bluuebunny/crossref_metadata_2025 huggingface dataset:
Barriers for early initiation and exclusive breastfeeding up to six months in predominantly rural Sri Lanka: a need to strengthen policy implementation
Authors: Agampodi Thilini Chanchala , Dharmasoma Neerodha Kithmini , Koralagedara Iresha Sandamali , Dissanayaka Thushari , Warnasekara Janith , Agampodi Suneth Buddhika , Perez-Escamilla Rafael
Published: April 2021

Background

Sri Lanka was named as the first-ever ‘Green’ breastfeeding nation status by the World Breastfeeding Trends Initiative (WBTi) in January 2020. However, improvements are still needed. This study aims to identify barriers and facilitators for early initiation of breastfeeding and exclusive breastfeeding for 6 months in rural Sri Lanka.

Methods

We conducted in-depth interviews with 16 mothers with infants, who had been unable to practice early initiation of breastfeeding and/or exclusive breastfeeding (EBF), in six child-welfare clinics in Anuradhapura, Sri Lanka. Three focus group discussions were held with public health midwives (PHMs). Initial thematic analysis that built upon force field and social learning theories was performed.

Results

Main barriers for EBF were clustered at three time periods; during the first 2–3 days, 2–3 weeks, and 4–5 months postpartum. Early barriers included cesarean section pain, poor breast latch, maternal exhaustion, suboptimal maternity ward environment, and lack of support for breastfeeding. Around 2–3 weeks postpartum mothers introduced water or infant formula due to social norms and poor support. On-demand feeding was misunderstood. Around 4 and 5 months postpartum, EBF ended due to return to work. PHMs reported a heavy workload limiting their time to support breastfeeding.

Conclusion

EBF interruption was due to diverse individual- and environnmental- level barriers that varied across the first 6 months. To improve EBF, Sri Lanka should focus on strengthening policies for reducing the excessive rates of cesarean section, improving support in maternity ward facilities, fostering on-demand breastfeeding, enhancing support for working mothers and reducing the work load of PHMs.
An improved method for the segmentation of roots from X-ray computed tomography 3D images: Rootine v.2
Authors: Phalempin Maxime , Lippold Eva , Vetterlein Doris , Schlüter Steffen
Published: April 2021

Background

X-ray computed tomography is acknowledged as a powerful tool for the study of root system architecture of plants growing in soil. In this paper, we improved the original root segmentation algorithm “Rootine” and present its succeeding version “Rootine v.2”. In addition to gray value information, Rootine algorithms are based on shape detection of cylindrical roots. Both algorithms are macros for the ImageJ software and are made freely available to the public. New features in Rootine v.2 are (i) a pot wall detection and removal step to avoid segmentation artefacts for roots growing along the pot wall, (ii) a calculation of the root average gray value based on a histogram analysis, (iii) an automatic calculation of thresholds for hysteresis thresholding of the tubeness image to reduce the number of parameters and (iv) a false negatives recovery based on shape criteria to increase root recovery. We compare the segmentation results of Rootine v.1 and Rootine v.2 with the results of root washing and subsequent analysis with WinRhizo. We use a benchmark dataset of maize roots (Zea maysL. cv. B73) grown in repacked soil for two scenarios with differing soil heterogeneity and image quality.

Results

We demonstrate that Rootine v.2 outperforms its preceding version in terms of root recovery and enables to match better the root diameter distribution data obtained with root washing. Despite a longer processing time, Rootine v.2 comprises less user-defined parameters and shows an overall greater usability.

Conclusion

The proposed method facilitates higher root detection accuracy than its predecessor and has the potential for improving high-throughput root phenotyping procedures based on X-ray computed tomography data analysis.
Harmonizing healthcare and other resource measures for evaluating economic costs in substance use disorder research
Authors: Papp Michelle A. , Leff Jared A. , Murphy Sean M. , Yang April , Crane Heidi M. , Metsch Lisa R. , Del Rio Carlos , Feaster Daniel J. , Rich Josiah D. , Schackman Bruce R. , McCollister Kathryn E.
Published: April 2021

Background

Standardization and harmonization of healthcare resource utilization data can improve evaluations of the economic impact of treating people with substance use disorder (SUD), including reductions in use of expensive hospital and emergency department (ED) services, and can ensure consistency with current cost-effectiveness and cost-benefit analysis guidelines.

Methods

We examined self-reported healthcare and other resource utilization data collected at baseline from three National Institute on Drug Abuse (NIDA)-funded Seek, Test, Treat, and Retain intervention studies of individuals living with/at risk for HIV with SUD. Costs were calculated by multiplying mean healthcare resource utilization measures by monetary conversion factors reflecting cost per unit of care. We normalized baseline recall timeframes to past 30 days and evaluated for missing data.

Results

We identified measures that are feasible and appropriate for estimating healthcare sector costs including ED visits, inpatient hospital and residential facility stays, and outpatient encounters. We also identified two self-reported measures to inform societal costs (days experiencing SUD problems, participant spending on substances). Missingness was 8% or less for all study measures and was lower for single questions measuring utilization in a recall period.

Conclusions

We recommend including measures representing units of service with specific recall periods (e.g., 6 months vs. lifetime), and collecting healthcare resource utilization data using single-question measures to reduce missingness.
Gap balancing improve squat function and knee function: a randomized controlled trial comparing gap balancing and measured resection
Authors: Xiao Qingfang , Liu Bo , Zhao Binghao
Published: April 2021

Objective

We compared the measured resection (MR) technique and the gap balancing (GB) technique in patients with knee osteoarthritis after primary total knee arthroplasty (TKA) in China to understand the effects of the two techniques on knee function and squat function.

