bluuebunny/crossref_metadata_2025 huggingface dataset:
Enhancing sleep quality for nursing home residents with dementia: a pragmatic randomized controlled trial of an evidence-based frontline huddling program
Authors: Snow A. Lynn , Loup Julia , Morgan Robert O. , Richards Kathy , Parmelee Patricia A. , Baier Rosa R. , McCreedy Ellen , Frank Barbara , Brady Cathie , Fry Liam , McCullough Megan , Hartmann Christine W.
Published: April 2021

Background

Disturbed sleep places older adults at higher risk for frailty, morbidity, and even mortality. Yet, nursing home routines frequently disturb residents’ sleep through use of noise, light, or efforts to reduce incontinence. Nursing home residents with Alzheimer’s disease and or related dementias—almost two-thirds of long-stay nursing home residents—are likely to be particularly affected by sleep disturbance. Addressing these issues, this study protocol implements an evidence-based intervention to improve sleep: a nursing home frontline staff huddling program known as LOCK. The LOCK program is derived from evidence supporting strengths-based learning, systematic observation, relationship-based teamwork, and efficiency.

Methods

This study protocol outlines a NIH Stage III, real-world hybrid efficacy-effectiveness pragmatic trial of the LOCK sleep intervention. Over two phases, in a total of 27 non-VA nursing homes from 3 corporations, the study will (1) refine the LOCK program to focus on sleep for residents with dementia, (2) test the impact of the LOCK sleep intervention for nursing home residents with dementia, and (3) evaluate the intervention’s sustainability. Phase 1 (1 year; n = 3 nursing homes; 1 per corporation) will refine the intervention and train-the-trainer protocol and pilot-tests all study methods. Phase 2 (4 years; n = 24 nursing homes; 8 per corporation) will use the refined intervention to conduct a wedge-design randomized, controlled, clinical trial. Phase 2 results will measure the LOCK sleep intervention’s impact on sleep (primary outcome) and on psychotropic medication use, pain and analgesic medication use, and activities of daily living decline (secondary outcomes). Findings will point to inter-facility variation in the program’s implementation and sustainability.

Discussion

This is the first study to our knowledge that applies a dementia sleep intervention to systematically address known barriers to nursing home quality improvement efforts. This innovative study has future potential to address clinical issues beyond sleep (safety, infection control) and expand to other settings (assisted living, inpatient mental health). The study’s strong team, careful consideration of design challenges, and resulting rigorous, pragmatic approach will ensure success of this promising intervention for nursing home residents with dementia.

Trial registration

NCT04533815, ClinicalTrials.gov, August 20, 2020.
Predicting outcomes in older ED patients with influenza in real time using a big data-driven and machine learning approach to the hospital information system
Authors: Tan Tian-Hoe , Hsu Chien-Chin , Chen Chia-Jung , Hsu Shu-Lien , Liu Tzu-Lan , Lin Hung-Jung , Wang Jhi-Joung , Liu Chung-Feng , Huang Chien-Cheng
Published: April 2021

Background

Predicting outcomes in older patients with influenza in the emergency department (ED) by machine learning (ML) has never been implemented. Therefore, we conducted this study to clarify the clinical utility of implementing ML.

Methods

We recruited 5508 older ED patients (≥65 years old) in three hospitals between 2009 and 2018. Patients were randomized into a 70%/30% split for model training and testing. Using 10 clinical variables from their electronic health records, a prediction model using the synthetic minority oversampling technique preprocessing algorithm was constructed to predict five outcomes.

Results

The best areas under the curves of predicting outcomes were: random forest model for hospitalization (0.840), pneumonia (0.765), and sepsis or septic shock (0.857), XGBoost for intensive care unit admission (0.902), and logistic regression for in-hospital mortality (0.889) in the testing data. The predictive model was further applied in the hospital information system to assist physicians’ decisions in real time.

Conclusions

ML is a promising way to assist physicians in predicting outcomes in older ED patients with influenza in real time. Evaluations of the effectiveness and impact are needed in the future.
Successful treatment by on-demand glecaprevir and pibrentasvir for hepatitis C flare during R-CHOP in patients with diffuse large B-cell lymphoma: a case report
Authors: Umemura Machiko , Suda Goki , Tsukamoto Shihori , Ebata Ko , Takahash Shinjiro , Sasaki Takashi , Nakajima Sae , Hirata Koji , Ozasa Mariko , Takano Masatoshi , Katagiri Masaki , Sakamoto Naoya
Published: April 2021

Background

In patients with hepatitis C virus (HCV) and malignant lymphoma, hepatitis C flare during R-CHOP can result in discontinuation of treatment. However, appropriate therapeutic strategies for managing hepatitis C flare during R-CHOP have not been established, and this issue is complicated by conflicting results regarding the use of direct-acting antivirals in patients with uncontrolled malignancies.

Case presentation

We report the first case of effective and safe treatment with on-demand 8-week glecaprevir and pibrentasvir for hepatitis C flare during R-CHOP in a patient with diffuse large B-cell lymphoma (DLBCL). The patient completed five additional courses of R-CHOP without hepatic toxicity. A complete response of DLBCL and a sustained virological response were observed at 24 weeks after glecaprevir and pibrentasvir completion.

