bluuebunny/crossref_metadata_2025 huggingface dataset:
Pectoralis Major Ruptures: Tear Patterns and Patient Demographic Characteristics
Authors: Kowalczuk Marcin , Rubinger Luc , Elmaraghy Amr W.
Published: December 2020

Background:

The pectoralis major (PM) is made up of multilaminar muscle segments that form a complex insertion on the proximal humerus; it is composed of an anterior and a posterior tendon layer. The tear patterns and patient characteristics of operatively treated PM ruptures in the general population remain poorly understood.

Purpose:

To comprehensively report the demographic characteristics of patients who are clinically diagnosed with structurally significant PM ruptures and to describe PM tear patterns identified during surgery.

Study Design:

Case series; Level of evidence, 4.

Methods:

A retrospective analysis of surgically treated PM tears was performed for a single-surgeon case series between January 1, 2003, and November 1, 2017. Patient demographic characteristics, classification of tear pattern, and treatment (repair/reconstruction) were recorded.

Results:

A total of 104 surgical cases of PM tendon rupture were identified; 100 patients underwent primary repair and 4 underwent dermal allograft reconstruction. All patients were male, with a mean age of 36.5 ± 9.2 years. Chronic tears (>6 weeks old) accounted for 63.6% of surgical cases, and 96% (n = 100) of tears occurred at or between the musculotendinous junction and tendinous insertion. A partial-thickness, complete-width tear of the posterior tendon layer at this same location was the most common tear pattern identified.

Conclusion:

PM ruptures occurred almost exclusively at or between the musculotendinous junction and tendinous insertion, with predominant involvement of the posterior tendon layer. Chronic tears can be safely treated with primary repair in the vast majority of cases.
Drawing on knowledge: Visual narrative analysis for critical environment and development research
Authors: Simon Gregory L , Wee Bryan , Chatti Deepti , Anderson Emily
Published: December 2020

Counter-narratives to dominant development discourses are made possible using research methods designed to elicit marginalized voices. In this article, we propose a new analytical framework called the interpretive schema for drawings for analyzing visual narratives. The interpretive schema for drawings consists of five themes or interpretive lenses ( scale, centrality, inclusion, connections, and relationality) that were generated from maps of fuelwood collection in rural India. We suggest that the interpretive schema reflects and animates a range of spatialities that are central to geographic studies of human–environment dynamics. Using the interpretive schema for drawings in this way enables us to emphasize emic socio-spatial perspectives, and offers a critical research avenue through which everyday realities can be represented, understood, and validated. While other image-based research approaches, critical cartographies and participatory mapping exercises may encourage the expression of alternative knowledges, our proposed interpretive schema for drawing presents a specific set of guidelines for interpreting and making sense of visual narratives through explicit socio-spatial analysis.
AM Versus PM Postoperative Administration of Warfarin With a Mechanical Mitral Valve
Authors: Harris Justin R. , Hatch Rachel , Vallabhajosyula Prashanth , Lo Yancy , Mowery Danielle , Patel Neepa
Published: December 2020

Background: Currently, there are no guidelines regarding the optimal daily timing of inpatient warfarin administration. Objective: The purpose of this study was to determine whether dosing warfarin in the morning will have a significant impact on therapeutic international normalized ratio (INR) achievement compared with evening administration in mechanical mitral valve patients initiated on warfarin following cardiac surgery. Methods: This was a single-center, pre- and post-retrospective cohort conducted between 2014 and 2018. One-hundred fifty-four adult patients who underwent a mechanical mitral valve replacement or alternative cardiac surgery with a history of a mechanical mitral valve were enrolled. The primary outcome was achievement of therapeutic INR at any time point after initiation of warfarin. Pre-intervention administration timing was 6 pm and post-intervention timing was 10 am. Results: Baseline characteristics including age, sex, and race were similar between the 2 groups ( P = NS for each characteristic). Therapeutic INR achievement was significantly improved at all time points following 10 am warfarin administration compared with 6 pm (hazard ratio = 1.69; P = .005). Mean time-to-therapeutic INR was 7.37 days in the post-intervention group and 8.39 days in the pre-intervention group ( P = .073). There were no significant differences in INR >4, bleeding, or thrombotic complications between groups. Conclusion and Relevance: This retrospective analysis suggests that there may be a postoperative benefit in therapeutic INR achievement in mechanical valve patients when dosing warfarin in the morning compared with evening administration. Large-scale studies should be conducted to further elucidate the potential benefit across more heterogeneous populations.
Modeling housing recovery after the 2018 Lombok earthquakes using a stochastic queuing model
Authors: Alisjahbana Irene , Kiremidjian Anne
Published: December 2020

