bluuebunny/crossref_metadata_2025 huggingface dataset:
Diabetic foot ulcer, the effect of resource‐poor environments on healing time and direct cost: A cohort study during Syrian crisis
Authors: Alsabek Mhd Belal , Abdul Aziz Abdul Razzak
Published: July 2021

Diabetic foot ulcer (DFU) is one of the slowest healing wounds that hurt the human body. Many studies from developed countries are concerned about materials, procedures, and equipment that accelerate the healing time. In Sweden, the diabetic foot management costs around 24965$/patient. In this review, we would evaluate the healing time of DFUs during what is considered one of the worst humanitarian crisis of the 21st century. 1747 DFUs were studied from the main diabetic foot clinic in Damascus (2014‐2019). We predicted many variables that could prolong the healing time. The cost according to these variables was also reported. The SINBAD Classification was performed to grade the severity of ulcers. We noticed that the median healing time for DFUs was 8 weeks. Almost half of these ulcers healed between 3 and 12 weeks. The time of healing for men was significantly longer than that for women. While the presence of infection doubled the median time of healing, the presence of peripheral artery disease doubled the mean of the direct health care cost. The location of the ulcer acted as another independent risk factor. In conclusion, DFUs face many barriers to heal during a crisis.The environment with resource‐poor settings should be added to the traditional risk factors that delay the healing of DFUs for months or even years. More studies from disaster are as are needed to evaluate low‐cost materials that could be cost effective in applying standard care of the diabetic foot.
Effect of ultrasound intensity on the functional characteristics of rennet‐coagulated skim milk
Authors: Hammam Ahmed R. A. , Martinez‐Monteagudo Sergio I. , Metzger Lloyd E. , Alsaleem Khalid A.
Published: July 2021

The objective of this study was to examine the impact of ultrasound energy density (USED) on the functional properties of rennet‐coagulated skim milk. Skim pasteurized milk was ultrasonicated at 106 W and 375 W at two different times (3 and 9 min) to produce different USED levels (190.4, 570.7, 674.3, and 2016.9 J g−1). The rheological and textural properties of ultrasonicated milk samples were determined during the rennet coagulation as compared to nonsonicated skim milk. The rennet coagulation time was doubled when 674.3 J g−1 was applied to skim milk; however, applying 2016.9 J g−1 did not lead to milk coagulation. Additionally, gel firmness of rennet‐coagulated milk increased significantly from 80 g to 130 g when USED boosted from 190.4 to 674.3 J g−1. The coagulum strength and curd‐firming rate decreased significantly when USED elevated to 2016.9 J g−1. The outcome provides that using suitable USED could be utilized efficiently in the cheese industry to prolong the renneting time of milk.

Practical Applications

The ultrasound process can be applied to milk before making different dairy products, such as cheese or other dairy products that need rennet for coagulation to improve the characteristics of those products. Also, ultrasound can be utilized to fractionate dairy components to improve the functionality or yield of products.
CDE4 encodes a pentatricopeptide repeat protein involved in chloroplast RNA splicing and affects chloroplast development under low‐temperature conditions in rice
Authors: Liu Xinyong , Zhang Xichun , Cao Ruijie , Jiao Guiai , Hu Shikai , Shao Gaoneng , Sheng Zhonghua , Xie Lihong , Tang Shaoqing , Wei Xiangjin , Hu Peisong
Published: July 2021

Pentatricopeptide repeat (PPR) proteins play important roles in the post‐transcriptional modification of organellar RNAs in plants. However, the function of most PPR proteins remains unknown. Here, we characterized the rice (Oryza sativa L.) chlorophyll deficient 4 (cde4) mutant which exhibits an albino phenotype during early leaf development, with decreased chlorophyll contents and abnormal chloroplasts at low‐temperature (20°C). Positional cloning revealed that CDE4 encodes a P‐type PPR protein localized in chloroplasts. In the cde4 mutant, plastid‐encoded polymerase (PEP)‐dependent transcript levels were significantly reduced, but transcript levels of nuclear‐encoded genes were increased compared to wild‐type plants at 20°C. CDE4 directly binds to the transcripts of the chloroplast genes rpl2, ndhA, and ndhB. Intron splicing of these transcripts was defective in the cde4 mutant at 20°C, but was normal at 32°C. Moreover, CDE4 interacts with the guanylate kinase VIRESCENT 2 (V2); overexpression of V2 enhanced CDE4 protein stability, thereby rescuing the cde4 phenotype at 20°C. Our results suggest that CDE4 participates in plastid RNA splicing and plays an important role in rice chloroplast development under low‐temperature conditions.
Validation of a flash glucose monitoring system in outpatient diabetic cats
Authors: Shea Emily K. , Hess Rebecka S.
Published: July 2021

Background

Interstitial glucose (IG) concentration measurement using a flash glucose monitoring system (FGMS) is a noninvasive, affordable, and informative method to regulate patients with diabetes mellitus (DM) but has not been fully validated in outpatient cats with DM.