Methods

From March 2017 to September 2019, a prospective randomized controlled trial was conducted with 96 patients with knee osteoarthritis undergoing primary TKA from March 2017 to September 2019 randomized to GB group (n= 48) and MR group (n= 48). Intraoperative indicators (operation time, osteotomy volume of medial and lateral of posterior femoral condyles, external rotation angle) were recorded during operation. At 1, 3, 6, and 12 months after surgery, all the patients came to the hospital for review and underwent the pain severity, Western Ontario and McMaster University Osteoarthritis Index (WOMAC), knee joint range of motion, Oxford Knee Score (OKS), and American Knee Society Score (AKSS) tests. All patients were followed up for more than 1 year.

Results

The osteotomy volume of the medial femoral condyle in the GB group was higher than that in the MR group (P<0.05), and the operation time in the GB group was shorter than that in the MR group (P<0.05). At 1, 3, 6, and 12 months after surgery, the pain severity in the GB group was lower than that in the MR group (P<0.05), the knee range of motion in the GB group was larger than that in the MR group (P<0.05), the WOMAC of the GB group was lower than that of the MR group (P<0.05), the OKS of the GB group was higher than that of the MR group (P<0.05), the AKSS of the GB group was higher than that of the MR group. The incidence of postoperative complications in the GB group (4.17%) was significantly lower than that in the MR group (18.75%) (P<0.05).

Conclusion

The GB technique can effectively shorten the operation time, relieve pain, improve knee range of motion, improve squat function and knee function, reduce osteoarthritis index, and reduce the occurrence of complications, which is worthy of clinical popularization and application.
Matrix-associated autologous chondrocyte implantation with autologous bone grafting of osteochondral lesions of the talus in adolescents: patient-reported outcomes with a median follow-up of 6 years
Authors: Körner Daniel , Gonser Christoph E. , Döbele Stefan , Konrads Christian , Springer Fabian , Keller Gabriel
Published: April 2021

Background

This study presents patient-reported outcome measures after combined matrix-associated autologous chondrocyte implantation and autologous bone grafting in high-stage osteochondral lesions of the talus in adolescents.

Methods

A total of 12 adolescent patients (13 ankles) received matrix-associated autologous chondrocyte implantation and autologous bone grafting for a solitary osteochondral lesion of the talus at a single centre. The Foot and Ankle Outcome Score and Foot and Ankle Ability Measure were defined as outcome measures (median follow-up 80 months [range 22–107 months]). Pre- and postoperative ankle radiographs were evaluated according to the van Dijk ankle osteoarthritis scale.

Results

The study population consisted of four male and nine female cases (mean age at the time of surgery, 17.7 ± 2.1 years). Eight lesions were classified as traumatic and five as idiopathic. Twelve lesions were located medial vs one lateral in the coronal plane and all central in the sagittal plane. The median lesion size and depth were 1.3 cm2 (range 0.9–3.2 cm2) and 5 mm (range 5–9 mm), respectively.

There were no perioperative complications in any of the cases.

In 9 cases patient-reported outcome measures were available. The results of the Foot and Ankle Outcome Score subscales were symptoms, 70 ± 14; pain, 83 ± 10; activities of daily living, 89 ± 12; sports/recreational activities, 66 ± 26; and quality of life, 51 ± 17. The mean overall Foot and Ankle Outcome Score was 78 ± 13.

The results of the Foot and Ankle Ability Measure subscales were activities of daily living, 81 ± 20; function/activities of daily living, 84 ± 13; sports, 65 ± 29; and function/sports, 73 ± 27. According to the function overall subscale of the Foot and Ankle Ability Measure, in two cases, the patients assessed the ankle function as normal, in three as nearly normal, and in three as abnormal (missing data, n = 1).

Preoperative van Dijk scale: stage 0 in five cases and stage I in eight cases; postoperative van Dijk scale: stage 0 in four cases, stage I in 9 cases

Conclusions

Patient-reported outcome measures following matrix-associated autologous chondrocyte implantation and autologous bone grafting for high-stage osteochondral lesions of the talus in adolescents show heterogeneous results. Long-term limitations mainly affect sports and recreational activities. Osteochondral lesions of the talus are associated with osteoarthritis, even preoperatively. However, we did not find significant osteoarthritis progression after matrix-associated autologous chondrocyte implantation and autologous bone grafting in the long term.
Intimate partner violence against women on the Colombia Ecuador border: a mixed-methods analysis of the liminal migrant experience
Authors: Keating Colleen , Treves-Kagan Sarah , Buller Ana Maria
Published: April 2021

Background

Intimate partner violence (IPV) has serious long-term health and psychological consequences and is highly prevalent in Latin America and among displaced populations. Liminality - the ambiguous in-between state of individuals completing a migratory journey - represents a state of legal, economic, and physical insecurity. Through the framework of liminality, this analysis seeks to understand the unique challenges faced by displaced Colombian women in Ecuador including their experience of IPV.

Methods

We performed a secondary analysis of 15 in-depth interviews and 319 longitudinal surveys, conducted on the border of Ecuador and Colombia, following a sequential explanatory mixed-methods design. We analysed interviews thematically and mapped the main themes onto complementary quantitative variables. We conducted logistic regression with identified risk and protective factors (measured at time 1) and recent IPV (measured at time 2), controlling for demographic characteristics and IPV at time 1.