Conclusion

On-demand, direct-acting antivirals could be a novel strategy for managing hepatitis C flare during R-CHOP.
Factors associated with birthweight decline in Japan (1980–2004)
Authors: Kato Noriko , Sauvaget Catherine , Yoshida Honami , Yokoyama Tetsuji , Yoshiike Nobuo
Published: April 2021

Background

Birthweight has been declining consistently for more than 30 years in Japan. This rapid rise in low birthweight is one of the worst among the countries of the Organization for Economic Co-operation and Development. We examined potential determinants of birthweight decline in Japan.

Methods

We used population-based birth certificate data from vital statistics records and retrieved 40,968,266 birth certificates of neonates born between 1980 and 2004. We analyzed time trends using linear regression analysis in examining whether the decline in birthweight could be explained by obstetrical variables such as gestational age and multiple gestations.

Results

From 1980 to 2004, we observed a decline in mean birthweight with a yearly effect of − 8.07 g, which became steeper after 1985, persisted until 1999, and plateaued thereafter. After adjusting for gestational age, gender, birth order, multiple gestations, and fathers’ age, the yearly effect between 1980 and 2004 persisted at − 5.13 g.

Conclusion

Recent decreases in birthweight among Japanese neonates were not fully explained by trends in gestational age, gender, birth order, multiple gestations, and fathers’ age. Thus, additional factors such as pre-pregnancy maternal body mass index (BMI) and maternal diet should be considered. Reducing the rate of induced deliveries and improving the BMI or diet of young women should be a public health priority.
Isolated pulmonary mucormycosis in an immunocompetent patient: a case report and systematic review of the literature
Authors: He Jianhan , Sheng Gaohong , Yue Huihui , Zhang Fengqin , Zhang Hui-Lan
Published: April 2021

Background

Pulmonary mucormycosis caused by Mucorales is a highly lethal invasive fungal infection usually found in immunocompromised patients. Isolated pulmonary mucormycosis in immunocompetent patients is very rare. Here, we present a case of a 32-year-old male who developed pulmonary mucormycosis without any known immunodeficiency.

Case presentation

The patient presented to our hospital because of cough and chest pain along with blood in the sputum. He was first treated for community-acquired pneumonia until bronchoalveolar lavage fluid culture confirmed the growth of Absidia. His symptoms were relieved with the use of amphotericin B, and he eventually recovered. We also provide a systematic review of relevant literature to summarize the characteristics of pulmonary mucormycosis in immunocompetent patients.

Conclusions

Pulmonary mucormycosis has variable clinical presentations and is difficult to identify. Due to its high fatality rate, clinicians should make judgements regarding suspected cases correctly and in a timely manner to avoid misdiagnosis and delayed treatment.
Proctotomy leak following laparoscopic total gastrectomy with transrectal specimen extraction for gastric cancer: a case report
Authors: Meng Haipeng , Liu Jinchao , Xu Hui , Wang Song , Rong Yu , Xu Yanling , Yu Gang
Published: April 2021

Background

Despite increasing acceptance in colorectal surgery, natural orifice specimen extraction (NOSE) surgery for the treatment of gastric cancer is still in its infancy, especially via the transrectal approach, which was barely reported. So little is known about its complications. Here we report the first case of proctotomy leak after transrectal NOSE gastrectomy, and our experience in preventive interventions.

Case presentation

A 62-year-old male patient complaining of upper abdominal pain who underwent open distal gastrectomy for gastric cancer one year ago was diagnosed with recurrent gastric cancer by gastroscopic biopsy. We performed laparoscopic total gastrectomy with transrectal specimen extraction on the patient. The operation was completed in a total laparoscopic approach and the specimen was extracted through a 3 cm longitudinal incision in the anterior wall of the upper rectum, then interrupted sutures were used for full-thickness closure of the rectal incision. The operative time was 470 min and intra-operative blood loss was 100 mL. The postoperative pathological examination showed pT1bN0M0 gastric adenocarcinoma. The patient developed proctotomy leak on the 10th postoperative day. We analyzed the causes of this rare complication and put forward a series of technical improvements. After failure of conservative treatment, a diverting ileostomy was created and the patient eventually recovered. We successfully prevented proctotomy leak in the subsequent 20 transrectal NOSE gastrectomies using improved techniques.

Conclusions

Proctotomy leak after transrectal specimen extraction should be considered among the complications of NOSE surgery and can be prevented by technical precautions.
Construction of a demand and capacity model for intensive care and hospital ward beds, and mortality from COVID-19
Authors: Martin Christopher , McDonald Stuart , Bale Steve , Luteijn Michiel , Sarkar Rahul
Published: April 2021

Background

This paper describes a model for estimating COVID-19 related excess deaths that are a direct consequence of insufficient hospital ward bed and intensive care unit (ICU) capacity.

Methods

Compartmental models were used to estimate deaths under different combinations of ICU and ward care required and received in England up to late April 2021. Model parameters were sourced from publicly available government information and organisations collating COVID-19 data. A sub-model was used to estimate the mortality scalars that represent increased mortality due to insufficient ICU or general ward bed capacity. Three illustrative scenarios for admissions numbers, ‘Optimistic’, ‘Middling’ and ‘Pessimistic’, were modelled and compared with the subsequent observations to the 3rd February.