Post-earthquake housing recovery monitoring is necessary, especially since the housing sector usually represents 50 percent of the total monetary disaster loss. However, very scarce recovery data, in addition to the complexities of the recovery process, make modeling housing recovery very difficult. Time-based stochastic models, which are commonly used in well-known frameworks such as the U.S. Federal Emergency Management Agency’s HAZARD-US (HAZUS), do not explicitly capture how the recovery process occurs in real life. In this article, we introduce a stochastic queuing model that considers the total number of damaged buildings, the damage distribution, resource constraints, and government-led reconstruction prioritization strategies. We applied our model to seven regions affected by the 2018 Lombok earthquakes, which destroyed over 226,000 residential buildings. In this study, we use publicly available daily data of the reconstruction progress obtained by local authorities for all damaged buildings. Using that dataset, we present recovery parameters for the Lombok region, including delay and reconstruction times. These parameters are an improvement over parameters currently available, which only apply to the U.S. region. Furthermore, we show that our model captures the observed recovery trajectory disaggregated by damage states, which provides insights into how the different building damage states recover individually. Results show that our queuing model reduces the root mean squared error (RMSE) of the recovery trajectory by 31.58% and is better able to represent the observed overall recovery trajectory compared to a time-based stochastic model.
Metabolic abnormalities in G6PC3-deficient human neutrophils result in severe functional defects
Authors: McKinney Christopher , Ellison Michael , Briones Natalie J. , Baroffio Angelina , Murphy John , Tran Alexander D. , Reisz Julie A. , D’Alessandro Angelo , Ambruso Daniel R.
Published: December 2020

Severe congenital neutropenia type 4 (SCN-4) is an autosomal recessive condition in which mutations in the G6PC3 gene encoding for the catalytic 3 subunit of glucose-6-phosphatase-β result in neutropenia, neutrophil dysfunction, and other syndromic features. We report a child with SCN-4 caused by compound heterozygous mutations in G6PC3, a previously identified missense mutation in exon 6 (c.758G>A[p.R235H]), and a novel missense mutation in exon 2 (c.325G>A[p.G109S]). The patient had recurrent bacterial infections, inflammatory bowel disease, neutropenia, and intermittent thrombocytopenia. Administration of granulocyte colony–stimulating factor (G-CSF) resolved the neutropenia and allowed for detailed evaluation of human neutrophil function. Random and directed migration by the patient’s neutrophils was severely diminished. Associated with this were defects in CD11b expression and F-actin assembly. Bactericidal activity at bacteria/neutrophil ratios >1:1 was also diminished and was associated with attenuated ingestion. Superoxide anion generation was <25% of control values, but phox proteins appeared quantitatively normal. Extensive metabolomics analysis at steady state and upon incubation with stable isotope–labeled tracers (U-13C-glucose, 13C,15N-glutamine, and U-13C-fructose) demonstrated dramatic impairments in early glycolysis (hexose phosphate levels), hexosemonophosphate shunt (required for the generation of the NADPH), and the total adenylate pool, which could explain the dramatic cell dysfunction displayed by the patient’s neutrophils. Preliminary experiments with fructose supplementation to bypass the enzyme block demonstrated that the metabolic profile could be reversed, but was not sustained long enough for functional improvement. In human deficiency of G6PC3, metabolic defects resulting from the enzyme deficiency account for diverse neutrophil functional defects and present a major risk of infection.
Late Palaeozoic tectonics in Central Mediterranean: a reappraisal
Authors: Molli Giancarlo , Brogi Andrea , Caggianelli Alfredo , Capezzuoli Enrico , Liotta Domenico , Spina Amalia , Zibra Ivan
Published: December 2020

A revision of late Palaeozoic tectonics recorded in Tuscany, Calabria and Corsica is here presented. We propose that, in Tuscany, upper Carboniferous-Permian shallow-marine to continental sedimentary basins, characterized by unconformities and abrupt changes in sedimentary facies, coal-measures, red fanglomerate deposits and felsic magmatism, may be related with a transtensional setting where upper-crustal splay faults are linked with a mid-crustal shear zone. The remnants of the latter can be found in the deep-well logs of Pontremoli and Larderello-Travale in northern and southern Tuscany respectively. In Calabria (Sila, Serre and Aspromonte), a continuous pre-Mesozoic crustal section is exposed, where the lower-crustal portion mainly includes granulites and migmatitic paragneisses, together with subordinate marbles and metabasites. The mid-crustal section, up to 13 km-thick, includes granitoids, tonalitic to granitic in composition, emplaced between 306 and 295 Ma. They were progressively deformed during retrograde extensional shearing, with a final magmatic activity, between 295 ± 1 and 277 ± 1 Ma, when shallower dykes were emplaced in a transtensional regime. The section is completed by an upper crustal portion, mainly formed by a Palaeozoic sedimentary succession deformed as a low-grade fold and thrust belt, and locally overlaying medium-grade paragneiss units. As a whole, these features are reminiscent of the nappe zone domains of the Sardinia Variscan Orogen. In Corsica, besides the well-known effusive and intrusive Permian magmatism of the “Autochthonous” domain, the Alpine Santa Lucia Nappe exposes a kilometer-scale portion of the Permian lower to mid-crust, exhibiting many similarities to the Ivrea Zone. The distinct Mafic and Granitic complexes characterizing this crustal domain are juxtaposed through an oblique-slip shear zone named Santa Lucia Shear Zone. Structural and petrological data witness the interaction between magmatism, metamorphism and retrograde shearing during Permian, in a temperature range of c. 800–400 °C. We frame the outlined paleotectonic domains within a regional-scale, strain–partitioned, tectonic setting controlled by a first-order transcurrent/transtensional fault network that includes a westernmost fault (Santa Lucia Fault) and an easternmost one (East Tuscan Fault), with intervening crustal domains affected by extensional to transtensional deformation. As a whole, our revision allows new suggestions for a better understanding of the tectonic framework and evolution of the Central Mediterranean during the late Palaeozoic.
Multicolor Emitting N-Doped Carbon Dots Derived from Ascorbic Acid and Phenylenediamine Precursors
Authors: Wang Linlin , Choi Won Mook , Chung Jin Suk , Hur Seung Hyun
Published: December 2020