Objectives

To further validate the FreeStyle Libre FGMS in outpatient diabetic cats.

Animals

Eight client‐owned cats with DM.

Methods

Prospective observational validation study. Tissue glue was used to attach the sensor to the cat. Lin's concordance correlation coefficient (ρc) was used to compare IG concentrations measured by the FGMS to blood glucose concentrations measured using an automated biochemistry analyzer (ABA) and point‐of‐care glucometer (POCG).

Results

Data from 15 sensor placements in 8 cats were analyzed. Paired IG and ABA glucose concentrations (139 samples) had excellent correlation (ρc = 0.96) as did IG and POCG glucose concentrations (142 samples,ρc = 0.92). Sensor failure or displacement were recorded for 12/15 (80%) sensor placements. Median time of sensor activity was 7 days (range, 2‐13 days).

Conclusions and Clinical Importance

In outpatient cats with DM, the FGMS‐measured IG concentration correlated well with ABA‐measured blood glucose concentration, but a high rate of sensor failures was observed.
High prevalence of celiac disease in autoimmune hepatitis: Systematic review and meta‐analysis
Authors: Haggård Linnea , Glimberg Ida , Lebwohl Benjamin , Sharma Rajani , Verna Elizabeth C. , Green Peter H. R. , Ludvigsson Jonas F.
Published: July 2021

Background

Previous studies investigating the prevalence of celiac disease (CD) in individuals with autoimmune hepatitis (AIH) have shown highly variable results. We therefore aimed to examine the prevalence of CD in individuals with AIH.

Methods

Two professional librarians searched PubMed, EMBASE, Cochrane and Web of Science Core Collection up until 7 February 2020. The search terms included ‘celiac disease’, ‘celiac’, ‘transglutaminases’, ‘gluten’, ‘gliadin’, ‘EMA’, ‘TTG’ and ‘villous’ combined with ‘autoimmune’, ‘hepatitis’, ‘ANA’, ‘SMA’ and ‘LKM’. This search yielded 2419 unique publications. A systematic review based on the PRISMA guidelines resulted in 31 articles eligible for full text review. Fifteen articles were deemed relevant, with 8 being included in our main analysis. A fixed‐effect inverse variance‐weighted model was used, and heterogeneity was calculated.

Results

Our main analysis included 567 individuals with AIH from eight studies, where biopsy‐verified CD (equivalent to Marsh III) was seen in 23 individuals (4.1%). The pooled prevalence of CD in AIH was 3.5% (95% CI = 1.6%‐5.3%) (heterogeneity: P = .874; I2 = 0.0%), which is clearly higher than the 1% CD seen in most general populations. When also including studies where CD had been diagnosed through positive serology without biopsy (15 studies: n = 1817 individuals with AIH), the pooled prevalence of CD was 2.9% (95% CI = 2.1%‐3.8%) (heterogeneity: P < .001; I2 = 66.8%).

Conclusion

Our results demonstrate a higher prevalence of CD in individuals with AIH compared to the general population. CD screening may be considered in patients with AIH.
The relationship between frailty and cirrhosis etiology: From the Functional Assessment in Liver Transplantation (FrAILT) Study
Authors: Xu Chelsea Q. , Mohamad Yara , Kappus Matthew R. , Boyarsky Brian , Ganger Daniel R. , Volk Michael L. , Rahimi Robert S. , Duarte‐Rojo Andres , McAdams‐DeMarco Mara , Segev Dorry L. , Ladner Daniela P. , Verna Elizabeth C. , Grab Joshua , Tincopa Monica , Dunn Michael A. , Lai Jennifer C.
Published: July 2021

Background & Aims

Cirrhosis leads to malnutrition and muscle wasting that manifests as frailty, which may be influenced by cirrhosis aetiology. We aimed to characterize the relationship between frailty and cirrhosis aetiology.

Methods

Included were adults with cirrhosis listed for liver transplantation (LT) at 10 US centrer who underwent ambulatory testing with the Liver Frailty Index (LFI; ‘frail’ = LFI ≥ 4.4). We used logistic regression to associate aetiologies and frailty, and competing risk regression (LT as the competing risk) to determine associations with waitlist mortality (death/delisting for sickness).

Results

Of 1,623 patients, rates of frailty differed by aetiology: 22% in chronic hepatitis C, 31% in alcohol‐associated liver disease (ALD), 32% in non‐alcoholic fatty liver disease (NAFLD), 21% in autoimmune/cholestatic and 31% in ‘other’ (P < .001). In univariable logistic regression, ALD (OR 1.53, 95% CI 1.12‐2.09), NAFLD (OR 1.64, 95% CI 1.18‐2.29) and ‘other’ (OR 1.58, 95% CI 1.06‐2.36) were associated with frailty. In multivariable logistic regression, only ALD (OR 1.40; 95% 1.01‐1.94) and ‘other’ (OR 1.59; 95% 1.05‐2.40) remained associated with frailty. A total of 281 (17%) patients died/were delisted for sickness. In multivariable competing risk regression, LFI was associated with waitlist mortality (sHR 1.05, 95% CI 1.03‐1.06), but aetiology was not (P > .05 for each). No interaction between frailty and aetiology on the association with waitlist mortality was found (P > .05 for each interaction term).

