bluuebunny/crossref_metadata_2025 huggingface dataset:
An initial study of the dynamic influences and interactions upon levels of sustainability at the global spatial scale
Authors: Phillips Jason
Published: August 2021

This paper conducts an initial determination and evaluation of the fundamental dynamic influences and interactions upon indicated levels and nature of sustainability occurring, at the global spatial scale over the specified period of 2006–2016. This is achieved by the first full application of the Sustainability Dynamics Framework (SDF) to the results of the Sustainable Society Index (SSI). The results indicate that obtained S-values are potentially influenced primarily by a triumvirate of influencing factors – Population Growth, GDP and Greenhouse Gases. A cumulative analysis of indicator categories indicated that Environmental Wellbeing was the dominant influencing category upon obtained S-values for the period 2008–2014, and Anthropospheric Wellbeing was the dominant influence in 2006 and 2016. The analysis concludes that the triumvirate has potentially caused fundamental breaches and dynamic impacts and feedbacks upon the global environment-human relationship and system. Unless the triumvirate is managed and mitigated urgently, then there is a potential realistic risk of unsustainability occurring.
Copyright Gossip: Exploring Copyright Opinions, Theories, and Strategies on YouTube
Authors: Kaye D. Bondy Valdovinos , Gray Joanne E.
Published: August 2021

This study investigates copyright discourses on YouTube. Through a qualitative content analysis of 144 YouTube videos, we explore how YouTube creators understand copyright law, how they minimize risks posed by copyright infringement, and how they navigate a highly technical and dynamic copyright enforcement ecosystem. Our findings offer insights into how digitally situated cultural producers are impacted by and respond to automated content moderation. This is important because increasingly lawmakers around the world are asking digital platforms to implement efficient systems for content moderation, and yet there is a lack of good information about the stakeholders most directly impacted by these practices. In this study, we present a systematic analysis of copyright gossip, building on the concept of algorithmic gossip, which comprises the opinions, theories, and strategies of creators who are affected by YouTube’s copyright enforcement systems.
Parent satisfaction with child health centres for children 0–5 years old in Norway: A cross-sectional study
Authors: Kaiser Sabine , Lillevik Christine Charlotte , Jakobsen Karine , Hansen Mariann Bellika , Martinussen Monica
Published: August 2021

In Norway, all children are entitled to receive regular health checks. Child health centres for children 0–5 years old (CHC) provide these check-ups and are one of many health services that Norwegian municipalities have to offer. The aim of this study was to examine parents’ satisfaction with CHCs, and to identify predictors for the overall evaluation of the service. The sample comprised 1654 parents who visited a CHC with their children. A hierarchical multiple regression analysis was conducted to predict the overall evaluation of the service with four user satisfaction scales (i.e. User participation, Public health nurse, Accessibility, and Information). The STROBE checklist was applied. Most users were satisfied with the service (95%) and with the help they received from it (91%). All four user satisfaction scales were significant in the prediction of the overall evaluation of the service. Users of the CHC seem to be very satisfied with the service, especially with the public health nurse.
“How Is My English?”: Chinese University Students’ Attitudes Toward China English and Their Identity Construction
Authors: Pan Haiying , Liu Chang , Fang Fan , Elyas Tariq
Published: August 2021

Due to the spread of the English language in various domains and the fact that English is used as a global language, researchers and educators have started to rethink the models and aims of English language teaching in different settings. From the World Englishes (WE) perspective, this study investigated the attitudes of Chinese university students toward the localized variety of “China English,” as well as the students’ identity construction and negotiation during their English language learning journey. Data were collected through a questionnaire completed by 190 respondents and interviews conducted with 20 participants. The findings revealed the students’ positive attitudes toward China English and non-conformity to English as a native language (ENL). This further reflected the communicative function of English and the students’ interest in forming a Chinese cultural identity. However, the students also showed self-contradictory attitudes toward China English, as most did not want to be clearly identified as Chinese when using English. The data revealed some important reasons for this attitudinal conflict, including the belief that ENL is the standard form of English, as well as the students’ desire to develop an identity as competent second language learners of English. The findings suggest the importance of increasing awareness of the global spread of English and reforming English curricula and assessment in contexts where local varieties of English are emerging.
By Default: How Mothers in Different-Sex Dual-Earner Couples Account for Inequalities in Pandemic Parenting
Authors: Calarco Jessica McCrory , Meanwell Emily , Anderson Elizabeth M. , Knopf Amelia S.
Published: August 2021

Mothers did a disproportionate share of the child care during the COVID-19 pandemic—an arrangement that negatively impacted their careers, relationships, and well-being. How did mothers account for these unequal roles? Through interviews and surveys with 55 mothers (and 14 fathers) in different-sex, prepandemic dual-earner couples, we found that mothers (and fathers) justified unequal parenting arrangements based on gendered structural and cultural conditions that made mothers’ disproportionate labor seem “practical” and “natural.” These justifications allowed couples to rely on mothers by default rather than through active negotiation. As a result, many mothers did not feel entitled to seek support with child care from fathers or nonparental caregivers and experienced guilt if they did so. These findings help explain why many mothers have not reentered the workforce, why fathers’ involvement at home waned as the pandemic progressed, and why the pandemic led to growing preferences for inegalitarian divisions of domestic and paid labor.
An alternate covalent form of platelet αIIbβ3 integrin that resides in focal adhesions and has altered function
Authors: Pijning Aster E. , Blyth Mitchell T. , Coote Michelle L. , Passam Freda , Chiu Joyce , Hogg Philip J.
Published: August 2021