In this research, we report the green, blue, and orange color emitting N-doped carbon dots (CDs), which are being synthesized from ascorbic acid and o-/m-/p-phenylenediamine (o-PDA, m-PDA, and p-PDA, respectively). The effects of the solvent polarity and solution pH on the PL emission properties of the as-synthesized CDs have been systematically investigated. It has been observed that the PL emission of the as-synthesized CDs decreases with the increase in solvent polarity due to the greater agglomeration. The surface charge of CDs also shows prominent effects on the pH-dependent PL emission properties.
Tissue-associated microbial detection in cancer using human sequencing data
Authors: Rodriguez Rebecca M. , Khadka Vedbar S. , Menor Mark , Hernandez Brenda Y. , Deng Youping
Published: December 2020

Cancer is one of the leading causes of morbidity and mortality in the globe. Microbiological infections account for up to 20% of the total global cancer burden. The human microbiota within each organ system is distinct, and their compositional variation and interactions with the human host have been known to attribute detrimental and beneficial effects on tumor progression. With the advent of next generation sequencing (NGS) technologies, data generated from NGS is being used for pathogen detection in cancer. Numerous bioinformatics computational frameworks have been developed to study viral information from host-sequencing data and can be adapted to bacterial studies. This review highlights existing popular computational frameworks that utilize NGS data as input to decipher microbial composition, which output can predict functional compositional differences with clinically relevant applicability in the development of treatment and prevention strategies.
A distance based multisample test for high-dimensional compositional data with applications to the human microbiome
Authors: Zhang Qingyang , Dao Thy
Published: December 2020

Background

Compositional data refer to the data that lie on a simplex, which are common in many scientific domains such as genomics, geology and economics. As the components in a composition must sum to one, traditional tests based on unconstrained data become inappropriate, and new statistical methods are needed to analyze this special type of data.

Results

In this paper, we consider a general problem of testing for the compositional difference between K populations. Motivated by microbiome and metagenomics studies, where the data are often over-dispersed and high-dimensional, we formulate a well-posed hypothesis from a Bayesian point of view and suggest a nonparametric test based on inter-point distance to evaluate statistical significance. Unlike most existing tests for compositional data, our method does not rely on any data transformation, sparsity assumption or regularity conditions on the covariance matrix, but directly analyzes the compositions. Simulated data and two real data sets on the human microbiome are used to illustrate the promise of our method.

Conclusions

Our simulation studies and real data applications demonstrate that the proposed test is more sensitive to the compositional difference than the mean-based method, especially when the data are over-dispersed or zero-inflated. The proposed test is easy to implement and computationally efficient, facilitating its application to large-scale datasets.
Delirium is associated with high mortality in older adult patients with acute decompensated heart failure
Authors: Pak Misun , Hara Masahiko , Miura Shoko , Furuya Motohide , Tamaki Masatake , Okada Taiji , Watanabe Nobuhide , Endo Akihiro , Tanabe Kazuaki
Published: December 2020

Background

Delirium is associated with high mortality after cardiac surgery. However, evidence on the epidemiology of delirium in patients with acute decompensated heart failure (ADHF) is limited. This study aimed to assess the incidence and prognostic impact of delirium in patients with ADHF.

Methods

This single-center prospective observational study enrolled 132 consecutive patients with ADHF. We utilized the Diagnostic and Statistical Manual of Mental Disorders, fifth edition and classified the patients into two groups according to the presence or absence of delirium. The primary endpoint was 90-day all-cause mortality. The prognostic impact and risk factors of delirium were evaluated using multivariable Cox and logistic regression analyses, respectively.

Results

The median patient age was 83 (interquartile range, 75–87) years. Approximately 51.5% were men. Delirium occurred in 36 (27.3%) patients, and hyperactive delirium was the most frequent type (86.1%). The 90-day all-cause mortality was higher in the patients with delirium than in those without (21.6% versus 3.9%, log-rank p = 0.002). Delirium was associated with higher mortality with an adjusted hazard ratio of 6.8 (95% confidence interval, 1.1–42.6, p = 0.042). The risk factors associated with delirium included advanced age, male sex, higher clinical frailty scale score, and dementia.