Conclusions

Frailty is more common in patients with ALD, NAFLD and ‘other’ aetiologies. However, frailty was associated with waitlist mortality independent of cirrhosis aetiology, supporting the applicability of frailty across all cirrhosis aetiologies.
Model analyses show how biodiversity conservation could reduce infectious diseases in an ecosystem
Authors: Duffy Kevin J. , Collins Obiora C.
Published: July 2021

Biodiversity conservation benefits the sustainability of the environment and also the well‐being of humanity. Here we consider the possible importance of biodiversity of resources in limiting disease. With this aim we formulate a dynamical system model for a terrestrial ecosystem that takes into account, biodiversity of resources together with competition among species. The dynamics of the model are explored using appropriate dynamical system analyses. The effects of the competition terms and carrying capacity on the dynamics of the model are considered in terms of which ranges allow sustainability of the system. Simulations illustrate how biodiversity conservation can of itself lead to reduction in infectious diseases in an ecosystem.

The sustainability of the environment is generally improved by robust biodiversity and important for human welfare.

Diseases and their control are also important in natural and human systems.

Here we use models to establish to what extent natural resource biodiversity can reduce the extent of infected resources.

Our results show that biodiversity conservation is a possible control mechanism for reducing infectious diseases in an ecosystem.

These results can help natural resource manages concentrate time and money on biodiversity conservation over and above the already obvious need for such efforts.
Brain network modularity predicts changes in cortical thickness in children involved in a physical activity intervention
Authors: Chaddock‐Heyman Laura , Weng Timothy B. , Loui Psyche , Kienzler Caitlin , Weisshappel Robert , Drollette Eric S. , Raine Lauren B. , Westfall Daniel , Kao Shih‐Chun , Pindus Dominika M. , Baniqued Pauline , Castelli Darla M. , Hillman Charles H. , Kramer Arthur F.
Published: July 2021

Individual differences in brain network modularity at baseline can predict improvements in cognitive performance after cognitive and physical interventions. This study is the first to explore whether brain network modularity predicts changes in cortical brain structure in 8‐ to 9‐year‐old children involved in an after‐school physical activity intervention (N = 62), relative to children randomized to a wait‐list control group (N = 53). For children involved in the physical activity intervention, brain network modularity at baseline predicted greater decreases in cortical thickness in the anterior frontal cortex and parahippocampus. Further, for children involved in the physical activity intervention, greater decrease in cortical thickness was associated with improvements in cognitive efficiency. The relationships among baseline modularity, changes in cortical thickness, and changes in cognitive performance were not present in the wait‐list control group. Our exploratory study has promising implications for the understanding of brain network modularity as a biomarker of intervention‐related improvements with physical activity.
Aetiological analysis and diagnosis of reproductive disorders in male dromedary camels
Authors: Ali Ahmed , Derar Derar Refaat , Almundarij Tariq I.
Published: July 2021

The purpose of this paper was to analyse the aetiology and methods of diagnosing reproductive disorders in male dromedary camels. Male camel infertility manifests as one of three conditions: post‐coital infertility (IG), inability to copulate (IC) and lack of sexual desire (LSD). IG is mainly a testicular disorder that is linked to a deteriorated seminogram, arrested spermatogenesis, Sertoli cell‐only syndrome and testicular degeneration. For IG diagnosis, semen analysis, testicular biopsy and fine‐needle aspiration are gold standards. Testicular ultrasonography was generally inefficient. High serum FSH was found in IG camels with oligo‐ and azoospermia, implying primary spermatogenesis defects. The testis‐expressed protein (TEX101) and the epididymis‐expressed protein (ECM1) are reliable biomarkers for distinguishing between obstructive and non‐obstructive azoospermia. IC manifests in two forms: phimosis (PHI) and erectile dysfunction (ED). PHI is frequently linked to preputial and penile pathologies, as well as leucocytosis, neutrophilia and elevated nitric oxide metabolites. The majority of camels with ED have normal genital organs, and the condition is associated with an increase in cardiac troponin I. LSD is a rare disorder brought on by hormonal imbalances, high temperatures, stress and debilitating diseases. In conclusion, IG diagnosis necessitates semen analysis, testicular biopsy or fine‐needle aspiration, and FSH testing, whereas IC diagnosis requires preputial and penile examinations. Diagnostic aids include serum and seminal biomarkers.
Social‐cognitive risk for suicide and new relationship formation: False perception, self‐fulfilling prophecy, or both?
Authors: Jankowski Melissa S. , Erdley Cynthia A. , Schwartz‐Mette Rebecca A.
Published: July 2021

Objective

This study examined the impact of social‐cognitive constructs associated with increased suicide risk (i.e., perceived burdensomeness and thwarted belongingness) on relationship formation during real‐time interactions of older adolescents with strangers in a dyadic context.