The αIIbβ3 integrin receptor coordinates platelet adhesion, activation, and mechanosensing in thrombosis and hemostasis. Using differential cysteine alkylation and mass spectrometry, we have identified a disulfide bond in the αIIb subunit linking cysteines 490 and 545 that is missing in ∼1 in 3 integrin molecules on the resting and activated human platelet surface. This alternate covalent form of αIIbβ3 is predetermined as it is also produced by human megakaryoblasts and baby hamster kidney fibroblasts transfected with recombinant integrin. From coimmunoprecipitation experiments, the alternate form selectively partitions into focal adhesions on the activated platelet surface. Its function was evaluated in baby hamster kidney fibroblast cells expressing a mutant integrin with an ablated C490-C545 disulfide bond. The disulfide mutant integrin has functional outside-in signaling but extended residency time in focal adhesions due to a reduced rate of clathrin-mediated integrin internalization and recycling, which is associated with enhanced affinity of the αIIb subunit for clathrin adaptor protein 2. Molecular dynamics simulations indicate that the alternate covalent form of αIIb requires higher forces to transition from bent to open conformational states that is in accordance with reduced affinity for fibrinogen and activation by manganese ions. These findings indicate that the αIIbβ3 integrin receptor is produced in various covalent forms that have different cell surface distribution and function. The C490, C545 cysteine pair is conserved across all 18 integrin α subunits, and the disulfide bond in the αV and α2 subunits in cultured cells is similarly missing, suggesting that the alternate integrin form and function are also conserved.
Five-year outcomes after IVIG for mild cognitive impairment due to alzheimer disease
Authors: Kile Shawn , Au William , Parise Carol , Rose Kimberley , Donnel Tammy , Hankins Andrea , Au Yvonne , Chan Matthew , Ghassemi Azad
Published: August 2021

Background

The purpose of this study was to assess the five-year treatment effects of a short course of intravenous immunoglobulin (IVIG) in subjects with mild cognitive impairment (MCI) due to Alzheimer disease (AD).

Methods

Fifty subjects 50 to 84 years of age with MCI due to AD were administered 0.4 g/kg 10% IVIG or 0.9% saline every two weeks x five doses in a randomized double-blinded design as part of a two-year study. Twenty-seven subjects completed an additional three-year extension study. MRI brain imaging, cognitive testing, and conversion to dementia were assessed annually. Participants were stratified into early MCI (E-MCI) and late MCI (L-MCI). The primary endpoint was brain atrophy measured as annualized percent change in ventricular volume (APCV) annually for five years. ANOVA was used to compare annualized percent change in ventricular volume from baseline between the groups adjusting for MCI status (E-MCI, L-MCI).

Results

Differences in brain atrophy between the groups, which were statistically significant after one year, were no longer significant after five years. IVIG-treated L-MCI subjects did demonstrate a delay in conversion to dementia of 21.4 weeks.

Conclusion

An eight-week course of IVIG totaling 2 g/kg in MCI is safe but is not sufficient to sustain an initial reduction in brain atrophy or a temporary delay in conversion to dementia at five years. Other dosing strategies of IVIG in the early stages of AD should be investigated to assess more sustainable disease-modifying effects.

Trial registrationClinicalTrials.gov NCT01300728. Registered 23 February 2011.
Genome editing with CRISPR/Cas9 in Pinus radiata (D. Don)
Authors: Poovaiah Charleson , Phillips Lorelle , Geddes Barbara , Reeves Cathie , Sorieul Mathias , Thorlby Glenn
Published: August 2021

Background

To meet increasing demand for forest-based products and protect natural forests from further deforestation requires increased productivity from planted forests. Genetic improvement of conifers by traditional breeding is time consuming due to the long juvenile phase and genome complexity. Genetic modification (GM) offers the opportunity to make transformational changes in shorter time frames but is challenged by current genetically modified organism (GMO) regulations. Genome editing, which can be used to generate site-specific mutations, offers the opportunity to rapidly implement targeted improvements and is globally regulated in a less restrictive way than GM technologies.

Results

We have demonstrated CRISPR/Cas9 genome editing in P. radiata targeting a single-copy cell wall gene GUX1 in somatic embryogenic tissue and produced plantlets from the edited tissue. We generated biallelic INDELs with an efficiency of 15 % using a single gRNA. 12 % of the transgenic embryogenic tissue was edited when two gRNAs were used and deletions of up to 1.3 kb were identified. However, the regenerated plants did not contain large deletions but had single nucleotide insertions at one of the target sites. We assessed the use of CRISPR/Cas9 ribonucleoproteins (RNPs) for their ability to accomplish DNA-free genome editing in P. radiata. We chose a hybrid approach, with RNPs co-delivered with a plasmid-based selectable marker. A two-gRNA strategy was used which produced an editing efficiency of 33 %, and generated INDELs, including large deletions. Using the RNP approach, deletions found in embryogenic tissue were also present in the plantlets. But, all plants produced using the RNP strategy were monoallelic.