Conclusions

Delirium was associated with a higher 90-day all-cause mortality in the older adult patients with ADHF. Hyperactive delirium was the most common subtype.
A rare complication following internal jugular vein catheterization to malposition: acute Budd Chiari syndrome
Authors: Koyuncu Sumeyra , Herdem Nevzat , Uysal Cihan , Kahriman Guven , Kocyigit Ismail , Sipahioğlu Murat , Tokgoz Bulent , Oymak Oktay
Published: December 2020

Background

Tunneled catheters can be used as an alternative vascular access in patients with limited health expectancy,vascular access problems and several comorbidities. We aimed to present a patient with venous stenosis related- reversible acute Budd-Chiari syndrome after catheter malposition.

Case presentation

After changing of tunneled catheter insertion, 36-year old man was admitted to our hospital with sudden onset of nausea, fever, chills and worsening general condition In computed tomography (CT) imaging, a hypodense thrombus was observed in which the distal end of the catheter is at the level of drainage of the hepatic veins in the inferior vena cava and that blocked hepatic vein drainage around the catheter. The catheter was removed and a new catheter was inserted in the same session. Because patient’s general condition was good and without fever, he was discharged with advices on the 9th day of hospitalization.

Conclusion

Although catheter malposition and thrombosis are not a common complication, clinicians should be alert of these complications.
Clinically relevant prognostic and predictive markers for immune-checkpoint-inhibitor (ICI) therapy in non-small cell lung cancer (NSCLC)
Authors: Brueckl Wolfgang M. , Ficker Joachim H. , Zeitler Gloria
Published: December 2020

Background

Immune checkpoint inhibitors (ICI) either alone or in combination with chemotherapy have expanded our choice of agents for the palliative treatment of non-small cell lung cancer (NSCLC) patients. Unfortunately, not all patients will experience favorable response to treatment with ICI and may even suffer from severe side effects. Therefore, prognostic and predictive markers, beyond programmed death ligand 1 (PD-L1) expression status, are of utmost importance for decision making in the palliative treatment. This review focuses on clinical, laboratory and genetic markers, most of them easily to obtain in the daily clinical practice.

Results

Recently, a number of prognostic and predictive factors in association to palliative ICI therapy have been described in NSCLC. Besides biometric parameters and clinical characteristics of the tumor, there are useful markers from routine blood sampling as well as innovative soluble genetic markers which can be determined before and during ICI treatment. Additionally, the level of evidence is noted.

Conclusions

These factors can be helpful to predict patients’ outcome and tumor response to ICI. They should be implemented prospectively in ICI based clinical trials to develop reliable algorithms for palliative NSCLC treatment.
Analysis of total corneal astigmatism with a rotating Scheimpflug camera in keratoconus
Authors: Kim Jinho , Whang Woong-Joo , Kim Hyun-Seung
Published: December 2020

Background

To analyze mean corneal powers and astigmatisms on anterior, posterior, and total cornea in patients with keratoconus as calculated according to various keratometric measurements using a Scheimpflug camera.

Methods

We examined the left eyes of 64 patients (41 males and 23 females; mean age 29.94 ± 6.63 years) with keratoconus. We measured simulated K (Sim-K), posterior K, true net power (TNP) and four types of total corneal refractive powers (TCRP). We then used the obtained values to analyze mean K, and corneal astigmatism. TCRP were measured at 2.0 ~ 5.0 mm.

Results

Mean corneal powers from Sim K, posterior K, and TNP were 49.12 ± 3.99, − 7.39 ± 0.79, and 47.78 ± 4.09 diopters, respectively. For TCRP centered on the pupil, mean K tended to decrease with measurement area (all p < 0.01). While, both mean K and astigmatism measured using TCRP centered on the apex decreased with measurement area (all p < 0.001). TCRP centered on the apex were greater than those centered on the pupil for mean K values calculated using TCRP (all p < 0.001). The proportion of WTR was greatest on the anterior and total cornea. As the measurement area moved to the periphery, the proportion of WTR increased.

Conclusions

Mean corneal powers and astigmatisms on total cornea with keratoconus change depending on calculation methods and measurement areas.
Mental health status of Chinese residents during the COVID-19 epidemic
Authors: Jiang Wen , Liu Xuerong , Zhang Jingxuan , Feng Zhengzhi
Published: December 2020

Background

To investigate the mental health status of Chinese residents during the epidemic of COVID-19, as well as to identify the positive and negative factors and regulatory effect of negative cognitive processing bias on mental health.

Methods

A total of 60,199 residents in China were surveyed via an internet-based survey containing a general questionnaire, such as the self-rating depression scale, the state anxiety inventory, and the negative cognitive processing bias questionnaire. An ordered multiple logistic regression analysis model was used to analyze the collected data.