Results

Our mixed-methods analysis revealed four main mechanisms by which displacement influenced the social and economic realities of Colombian women years after crossing the border, compounding their risk of IPV and limiting their ability to escape it. Lack of legal residence and documentation, violence experienced along life course and migratory continuums which increased their risk for later revictimisation, social isolation including loss of support networks and restricted mobility and lastly, financial stress.

Conclusions

This research highlights the critical importance of supporting the economic and social integration of migrants and refugees in host communities, as well as the need to carefully consider migration-related vulnerabilities in IPV prevention and response interventions. As the regional refugee crisis grows, policy makers must consider how the long-term marginalisation of refugee women contributes to their victimisation. This research also supports the idea of incorporating gender synchronised, transformative IPV prevention and response programmes into migration-related and poverty alleviation international development efforts.
Emotional symptoms and their related factors in adolescents during the acute phase of Covid-19 outbreak in South Italy
Authors: Pisano Simone , Catone Gennaro , Gritti Antonella , Almerico Luisa , Pezzella Anna , Santangelo Pia , Bravaccio Carmela , Iuliano Raffaella , Senese Vincenzo Paolo
Published: April 2021

Background

Several studies have shown that during COVID-19 pandemic outbreak, emotional symptoms increased in the general population. Less is known about youths.

Methods

We surveyed a sample of Italian adolescents during the strictest quarantine period and assessed the effects of socio-demographic and psychological factors on current emotional symptoms. A convenient sample of 326 adolescents (age range 14–19 years) participated in a web-based survey. We collected data on several socio-demographic and psychological variables (summarized into three indexes: environmental context, changes in lifestyle, and worries about infection) and psychopathological symptoms (previous psychopathological status, current anxiety and depressive symptoms).

Results

Descriptive analysis showed that adolescents have experienced quarantine under very different conditions; they reported 47.5 and 14.1% of anxiety and depressive symptoms, respectively. Regression analyses indicated that previous psychopathological status and worries about infection are linked to anxiety and that female gender, previous psychopathological status (moderated by change in lifestyle), worse environmental context are linked to depression.

Conclusion

This study indicates that, facing the COVID-19 pandemic and its related safety measures, adolescents show relevant emotional symptoms and therefore should be monitored, assessed and supported.
The COVID-19 pandemic and new clinical trial activations
Authors: Unger Joseph M. , Xiao Hong
Published: April 2021

Background

The COVID-19 pandemic has caused severe disruptions in care for many patients. A key question is whether the landscape of clinical research has also changed.

Methods

In a retrospective cohort study, we examined the association of the COVID-19 outbreak with new clinical trial activations. Trial data for all interventional and observational oncology, cardiovascular, and mental health studies from January 2015 through September 2020 were obtained from ClinicalTrials.gov. An interrupted time-series analysis with Poisson regression was used.

Results

We examined 62,252 trial activations. During the initial COVID-19 outbreak (February 2020 through May 2020), model-estimated monthly trial activations for US-based studies were only 57% of the expected estimate had the pandemic not occurred (relative risk = 0.57, 95% CI 0.52 to 0.61, p < .001). For non-US-based studies, the impact of the pandemic was less dramatic (relative risk = 0.77, 95% CI 0.73 to 0.82, p < .001), resulting in an overall 27% reduction in the relative risk of new trial activations for US-based trials compared to non-US-based trials (relative risk ratio = 0.73, 95% CI 0.67 to 0.81, p < .001). Although a rebound occurred in the initial reopening phase (June 2020 through September 2020), the rebound was weaker for US-based studies compared to non-US-based studies (relative risk ratio = 0.87, 95% CI 0.80 to 0.95, p < .001).

Conclusions

These findings are consistent with the disproportionate burden of COVID-19 diagnoses and deaths during the initial phase of the pandemic in the USA. Reduced activation of cancer clinical trials will likely slow the pace of clinical research and new drug discovery, with long-term negative consequences for cancer patients. An important question is whether the renewed outbreak period of winter 2020/2021 will have a similarly negative impact on the initiation of new clinical research studies for non-COVID-19 diseases.
Characterization of simultaneous uptake of xylose and glucose in Caldicellulosiruptor kronotskyensis for optimal hydrogen production
Authors: Vongkampang Thitiwut , Sreenivas Krishnan , Engvall Jonathan , Grey Carl , van Niel Ed W. J.
Published: April 2021

Background

Caldicellulosiruptor kronotskyensis has gained interest for its ability to grow on various lignocellulosic biomass. The aim of this study was to investigate the growth profiles of C. kronotskyensis in the presence of mixtures of glucose–xylose. Recently, we characterized a diauxic-like pattern for C. saccharolyticus on lignocellulosic sugar mixtures. In this study, we aimed to investigate further whether C. kronotskyensis has adapted to uptake glucose in the disaccharide form (cellobiose) rather than the monosaccharide (glucose).

Results

Interestingly, growth of C. kronotskyensis on glucose and xylose mixtures did not display diauxic-like growth patterns. Closer investigation revealed that, in contrast to C. saccharolyticus, C. kronotskyensis does not possess a second uptake system for glucose. Both C. saccharolyticus and C. kronotskyensis share the characteristics of preferring xylose over glucose. Growth on xylose was twice as fast (μmax = 0.57 h−1) as on glucose (μmax = 0.28 h−1). A study of the sugar uptake was made with different glucose–xylose ratios to find a kinetic relationship between the two sugars for transport into the cell. High concentrations of glucose inhibited xylose uptake and vice versa. The inhibition constants were estimated to be KI,glu = 0.01 cmol L−1 and KI,xyl = 0.001 cmol L−1, hence glucose uptake was more severely inhibited by xylose uptake. Bioinformatics analysis could not exclude that C. kronotskyensis possesses more than one transporter for glucose. As a next step it was investigated whether glucose uptake by C. kronotskyensis improved in the form of cellobiose. Indeed, cellobiose is taken up faster than glucose; nevertheless, the growth rate on each sugar remained similar.