Method

Two hundred and seventy‐four older adolescents (61.9% female,Mage = 18.96 years) were paired with same‐gender strangers and completed a laboratory‐based interaction task. Both target participants and their partners answered questions about their interaction at three time points during the 45‐min session. Structural equation modeling was used to test hypothesized models.

Results

Perceived burdensomeness and thwarted belongingness predicted interpersonal consequences during the interaction. In the first model, thwarted belongingness led targets to inaccurately perceive their partners’ assessments of the interaction. This misperception negatively impacted the participants’ own desires for friendship. In the second model, thwarted belongingness predicted decreases in targets’ desire to continue the conversation, whereas perceived burdensomeness predicted higher levels of desire to continue the conversation. For females, thwarted belongingness in particular was related to new relationship formation in these models. Overall, those who desired to continue talking were more likely to like their partner at the end of the conversation.

Conclusions

Results add to our understanding of how perceived burdensomeness and thwarted belongingness contribute to increased social alienation, which could serve to increase suicide risk.
In elderly Caucasian women, younger facial perceived age correlates with better forearm skin microcirculation reactivity
Authors: Guéré Christelle , Bigouret Armelle , Nkengne Alex , Vié Katell , Gélis Anthony , Dulong Joshua , Lamartine Jérôme , Fromy Bérengère
Published: July 2021

Background

Visual and molecular changes occurring upon aging are rather well characterized. Still, aging signs show great significant inter‐individual variations, and little is known concerning the link between perceived age and cutaneous microcirculation.

Materials and Methods

To investigate this point, we recruited Caucasian women in their mid‐50's to mid‐70's and subsampled women looking older or younger than their age. We studied their facial skin color, as well as their microvascular reactivity to local heating assessed in the forearm skin. We also used skin biopsies from some of these women for gene expression or immunohistochemical analysis.

Results

Clinical and instrumental analysis of skin color revealed that subjects who look 5 years younger differ only by a higher glowing complexion. Our most striking result is that subjects looking 5 years younger than their age present a higher microcirculation reactivity in forearm skin. Transcriptome comparison of skin samples from women looking older or younger than their age revealed 123 annotated transcripts differentially expressed, among which MYL9 relates to microcirculation. MYL9 is downregulated in the group of women looking younger than their real age. Microscopy shows that the labeling of MYL9 and CD31 are altered and heterogeneous with age, as is the morphology of microvessels.

Conclusion

Therefore, assessing generalized vascular reactivity in non‐photo‐exposed skin to focus on the intrinsic aging allows subtle discrimination of perceived age within elderly healthy subjects.
The Effectiveness of the Flipped Classroom in a 300 Level Terrorism Class
Authors: Verrecchia PJ
Published: July 2021

This study compares a 300 level terrorism class taught using a flipped classroom to the same class taught one year earlier in the traditional, face to face method. While one examination score was better for the face to face class, the flipped class did better than the traditional class on the final examination. Every other point of comparison showed no difference between the classes, except for the end of semester student evaluations, which were significantly higher for the face to face class than the flipped classroom.
Effect of Previous-Day Alcohol Ingestion on Muscle Function and Performance of Severe-Intensity Exercise
Authors: Shaw Alex G. , Chae Sungwon , Levitt Danielle E. , Nicholson Jonathan L. , Vingren Jakob L. , Hill David W.
Published: July 2021

Purpose: Many athletes report consuming alcohol the day before their event, which might negatively affect their performance. However, the effects of previous-day alcohol ingestion on performance are equivocal, in part, due to no standardization of alcohol dose in previous studies. The purpose of this study was to examine the impact of a standardized previous-day alcohol dose and its corresponding impact on morning-after muscular strength, muscular power, and muscular fatigue in a short-duration test and on performance of severe-intensity exercise. Methods: On 2 occasions, 12 recreationally active individuals reported to the Applied Physiology Laboratory in the evening and ingested a beverage containing either 1.09 g ethanol·kg−1 fat-free body mass (ALC condition) or water (PLA condition). The following morning, they completed a hangover symptom questionnaire, vertical jumps, isometric midthigh pulls, biceps curls, and a constant-power cycle ergometer test to exhaustion. The responses from ALC and PLA were compared using paired-means t tests. Results: Time to exhaustion in the cycle ergometer tests was less (P = .03) in the ALC condition (181 [39] s vs 203 [34] s; –11%, Cohen d = 0.61). There was no difference in performance in vertical jump test, isometric midthigh pulls, and biceps curls tests between the ALC and PLA conditions. Conclusions: Previous-day alcohol consumption significantly reduces morning-after performance of severe-intensity exercise. Practitioners should educate their athletes, especially those whose events rely on anaerobic capacity and/or a rapid response of the aerobic pathways, of the adverse effect of previous-day alcohol consumption on performance.
Trends in Aerobic Physical Activity Participation Across Multiple Domains Among US Adults, National Health and Nutrition Examination Survey 2007/2008 to 2017/2018
Authors: Whitfield Geoffrey P. , Ussery Emily N. , Saint-Maurice Pedro F. , Carlson Susan A.
Published: July 2021