Results

The survey revealed mild, moderate, and severe depressive symptoms in 62.65, 11.33, and 6.14% participants, respectively, and mild, moderate, and severe anxiety symptoms in 33.21, 41.27, and 22.99% participants, respectively. Multiple logistic regression analysis showed that factors, such as female gender, being older than 55 years, high school education level, medical staff, marital conflicts, negative attention bias, rumination, and death growth rate, positively affected depression and anxiety symptoms. The good family functionality, democratic working atmosphere, and a myriad of social activities negatively affected the level of depressive and anxiety symptoms.

Conclusion

Chinese residents exhibited a high prevalence of anxiety and depressive symptoms during the epidemic. Thus, psychological interventions should focus on the vulnerable groups, and cognitive training should focus on reducing the negative cognitive processing bias. This might be an effective way to alleviate the mental stress of the general public during the COVID-19 pandemic.
Walking the talk: evaluating the alignment between Australian governments’ stated principles for working in Aboriginal and Torres Strait Islander health contexts and health evaluation practice
Authors: Luke Joanne N. , Ferdinand Angeline S. , Paradies Yin , Chamravi Daniel , Kelaher Margaret
Published: December 2020

Background

Stated principles in government policy documents serve as a set of values outlining how governments intend to work. As such, health planning principles should be reflected in health policy across the cycle of planning, implementation and evaluation. Such principles should be reflected in the process of governments commissioning and funding evaluation, and in the work of those commissioned to do evaluation on behalf of governments.

Methods

We reviewed health planning policy documents to identify principles Australian State and Territory and National governments stated as being important to the work they do within Aboriginal and Torres Strait Islander health contexts. Evaluation tenders and reports relating to Aboriginal and Torres Strait Islander health policy, programs and service for the period 1-Jan-2007 to 1-Jan-2017 were retrieved and assessed as to whether they embedded principles governments state as important.

Results

In Aboriginal and Torres Strait Islander health planning policy contexts, Australian governments outline shared responsibility, cultural competence, engagement, partnership, capacity building, equity, a holistic concept of health, accountability, and evidence-based as fundamental principles that will underpin the work they will do.

In total, we identified 390 publicly advertised evaluation tenders, but were only able to retrieve 18 tenders and 97 reports. Despite strong rhetoric placing importance on the abovementioned principles, these were not consistently embedded in tenders released by government commissioners, nor in reports largely commissioned by governments. Principles most widely incorporated in documents were those corresponding to Closing the Gap - accountability, evidence-based and equity. Principles of holistic concept of health, capacity building, cultural competence and partnership do not appear well applied in evaluation practice.

Conclusion

Notwithstanding the tensions and criticism of current practice that sees dominant governments policing Aboriginal and Torres Strait Islander populations and defining what principles should inform health policy and evaluation practice, this paper reveals shortcomings in current evaluation practice. Firstly, this paper reveals a lack of transparency about current practice, with only 2% of tenders and 25% of reports in the public domain. Secondly, this paper reveals that governments do not ‘walk the talk’, particularly when it comes to principles relating to Aboriginal participation in health.
The impact of COVID-19 pandemic on dental practice in Iran: a questionnaire-based report
Authors: Ahmadi Hanie , Ebrahimi Alireza , Ghorbani Farhad
Published: December 2020

Background

The highly contagious nature of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), besides the fact that dental procedures commonly generate blood and saliva droplets that could lead to the contagion have resulted in the closure of many dental clinics. In the present study, we aimed to evaluate the impact of coronavirus disease 2019 (COVID-19) pandemic on dental practice by conducting an online questionnaire among the Iranian dental practitioners and finding their perspectives on the subject.

Methods

This report is based on a questionnaire that was conducted among Iranian dentists. The survey included questions that evaluate the dentists’ perceptions and attitudes toward the COVID-19 pandemic and its effect on their personal life, financial status, and the quality of dental services for patients.

Results

Overall, 240 dentists contributed to this study (214 general dentists and 26 specialists). The majority of the participants (n = 170, 70%) did not perform non-emergency procedures during the pandemic. The dental practitioners have suggested several strategies to decrease the risk of contagion, such as reducing treatment sessions (n = 90, 37%), strict triage of patients (n = 156, 64%), and using personal protective equipment (n = 108, 45%). However, most of the dentists (n = 210, 87%) had problems, providing personal protective equipment during the pandemic. Moreover, 97% (n = 234) of the participants reported that they encountered a decrease in their financial income since the eruption of the pandemic.

Conclusion

Dental health care workers are at the highest risk of contracting COVID-19. Thus, dental practitioners ought to execute the standard protocols more cautiously during the pandemic. They could also lower their work hours and limit dental procedures to emergency treatments to reduce the risk of COVID-19 transmission. Besides, the public organizations should provide proper equipment for the dental practitioners to decrease the risk of contagion.
Planning, preparing and structuring a small group teaching session
Authors: van Diggele Christie , Burgess Annette , Mellis Craig
Published: December 2020

A structured approach is critical to the success of any small group teaching session; preparation and planning are key elements in ensuring the session is systematic and effective. Learning activities guide and engage students towards the achievement of agreed learning outcomes. This paper introduces the central concepts of planning and preparing a small group teaching session. It provides an overview of key theoretical principles in lesson planning, delivery, and how to provide effective feedback in this setting.
Tips for teaching procedural skills
Authors: Burgess Annette , van Diggele Christie , Roberts Chris , Mellis Craig
Published: December 2020