Conclusions

C. kronotskyensis possesses a xylose transporter that might take up glucose at an inferior rate even in the absence of xylose. Alternatively, glucose can be taken up in the form of cellobiose, but growth performance is still inferior to growth on xylose. Therefore, we propose that the catabolism of C. kronotskyensis has adapted more strongly to pentose rather than hexose, thereby having obtained a specific survival edge in thermophilic lignocellulosic degradation communities.
Effect of blood source on vector competence of Culex pipiens biotypes for Usutu virus
Authors: Abbo Sandra R. , Visser Tessa M. , Koenraadt Constantianus J. M. , Pijlman Gorben P. , Wang Haidong
Published: April 2021

Background

Infectious blood meal experiments have been frequently performed with different virus-vector combinations to assess the transmission potential of arthropod-borne (arbo)viruses. A wide variety of host blood sources have been used to deliver arboviruses to their arthropod vectors in laboratory studies. The type of blood used during vector competence experiments does not always reflect the blood from the viremic vertebrate hosts in the field, but little is known about the effect of blood source on the experimental outcome of vector competence studies. Here we investigated the effect of avian versus human blood on the infection and transmission rates of the zoonotic Usutu virus (USUV) in its primary mosquito vector Culex pipiens.

Methods

Cx. pipiens biotypes (pipiens and molestus) were orally infected with USUV through infectious blood meals containing either chicken or human whole blood. The USUV infection and transmission rates were determined by checking mosquito bodies and saliva for USUV presence after 14 days of incubation at 28 °C. In addition, viral titers were determined for USUV-positive mosquito bodies and saliva.

Results

Human and chicken blood lead to similar USUV transmission rates for Cx. pipiens biotype pipiens (18% and 15%, respectively), while human blood moderately but not significantly increased the transmission rate (30%) compared to chicken blood (17%) for biotype molestus. USUV infection rates with human blood were consistently higher in both Cx. pipiens biotypes compared to chicken blood. In virus-positive mosquitoes, USUV body and saliva titers did not differ between mosquitoes taking either human or chicken blood. Importantly, biotype molestus had much lower USUV saliva titers compared to biotype pipiens, regardless of which blood was offered.

Conclusions

Infection of mosquitoes with human blood led to higher USUV infection rates as compared to chicken blood. However, the blood source had no effect on the vector competence for USUV. Interestingly, biotype molestus is less likely to transmit USUV compared to biotype pipiens due to very low virus titers in the saliva.

Graphical Abstract
Dynamically localizing multiple speakers based on the time-frequency domain
Authors: Hammer Hodaya , Chazan Shlomo E. , Goldberger Jacob , Gannot Sharon
Published: April 2021

In this study, we present a deep neural network-based online multi-speaker localization algorithm based on a multi-microphone array. Following the W-disjoint orthogonality principle in the spectral domain, time-frequency (TF) bin is dominated by a single speaker and hence by a single direction of arrival (DOA). A fully convolutional network is trained with instantaneous spatial features to estimate the DOA for each TF bin. The high-resolution classification enables the network to accurately and simultaneously localize and track multiple speakers, both static and dynamic. Elaborated experimental study using simulated and real-life recordings in static and dynamic scenarios demonstrates that the proposed algorithm significantly outperforms both classic and recent deep-learning-based algorithms. Finally, as a byproduct, we further show that the proposed method is also capable of separating moving speakers by the application of the obtained TF masks.
Some generalized Hermite–Hadamard–Fejér inequality for convex functions
Authors: Vivas-Cortez Miguel , Kórus Péter , Nápoles Valdés Juan E.
Published: April 2021

In this paper, we have established some generalized inequalities of Hermite–Hadamard–Fejér type for generalized integrals. The results obtained are applied for fractional integrals of various type and therefore contain some previous results reported in the literature.
A case of simultaneous laparoscopic surgery for double cancer comprising multiple early gastric cancer and advanced sigmoid colon cancer after revascularization
Authors: Takiguchi Koichi , Furuya Shinji , Sudo Makoto , Hirayama Kazuyoshi , Saito Ryo , Yamamoto Atsushi , Shoda Katsutoshi , Akaike Hidenori , Hosomura Naohiro , Kawaguchi Yoshihiko , Amemiya Hidetake , Kawaida Hiromichi , Kono Hiroshi , Ichikawa Daisuke
Published: April 2021

Background

Traditionally, the surgery for simultaneous double cancer of the stomach and colon required a large incision to the upper and lower region of the abdomen. In this case, an artificial blood vessel was located under the skin after revascularization. Considering ischemia due to graft compression by incision retractor during laparotomy, this was difficult to do. This is a report on laparoscopic surgery for simultaneous double cancer of the stomach and colon after revascularization.