Background: Understanding how participation is changing across domains of physical activity is important for monitoring progress and informing promotion efforts. The authors examined changes in physical activity participation in the National Health and Nutrition Examination Survey 2007/2008 to 2017/2018. Methods: The prevalence of inactivity, insufficient activity, and meeting the aerobic physical activity guideline in multidomain physical activity and each domain (leisure time, occupational/household, and transportation) was estimated for each cycle and stratified by selected characteristics. The authors tested trends over time and overall changes (2017/2018 vs 2007/2008). Results: For multidomain physical activity, the prevalence of inactivity decreased linearly; meeting the aerobic guideline increased nonmonotonically, and the 2017/2018 prevalence (68.1%) was higher than 2007/2008 (64.1%). Similar findings were observed for adults aged ≥65 years, non-Hispanic Blacks, Hispanics, high school graduates, and adults with obesity. Domain-specific results varied, but decreasing trends in inactivity and increasing trends in meeting the guideline were consistently observed across subgroups for occupational/household activity. Meeting the guideline through transportation activity was rare. Conclusions: Increases in meeting the guideline and decreases in inactivity in multidomain activity and selected domains are encouraging results, especially among subgroups historically reporting low activity participation. Activity promotion efforts are important to maintain progress, and the transportation domain may be an underutilized source of physical activity.
Eliminating hepatitis C in a rural Appalachian county: protocol for the Kentucky Viral Hepatitis Treatment Study (KeY Treat), a phase IV, single-arm, open-label trial of sofosbuvir/velpatasvir for the treatment of hepatitis C
Authors: Havens Jennifer R , Schaninger Takako , Fraser Hannah , Lofwall Michelle , Staton Michele , Young April M , Hoven Ardis , Walsh Sharon L , Vickerman Peter
Published: July 2021

Objectives

The overall goal of the Kentucky Viral Hepatitis Treatment Study (KeY Treat) is to eliminate hepatitis C transmission from a county in Appalachian Kentucky by removing the barriers to accessing hepatitis C virus (HCV) treatment.

Methods/analysis

KeY Treat is a phase IV, open-label, single-arm clinical trial of sofosbuvir/velpatasvir (SOF/VEL) for the treatment of viraemic HCV infections. Those eligible for KeY Treat are at least 18 years of age, viraemic and are residents of the target county. Pregnant women are not eligible. Rapid HCV RNA screening is used to determine eligibility, and those with a quantifiable viral load (VL) consenting to participate initiate SOF/VEL on the same day. All pharmacologic treatment and related medical care is provided free of charge using a non-specialist provider model. Follow-up visits occur at 2, 6 and 12 weeks during treatment to assess medication adherence (measured via VL and self-report), side effects and engagement in risk behaviours. Post-treatment visits occur at 12 weeks (sustained virologic response (SVR12) visit), 6 months and 12 months post-treatment completion to assess re-infection. A control county has also been identified, and prevalence and incidence of chronic HCV infections will be compared with the target community longitudinally. The primary outcome to assess elimination is SVR12. However, several outcomes will be measured to assess the effectiveness of removing the barriers to HCV treatment, including treatment entry, completion and re-infection. Analyses will be conducted via a generalised linear model framework that can incorporate flexible covariate adjustment and multiple outcome types with a compatible link function. Mathematical modelling will be completed assessing the impact and cost-effectiveness of the intervention.

Ethics and dissemination

KeY Treat has been approved by the Institutional Review Board at the University of Kentucky. Results from KeY Treat will be presented at conferences and published in peer-reviewed journals.

Trial registration number

NCT03949764.
Catheter to vein ratio and risk of peripherally inserted central catheter (PICC)-associated thrombosis according to diagnostic group: a retrospective cohort study
Authors: Sharp Rebecca , Carr Peter , Childs Jessie , Scullion Andrew , Young Mark , Flynn Tanya , Kirker Carolyn , Jackson Gavin , Esterman Adrian
Published: July 2021

Objectives

Determine the effect of the catheter to vein ratio (CVR) on rates of symptomatic thrombosis in individuals with a peripherally inserted central catheter (PICC) and identify the optimal CVR cut-off point according to diagnostic group.

Design

Retrospective cohort study.

Setting

4 tertiary hospitals in Australia and New Zealand.