Conclusions

We have demonstrated the generation of biallelic and monoallelic INDELs in the coniferous tree P. radiata with the CRISPR/Cas9 system using plasmid expressed Cas9 gRNA and RNPs respectively. This opens the opportunity to apply genome editing in conifers to rapidly modify key traits of interest.
Multi-locus genome-wide association studies for five yield-related traits in rice
Authors: Zhong Hua , Liu Shuai , Sun Tong , Kong Weilong , Deng Xiaoxiao , Peng Zhaohua , Li Yangsheng
Published: August 2021

Background

Improving the overall production of rice with high quality is a major target of breeders. Mining potential yield-related loci have been geared towards developing efficient rice breeding strategies. In this study, one single-locus genome-wide association studies (SL-GWAS) method (MLM) in conjunction with five multi-locus genome-wide association studies (ML-GWAS) approaches (mrMLM, FASTmrMLM, pLARmEB, pKWmEB, and ISIS EM-BLASSO) were conducted in a panel consisting of 529 rice core varieties with 607,201 SNPs.

Results

A total of 152, 106, 12, 111, and 64 SNPs were detected by the MLM model associated with the five yield-related traits, namely grain length (GL), grain width (GW), grain thickness (GT), thousand-grain weight (TGW), and yield per plant (YPP), respectively. Furthermore, 74 significant quantitative trait nucleotides (QTNs) were presented across at least two ML-GWAS methods to be associated with the above five traits successively. Finally, 20 common QTNs were simultaneously discovered by both SL-GWAS and ML-GWAS methods. Based on genome annotation, gene expression analysis, and previous studies, two candidate key genes (LOC_Os09g02830 and LOC_Os07g31450) were characterized to affect GW and TGW, separately.

Conclusions

These outcomes will provide an indication for breeding high-yielding rice varieties in the immediate future.
Negative SARS-CoV-2 PCR or rapid antigen test result and the subsequent risk of being infectious: a mathematical simulation study
Authors: Krumkamp Ralf , Kreuels Benno , Jaeger Veronika K. , May Jürgen , Mikolajczyk Rafael , Karch André
Published: August 2021

Background

A considerable proportion of SARS-CoV-2 transmission occurs from asymptomatic and pre-symptomatic cases. Therefore, different polymerase chain reaction (PCR)- or rapid antigen test (RAT)-based approaches are being discussed and applied to identify infectious individuals that would have otherwise gone undetected. In this article, we provide a framework to estimate the time-dependent risk of being infectious after a negative SARS-CoV-2 test, and we simulate the number of expected infectious individuals over time in populations who initially tested negative.

Methods

A Monte Carlo approach is used to simulate asymptomatic infections over a 10-days period in populations of 1000 individuals following a negative SARS-CoV-2 test. Parameters representing the application of PCR tests or RATs are utilized, and SARS-CoV-2 cumulative 7-day incidences between 25 and 200 per 100,000 people are considered. Simulation results are compared to case numbers predicted via a mathematical equation.

Results

The simulations showed a continuous increase in infectious individuals over time in populations of individuals who initially tested SARS-CoV-2 negative. The interplay between false negative rates of PCR tests or RATs, and the time that has passed since testing determines the number of infectious individuals. The simulated and the mathematically predicted number of infectious individuals were comparable. However, Monte Carlo simulations highlight that, due to random variation, theoretically observed infectious individuals can considerably exceed predicted case numbers even shortly after a test was conducted.

Conclusions

This study demonstrates that the number of infectious individuals in a screened group of asymptomatic people can be effectively reduced, and this effect can be described mathematically. However, the false negative rate of a test, the time since the negative test and the underlying SARS-CoV-2 incidence are critical parameters in determining the observed subsequent number of cases in tested population groups.
Clinic-based diabetes screening at the time of HIV testing and associations with poor clinical outcomes in South Africa: a cohort study
Authors: Kubiak Rachel W. , Kratz Mario , Motala Ayesha A. , Galagan Sean , Govere Sabina , Brown Elisabeth R. , Moosa Mahomed-Yunus S. , Drain Paul K.
Published: August 2021

Background

HIV clinical care programs in high burden settings are uniquely positioned to facilitate diabetes diagnosis, which is a major challenge. However, in sub-Saharan Africa, data on the burden of diabetes among people living with HIV (PLHIV) and its impact on HIV outcomes is sparse.

Methods

We enrolled adults presenting for HIV testing at an outpatient clinic in Durban. Those who tested positive for HIV-infection were screened for diabetes using a point-of-care hemoglobin A1c (HbA1c) test. We used log-binomial, Poisson, and Cox proportional hazard models adjusting for confounders to estimate the relationship of diabetes (HbA1c ≥ 6.5%) with the outcomes of HIV viral suppression (< 50 copies/mL) 4–8 months after antiretroviral therapy initiation, retention in care, hospitalization, tuberculosis, and death over 12 months.

Results

Among 1369 PLHIV, 0.5% (n = 7) reported a prior diabetes diagnosis, 20.6% (95% CI 18.5–22.8%, n = 282) screened positive for pre-diabetes (HbA1c 5.7–6.4%) and 3.5% (95% CI 2.7–4.6%, n = 48) for diabetes. The number needed to screen to identify one new PLHIV with diabetes was 46.5 persons overall and 36.5 restricting to those with BMI ≥ 25 kg/m2. Compared to PLHIV without diabetes, the risk of study outcomes among those with diabetes was not statistically significant, although the adjusted hazard of death was 1.79 (95% CI 0.41–7.87).