The teaching of procedural skills required for clinical practice remains an ongoing challenge in healthcare education. Health professionals must be competent to perform a wide range of clinical skills, and are also regularly required to teach these clinical skills to their peers, junior staff, and students. Teaching of procedural skills through the use of frameworks, observation and provision of feedback, with opportunities for repeated practice assists in the learners’ acquisition and retention of skills. With a focus on the teaching of non-complex skills, this paper explores how skills are learned; ways to improve skill performance; determining competency; and the provision of effective feedback.
Teaching clinical handover with ISBAR
Authors: Burgess Annette , van Diggele Christie , Roberts Chris , Mellis Craig
Published: December 2020

Clinical handover is one of the most critical steps in a patient’s journey and is a core skill that needs to be taught to health professional students and junior clinicians. Performed well, clinical handover should ensure that lapses in continuity of patient care, errors and harm are reduced in the hospital or community setting. Handover, however, is often poorly performed, with critical detail being omitted and irrelevant detail included. Evidence suggests that the use of a structured, standardised framework for handover, such as ISBAR, improves patient outcomes. The ISBAR (Introduction, Situation, Background, Assessment, Recommendation) framework, endorsed by the World Health Organisation, provides a standardised approach to communication which can be used in any situation. In the complex clinical environment of healthcare today, ISBAR is suited to a wide range of clinical contexts, and works best when all parties are trained in using the same framework. It is essential that healthcare leaders and professionals from across the health disciplines work together to ensure good clinical handover practices are developed and maintained. Organisations, including universities and hospitals, need to invest in the education and training of health professional students and health professionals to ensure good quality handover practice. Using ISBAR as a framework, the purpose of this paper is to highlight key elements of effective clinical handover, and to explore teaching techniques that aim to ensure the framework is embedded in practice effectively.
Interprofessional education: tips for design and implementation
Authors: van Diggele Christie , Roberts Chris , Burgess Annette , Mellis Craig
Published: December 2020

Interprofessional education (IPE) is a critical approach for preparing students to enter the health workforce, where teamwork and collaboration are important competencies. IPE has been promoted by a number of international health organisations, as part of a redesign of healthcare systems to promote interprofessional teamwork, to enhance the quality of patient care, and improve health outcomes. In response, universities are beginning to create and sustain authentic and inclusive IPE activities, with which students can engage. A growing number of health professionals are expected to support and facilitate interprofessional student groups. Designing interprofessional learning activities, and facilitating interprofessional groups of students requires an additional layer of skills compared with uniprofessional student groups. This article outlines the key points for planning and practicing interprofessional facilitation within the classroom and clinical setting.
Team-based learning: design, facilitation and participation
Authors: Burgess Annette , van Diggele Christie , Roberts Chris , Mellis Craig
Published: December 2020

Team-based learning (TBL) provides an active, structured form of small group learning, that can be applied to large classes. Student accountability is achieved through the specific steps of TBL, including pre-class preparation, readiness assurance testing, problem-solving activities, and immediate feedback. Globally, a growing number of healthcare faculties have adopted TBL in a variety of combinations, across diverse settings and content areas. This paper provides a succinct overview of TBL and guidance for teachers towards successful design and implementation of TBL within health professional education. It also offers guidance for students participating in TBL. The paper is informed by both educational theory, and the extensive, seven year experience of the first and last authors in designing, implementing, facilitating and evaluating TBL at a large medical school.
Impact of a web-based module on trainees’ ability to interpret neonatal cranial ultrasound
Authors: Ben Fadel Nadya , McAleer Sean
Published: December 2020

Background

Accurate interpretations of neonatal cranial ultrasound (CUS) studies are essential skills for physicians in neonatal intensive care units (NICUs) in order to properly diagnose and manage brain injury. However, these skills are not formally taught to pediatric and neonatal-perinatal medicine (NPM) trainees in Canada. Therefore, our study describes the design, implementation, and evaluation of a new web-based learning (WBL) module that focuses on teaching these skills.

Methods

Trainees’ needs assessment survey, sent to all NPM and pediatrics trainees (n = 62), concluded that most of them feel uncomfortable with their ability to interpret CUS, highlighting the need for a new educational intervention. The needs assessment informed the development of the WBL module, which we evaluated using questionnaires and pre-and post-testing methods to measure participants’ satisfaction, knowledge gain, skills development, and behaviour changes. Only trainees rotating through the NICU over 6 months (n = 23) were invited to participate in all the evaluation steps. We used the ADDIE instructional design model as a framework for this project.

Results

Respondents were very satisfied with the module, and their baseline knowledge increased significantly after studying and engaging with the module. The post-test score was 76% (p < 0.001) compared to the pre-test mean score of 42%. Tests for CUS interpretation skills assessment showed that 49% of pre-test answers were incorrect compared to 8% in the post-test (p < 0.001). Seventy-eight percent of trainees (n = 18) responded to a survey conducted a year after implementation, and 78% of the respondents (n = 14) reported that they still used these skills and shared this knowledge with junior trainees.