Results

The key output was the demand and capacity model described. There were no excess deaths from a lack of capacity in the ‘Optimistic’ scenario. Several of the ‘Middling’ scenario applications resulted in excess deaths—up to 597 deaths (0.6% increase) with a 20% reduction compared to best estimate ICU capacity. All the ‘Pessimistic’ scenario applications resulted in excess deaths, ranging from 49,178 (17.0% increase) for a 20% increase in ward bed availability, to 103,735 (35.8% increase) for a 20% shortfall in ward bed availability. These scenarios took no account of the emergence of the new, more transmissible, variant of concern (b.1.1.7).

Conclusions

Mortality is increased when hospital demand exceeds available capacity. No excess deaths from breaching capacity would be expected under the ‘Optimistic’ scenario. The ‘Middling’ scenario could result in some excess deaths—up to a 0.7% increase relative to the total number of deaths. The ‘Pessimistic’ scenario would have resulted in significant excess deaths. Our sensitivity analysis indicated a range between 49,178 (17% increase) and 103,735 (35.8% increase). Given the new variant, the pessimistic scenario appeared increasingly likely and could have resulted in a substantial increase in the number of COVID-19 deaths. In the event, it would appear that capacity was not breached at any stage at a national level with no excess deaths. it will remain unclear if minor local capacity breaches resulted in any small number of excess deaths.
Effectiveness of a group intervention to reduce the psychological distress of healthcare staff: a pre-post quasi-experimental evaluation
Authors: Dawson Jeremy , McCarthy Imelda , Taylor Cath , Hildenbrand Kristin , Leamy Mary , Reynolds Ellie , Maben Jill
Published: April 2021

Background

Work stress and compassion fatigue are prevalent among healthcare staff and their negative effects on staff well-being and patient care are well-known. This paper reports on the implementation and evaluation of Schwartz Rounds® (Rounds) in UK healthcare organizations, predominantly part of the National Health Service (NHS). Rounds are one-hour, typically monthly, multidisciplinary forums during which clinical and nonclinical healthcare staff discuss the emotional and social demands of delivering patient care. The purpose of this research was to evaluate the effectiveness of Rounds attendance on the psychological distress, work engagement, compassion and self-reflection of healthcare staff.

Methods

We used a pre-post control design to assess the effect of Rounds attendance across 10 UK healthcare organizations. This design was most appropriate given the voluntary nature of Rounds and ensured the study had ecological validity. Self-reported data were collected from attenders and non-attenders at baseline and at eight-months follow-up. The outcomes were psychological distress, work engagement, compassion and self-reflection.

Results

During the 8 months’ study duration, regular attenders (N = 51) attended Rounds on average 4 times (2–8). Attenders showed a significantly greater decrease in psychological distress (as measured with the General Health Questionnaire (GHQ)) than non-attenders (N = 233; odds ratio of 0.197; 95% confidence interval (0.047–0.823)). However, Rounds attendance had no significant effect on work engagement, compassion and self-reflection.

Conclusions

Rounds attendance was linked to a 19% reduction in psychological distress adjusting for covariates. As an organization-wide intervention, Rounds thus constitute an effective, relatively low-cost intervention to assist staff in dealing with the demands of their work and to improve their well-being.
NKX6-1 mediates cancer stem-like properties and regulates sonic hedgehog signaling in leiomyosarcoma
Authors: Su Po-Hsuan , Huang Rui-Lan , Lai Hung-Cheng , Chen Lin-Yu , Weng Yu-Chun , Wang Chih-Chien , Wu Chia-Chun
Published: April 2021

Background

Leiomyosarcoma (LMS), the most common soft tissue sarcoma, exhibits heterogeneous and complex genetic karyotypes with severe chromosomal instability and rearrangement and poor prognosis.

Methods

Clinical variables associated with NKX6-1 were obtained from The Cancer Genome Atlas (TCGA). NKX6-1 mRNA expression was examined in 49 human uterine tissues. The in vitro effects of NXK6-1 in LMS cells were determined by reverse transcriptase PCR, western blotting, colony formation, spheroid formation, and cell viability assays. In vivo tumor growth was evaluated in nude mice.

Results

Using The Cancer Genome Atlas (TCGA) and human uterine tissue datasets, we observed that NKX6-1 expression was associated with poor prognosis and malignant potential in LMS. NKX6-1 enhanced in vitro tumor cell aggressiveness via upregulation of cell proliferation and anchorage-independent growth and promoted in vivo tumor growth. Moreover, overexpression and knockdown of NKX6-1 were associated with upregulation and downregulation, respectively, of stem cell transcription factors, including KLF8, MYC, and CD49F, and affected sphere formation, chemoresistance, NOTCH signaling and Sonic hedgehog (SHH) pathways in human sarcoma cells. Importantly, treatment with an SHH inhibitor (RU-SKI 43) but not a NOTCH inhibitor (DAPT) reduced cell survival in NKX6-1-expressing cancer cells, indicating that an SHH inhibitor could be useful in treating LMS. Finally, using the TCGA dataset, we demonstrated that LMS patients with high expression of NKX6-1 and HHAT, an SHH pathway acyltransferase, had poorer survival outcomes compared to those without.