Conclusions

Diabetes and pre-diabetes were common among adults testing positive for HIV and associated with death. Clinic-based diabetes screening could be targeted to higher risk groups and may improve HIV treatment outcomes.
Seizure in HIV-infected patients: clinical presentation, cause and treatment outcome in Ethiopia—a retrospective study
Authors: Amare Amanuel
Published: August 2021

Background

The estimated number of adult patients living with HIV infection in Ethiopia in 2012 was approximately 800,000. Seizure occurs in 2 to 3% and 6.1% to 34.3% in patients with HIV infection and patients with neurological complications of HIV infection, respectively. Studies on HIV infection and seizure are rare in Ethiopia. The purpose of this study was to assess clinical presentation, cause and treatment outcome of patients with HIV infection presented with seizure.

Methods

In this retrospective study, patients aged ≥ 13 years with HIV infection presented with seizure were included. Medical records were reviewed and demographic and clinical data were collected.

Results

Records of 146 patients were analysed. Males were 55.5% and the mean age was 34 years. The diagnosis of HIV infection was made after current hospital admission in 69% of patients. Almost all patients (98.6%) had stage 4 HIV infection with very low CD4 count (mean = 77/mm3). In almost all patients seizure was a recent onset at current admission; either it started after admission (42.5%) or within 3 months prior to admission (52.5%). The types of seizures were: generalized tonic–clonic seizure [GTCS] (69.2%), focal motor with secondarily generalization [FMWSG] (19.9%) and simple focal motor (11%). The common causes of seizure were: cerebral toxoplasmosis (46%), tuberculous meningitis (35.6%) and cryptococcal meningitis (13.7%). Case-fatality was 53% and predictors of mortality were: seizure started after admission, change in mentation and comatose at initial evaluation.

Conclusions

Most patients had stage 4 HIV infection with very low CD4 count and a recent onset seizure which started within 3 months at initial evaluation. GTCS was the commonest seizure type and most causes of seizure were central nervous system opportunistic infections. The case-fatality was high and change in sensorium was an independent predictor of mortality. To prevent the high mortality and morbidity prevention of HIV infection, early diagnosis and treatment, improving diagnostic facilities and access to non-enzyme inducing antiepileptic drugs are recommended.
Dynamics of hepatitis C epidemic among people living with HIV in Estonia based on Estonian HIV cohort study
Authors: Kase Kerstin , Avi Radko , Toompere Karolin , Rajasaar Heli , Pauskar Merit , Soodla Pilleriin , Jõgeda Ene-Ly , Zilmer Kai , Lutsar Irja , Huik Kristi
Published: August 2021

Background

Estonia has a typical Eastern European HIV epidemic where the most frequent co-infection is chronic hepatitis C (HCV). We aimed to describe the changes in HCV prevalence, the distribution of HCV genotypes (GT), and HCV treatment in Estonian people living with HIV over 15 years.

Methods

We used data of subjects included to the Estonian HIV Cohort Study (E-HIV) before 31st of December 2015. We compared two time periods—first, 1st of January 2000 to 31st of December 2008 when the HIV epidemic was mostly spreading among people who inject drugs (PWID) and second, 1st of January 2009 to 31st of December 2015 when HIV started to emerge to the general population.

Results

Of 4422 HIV positives 3708 (84%) had information about their HCV serostatus; 2706 (61%) were HCV seropositive, of latter 1625 (60%) were HCV RNA positive, 239 (9%) had their HCV GT determined, and 141 (5%) received treatment for HCV. The dominating subtypes were 1b (42%) and 3a (37%) followed by 1a (16%), and the few cases of 2 (1.5%). HCV prevalence was 1.5 times (95% CI 1.4–1.6) higher in subjects diagnosed with HIV in first as compared to those diagnosed in second period (84% vs 56%, respectively). There were more men and the median age at HIV diagnosis was lower in HIV/HCV co-infected than in HIV mono-infected patients (70% vs 47% and 24 years vs. 30 years, respectively; both p < 0.001).

Conclusion

There is a decrease in HCV prevalence but it remains high among HIV positive PWID, suggesting that there is need for improvement of harm reduction programs among PWID.
Chronic kidney disease linked to SARS-CoV-2 infection: a case report
Authors: Tarris Georges , de Rougemont Alexis , Estienney Marie-Anaïs , Journet Julien , Lariotte Anne-Cécile , Aubignat Damien , Rebibou Jean-Michel , De La Vega Mathilde Funes , Legendre Mathieu , Belliot Gael , Martin Laurent
Published: August 2021

Background

The recent COVID-19 pandemic has raised concerns about patient diagnosis and follow-up of chronically ill patients. Patients suffering from chronic illnesses, concomitantly infected by SARS-CoV-2, globally tend to have a worse prognosis and poor outcomes. Renal tropism and acute kidney injury following SARS-CoV-2 infection has recently been described in the literature, with elevated mortality rates. Furthermore, patients with pre-existing chronic kidney disease, infected by SARS-CoV-2, should be monitored carefully. Here, we report the case of a 69-year-old patient with splenic marginal zone lymphoma, suffering from longstanding chronic kidney disease following SARS-CoV-2 infection.