Participants

Adults who had undergone PICC insertion.

Primary outcome measure

Symptomatic thrombus of the limb in which the PICC was inserted.

Results

2438 PICC insertions were included with 39 cases of thrombosis (1.6%; 95% CI 1.14% to 2.19%). Receiver operator characteristic analysis was unable to be performed to determine the optimal CVR overall or according to diagnosis. The association between risk of thrombosis and CVR cut-offs commonly used in clinical practice were analysed. A 45% cut-off (≤45% versus ≥46%) was predictive of thrombosis, with those with a higher ratio having more than twice the risk (relative risk 2.30; 95% CI 1.202 to 4.383; p=0.01). This pattern continued when only those with malignancy were included in the analysis, those with cancer had twice the risk of thrombosis with a CVR greater than 45%. Whereas the 33% CVR cut-off was not associated with statistically significant results overall or in those with malignancy. Neither the 33% or 45% CVR cut-off produced statistically significant results in those with infection or other non-malignant conditions.

Conclusions

Adherence to CVR cut-offs are an important component of PICC insertion clinical decision making to reduce the risk of thrombosis. These results suggest that in individuals with cancer, the use of a CVR ≤45% should be considered to minimise risk of thrombosis. Further research is needed to determine the risk of thrombosis according to malignancy type and the optimal CVR for those with a non-malignant diagnosis.
Microablative fractional radiofrequency for the genitourinary syndrome of menopause: protocol of randomised controlled trial
Authors: Sarmento Ayane Cristine Alves , Fernandes Fabíola S , Costa Ana Paula Ferreira , Medeiros Kleyton Santos , Crispim Janaina Cristina , Gonçalves Ana Katherine
Published: July 2021

Introduction

Menopause is a physiological and progressive phenomenon secondary to decreased ovarian follicular reserve. These changes have consequences: vaginal dryness, dyspareunia, discomfort, burning and irritation, vulvovaginal pruritus, dysuria and increased frequency of genitourinary infections. The therapy more suitable for vaginal symptoms in postmenopause yet is the use of a topical hormone. However, the prescription of topical oestrogens should also be avoided in women with a history of breast cancer, oestrogen-sensitive tumours and thromboembolism, emphasising the necessity of alternative treatments. Recently, physical methods, such as laser and radiofrequency (RF), in their non-ablative, ablative and microablative forms have been used in the vaginal mucosa to promote neocolagenesis and neoelastogenesis. This randomised study aims to compare the efficiency of microablative fractional RF (MAFRF) treatment with vaginal oestrogens and no treatment.

Methods and analyses

This randomised, controlled clinical intervention trial with an open label design comparing the treatment of MAFRF with vaginal oestrogens and no treatment. Four important moments were considered to evaluate treatment results (T0, T1, T2 and T3). The primary outcome includes vulvovaginal atrophy (vaginal pain, burning, itching, dryness, dyspareunia and dysuria), and the secondary outcomes will be sexual function, vaginal health (epithelial integrity, vaginal elasticity, moisture, fluid volume and vaginal pH) and quality of life.

Ethics and dissemination

Due to the nature of the study, we obtained approval from the ethics committee. All participants must sign an informed consent form before randomisation. The results of this study will be published in peer-reviewed journals. The data collected will also be available in a public repository of data.

Trial registration number

RBR-94DX93.
Point-of-care ultrasound-guided regional anaesthesia in older ED patients with hip fractures: a study to test the feasibility of a training programme and time needed to complete nerve blocks by ED physicians after training
Authors: Lee Jacques Simon , Bhandari Tina , Simard Robert , Emond Marcel , Topping Claude , Woo Michael , Perry Jeffrey , Eagles Debra , McRae Andrew D , Lang Eddy , Wong Charles , Sivilotti Marco , Newbigging Joseph , Borgundvaag Bjug , McLeod Shelley L , Melady Donald , Chernoff Lan , Kiss Alex , Chenkin Jordan
Published: July 2021

Objectives

Point-of-care ultrasound-guided regional anaesthesia (POCUS-GRA) provides safe, rapid analgesia for older people with hip fractures but is rarely performed in the emergency department (ED). Self-perceived inadequate training and time to perform POCUS-GRA are the two most important barriers. Our objective is to assess the feasibility of a proposed multicentre, stepped-wedge cluster randomised clinical trial (RCT) to assess the impact of a knowledge-to-practice (KTP) intervention on delirium.

Design

Open-label feasibility study.

Setting

An academic tertiary care Canadian ED (annual visits 60 000).

Participants

Emergency physicians working at least one ED shift per week, excluding those already performing POCUS-GRA more than four times per year.

Intervention

A KTP intervention, including 2-hour structured training sessions with procedure bundle and email reminders.

Primary and secondary outcome measures

The primary feasibility outcome is the proportion of eligible physicians that completed training and subsequently performed POCUS-GRA. Secondary outcome is the time needed to complete POCUS-GRA. We also test the feasibility of the enrolment, consent and randomisation processes for the future stepped-wedge cluster RCT (NCT02892968).

