m2) female subjects (45.1 ± 3.6 years) pre- and 3-month post-surgery with euglycemic hyperinsulinemic clamps to assess insulin sensitivity. Four lean (BMI < 25 kg/m2) females (38.5 ± 5.8 years) served as controls. We performed reduced representation bisulfite sequencing next generation methylation on DNA isolated from the vastus lateralis muscle biopsies.

Results

Global methylation was significantly higher in the pre- (32.97 ± 0.02%) and post-surgery (33.31 ± 0.02%) compared to the lean (30.46 ± 0.02%), P < 0.05. MethylSig analysis identified 117 differentially methylated cytosines (DMCs) that were significantly altered in the post- versus pre-surgery (Benjamini–Hochberg q < 0.05). In addition, 2978 DMCs were significantly altered in the pre-surgery obese versus the lean controls (Benjamini–Hochberg q < 0.05). For the post-surgery obese versus the lean controls, 2885 DMCs were altered (Benjamini–Hochberg q < 0.05). Seven post-surgery obese DMCs were normalized to levels similar to those observed in lean controls. Of these, 5 were within intergenic regions (chr11.68,968,018, chr16.73,100,688, chr5.174,115,531, chr5.1,831,958 and chr9.98,547,011) and the remaining two DMCs chr17.45,330,989 and chr14.105,353,824 were within in the integrin beta 3 (ITGB3) promoter and KIAA0284 exon, respectively. ITGB3 methylation was significantly decreased in the post-surgery (0.5 ± 0.5%) and lean controls (0 ± 0%) versus pre-surgery (13.6 ± 2.7%, P < 0.05). This decreased methylation post-surgery was associated with an increase in ITGB3 gene expression (fold change + 1.52, P = 0.0087). In addition, we showed that ITGB3 promoter methylation in vitro significantly suppressed transcriptional activity (P < 0.05). Transcription factor binding analysis for ITGB3 chr17.45,330,989 identified three putative transcription factor binding motifs; PAX-5, p53 and AP-2alphaA.

Conclusions

These results demonstrate that weight loss after RYGB alters the epigenome through DNA methylation. In particular, this study highlights ITGB3 as a novel gene that may contribute to the metabolic improvements observed post-surgery. Future additional studies are warranted to address the exact mechanism of ITGB3 in skeletal muscle.
Clinical outcomes of modified simple limbal epithelial transplantation for limbal stem cell deficiency in Chinese population: a retrospective case series
Authors: Wang Yinghui , Hu Xiaodan , Yang Ke , Zhang Yang , Deng Shijing , Wang Zhiqun , Li Shang , Tian Lei , Jie Ying
Published: May 2021

Objective

To report the clinical outcomes of a novel surgical technique, namely simple limbal epithelial transplantation (SLET), for the treatment of limbal stem cell deficiency (LSCD).

Methods

Thirteen patients (13 eyes) with LSCD who underwent autologous (10 eyes) or allogeneic (3 eyes) modified SLET between 2018 and 2021 were enrolled in this study. Grades of symblepharon, corneal conjunctivalization, vascularization, opacification, and visual acuity (VA) were evaluated preoperatively and postoperatively. In 2 cases, in vivo confocal microscopy (IVCM) and impression cytology (IC) were performed to assess the proliferation and degeneration of limbal tissue.

Results

At a postoperative follow-up of 6.5±5.3 (range, 2–20) months, 10 (10/13, 76.92%) eyes maintained a successful outcome. The grades of symblepharon, corneal conjunctivalization, vascularization, and opacification were significantly improved after SLET (P<0.05). Two-line improvement in VA was found in 6 (6/10, 60%) eyes of the successful cases. Recurrence of LSCD occurred in 3 (3/13, 23.08%) eyes, and conjunctival cyst occurred in 1 patient. After SLET, the morphology and structure of corneal epithelial cells and epithelial transition around the limbal tissue fragments were detected by IVCM and IC.

Conclusions

Our findings suggest that the SLET is a safe and effective technique for the treatment of LSCD. The corneal stroma and hAM can provide protection and nutrition for the limbal stem cells (LSCs) without negatively influencing the clinical outcomes. IVCM and IC after SLET can evaluate the effectiveness of surgery and the transition of LSCs and corneal epithelial cells.
Multi-omics reveals age-related differences in the diaphragm response to mechanical ventilation: a pilot study
Authors: Lyu Qiong , Wen Ya , Zhang Xiang , Addinsall Alex B. , Cacciani Nicola , Larsson Lars
Published: May 2021

Background

Old age is associated with a significantly increased mortality in COVID-19 patients exposed to long-term controlled mechanical ventilation (CMV) and suggested to be due to the hyperinflammatory response associated with the viral infection. However, our understanding of age-related differences in the response to CMV in the absence of a viral infection remains insufficient.

Methods

Young (7–8 months) and old (28–32 months) F344 BN hybrid rats were exposed to the ICU condition for 5 days, i.e., complete immobilization, mechanical ventilation, and extensive monitoring. Transcriptomic (RNA-Seq) and proteomics (Proximity Extension Assay) analyses of the diaphragm and proteomics analysis of plasma were conducted to investigate the molecular differences between young and old rats exposed to the ICU condition.

Results

According to multi-omics analyses, significant differences were observed in the diaphragm between young and old rats in response to 5 days CMV and immobilization. In young rats, metabolic pathways were primarily downregulated in response to immobilization (post-synaptic blockade of neuromuscular transmission). In old rats, on the other hand, dramatic immune and inflammatory responses were observed, i.e., an upregulation of specific related pathways such as “IL-17 signaling pathway”, along with a higher level of inflammatory factors and cytokine/chemokine in plasma.

Conclusions

The dramatically increased mortality in old ICU patients with COVID-19-associated hyperinflammation and cytokine storm need not only reflect the viral infection but may also be associated with the ventilator induced diaphragm dysfunction (VIDD) and hyperinflammatory responses induced by long-term CMV per se. Although mechanical ventilation is a life-saving intervention in COVID-19 ICU patients, CMV should be cautiously used especially in old age and other means of respiratory support may be considered, such as negative pressure ventilation.
Auditory streaming emerges from fast excitation and slow delayed inhibition
Authors: Ferrario Andrea , Rankin James
Published: May 2021

In the auditory streaming paradigm, alternating sequences of pure tones can be perceived as a single galloping rhythm (integration) or as two sequences with separated low and high tones (segregation). Although studied for decades, the neural mechanisms underlining this perceptual grouping of sound remains a mystery. With the aim of identifying a plausible minimal neural circuit that captures this phenomenon, we propose a firing rate model with two periodically forced neural populations coupled by fast direct excitation and slow delayed inhibition. By analyzing the model in a non-smooth, slow-fast regime we analytically prove the existence of a rich repertoire of dynamical states and of their parameter dependent transitions. We impose plausible parameter restrictions and link all states with perceptual interpretations. Regions of stimulus parameters occupied by states linked with each percept match those found in behavioural experiments. Our model suggests that slow inhibition masks the perception of subsequent tones during segregation (forward masking), whereas fast excitation enables integration for large pitch differences between the two tones.