Case presentation

A 69-year-old man had early gastric cancer and advanced sigmoid colon cancer. He had suffered from thromboangitis obliterans and has undergone revascularization many times due to poor blood flow in his lower limbs. He had had some artificial blood vessels inserted under the skin, confirmed by blood vessel construction image by preoperative computed tomography (CT). There was a bypass vessel from the left axillary artery to the left femoral artery under the skin of the left thoracoabdominal. In addition, there were two bypass vessels from the left external iliac artery to the right femoral artery under the skin of the lower abdomen. One of the two bypasses was occluded. In the blood flow to the intestinal tract, the inferior mesenteric artery was already occluded. Peripheral blood flow in the common iliac artery depended on blood flow from the artificial blood vessel, and blood flow from the internal iliac artery to the rectum was poor. Laparoscopic Hartmann’s operation was performed for Stage II B (UICC 8th Edition) sigmoid colon cancer. Because the blood flow in the intestinal tract on the anal side was poor, we thought that anastomosis was at a high risk for leakage. Laparoscopic total gastrectomy was also performed simultaneously for two Stage I (UICC 8th edition) gastric cancers in the cardia and body. The location of the port site and stoma was carefully determined preoperatively to prevent damage and infection to the artificial blood vessels. Minimal invasive surgery was performed using laparoscopic surgery.

Conclusions

Laparoscopic surgery with small incisions is useful for patients with double cancer who need an approach to the upper and lower abdomen. Furthermore, laparoscopic surgery has less interference on graft in patients with artificial blood vessels under the skin by intraperitoneal approach.
Obesity paradigm and web-based weight loss programs: an updated systematic review and meta-analysis of randomized controlled trials
Authors: Jahangiry Leila , Farhangi Mahdieh Abbasalizad
Published: April 2021

Backgrounds

Web-based therapeutic approaches are new and attractive tools for primary health care systems due to their time and cost-saving nature and their accessibility for different populations. The aim of the current systematic review and meta-analysis is to summarize the results of studies evaluating the effect of web-based interventional programs on weight loss among overweight and obese individuals.

Methods

A literature review from 2000 to 2016 was conducted. Studies were included in the study if they had adult participants with body mass index (BMI) ≥ 25 kg/m2, a web-user intervention arm, and a non-web user control arm, with the primary aim of weight loss. Weight change in the interventional group versus control group was pooled with the random-effect model. Data were extracted on sample characteristics, drop-outs, weight loss, intervention duration, and the amount of weight loss. The mean weighted difference and 95% confidence intervals (CI) were calculated.

Results

Eight studies met the inclusion criteria and included in the final model. Overall, using the web-based interventions had a weak non-significant effect on weight loss in overweight and obese individuals (WMD 0.56 kg, CI − 3.474, 4.592; P = 0.786). The most important reason was the unadjusted baseline weight of experimental and control groups in included studies, although the stratified analysis showed that, low study quality score and not using feedback and goal-setting in the study were the main factors diminishing the effectiveness of web-based intervention treatment group.

Conclusion

The results of the current meta-analysis indicated no effectiveness of web-based interventional programs in the weight loss of overweight and obese individuals. Although the great between-study heterogeneity and a small number of included studies further highlight the need for additional researches in this field.
State of the Science: Screening, Surveillance, and Epidemiology of HPV-Related Malignancies
Authors: Ghebre Rahel , Berry-Lawhorn J. Michael , D’Souza Gypsyamber
Published: April 2021

Oropharyngeal, cervical, vulvar, and anal cancers share a common risk factor of HPV infection. HPV vaccination is currently recommended at age 11 or 12 to prevent new HPV infections for all genders with catch-up vaccination recommened up to age 26. Despite the known effectiveness of HPV vaccination to prevent HPV-related cancer, there is continued low uptake in the United States; only 40% of eligible persons were vaccinated in 2018, though rates are 70% among teenagers. Current American Cancer Society cancer screening guidelines recommend cervical cancer screening, but do not have specific recommendations for screening for other HPV-related cancers. Oropharyngeal cancer precursors have yet to be identified, and there are currently no routine screening tests for oropharyngeal cancer recommended by the U.S. Preventive Services Task Force. The U.S. Preventive Services Task Force and American Cancer Society recommend cervical cancer screening for women at average risk up to age 65, and screening guidelines do not currently differ by HPV vaccination status. Primary HPV DNA testing was first approved for cervical cancer screening in 2016 and was shown to be superior for cervical cancer prevention. Vulvar and anal cancer precursors have been identified, but optimal screening remains unclear. Examination of the anal canal and perianus is best performed by trained clinicians using high-resolution anoscopy, and effectiveness of using high-resolution anoscopy to detect and treat anal high-grade squamous intraepithelial lesions to prevent cancer is actively being researched. Current multistep approaches to control HPV-related malignancies include HPV vaccination coupled with cervical cancer screening or surveillance for oropharyngeal, vulvar, and anal cancers.
Electronic structure, magnetic properties, and elastic properties of full-Heusler alloys Cr2-xFexMnSi (x=0, 1, and 2)
Authors: Wu Chuang , Zheng Wei , Si Nan , Li Chunmei , Zhang Yanli , Jiang Wei
Published: April 2021