Case presentation

A 69-year-old male patient previously diagnosed with pulmonary embolism and splenic marginal zone lymphoma (Splenomegaly, Matutes 2/5, CD5 negative and CD23 positive), was admitted to the hospital with shortness of breath, fever and asthenia. A nasopharyngeal swab test was performed in addition to a CT-scan, which confirmed SARS-CoV-2 infection. Blood creatinine increased following SARS-CoV-2 infection at 130 μmol/l, with usual values at 95 μmol/l. The patient was discharged at home with rest and symptomatic medical treatment (paracetamol and hydration), then readmitted to the hospital in August 2020. A kidney biopsy was therefore conducted as blood creatinine levels were abnormally elevated. Immunodetection performed in a renal biopsy specimen confirmed co-localization of SARS-CoV2 nucleocapsid and protease 3C proteins with ACE2, Lewis x and sialyl-Lewis x antigens in proximal convoluted tubules and podocytes. Co-localization of structural and non-structural viral proteins clearly demonstrated viral replication in proximal convoluted tubules in this chronically ill patient. Additionally, we observed the co-localization of sialyl-Lewis x and ACE2 receptors in the same proximal convoluted tubules. Reverse Transcriptase-Polymerase Chain Reaction test performed on the kidney biopsy was negative, with very low Ct levels (above 40). The patient was finally readmitted to the haematology department for initiation of chemotherapy, including CHOP protocol and Rituximab.

Conclusions

Our case emphasizes on the importance of monitoring kidney function in immunosuppressed patients and patients suffering from cancer following SARS-CoV-2 infection, through histological screening. Further studies will be required to decipher the mechanisms underlying chronic kidney disease and the putative role of sialyl-Lewis x and HBGA during SARS-CoV-2 infection.
Prognostic factors of adult tuberculous meningitis in intensive care unit: a single-center retrospective study in East China
Authors: Feng Baobao , Fei Xiao , Sun Ying , Zhang Xingguo , Shang Deya , Zhou Yi , Sheng Meiyan , Xu Jiarui , Zhang Wei , Ren Wanhua
Published: August 2021

Background

Tuberculous meningitis (TBM) is the most lethal form of tuberculosis worldwide. Data on critically ill TBM patients in the intensive care unit (ICU) of China are lacking. We tried to identify prognostic factors of adult TBM patients admitted to ICU in China.

Methods

We conducted a retrospective study on adult TBM in ICU between January 2008 and April 2018. Factors associated with unfavorable outcomes at 28 days were identified by logistic regression. Factors associated with 1-year mortality were studied by Cox proportional hazards modeling.

Results

Eighty adult patients diagnosed with TBM (age 38.5 (18–79) years, 45 (56 %) males) were included in the study. An unfavorable outcome was observed in 39 (49 %) patients and were independently associated with Acute Physiology and Chronic Health Evaluation (APACHE) II > 23 (adjusted odds ratio (aOR) 5.57, 95 % confidence interval (CI) 1.55–19.97), Sequential Organ Failure Assessment (SOFA) > 8 (aOR 9.74, 95 % CI 1.46–64.88), and mechanical ventilation (aOR 18.33, 95 % CI 3.15–106.80). Multivariate Cox regression analysis identified two factors associated with 1-year mortality: APACHE II > 23 (adjusted hazard ratio (aHR) 4.83; 95 % CI 2.21–10.55), and mechanical ventilation (aHR 9.71; 95 % CI 2.31–40.87).

Conclusions

For the most severe adult TBM patients of Medical Research Council (MRC) stage III, common clinical factors aren’t effective enough to predict outcomes. Our study demonstrates that the widely used APACHE II and SOFA scores on admission can be used to predict short-term outcomes, while APACHE II could also be used to predict long-term outcomes of adult patients with TBM in ICU.
Prevalence of self-reported abdominal symptoms among 50–74-years-old men and women eligible for colorectal cancer screening –a cross-sectional study
Authors: Larsen Mette Bach , Bachmann Heidi Heinsen , Søborg Bo , Laurberg Tinne , Emmertsen Katrine J. , Laurberg Søren , Andersen Berit
Published: August 2021

Background

Screening is defined as the identification of unrecognized disease in an apparently healthy population. Symptomatic individuals are recommended to contact a physician instead of participating in screening. However, in colorectal cancer (CRC) screening this approach may be problematic as abdominal symptoms are nonspecific. This study aimed at identifying the prevalence of self-reported abdominal symptoms among screening-eligible men and women aged 50–74 years.

Methods

This cross-sectional survey study included 11,537 individuals aged 50–74 years invited for CRC screening from 9 to 23 September 2019. Descriptive statistics of responders experiencing alarm symptoms of CRC, Low Anterior Resection Syndrome Score (LARS) and the Patient Assessment of Constipation-Symptoms (PAC-SYM) were derived. The association between abdominal symptoms and demographic and socioeconomic variables were estimated by prevalence ratio (PR) using a Poisson regression model with robust variance.

Results

A total of 5488 respondents were included. The respondents were more likely women, of older age, Danish, cohabiting and had higher education and income level compared to non-respondents.