Results

Of 36 emergency physicians, 4 (12%) were excluded or declined participation. All remaining 32 emergency physicians completed training and 31 subsequently treated at least one eligible patient. Collectively, 27/31 (87.1%) performed 102 POCUS-GRA blocks (range 1–20 blocks per physician). The median (IQR) time to perform blocks was 15 (10–20) min, and reduction in pain was 6/10 (3–7) following POCUS-GRA. There were no reported complications.

Conclusion

Our KTP intervention, consent process and randomisation were feasible. The time to perform POCUS-GRA rarely exceeded 30 min, Our findings reinforce the existing data on the safety and effectiveness of POCUS-GRA, mitigate perceived barriers to more widespread adoption and demonstrate the feasibility of trialling this intervention for the proposed stepped-wedge cluster RCT.

Trial registration number

Clinicaltrials.gov #02892968
Transitional care of adolescents with Multiple Osteochondromas: a convergent mixed-method study ‘Patients’, parents’ and healthcare providers’ perspectives on the transfer process’
Authors: Amajjar Ihsane , Malik Romana , van Wier Marieke , Smeets Rob , Ham S John
Published: July 2021

Objectives

Multiple osteochondromas (MO) is a rare hereditary disease characterised by numerous benign bone tumours. Its chronic aspect requires a well-organised transition from paediatric care to adult care; however, little is known on organising this care specific for patients with MO. This study aims to gain insight on this topic.

Design

Convergent mixed-method study.

Setting

This study was conducted at the orthopaedic and paediatrics department of an MO-expertise centre in the Netherlands.

Participants

12 patients, 10 parents and 10 healthcare professionals were interviewed. An additional survey was completed by 20 young adults.

Primary and secondary outcomes

The (1) themes on transition, identified through template analysis and (2) transfer experience and satisfaction assessed by an 18-item On Your Own Feet-Transfer Experience Scale (OYOF-TES, range: 18–90) and by Numeric Rating Scale (NRS, range: 1–10).

Results

The following three key themes were identified in the qualitative analysis: (1) patient and parent in the lead can be encouraged by self-management tools, (2) successful transfers need interprofessional collaboration and communication and (3) how can we prepare patients for the transitional process? Stakeholders’ insights to improve transition were listed and divided into these three themes.

Several important aspects were underlined, particularly within the first theme; speaking-up was difficult for patients especially when parents were not directly involved. Moreover, the high psychological impact of the disease requires coaching of self-management and psychological counselling to facilitate stakeholders in their changing roles.

Twenty patients completed the quantitative survey. Mean satisfaction score with the transfer process was poor, which was assessed with the NRS (mean=5.7±2.1; range: 1–9) and the OYOF-TES (mean=56.3±14.2; range: 32–85). The OYOF-TES only showed a negative correlation (R2=0.25; p=0.026) with the number of surgical interventions in the past.

Conclusion

Overall, the transfer process was found unsatisfactory. Improvement can be achieved by supporting and guiding the patients to be in the lead of their care. Moreover, preparation for transfer and a multidisciplinary approach may enhance successful transition.
Work-related stress: the impact of COVID-19 on critical care and redeployed nurses: a mixed-methods study
Authors: Rattray Janice , McCallum Louise , Hull Alastair , Ramsay Pam , Salisbury Lisa , Scott Teresa , Cole Stephen , Miller Jordan , Dixon Diane
Published: July 2021

Introduction

We need to understand the impact of COVID-19 on critical care nurses (CCNs) and redeployed nurses and National Health Service (NHS) organisations.

Methods and analysis

This is a mixed-methods study (QUANT-QUAL), underpinned by a theoretical model of occupational stress, the Job Demand-Resources Model (JD-R). Participants are critical care and redeployed nurses from Scottish and three large English units.

Phase 1 is a cross-sectional survey in part replicating a pre-COVID-19 study and results will be compared with this data. Linear and logistic regression analysis will examine the relationship between antecedent, demographic and professional variables on health impairment (burnout syndrome, mental health, post-traumatic stress symptoms), motivation (work engagement, commitment) and organisational outcomes (intention to remain in critical care nursing and quality of care). We will also assess the usefulness of a range of resources provided by the NHS and professional organisations.

To allow in-depth exploration of individual experiences, phase 2 will be one-to-one semistructured interviews with 25 CCNs and 10 redeployed nurses. The JD-R model will provide the initial coding framework to which the interview data will be mapped. The remaining content will be analysed inductively to identify and chart content that is not captured by the model. In this way, the adequacy of the JD-R model is examined robustly and its expression in this context will be detailed.