In this study, we have systematically investigated the electronic structures, magnetic and elastic properties of the full-Heusler compounds Cr2-xFexMnSi (, 1, and 2) by density functional theory calculations using the CASTEP with the generalized gradient approximation for the exchange-correlation functional. Our calculation results show that the Cr2MnSi, CrFeMnSi and Fe2MnSi alloys exhibit excellent half-metallic materials, and half-metallic band gap will be larger as the number of Fe atoms increases. The magnetism originates from the spin contribution of Cr-, Fe- and Mn-dorbital electrons and the strong hybridization between them. The total magnetic moment of Cr2-xFexMnSi (, 1, and 2) remains an integer value when the lattice parameter is changed within a narrow range, and the range will be larger as the number of Fe atoms increases. Investigation of elastic properties shows that the Cr2-xFexMnSi (, 1, and 2) alloys are ductile and anisotropic materials.
Clinical and Hormonal Profiles Correlate With Molecular Characteristics in Patients With 11β-Hydroxylase Deficiency
Authors: Yildiz Melek , Isik Emregul , Abali Zehra Yavas , Keskin Mehmet , Ozbek Mehmet Nuri , Bas Firdevs , Ucakturk Seyit Ahmet , Buyukinan Muammer , Onal Hasan , Kara Cengiz , Storbeck Karl-Heinz , Darendeliler Feyza , Cayir Atilla , Unal Edip , Anik Ahmet , Demirbilek Huseyin , Cetin Tugba , Dursun Fatma , Catli Gonul , Turan Serap , Falhammar Henrik , Baris Tugba , Yaman Ali , Haklar Goncagul , Bereket Abdullah , Guran Tulay
Published: April 2021

Background

Given the rarity of 11β-hydroxylase deficiency (11βOHD), there is a paucity of data about the differences in clinical and biochemical characteristics of classic (C-11βOHD) and nonclassic 11βOHD (NC-11βOHD).

Objective

To characterize a multicenter pediatric cohort with 11βOHD.

Method

The clinical and biochemical characteristics were retrospectively retrieved. CYP11B1 gene sequencing was performed. Seventeen plasma steroids were quantified by liquid chromatography-mass spectrometry and compared to that of controls.

Results

102 patients (C-11βOHD, n = 92; NC-11βOHD, n = 10) from 76 families (46,XX; n = 53) had biallelic CYP11B1 mutations (novel 9 out of 30). Five 46,XX patients (10%) were raised as males. Nineteen patients (19%) had initially been misdiagnosed with 21-hydroxylase deficiency. Female adult height was 152 cm [−1.85 SD score (SDS)] and male 160.4 cm (−2.56 SDS).None of the NC-11βOHD girls had ambiguous genitalia (C-11βOHD 100%), and none of the NC-11βOHD patients were hypertensive (C-11βOHD 50%). Compared to NC-11βOHD, C-11βOHD patients were diagnosed earlier (1.33 vs 6.9 years; P < 0.0001), had higher bone age-to-chronological age (P = 0.04) and lower adult height (−2.46 vs −1.32 SDS; P = 0.05). The concentrations of 11-oxygenated androgens and 21-deoxycortisol were low in all patients. The baseline ACTH and stimulated cortisol were normal in NC-11βOHD. Baseline cortisol; cortisone; 11-deoxycortisol; 11-deoxycorticosterone and corticosterone concentrations; and 11-deoxycortisol/cortisol, 11-deoxycorticosterone/cortisol, and androstenedione/cortisol ratios were higher in C-11βOHD than NC-11βOHD patients (P < 0.05). The 11-deoxycortisol/cortisol ratio >2.2, <1.5, and <0.1 had 100% specificity to segregate C-11βOHD, NC-11βOHD, and control groups.

Conclusion

NC-11βOHD can escape from clinical attention due to relatively mild clinical presentation. However, steroid profiles enable the diagnosis, differential diagnosis, and subtyping of 11βOHD.
Η αρχιτεκτονική του Μαρουλά Ρεθύμνου
Authors: Κατσαράκης Αντώνιος
Published: April 2021

Ο Μαρουλάς, οικισμός κοντά στην πόλη του Ρεθύμνου, διασώζει πυκνά στοιχεία από παλαιότερα ιστορικά στρώματα μιας αρχιτεκτονικής μεγάλων, οχυρών συγκροτημάτων του 17ου-18ου αι., τα οποία εποπτεύουν τη στενή αλλά εύφορη παραλιακή πεδινή ζώνη ανατολικά της πόλης. Τα κτίσματα αυτά, όπως και όμοιά τους σε άλλες περιοχές της Κρήτης, εξετάστηκαν στο ευρύτερο πλαίσιο του περάσματος από την όψιμη βενετοκρατία στην τουρκοκρατία. Μέσα σε τούτο το πρίσμα, ο Μαρουλάς αναλύθηκε σε επάλληλα χωρικά επίπεδα, ώστε να γίνει δυνατή η αποτύπωση σχέσεων οι οποίες αφορούν δίκτυα εποπτείας, κυκλοφορίας και άμυνας. Ειδικότερα σημεία της διατριβής ασχολούνται με τη χρήση μονάδων μέτρησης, γεωμετρικών χαράξεων, την εμπλοκή οθωμανών αυτοκρατορικών αρχιτεκτόνων και τη χρονολόγηση των κτισμάτων. Η αρχιτεκτονική αυτή γίνεται καλύτερα κατανοητή όταν μελετηθεί μέσα στο ευρύτερο πλαίσιο των φεουδαρχικών σχέσεων εξάρτησης και παραγωγής, οι οποίες εισήχθησαν θεσμικώς κατά τον πρώτο αιώνα της βενετοκρατίας στο νησί και οι οποίες στην ύπαιθρο δεν σταμάτησαν ποτέ να κυριαρχούν κοινωνικά και οικονομικά ως τα ύστατα χρόνια της βενετοκρατίας. Η οθωμανική κατάκτηση συνέχισε κάτω από νέο μανδύα τις σχέσεις αυτές, καθιστώντας αναγκαία την ύπαρξη οχυρωμένων υποστατικών σε ένα πλαίσιο όπου το στρώμα εξισλαμισθέντων τοπαρχών εμπλέχθηκε όλο και πιο ενεργά σε πλέγματα φορολογικών, στρατιωτικών και διοικητικών αρμοδιοτήτων, εντός της οικονομίας και τρόπου λειτουργίας της όψιμης Οθωμανικής Αυτοκρατορίας. Η διερεύνηση των κτισμάτων αυτών φανέρωσε το συγκερασμό δύο διακριτών τυπολογιών οχυρωμένης κατοικίας, η μία εκ των οποίων αντιπροσωπεύεται από την πυργοειδή κατοικία-αμυντήριο, ενώ η έτερη από τον οθωμανικό πύργο-περίπτερο. Σε μορφολογικό επίπεδο, η σύμφυση αυτή εκφράζεται με την υιοθέτηση θρησκευτικώς αδιάφορων στοιχείων από το προγενέστερο μορφολογικό λεξιλόγιο των υποστατικών της υπαίθρου, αλλά και τη συνειδητή απόρριψη άλλων, πάντα στα πλαίσια προσπάθειας συμβολικής κατασήμανσης της παρουσίας των μουσουλμάνων τοπαρχών στην κρητική ύπαιθρο.
Σχεδιασμός, σύνθεση και αξιολόγηση νανοσωματιδίων με εγκλωβισμό πεπτιδίων των πρωτεινών της μυελίνης
Authors: Τριανταφυλλάκου Ηρώ
Published: April 2021