Conclusions

Our findings indicate that NKX6-1 and HHAT play critical roles in the pathogenesis of LMS and could be promising diagnostic and therapeutic targets for LMS patients.
Small molecule inhibitors against PD-1/PD-L1 immune checkpoints and current methodologies for their development: a review
Authors: Liu Chang , Seeram Navindra P. , Ma Hang
Published: April 2021

Programmed death-1/programmed death ligand-1 (PD-1/PD-L1) based immunotherapy is a revolutionary cancer therapy with great clinical success. The majority of clinically used PD-1/PD-L1 inhibitors are monoclonal antibodies but their applications are limited due to their poor oral bioavailability and immune-related adverse effects (irAEs). In contrast, several small molecule inhibitors against PD-1/PD-L1 immune checkpoints show promising blockage effects on PD-1/PD-L1 interactions without irAEs. However, proper analytical methods and bioassays are required to effectively screen small molecule derived PD-1/PD-L1 inhibitors. Herein, we summarize the biophysical and biochemical assays currently employed for the measurements of binding capacities, molecular interactions, and blocking effects of small molecule inhibitors on PD-1/PD-L1. In addition, the discovery of natural products based PD-1/PD-L1 antagonists utilizing these screening assays are reviewed. Potential pitfalls for obtaining false leading compounds as PD-1/PD-L1 inhibitors by using certain binding bioassays are also discussed in this review.
Event-related EEG oscillatory responses elicited by dynamic facial expression
Authors: Aktürk Tuba , de Graaf Tom A. , Abra Yasemin , Şahoğlu-Göktaş Sevilay , Özkan Dilek , Kula Aysun , Güntekin Bahar
Published: April 2021

Background

Recognition of facial expressions (FEs) plays a crucial role in social interactions. Most studies on FE recognition use static (image) stimuli, even though real-life FEs are dynamic. FE processing is complex and multifaceted, and its neural correlates remain unclear. Transitioning from static to dynamic FE stimuli might help disentangle the neural oscillatory mechanisms underlying face processing and recognition of emotion expression. To our knowledge, we here present the first time–frequency exploration of oscillatory brain mechanisms underlying the processing of dynamic FEs.

Results

Videos of joyful, fearful, and neutral dynamic facial expressions were presented to 18 included healthy young adults. We analyzed event-related activity in electroencephalography (EEG) data, focusing on the delta, theta, and alpha-band oscillations. Since the videos involved a transition from neutral to emotional expressions (onset around 500 ms), we identified time windows that might correspond to face perception initially (time window 1; first TW), and emotion expression recognition subsequently (around 1000 ms; second TW). First TW showed increased power and phase-locking values for all frequency bands. In the first TW, power and phase-locking values were higher in the delta and theta bands for emotional FEs as compared to neutral FEs, thus potentially serving as a marker for emotion recognition in dynamic face processing.

Conclusions

Our time–frequency exploration revealed consistent oscillatory responses to complex, dynamic, ecologically meaningful FE stimuli. We conclude that while dynamic FE processing involves complex network dynamics, dynamic FEs were successfully used to reveal temporally separate oscillation responses related to face processing and subsequently emotion expression recognition.
Novel coronavirus seropositivity and related factors among healthcare workers at a university hospital during the prevaccination period: a cross-sectional study
Authors: Ogutlu Aziz , Karabay Oguz , Erkorkmaz Unal , Guclu Ertugrul , Sen Seher , Aydin Abdulkadir , Koroglu Mehmet
Published: April 2021

Background

This study aimed to investigate the specific risk factors for the transmission of novel coronavirus (SARS-CoV-2) among healthcare workers in different campuses of a university hospital and to reveal the risk factors for antibody positivity.

Methods

In this retrospective cross-sectional study, 2988 (82%) of 3620 healthcare workers in a university hospital participated. The coronavirus disease 2019 (COVID-19) antibody was investigated using serum from healthcare workers who underwent COVID-19 antibody testing. The antibody test results of the participants were evaluated based on their work campus, their profession and their workplace. The statistical significance level was p < 0.05 in all analyses.

Results

Of the participants in this study, 108 (3.6%) were antibody positive, and 2880 (96.4%) were negative. Antibody positivity rates were greater in nurses compared with other healthcare workers (p < 0.001). Regarding workplace, antibody positivity was greater in those working in intensive care compared to those working in other locations (p < 0.001).

Conclusions

Healthcare workers are at the highest risk of being infected with COVID-19. Those who have a higher risk of infection among healthcare workers and those working in high-risk areas should be vaccinated early and use personal protective equipment during the pandemic.

Trial Registration: Retrospective permission was obtained from both the local ethics committee and the Turkish Ministry of Health for this study (IRB No:71522473/050.01.04/370, Date: 05.20.2020).
Molecular characteristics of antibiotic-resistant Escherichia coli and Klebsiella pneumoniae strains isolated from hospitalized patients in Tehran, Iran
Authors: Sharahi Javad Yasbolaghi , Hashemi Ali , Ardebili Abdollah , Davoudabadi Sara
Published: April 2021

Background

We evaluated the distribution of carbapenem and colistin resistance mechanisms of clinical E. coli and K. pneumoniae isolates from Iran.