Conclusion

A WBL module for teaching neonatal CUS interpretation considerably improved trainees’ knowledge and enhanced their skills in interpreting neonatal CUS.
Biomechanical analysis of canine medial patellar luxation with femoral varus deformity using a computer model
Authors: Lee Jiyun , Sim Heedong , Jeong Jaemin , Kim Sun-Young , Yang Seokjo , Jeong SeongMok , Lee HaeBeom
Published: December 2020

Background

Femoral varus deformities complicating the realignment of the quadriceps muscles are frequently associated with medial patellar luxation (MPL) in dogs. Therefore, distal femoral osteotomy (DFO) is recommended in dogs affected with severe MPL and a distal femoral varus deformity. The presence of an anatomic lateral distal femoral angle (aLDFA) of ≥ 102° has been anecdotally recommended as an indication for performing corrective DFO in large-breed dogs. However, the effect of a femoral varus deformity on MPL has not been scientifically evaluated. We aimed to evaluate the influence of a femoral varus deformity on MPL using a finite element method based computer model.

Three-dimensionally reconstructed computed tomographic images of a normal femur from a Beagle dog were deformed using meshing software to create distal varus deformities. A total of thirteen aLDFAs, including 95°, 98° and 100°–110°, were simulated. The patellar positions and reaction force between the patella and trochlear grooves were calculated for all finite element models under constant rectus femoris muscle activation.

Results

The patella was displaced medially from the trochlear groove at an aLDFA of ≥103°. With an aLDFA of 103° to 110°, the reaction force was equal to zero and then decreased to negative values during the simulation, while other models with aLDFAs of 95°, 98°, and 100°-102° had positive reaction force values. The patella began to luxate at 24.90 seconds (sec) with an aLDFA of 103°, 19.80 sec with an aLDFA of 104°, 21.40 sec with an aLDFA of 105°, 20.10 sec with an aLDFA of 106°, 18.60 sec with an aLDFA of 107°, 15.30 sec with an aLDFA of 108°, 16.60 sec with an aLDFA of 109°, and 11.90 sec with an aLDFA of 110°.

Conclusion

Severe distal femoral varus with an aLDFA of ≥103° caused MPL when other anatomical factors were controlled. Thissimplified computer model provides complementary information to anecdotal cutoffs for DFO, hence it should be applied to clinical patients with caution.
Averting expenditure on malaria: effects on labour productivity of maize farmers in Bunkpurugu-Nakpanduri District of Ghana
Authors: Mabe Franklin Nantui , Dafurika Thomas
Published: December 2020

Background

Malaria has been one of the commonest diseases during farming season, which affects farmers’ health resulting in a reduction in the number of days spent on the farm. As a result, farmers are regularly trying to avert malaria infection through preventive measures. Motivated by this argument, this study sought to determine the effects of malaria averting expenditure on labour productivity of maize farmers in Bunkpurugu-Nakpanduri District in the Northern Region of Ghana.

Methods

A cross-sectional primary data was collected from 194 maize farmers. Both descriptive and quantitative data analysis approaches were employed. Conditional mixed process was used to estimate the effects of malaria prevention expenditure on maize farmers’ labour productivity.

Results

The study revealed that maize farmers incurred an average expenditure of GHc284.6 to prevent malaria annually. The result shows that factors that affect maize farmers’ malaria prevention expenditure include off-farm income, household size, presence of bushes around houses, presence of pregnant women and number of household members in school. Meanwhile, quantity of fertilizer, seed, weedicides, farming experience, age, ownership of motorbike and averting expenditure are significant determinants of maize labour productivity. The study revealed that farmers who spend more money to avert malaria attack are more labour productive.

Conclusions

Therefore, this study recommends that Ministry of Health and Ministry of Food and Agriculture should collaborate and integrate health extension service on malaria in agricultural extension to educate farmers on the need to avert malaria. Farmers should be educated on malaria preventive strategies, such as clearing of bushes around houses, draining of stagnant water, sleeping in treated mosquito nets among others. Lastly, aside distribution of free mosquito nets to pregnant women, they should be subsidized and made available to all farmers for malaria prevention.
The effects of everyday-life exposure to polycyclic aromatic hydrocarbons on biological age indicators
Authors: Pavanello Sofia , Campisi Manuela , Mastrangelo Giuseppe , Hoxha Mirjam , Bollati Valentina
Published: December 2020

Background

Further knowledge on modifiable aging risk factors is required to mitigate the increasing burden of age-related diseases in a rapidly growing global demographic of elderly individuals. We explored the effect of everyday exposure to polycyclic aromatic hydrocarbons (PAHs), which are fundamental constituents of air pollution, on cellular biological aging. This was determined via the analysis of leukocyte telomere length (LTL), mitochondrial DNA copy number (LmtDNAcn), and by the formation of anti-benzo[a]pyrene diolepoxide (B[a]PDE–DNA) adducts.