Το αντικείμενο της παρούσας ΔΔ ήταν η ανάπτυξη πολυμερικών νανοσωματιδίων με εγκλωβισμένα πεπτιδικά ανάλογα που εμπλέκονται στην εμφάνιση και εξέλιξη της σκλήρυνσης κατά πλάκας (ΣΚΠ, Multiple Sclerosis, MS), καθώς και η βιολογική αξιολόγηση αυτών. Συγκεκριμένα, αναπτύχθηκαν σωματίδια πολυ(γλυκολικού-γαλακτικού) οξέος [poly(lactic-co-glycolic) acid, PLGA] με εγκλωβισμένα πεπτίδια με βάση τον επίτοπο 35-55 της μυελικής γλυκοπρωτεΐνης των ολιγοδενδριτών (Myelin Oligodendrocyte Glycoprotein, ΜΟG) με βάση την αλληλουχία που συναντάται στους μύες (rMOG), συζευγμένα ή μη με μόρια σακχαριτών. Η σύζευξη των πεπτιδικών αναλόγων με μόρια σακχαριτών όπως η μαννόζη και η γλυκοζαμίνη στόχευσε στην πιθανή αλληλεπίδραση με τους υποδοχείς μαννόζης που βρίσκονται στα δενδριτικά κύτταρα, κύρια αντιγονοπαρουσιαστικά κύτταρα που εμπλέκονται στην ΣΚΠ, με τους οποίους υποδοχείς παρουσιάζουν ισχυρή προσδετική ικανότητα και με σκοπό την ανάπτυξη ανοσοανοχής απέναντι στην νόσο.Η διατριβή περιλαμβάνει τον σχεδιασμό και την ανάπτυξη PLGA νανοσωματιδίων που θα φέρουν εγκλωβισμένα τα πεπτιδικά ανάλογα, παρέχοντας αυξημένη σταθερότητα στα πεπτιδικά ανάλογα και παρέχοντας την δυνατότητα βραδείας αποδέσμευσης από την πολυμερική μήτρα. Τα νανοσωματίδια που αναπτύχθηκαν μελετήθηκαν ως προς τα φυσικοχημικά τους χαρακτηριστικά ώστε να βελτιστοποιηθεί η μεθοδολογία σύνθεσης. Επιπλέον, πραγματοποιήθηκε μελέτη της βραδείας αποδέσμευσης και ποσοτικός προσδιορισμός τόσο της αρχικά εγκλωβισμένης ουσίας όσο και της ημερήσιας αποδέσμευσης σε φυσιολογικό ορό in vitro. Τέλος, τα συντεθειμένα νανοσωματίδια αξιολογήθηκαν βιολογικά in vivo στο πειραματικό μοντέλο της ΣΚΠ, την πειραματική αυτοάνοση εγκεφαλομυελίτιδα (Experimental Autoimmune Encephalomyelitis, EAE) με χρήση δύο μοντέλων ανοσοποίησης, προφυλακτικού και θεραπευτικού σε θηλυκούς μύες του γένους C57BL/6. Οι ιστοί που ελήφθησαν από τους μύες μελετήθηκαν για διηθήσεις και καταστροφές της λευκής ουσίας που οφείλονται στην ασθένεια ενώ μελετήθηκαν και τα επίπεδα κυτταροκινών στον ορό αίματος στα διάφορα στάδια εξέλιξης της νόσου.
Applied System Analysis in Management As a Tool for Modeling the Functioning of Economic Systems
Authors: Zvyagin Leonid
Published: April 2021

The main purpose of applied system analysis is the application of the system principle in applied areas of human activity. Therefore, the topic of this study is relevant. System analysis is a fairly popular scientific direction, which has applications in almost all areas of human life. Initially, system analysis was used in the technical field, then it was extended to other areas of human activity. The value of the system approach lies in the fact that the consideration of categories of system analysis creates the basis for a logical and consistent approach to the problem of decision-making. The effectiveness of problem solving using system analysis is determined by the structure of the problems to be solved. The purpose of this article is to consider aspects of the application of applied system analysis in business Analytics and management. The object of the study is business Analytics and management and the study of the application of applied analysis in these areas. In this connection, you need to answer the following questions: define the essence of a systematic management principle; to reveal the concept of the system, describe its properties; to define the concept of the model, consider the types of models in the system analysis; to define the basic stages of modeling of economic objects as research objects business intelligence; identify the main stages of modeling organizational systems.
Using e-health tools and PROMs to support self-management in patients with inflammatory bowel disease
Authors: Avery Pearl
Published: April 2021

Background:

The use of digital health or e-health is growing. The potential positive impact on IBD care from supported self-management using these tools emerged from a literature review carried out in preparation for a service improvement project. A patient-reported outcomes measure (PROM) with validation across IBD sub-types was already available for use. This internationally recognised tool has potential for use with existing or new e-health systems.