Methods

165 non-duplicate non-consecutive isolates of K. pneumoniae and E. coli were collected from hospitalized patients admitted to Iran's tertiary care hospitals from September 2016 to August 2018. The isolates were cultured from different clinical specimens, including wound, urine, blood, and tracheal aspirates. Antibiotic susceptibility testing was performed by disc diffusion and microdilution method according to the Clinical and Laboratory Standards Institute (CLSI) guideline. The presence of extended spectrum β-lactamases (ESBLs) genes, carbapenemase genes, as well as fosfomycin resistance genes, and colistin resistance genes was also examined by PCR-sequencing. The ability of biofilm formation was assessed with crystal violet staining method. The expression of colistin resistance genes were measured by quantitative reverse transcription-PCR (RT-qPCR) analysis to evaluate the association between gene upregulation and colistin resistance. Genotyping was performed using the multi-locus sequencing typing (MLST).

Results

Colistin and tigecycline were the most effective antimicrobial agents with 90.3% and 82.4% susceptibility. Notably, 16 (9.7%) isolates showed resistance to colistin. Overall, 33 (20%), 31 (18.8%), and 95 (57.6%) isolates were categorized as strong, moderate, and weak biofilm-producer, respectively. Additionally, blaTEM, blaSHV, blaCTX-M, blaNDM-1, blaOXA-48-like and blaNDM-6 resistance genes were detected in 98 (59.4%), 54 (32.7%), 77 (46.7%), 3 (1.8%), 17 (10.30%) and 3 (1.8%) isolates, respectively. Inactivation of mgrB gene due to nonsense mutations and insertion of IS elements was observed in 6 colistin resistant isolates. Colistin resistance was found to be linked to upregulation of pmrA-C, pmrK, phoP, and phoQ genes. Three of blaNDM-1 and 3 of blaNDM-6 variants were found to be carried by IncL/M and IncF plasmid, respectively. MLST revealed that blaNDM positive isolates were clonally related and belonged to three distinct clonal complexes, including ST147, ST15 and ST3299.

Conclusions

The large-scale surveillance and effective infection control measures are also urgently needed to prevent the outbreak of diverse carbapenem- and colistin-resistant isolates in the future.
Correction to: A DM1-doped porous gold nanoshell system for NIR accelerated redox-responsive release and triple modal imaging guided photothermal synergistic chemotherapy
Authors: Xu Pengcheng , Wang Ru , Yang Wenqian , Liu Yanyan , He Dongsheng , Ye Zixuan , Chen Daquan , Ding Yuan , Tu Jiasheng , Shen Yan
Published: April 2021

An amendment to this paper has been published and can be accessed via the original article.
Bacterial extracellular electron transfer: a powerful route to the green biosynthesis of inorganic nanomaterials for multifunctional applications
Authors: Zou Long , Zhu Fei , Long Zhong-er , Huang Yunhong
Published: April 2021

Synthesis of inorganic nanomaterials such as metal nanoparticles (MNPs) using various biological entities as smart nanofactories has emerged as one of the foremost scientific endeavors in recent years. The biosynthesis process is environmentally friendly, cost-effective and easy to be scaled up, and can also bring neat features to products such as high dispersity and biocompatibility. However, the biomanufacturing of inorganic nanomaterials is still at the trial-and-error stage due to the lack of understanding for underlying mechanism. Dissimilatory metal reduction bacteria, especially Shewanella and Geobacter species, possess peculiar extracellular electron transfer (EET) features, through which the bacteria can pump electrons out of their cells to drive extracellular reduction reactions, and have thus exhibited distinct advantages in controllable and tailorable fabrication of inorganic nanomaterials including MNPs and graphene. Our aim is to present a critical review of recent state-of-the-art advances in inorganic biosynthesis methodologies based on bacterial EET using Shewanella and Geobacter species as typical strains. We begin with a brief introduction about bacterial EET mechanism, followed by reviewing key examples from literatures that exemplify the powerful activities of EET-enabled biosynthesis routes towards the production of a series of inorganic nanomaterials and place a special emphasis on rationally tailoring the structures and properties of products through the fine control of EET pathways. The application prospects of biogenic nanomaterials are then highlighted in multiple fields of (bio-) energy conversion, remediation of organic pollutants and toxic metals, and biomedicine. A summary and outlook are given with discussion on challenges of bio-manufacturing with well-defined controllability.
The client satisfaction with device: a Rasch validation of the Arabic version in patients with upper and lower limb amputation
Authors: Bakhsh Hadeel R. , Kablan Nilüfer , Alammar Walaa , Tatar Yaşar , Ferriero Giorgio
Published: April 2021

Background

The Client Satisfaction with Devices (CSD) module of the Orthotics and Prosthetics Users’ Survey is an extensively used questionnaire that measures patients’ satisfaction with orthosis and prosthesis. However, the validated version for Arabic speakers (CSD-Ar) is only applicable for orthosis users.

Objectives

The aim of this study was to evaluate the psychometric proprieties of the CSD-Ar for prosthetics users.

Methods

The study used a convenience sample of prosthesis users from Saudi Arabia and Turkey (N = 183), who completed the CSD-Ar. The collected data were analysed using Rasch analysis to evaluate item fit, reliability indices, item difficulty, local item dependency, and differential item functioning (DIF) using WINSTEPS version 4.6.1.