Methods

The study population consisted of 585 individuals living in North-East Italy. PAH exposure (diet, indoor activities, outdoor activities, traffic, and residential exposure) and smoking behavior were assessed by questionnaire and anti-B[a]PDE–DNA by high-performance-liquid-chromatography. LTL, LmtDNAcn and genetic polymorphisms [glutathione S-transferase M1 and T1 (GSTM1; GSTT1)] were measured by polymerase chain reaction. Structural equation modelling analysis evaluated these complex relationships.

Results

Anti-B[a]PDE–DNA enhanced with PAH exposure (p = 0.005) and active smoking (p = 0.0001), whereas decreased with detoxifying GSTM1 (p = 0.021) and in females (p = 0.0001). Subsequently, LTL and LmtDNAcn reduced with anti-B[a]PDE–DNA (p = 0.028 andp = 0.018), particularly in males (p = 0.006 andp = 0.0001). Only LTL shortened with age (p = 0.001) while elongated with active smoking (p = 0.0001). Besides this, the most significant determinants of PAH exposure that raised anti-B[a]PDE–DNA were indoor and diet (p = 0.0001), the least was outdoor (p = 0.003).

Conclusion

New findings stemming from our study suggest that certain preventable everyday life exposures to PAHs reduce LTL and LmtDNAcn. In particular, the clear association with indoor activities, diet, and gender opens new perspectives for tailored preventive measures in age-related diseases.

Capsule

Everyday life exposure to polycyclic aromatic hydrocarbons reduces leukocyte telomere length and mitochondrial DNA copy number through anti-B[a]PDE-DNA adduct formation.
Is left-sided involvement of hepatocellular carcinoma an important preoperative predictive factor of poor outcome?
Authors: Sakuraoka Yuhki , Kubota Keiichi , Tanaka Genki , Shimizu Takayuki , Tago Kazuma , Park Kyung Hwa , Matsumoto Takatsugu , Shiraki Takayuki , Mori Shozo , Iso Yukihiro , Aoki Taku
Published: December 2020

Background

The tumor location is the most simple clinical factor and important in liver surgery to make surgical procedure. However, no previous study has investigated the prognostic differences and clinical features of hepatocellular carcinoma showing specific laterality. This study is the first report to focus on the laterality and aimed to lead to more simple and useful predictive factor rather than recent complicated predictive models.

Methods

Patients who underwent liver resection for the first time for single tumors located within each lobe between 2000 and 2018 were enrolled. We divided them into two groups based on tumor location: a right-sided group and a left-sided group. Univariable and multivariable analyses were performed to assess survival differences in relation to several other factors.

Results

There were 595 eligible patients; the 5-year survival rates and disease-free survival rates were 49.5% and 19.1% in the left-sided group and 55.6% and 24.5% in the right-sided group, respectively (p = 0.026). Statistical analyses revealed that the following preoperative prognostic factors were independently significant (p < 0.05) in the left-sided group: indocyanine green retention rate at 15 min, alpha fetoprotein, protein induced by vitamin K absence or antagonists-II level, and larger tumor size.

Conclusion

The left-sided group had a poorer prognosis than the right-sided group. A left-sided tumor location is a significant preoperative factor predictive of poor outcome in patients with hepatocellular carcinoma.
Workforce experience of the implementation of an advanced clinical practice framework in England: a mixed methods evaluation
Authors: Lawler Jessica , Maclaine Katrina , Leary Alison
Published: December 2020

Background

This study aims to understand how the implementation of the advanced clinical practice framework in England (2017) was experienced by the workforce to check assumptions for a national workforce modelling project. The advanced clinical practice framework was introduced in England in 2017 by Health Education England to clarify the role of advanced practice in the National Health Service.

Methods

As part of a large-scale workforce modelling project, a self-completed questionnaire was distributed via the Association of Advanced Practice Educators UK aimed at those studying to be an Advanced Clinical Practitioner or who are practicing at this level in order to check assumptions. Semi-structured phone interviews were carried out with this same group. Questionnaires were summarised using descriptive statistics in Excel for categorical responses and interviews and survey free-text were analysed using thematic analysis in NVivo 10.

Results

The questionnaire received over 500 respondents (ten times that expected) and 15 interviews were carried out. Advanced clinical practice was considered by many respondents the only viable clinical career progression. Respondents felt that employers were not clear about what practicing at this level involved or its future direction. 54% (287) thought that ‘ACP’ was the right job title for them. 19% (98) of respondents wanted their origin registered profession to be included in their title. Balancing advanced clinical practice education concurrently with a full-time role was challenging, participants underestimated the workload and expectations of employer’s training. There is an apparent dichotomy that has developed from the implementation of the 2017 framework: that of advanced clinical practice as an advanced level of practice within a profession, and that of Advanced Clinical Practitioner as a new generic role in the medical model.

Conclusions

Efforts to establish further clarity and structure around advanced clinical practice are needed for both the individuals practising at this level and their employers. A robust evaluation of the introduction of this role should take place.