Aims:

In order to test the concept of using PROMs to support practice and follow up a small-scale pilot study was designed. The aim of the study was to understand if empowering patients to undertake supported self-management could lead in turn to improved flow through outpatient services.

Methods:

An audit was carried out of PROMs looking at quality of life (QoL) as well as disease activity using an electronic platform in real time at the point of patient contact. The disease activity indices used were the Harvey Bradshaw Index and the Simple Clinical Colitis Activity Index, due to the author's familiarity with these tools.

Results:

Of the 15 participants, 10 reported themselves as ‘well’ or ‘well with questions’ all participants reported an acceptance of supported remote self-management using e-health.

Conclusion:

This evaluation led to PROMs being captured on a tablet in the outpatient setting in the pre-pandemic period. Allowing patients to use the PROM as a tool in the outpatient setting has led to longitudinal data being added to the e-health system for each individual. Well patients could be managed remotely, freeing capacity in outpatient clinics.
Adapting a 2-week-wait colorectal service in the pandemic using the quantitative faecal immunochemical test
Authors: Cock Karen , Bromley Rachael , Faux William
Published: April 2021

The coronavirus pandemic has brought about an economic and healthcare crisis. This has resulted in delays in virtually all areas of patient care and has forced clinicians to review and adapt their processes, in order to ensure patients continue to have access to timely and effective services. In the author's local Trust, this manifested in altered protocols, developed in order to maintain patient and staff safety while conducting invasive and potentially virus-spreading investigations. A new (temporary) standard operating procedure was developed in conjunction with Cancer Alliance South West to introduce the quantitative faecal immunochemical test (qFIT) as an indicator for diagnostic testing after the majority of diagnostic services were suspended or drastically reduced. Patients would then have their investigation(s) deferred on the basis of a negative result (<10 mcg Hb/g). This cohort (n=120) were revisited once diagnostic services were resumed and referred for CT examination. Audits carried out on the data showed that nine cancers had been identified in the negative qFIT population (lung, prostate, breast, bladder, small bowel carcinoid, oesophageal and three occurrences of caecal carcinoma. This article provides an overview of the experiences and outcomes of a colorectal 2-week-wait service in response to this global pandemic and how this experience will shape the service in the future.
The future of nurse education? Studying at the Open University in Scotland
Authors: Davidson Michael CJ , Malcolm Lorraine , Sturley Liz , Crowley Margaret , MacKinnon Fiona , McInally Wendy
Published: April 2021

This article describes nurse education with the Open University in Scotland (OUiS). Although there are problems with nurse recruitment and retention across the UK, in Scotland the landscape is somewhat different, with greater support for students required in remote and rural areas. Despite these challenges, the OUiS continues to recruit to the commissioned numbers of places. OUiS nursing students are primarily health care support workers who are a key group within the health and social care workforce but historically have faced many challenges in developing clear career pathways into nursing. At the heart of the OU is the fundamental recognition of distance online pedagogy, complemented by work-based learning support by employers. Partnership working between the OU, employers and education commissioners is crucial to its success.
Immune-mediated haemolytic anaemia, part 1: pathophysiology and diagnosis
Authors: Brunori Lara , Romero-Fernandez Nora
Published: April 2021

Immune-mediated haemolytic anaemia is a relatively common condition in dogs, and uncommonly encountered in cats. Prompt and appropriate recognition is paramount to optimal management and improved health outcomes. Currently, no single test has been proven to be definitively diagnostic for immune-mediated haemolytic anaemia. Therefore, a logical and thorough approach is key to achieving an accurate diagnosis.
Mediating Role of Self-Disclosure in the Relationship between Attitudes towards Online Counselling and Perception of Social Stigma due to Receiving Psychological Help
Authors: Buyruk-Genc Arzu , Kara Ece
Published: April 2021

People have needed mental health services more and more during Coronavirus disease (COVID-19) pandemic. Due to the contagious nature of the COVID-19 virus, online counseling has been preferred more during the COVID-19 pandemic. Those who need such mental health services might take actions to seek help by demanding psychological assistance from psychological counselors or mental health institutions. However, these people might avoid seeking and receiving such help when they think that they have a weak personality or they somehow will be criticized by the society or experience social stigma because they seek psychological help. This study aims to examine the mediating role of self-disclosure between attitudes towards online counselling and perception of social stigma due to receiving psychological help. Participants of the study consist of 519 adults who live in Turkey and are older than 18 years old.  The data for the study were collected through “Distress Disclosure Index”, “Online Counseling Attitudes Scale (OCAS)”, “Stigma Scale for Receiving Psychological Help (SSRPH)” and “Personal Information Form”. The hypothetical model developed in order to determine whether self-disclosure mediates in the relationship between perception of social stigma due to receiving psychological help and online psychological counselling attitudes was tested through SEM (Structural Equation Modeling). The results of the study revealed that self-disclosure play partial mediating role between perception of social stigma and value of online counselling and discomfort with online counselling.