Results

Based on the analysis, the four-response Likert-scale was acceptable, as shown by the category functioning test, All eight items did achieve a fit to the Rasch Model [(infit) and (outfit) mean-square 0.75 to 1.3]. Person separation reliability was 0.76, and item separation reliability was 0.94. A principal component analysis (PCA) showed satisfactory unidimensionality and no local item dependency. The DIF analysis showed no notable dependency among items on participant characteristics in terms of age, gender, duration of use, country, and level of amputation.

Conclusion

This study contributes to the confidence of using CSD-Ar to evaluate users’ satisfaction with different prostheses, affirming the need for further refinement of the quality of the outcome measure.
Job satisfaction of general practitioners: a cross-sectional survey in 34 countries
Authors: Stobbe Emiel J. , Groenewegen Peter P. , Schäfer Willemijn
Published: April 2021

Background

Job satisfaction of general practitioners (GPs) is important because of the consequences of low satisfaction for GPs, their patients and the health system, such as higher turnover, health problems for the physicians themselves, less satisfied patients, poor clinical outcomes and suboptimal health care delivery. In this study, we aim to explain differences in the job satisfaction of GPs within and between countries.

Methods

We performed a secondary analysis of cross-sectional survey data, collected between 2010 and 2012 on 7379 GPs in 34 (mostly European) countries, as well as data on country and health system characteristics from public databases. Job satisfaction is measured through a composite score of six items about self-reported job experience. Operationalisation of the theoretical constructs includes variables, such as the range of services GPs provide, working hours, employment status, and feedback from colleagues. Data were analysed using linear multilevel regression analysis, with countries and GPs as levels. We developed hypotheses on the basis of the Social Production Function Theory, assuming that GPs ‘produce’ job satisfaction through stimulating work that provides a certain level of comfort, adds to their social status and provides behavioural confirmation.

Results

Job satisfaction varies between GPs and countries, with high satisfaction in Denmark and Canada (on average 2.97 and 2.77 on a scale from 1–4, respectively) and low job satisfaction in Spain (mean 2.15) and Hungary (mean 2.17). One-third of the total variance is situated on the country level, indicating large differences between countries, and countries with a higher GDP per capita have more satisfied GPs. Health system characteristics are not related to GP job satisfaction. At the GP and practice level, performing technical procedures and providing preventive care, feedback from colleagues, and patient satisfaction are positively related to GP job satisfaction and working more hours is negatively related GP job satisfaction.

Conclusion

Overall and in terms of our theoretical approach, we found that GPs are able to ‘produce’ work-related well-being through activities and resources related to stimulation, comfort and behavioural confirmation, but not to status.
Astrocyte-specific expression of interleukin 23 leads to an aggravated phenotype and enhanced inflammatory response with B cell accumulation in the EAE model
Authors: Nitsch Louisa , Petzinna Simon , Zimmermann Julian , Schneider Linda , Krauthausen Marius , Heneka Michael T. , Getts Daniel R. , Becker Albert , Müller Marcus
Published: April 2021

Background

Interleukin 23 is a critical cytokine in the pathogenesis of multiple sclerosis. But the local impact of interleukin 23 on the course of neuroinflammation is still not well defined. To further characterize the effect of interleukin 23 on CNS inflammation, we recently described a transgenic mouse model with astrocyte-specific expression of interleukin 23 (GF-IL23 mice). The GF-IL23 mice spontaneously develop a progressive ataxic phenotype with cerebellar tissue destruction and inflammatory infiltrates with high amounts of B cells most prominent in the subarachnoid and perivascular space.

Methods

To further elucidate the local impact of the CNS-specific interleukin 23 synthesis in autoimmune neuroinflammation, we induced a MOG35-55 experimental autoimmune encephalomyelitis (EAE) in GF-IL23 mice and WT mice and analyzed the mice by histology, flow cytometry, and transcriptome analysis.

Results

We were able to demonstrate that local interleukin 23 production in the CNS leads to aggravation and chronification of the EAE course with a severe paraparesis and an ataxic phenotype. Moreover, enhanced multilocular neuroinflammation was present not only in the spinal cord, but also in the forebrain, brainstem, and predominantly in the cerebellum accompanied by persisting demyelination. Thereby, interleukin 23 creates a pronounced proinflammatory response with accumulation of leukocytes, in particular B cells, CD4+ cells, but also γδ T cells and activated microglia/macrophages. Furthermore, transcriptome analysis revealed an enhanced proinflammatory cytokine milieu with upregulation of lymphocyte activation markers, co-stimulatory markers, chemokines, and components of the complement system.