Abdominal pain more than once a week was experienced by 12.0% of the respondents. Of these, 70.8% had been experiencing this symptom for >1 month. Fresh blood in the stool was experienced by 0.7% and of these 82.1% for >1 month. About one third of those experiencing alarm symptoms more than once a week for >1 month had not consulted a doctor. A total of 64.1% of the respondents had no LARS, 21.7% had minor LARS and 14.2% had major LARS. The median PAC-SYM score was 0.33 (Interquartile range (IQR): 0.17;0.75), the median abdominal score was 0.50 (IQR: 0.00;1.00), median rectal score 0.00 (IQR:0.00;0.33) and median stool score 0.40 (IQR: 0.00;0.80). Men and those aged 65–74 reported less symptoms than women and those aged 50–64 years, respectively.

Conclusions

This study illustrated that abdominal symptoms were frequent among screening-eligible men and women. This should be taken into account when implementing and improving CRC screening strategies. A concerning high number of the respondents experiencing alarm symptoms had not consulted a doctor. This calls for attention to abdominal symptoms in general and how those with abdominal symptoms should participate in CRC screening.
Tranexamic acid in a periarticular multimodal cocktail injection for blood management in total knee arthroplasty: a prospective randomized study
Authors: Kim Kang-Il , Bae Jung-Kwon , Kim Jun-Ho , Gwak Hyun-Gon , Lee Sang Hak
Published: August 2021

Background

This study aimed to assess the efficacy of tranexamic acid (TXA) mixed in a periarticular multimodal cocktail (PAMC) as a topical administration and to determine whether combined use of intravenous and topical administration is more effective than a single administration of TXA.

Methods

A total of 240 patients who underwent primary total knee arthroplasty (TKA) was enrolled for this prospective randomized controlled study. Patients were divided into three groups of 80 patients each. Baseline data were comparable for all groups. Average follow-up was 18.7 months. Group 1 consisted of patients who received intravenous (IV) TXA, Group 2 patients were those who received TXA in a PAMC injection for topical administration, and Group 3 consisted of patients who received a combination of both intravenous and topical administration of TXA. Primary outcomes were postoperative hemoglobin drop and amount of suction drainage. Secondary outcomes were estimated blood loss (EBL), postoperative transfusion rate, and complications.

Results

The mean postoperative hemoglobin drop was significantly lower in Group 3 (2.13 ± 0.77 g/dL, p=0.004), and there was no difference between Group 1 and Group 2 (2.56 ± 1.07 g/dL vs 2.55 ± 0.86 g/dL, p=0.999). The mean drainage amount was significantly lower in Group 3 (326.58 ± 57.55 ml, p<0.001), and there was no difference between Group 1 and Group 2 (367.93 ± 87.26 ml vs 397.66 ± 104.10 ml, p=0.072). Similarly, the mean EBL was significantly lower in Group 3 (p=0.003), and there was no significant difference between Group 1 and Group 2 (p=0.992). There were no significant differences in requirement for postoperative transfusion rate or incidence of complications among the three groups.

Conclusion

TXA mixed in a PAMC injection showed a similar effect to IV administration of TXA following TKA. Furthermore, combined use of both IV and PAMC injection provided better perioperative bleeding control with similar safety in patients without relevant comorbidities.

Trial registration

WHO ICTRP identifier KCT0005703. Retrospectively registered: 12/24/2020
Bupi Yishen formula attenuates kidney injury in 5/6 nephrectomized rats via the tryptophan-kynurenic acid-aryl hydrocarbon receptor pathway
Authors: Mo Yenan , Jie Xina , Wang Lixin , Ji Chunlan , Gu Yueyu , Lu Zhaoyu , Liu Xusheng
Published: August 2021

Background

Bupi Yishen Formula (BYF), a patent traditional Chinese medicine (TCM) formulation, has been used in the clinical treatment of chronic kidney disease (CKD). However, the mechanism of action of BYF has not been fully elucidated.

Method

To investigate the variation in the metabolic profile in response to BYF treatment in a rat model of 5/6 nephrectomy (Nx), rats in the treatment groups received low- or high-dose BYF. At the end of the study, serum and kidney samples were collected for biochemical, pathological, and western blotting analysis. Metabolic changes in serum were analyzed by liquid chromatography-tandem mass spectrometry.

Results

The results showed that BYF treatment could reduce kidney injury, inhibit inflammation and improve renal function in a dose-dependent manner. In total, 405 and 195 metabolites were identified in negative and positive ion modes, respectively. Metabolic pathway enrichment analysis of differential metabolites based on the Kyoto Encyclopedia of Genes and Genomes database identified 35 metabolic pathways, 3 of which were related to tryptophan metabolism. High-dose BYF reduced the level of kynurenic acid (KA) by more than 50%, while increasing melatonin 25-fold and indole-3-acetic acid twofold. Expression levels of aryl hydrocarbon receptor (AhR), Cyp1A1, and CyP1B1 were significantly reduced in the kidney tissue of rats with high-dose BYF, compared to 5/6 Nx rats.