Conclusion

Taken together, the GF-IL23 model allowed a further breakdown of the different mechanisms how IL-23 drives neuroinflammation in the EAE model and proved to be a useful tool to further dissect the impact of interleukin 23 on neuroinflammatory models.
Auto-classification of biomass through characterization of their pyrolysis behaviors using thermogravimetric analysis with support vector machine algorithm: case study for tobacco
Authors: Yin Chao , Deng Xiaohua , Yu Zhiqiang , Liu Zechun , Zhong Hongxiang , Chen Ruting , Cai Guohua , Zheng Quanxing , Liu Xiucai , Zhong Jiawei , Ma Pengfei , He Wei , Lin Kai , Li Qiaoling , Wu Anan
Published: April 2021

Background

During the biomass-to-bio-oil conversion process, many studies focus on studying the association between biomass and bio-products using near-infrared spectra (NIR) and chemical analysis methods. However, the characterization of biomass pyrolysis behaviors using thermogravimetric analysis (TGA) with support vector machine (SVM) algorithm has not been reported. In this study, tobacco was chosen as the object for biomass, because the cigarette smoke (including water, tar, and gases) released by tobacco pyrolysis reactions decides the sensory quality, which is similar to biomass as a renewable resource through the pyrolysis process.

Results

SVM algorithm has been employed to automatically classify the planting area and growing position of tobacco leaves using thermogravimetric analysis data as the information source for the first time. Eighty-eight single-grade tobacco samples belonging to four grades and eight categories were split into the training, validation, and blind testing sets. Our model showed excellent performances in both the training and validation set as well as in the blind test, with accuracy over 91.67%. Throughout the whole dataset of 88 samples, our model not only provides precise results on the planting area of tobacco leave, but also accurately distinguishes the major grades among the upper, lower, and middle positions. The error only occurs in the classification of subgrades of the middle position.

Conclusions

From the case study of tobacco, our results validated the feasibility of using TGA with SVM algorithm as an objective and fast method for auto-classification of tobacco planting area and growing position. In view of the high similarity between tobacco and other biomasses in the compositions and pyrolysis behaviors, this new protocol, which couples the TGA data with SVM algorithm, can potentially be extrapolated to the auto-classification of other biomass types.
Ameliorative role of SIRT1 in peritoneal fibrosis: an in vivo and in vitro study
Authors: Guo Yanhong , Wang Liuwei , Gou Rong , Wang Yulin , Shi Xiujie , Zhang Yage , Pang Xinxin , Tang Lin
Published: April 2021

Background

Peritoneal fibrosis is one of the major complications induced by peritoneal dialysis (PD). Damaged integrity and function of peritoneum caused by peritoneal fibrosis not only limits the curative efficacy of PD and but affects the prognosis of patients. However, the detailed mechanisms underlying the process remain unclear and therapeutic strategy targeting TGF‐β is deficient. Transforming growth factor‐β (TGF‐β) signaling participates in the progression of peritoneal fibrosis through enhancing mesothelial-mesenchymal transition of mesothelial cells.

Methods

The study aims to demonstrate the regulatory role of Sirtuin1 (SIRT1) to the TGF‐β signaling mediated peritoneal fibrosis. SIRT1−/− mice were used to establish animal model. Masson’s staining and peritoneal equilibration assay were performed to evaluate the degree of peritoneal fibrosis. QRT-PCR assays were used to estimate the RNA levels of Sirt1 and matrix genes related to peritoneal fibrosis, and their protein levels were examined by Western blot assays.

Results

SIRT1 significantly decreased in vivo post PD treatment. SIRT1 knockout exacerbated peritoneal fibrosis both in vivo and vitro. Overexpression of SIRT1 efficiently inhibited peritoneal fibrosis by inhibiting the peritoneal inflammation and the activation of TGF‐β signaling.

Conclusion

SIRT1 ameliorated peritoneal fibrosis both in vivo and in vitro through inhibiting the expression of protein matrix induced by TGF‐β signaling.
Determinants of adolescent substance use in Africa: a systematic review and meta-analysis protocol
Authors: Jumbe Sandra , Kamninga Tony Mwenda , Mwalwimba Isaac , Kalu Ukwuori-Gisela
Published: April 2021

Background

Adolescent substance use continues to be a growing major public health concern in Africa. Recent studies infer an overall estimated prevalence of 42% among adolescents in sub-Saharan Africa. Unfortunately, this phenomenon is not adequately documented across many settings in the continent despite known negative health and social consequences on affected individuals and their communities. Little is known about the social context of substance use in Africa among this population. Our aim is to conduct a systematic review, exploring the determinants and associated factors that influence adolescent substance use in Africa.

Methods

We will search the following databases (from January 2000 onwards): PubMed, the Cochrane Library, African Journals Online (AJOL), Google Scholar, ScienceDirect and the World Health Organization (WHO) African Index Medicus. We will include population-based observational studies reporting on determinants and/or risk factors of substance use among adolescents (age 10–19 years) across Africa. Two reviewers will independently screen all citations, full-text articles and abstract data. Potential conflicts will be resolved through discussion. Study methodological quality (or bias) will be appraised using appropriate tools. If feasible, we will conduct a random-effects meta-analysis of data. We plan to conduct a meta-synthesis of qualitative studies where appropriate

Discussion

This review will describe the range of determinants and associated factors found to significantly influence adolescent substance use in Africa over the last two decades. Documenting this evidence is important as it can potentially inform comprehensive interventions and treatment programmes that are targeted at adolescents and their parents in these settings.