Conclusion

BYF has a reno-protective effect against 5/6 Nx-induced CKD, which may be mediated via inhibition of the tryptophan-KA-AhR pathway.
Impact of fatigue on nursing care rationing in paediatric haematology and oncology departments – a cross-sectional study
Authors: Jankowska-Polańska Beata , Czyrniańska Monika , Sarzyńska Kathie , Świątoniowska-Lonc Natalia , Chabowski Mariusz
Published: August 2021

Background

Rationing of nursing care is a relatively new concept. It refers to an error of omission and has a direct influence on the quality of nursing care and treatment outcomes. Nurses who experience chronic fatigue often fail to perform their duties properly, which may lead, for instance, to medical errors attributed to impaired judgment. Therefore, it is necessary to identify factors which give rise to fatigue, leading to rationing of nursing care, and develop strategies to eliminate them. The primary objective of the study was to assess the impact of fatigue on nursing care rationing in paediatric haematology and oncology departments. The secondary objective of this study was to identify the factors, which may influence the nursing care rationing.

Methods

The study was conducted among 95 nurses (aged between 23 and 58 years) workinginthe Department of Paediatric Oncology, Haematology and Bone Marrow Transplantation of the University Teaching Hospital in Wroclaw. Participation in the study was voluntary and anonymous. Our own sociodemographic questionnaire, the Basel Extent of Rationing of Nursing Carequestionnaire and the modified fatigue impact scale (MFIS) were used in the study.

Results

The level of fatigue among the nurses participating in the study, as measured by the MFIS, was high, namely 28.97 ± 16.78. It was found that the fatigue of the nurses influenced most often the psycho-social dimension of QoL (1.78 ± 1.05), and least often - cognitive (1.24 ± 0.78). A correlation analysis showed that all aspects of fatigue had a statistically significant positive impact on care rationing (p < 0.05), i.e. the greater the fatigue, the higher the level of care rationing. A regression analysis showed that a 12-h shift pattern was an independent predictor of the level of care rationing (r = 0.771, p < 0.05).

Conclusions

Nurses working in paediatric haematology departments report a high level of fatigue. Work pattern is an independent determinant of nursing carerationing. A high level of nursing care rationing was found for nurses working 12-h shifts.

Trial registration

The study was approved by the Bioethics Committee of the Wroclaw Medical University, Poland (February 8th 2019, No. 205/2019).
Experiences of frail older cardiac patients with a nurse-coordinated transitional care intervention - a qualitative study
Authors: Jepma Patricia , Latour Corine H. M. , ten Barge Iris H. J. , Verweij Lotte , Peters Ron J. G. , Scholte op Reimer Wilma J. M. , Buurman Bianca M.
Published: August 2021

Background

Older cardiac patients are at high risk of readmission and mortality. Transitional care interventions (TCIs) might contribute to the prevention of adverse outcomes. The Cardiac Care Bridge program was a randomized nurse-coordinated TCI combining case management, disease management and home-based rehabilitation for hospitalized frail older cardiac patients. This qualitative study explored the experiences of patients’ participating in this study, as part of a larger process evaluation as this might support interpretation of the neutral study outcomes. In addition, understanding these experiences could contribute to the design and application of future transitional care interventions for frail older cardiac patients.

Methods

A generic qualitative approach was used. Semi-structured interviews were performed with 16 patients ≥70 years who participated in the intervention group. Participants were selected by gender, diagnosis, living arrangement and hospital of inclusion. Data were analysed using thematic analysis. In addition, quantitative data about intervention delivery were analysed.

Results

Three themes emerged from the data: 1) appreciation of care continuity; 2) varying experiences with recovery and, 3) the influence of an existing care network. Participants felt supported by the transitional care intervention as they experienced post-discharge support and continuity of care. The perceived contribution of the program in participants’ recovery varied. Some participants reported physical improvements while others felt impeded by comorbidities or frailty. The home visits by the community nurse were appreciated, although some participants did not recognize the added value. Participants with an existing healthcare provider network preferred to consult these providers instead of the providers who were involved in the transitional care intervention.

Conclusion

Our results contribute to an explanation of the neutral study of a nurse-coordinated transitional care intervention. For future purpose, it is important to identify which patients might benefit most from TCIs. Furthermore, the intensity and content of TCIs could be more personalized by tailoring interventions to older cardiac patients’ needs, considering their frailty, self-management skills and existing formal and informal caregiver networks.
Maternal health care professionals’ experiences and views on the use of obstetric ultrasound in Rwanda: A cross-sectional study
Authors: Mogren Ingrid , Ntaganira Joseph , Sengoma Jean Paul Semasaka , Holmlund Sophia , Small Rhonda , Pham Thi Lan , Kidanto Hussein Lesio , Ngarina Matilda , Bergström Cecilia , Edvardsson Kristina
Published: August 2021

Background

This study, undertaken in Rwanda, aimed to investigate health professionals’ experiences and views on the following topics: current clinical guidelines for ultrasound from second trimester at the clinic, regional and national levels, and adherence to clinical guidelines; medically indicated ultrasound examinations; non-medical use of ultrasound including ultrasounds on maternal request; commercialisation of ultrasound; the value of ultrasound in relation to other clinical examinations in pregnancy; and ultrasound and medicalisation of pregnancy.

Methods

A cross-sectional design was adopted. Health professionals providing antenatal care and delivery services to pregnant women in 108 health facilities were invited to complete a survey, which was developed based on the results of earlier qualitative studies undertaken as part of the CROss Country Ultrasound Study (CROCUS).