Systematic review registration

PROSPERO CRD42020190158
Compressible flow simulation with moving
geometries using the Brinkman penalization in high-order Discontinuous
Galerkin
Authors: Ebrahimi Pour Neda , Anand Nikhil , Klimach Harald , Roller Sabine
Published: April 2021

In this work we investigate the Brinkman volume penalization technique in
the context of a high-order Discontinous Galerkin method to model moving wall boundaries
for compressible fluid flow simulations. High-order approximations are especially of
interest as they require few degrees of freedom to represent smooth solutions
accurately. This reduced memory consumption is attractive on modern computing systems
where the memory bandwidth is a limiting factor. Due to their low dissipation and
dispersion they are also of particular interest for aeroacoustic problems. However, a
major problem for the high-order discretization is the appropriate representation of
wall geometries. In this work we look at the Brinkman penalization technique, which
addresses this problem and allows the representation of geometries without modifying the
computational mesh. The geometry is modelled as an artificial porous medium and embedded
in the equations. As the mesh is independent of the geometry with this method, it is not
only well suited for high-order discretizations but also for problems where the
obstacles are moving. We look into the deployment of this strategy by briefly discussing
the Brinkman penalization technique and its application in our solver and investigate
its behavior in fundamental one-dimensional setups, such as shock reflection at a moving
wall and the formation of a shock in front of a piston. This is followed by the
application to setups with two and three dimensions, illustrating the method in the
presence of curved surfaces.
Comparing different response time threshold setting methods to detect low effort on a large-scale assessment
Authors: Soland James , Kuhfeld Megan , Rios Joseph
Published: April 2021

Low examinee effort is a major threat to valid uses of many test scores. Fortunately, several methods have been developed to detect noneffortful item responses, most of which use response times. To accurately identify noneffortful responses, one must set response time thresholds separating those responses from effortful ones. While other studies have compared the efficacy of different threshold-setting methods, they typically do so using simulated or small-scale data. When large-scale data are used in such studies, they often are not from a computer-adaptive test (CAT), use only a handful of items, or do not comprehensively examine different threshold-setting methods. In this study, we use reading test scores from over 728,923 3rd–8th-grade students in 2056 schools across the United States taking a CAT consisting of nearly 12,000 items to compare threshold-setting methods. In so doing, we help provide guidance to developers and administrators of large-scale assessments on the tradeoffs involved in using a given method to identify noneffortful responses.
Immigrant optimism or immigrant pragmatism? Linguistic capital, orientation towards science and occupational expectations of adolescent immigrants
Authors: Sikora Joanna , Pokropek Artur
Published: April 2021

Background

Studies demonstrate that occupational optimism can boost adolescents’ academic attainment and perseverance in education. To contribute to this literature, we consider two hypotheses. The first posits that bilingual immigrants are remarkably resourceful and determined. Thus, they are more occupationally ambitious than their peers. The second proposes that immigrant students engage in “strategic adaptation” by specializing in science, viewed as a level playing field.

Methods

To assess these hypotheses at two points of time, we analyze data from 19 societies that participated in the Programme for International Student Assessment (PISA) in 2006 and 2015. Our primary method is path analysis with balanced replicate weights (BRR) undertaken separately for each country’s data.

Results

We find that, in many countries, bilingual immigrants expect to enter higher status occupations than non-immigrants. However, immigrants who do not speak another language are also optimistic, so linguistic resources cannot explain occupational ambition. Furthermore, immigrants accord science more instrumental value and enjoy it more at school, which accounts, across societies, for up to 12% of the variation in vocational optimism indicated by the expected occupational status, and up to 41% in plans to pursue a career in science professions.

Conclusion

Our results align with the “strategic adaptation” argument that many young immigrants might seek to specialize in science as a pragmatic tactic to ensure high occupational attainment.
Postsurgical oral symptoms after insertion of one or two implants for mandibular overdentures: short-term results of a randomized clinical trial
Authors: de Resende Gabriela Pereira , Dias Ana Paula , Leles José Luiz Rodrigues , de Souza João Antônio Chaves , Leles Cláudio Rodrigues
Published: April 2021

Objective

This randomized clinical trial aimed to compare the short-term postsurgical symptoms after insertion of one or two implants for retention of a mandibular overdenture. This study investigated whether the less invasive single-implant approach results in lower postoperative symptoms compared to the conventional two-implant overdenture.

Materials and methods

Patients received new complete dentures and were randomly assigned to groups receiving one or two single-stage, early-loaded hydrophilic implants, inserted in the midline (n = 23), or the lateral incisor-canine area bilaterally (n = 24). Patient-reported postoperative symptoms were measured in a 0–100 visual analogue scale concerning pain in the surgical area, pain when chewing, bleeding, swelling, and unpleasantness. Data collection occurred 24 h and 7 and 21 days after surgery. Demographic and clinical features (smoking habit, classification of the residual ridges, and mucosal width and thickness at the implant sites), osteotomy for alveolar bone reduction, and surgery time were tested as predictors of symptom levels.

Results

Overall reported symptoms were mild and self-limited, with high rates of complete remission after the early loading period of 3 weeks. Progressive improvement of symptoms occurred from the 24-h to the 7-day and 21-day follow-ups (p < 0.001), similarly in both groups. None of the clinical predictors was significantly associated with the changes in symptoms.

Conclusions

Findings suggest that the insertion of one or two implants may result in similar postoperative outcomes.

Clinical relevance

The severity of short-term postoperative symptoms may not be a critical factor for the decision between overdenture treatment with one or two implants.