Results

Nine hundred and seven health professionals participated: obstetricians/gynecologists (3.2%,) other physicians (24.5%), midwives (29.7%) and nurses (42.7%). Few physicians reported the existence of clinical guidelines at clinic, regional or national levels in Rwanda, and guidelines were moderately adhered to. Three obstetric ultrasound examinations were considered medically indicated in an uncomplicated pregnancy. Most participants (73.0%) were positive about obstetric ultrasound examinations on maternal request. Commercialisation was not considered a problem, and the majority (88.5%) agreed that ultrasound had contributed to medicalisation of pregnancy.

Conclusions

Findings indicate that clinical guidelines for the use of obstetric ultrasound are limited in Rwanda. Non-medically indicated obstetric ultrasound was not considered a current problem at any level of the healthcare system. The positive attitude to obstetric ultrasound examinations on maternal request may contribute to further burden on a maternal health care system with limited resources. It is essential that limited obstetric ultrasound resources are allocated where they are most beneficial, and clearly stated medical indications would likely facilitate this.
An assessment of the knowledge, practices and resources during the delivery of malaria health care services among private health care practitioners: a cross section study in the Mid-Western Region of Uganda
Authors: Wanzira Humphrey , Tumwine Daniel , Bukoma Patrick , Musiime Alan , Biculu Juliet , Ediamu Tom , Gudoi Samuel , Tibenderana James K. , Mulebeke Ronald , Nantanda Rebecca , Achan Jane
Published: August 2021

Background

Approximately 50 % of the population in Uganda seeks health care from private facilities but there is limited data on the quality of care for malaria in these facilities. This study aimed to document the knowledge, practices and resources during the delivery of malaria care services, among private health practitioners in the Mid-Western region of Uganda, an area of moderate malaria transmission.

Methods

This was a cross sectional study in which purposive sampling was used to select fifteen private-for-profit facilities from each district. An interviewer-administered questionnaire that contained both quantitative and open-ended questions was used. Information was collected on availability of treatment aides, knowledge on malaria, malaria case management, laboratory practices, malaria drugs stock and data management. We determined the proportion of health workers that adequately provided malaria case management according to national standards.

Results

Of the 135 health facilities staff interviewed, 61.48 % (52.91–69.40) had access to malaria treatment protocols while 48.89 % (40.19–57.63) received malaria training. The majority of facilities, 98.52 % (94.75–99.82) had malaria diagnostic services and the most commonly available anti-malarial drug was artemether-lumefantrine, 85.19 % (78–91), followed by Quinine, 74.81 % (67–82) and intravenous artesunate, 72.59 % (64–80). Only 14.07 % (8.69–21.10) responded adequately to the acceptable cascade of malaria case management practice. Specifically, 33.33 % (25.46–41.96) responded correctly to management of a patient with a fever, 40.00 % (31.67–48.79) responded correctly to the first line treatment for uncomplicated malaria, whereas 85.19 % (78.05–90.71) responded correctly to severe malaria treatment. Only 28.83 % submitted monthly reports, where malaria data was recorded, to the national database.

Conclusions

This study revealed sub-optimal malaria case management knowledge and practices at private health facilities with approximately 14 % of health care workers demonstrating correct malaria case management cascade practices. To strengthen the quality of malaria case management, it is recommended that the NMCD distributes current guidelines and tools, coupled with training; continuous mentorship and supportive supervision; provision of adequate stock of essential anti-malarials and RDTs; reinforcing communication and behavior change; and increasing support for data management at private health facilities.
Risk assessment and integrated surveillance of foot-and-mouth disease outbreaks in Russia based on Monte Carlo simulation
Authors: Wang Jianying , Chen Jiahui , Zhang Shuwen , Ding Yanting , Wang Minjia , Zhang Hui , Liang Ruirui , Chen Qin , Niu Bing
Published: August 2021

Background

Foot-and-mouth disease (FMD) is a highly contagious disease of livestock worldwide. Russia is a big agricultural country with a wide geographical area where FMD outbreaks have become an obstacle for the development of the animal and animal products trade. In this study, we aimed to assess the export risk of FMD from Russia.

Results

After simulation by Monte Carlo, the results showed that the probability of cattle infected with FMD in the surveillance zone (Surrounding the areas where no epidemic disease has occurred within the prescribed time limit, the construction of buffer areas is called surveillance zone.) of Russia was 1.29 × 10− 6. The probability that at least one FMD positive case was exported from Russia per year in the surveillance zone was 6 %. The predicted number of positive cattle of the 39,530 - 50,576 exported from Russia per year was 0.06. A key node in the impact model was the probability of occurrence of FMD outbreaks in the Russian surveillance zone. By semi-quantitative model calculation, the risk probability of FMD defense system defects was 1.84 × 10− 5, indicating that there was a potential risk in the prevention and control measures of FMD in Russia. The spatial time scan model found that the most likely FMD cluster (P < 0.01) was in the Eastern and Siberian Central regions.

Conclusions

There was a risk of FMDV among cattle exported from Russia, and the infection rate of cattle in the monitored area was the key factor. Understanding the export risk of FMD in Russia and relevant epidemic prevention measures will help policymakers to develop targeted surveillance plans.