Ethics and dissemination

Ethics approval was granted from the University of Aberdeen CERB2020101993. We plan to disseminate findings at stakeholder events, publish in peer-reviewed journals and at present at national and international conferences.
The 100 most-cited papers on age-related macular degeneration: a bibliographic perspective
Authors: Grzybowski Andrzej , Shtayer Chen , Schwartz Stephen G , Moisseiev Elad
Published: July 2021

The 100 most-cited papers on age-related macular degeneration (AMD) were analysed using a bibliographic study. The bibliographic databases of the Institute for Scientific Information Web of Knowledge were searched, limited to research articles published between 1965 and 2020 in peer-reviewed journals. The papers were ranked in order of number of citations since publication. Five of the top 10 (and 3 of the top 4) papers reported randomised clinical trial results for either anti-vascular endothelial growth factor agents or nutritional supplements. Four of the top 10 papers reported genotype-phenotype associations between AMD and variants inComplement Factor H. This bibliographic study provides perspective and insight into many of the most influential contributions in the understanding and management of AMD and its evolution over time.
Tissue stress from laparoscopic grasper use and bowel injury in humans: establishing intraoperative force boundaries
Authors: Khan Amanda Farah , MacDonald Matthew Kenneth , Streutker Catherine , Rowsell Corwyn , Drake James , Grantcharov Teodor
Published: July 2021

Objectives

We aim to determine what threshold of compressive stress small bowel and colon tissues display evidence of significant tissue trauma during laparoscopic surgery.

Design

This study included 10 small bowel and 10 colon samples from patients undergoing routine gastrointestinal surgery. Each sample was compressed with pressures ranging from 100 kPa to 600 kPa. Two pathologists who were blinded to all study conditions, performed a histological analysis of the tissues. Experimentation: November 2018–February 2019. Analysis: March 2019–May 2020.

Setting

An inner-city trauma and ambulatory hospital with a 40-bed inpatient general surgery unit with a diverse patient population.

Participants

Patients were eligible if their surgery procured healthy tissue margins for experimentation (a convenience sample). 26 patient samples were procured; 6 samples were unusable. 10 colon and 10 small bowel samples were tested for a total of 120 experimental cases. No patients withdrew their consent.

Interventions

A novel device was created to induce compressive “grasps” to simulate those of a laparoscopic grasper. Experimentation was performed ex-vivo, in-vitro. Grasp conditions of 0–600 kPa for a duration of 10 s were used.

Results

Small bowel (10), M:F was 7:3, average age was 54.3 years. Colon (10), M:F was 1:1, average age was 65.2 years. All 20 patients experienced a significant difference (p<0.05) in serosal thickness post-compression at both 500 and 600 kPa for both tissue types. A logistic regression analysis with a sensitivity of 100% and a specificity of 84.6% on a test set of data predicts a safety threshold of 329–330 kPa.

Conclusions

A threshold was discovered that corresponded to both significant serosal thickness change and a positive histological trauma score rating. This “force limit” could be used in novel sensorized laparoscopic tools to avoid intraoperative tissue injury.
Applications of convex geometry to Minkowski sums of m ellipsoids in ℝN: Closed-form parametric equations and volume bounds
Authors: Chirikjian Gregory S. , Shiffman Bernard
Published: July 2021

General results on convex bodies are reviewed and used to derive an exact closed-form parametric formula for the Minkowski sum boundary of [Formula: see text] arbitrary ellipsoids in [Formula: see text]-dimensional Euclidean space. Expressions for the principal curvatures of these Minkowski sums are also derived. These results are then used to obtain upper and lower volume bounds for the Minkowski sum of ellipsoids in terms of their defining matrices; the lower bounds are sharper than the Brunn–Minkowski inequality. A reverse isoperimetric inequality for convex bodies is also given.
Moduli spaces of low-dimensional Lie superalgebras
Authors: Fialowski Alice , Penkava Michael
Published: July 2021

In this paper, we study moduli spaces of low-dimensional complex Lie superalgebras. We discover a similar pattern for the structure of these moduli spaces as we observed for ordinary Lie algebras, namely, that there is a stratification of the moduli space by projective orbifolds. The moduli spaces consist of some families as well as some singleton elements. The different strata are linked by jump deformations, which gives a unique manner of decomposing the moduli space which is consistent with deformation theory.
Aharonov–Bohm effect in a Coulomb-type potential under the influence of a cutoff point
Authors: Bakke K.
Published: July 2021

We analyze the influence of a cutoff point on a Coulomb-type potential that stems from the interaction of an electron with electric fields. This cutoff point establishes a forbidden region for the electron. Then, we search for bound state solutions to the Schrödinger equation. In addition, we consider a rotating reference frame. We show that the effects of rotation break the degeneracy of the energy levels. Further, we discuss the Aharonov–Bohm effect for bound states.
The 2D non self-dual Ising lattices: An exact renormalization group treatment
Authors: Kaya Tuncer
Published: July 2021

In this work, an exact renormalization group treatment of honeycomb lattice leading to an exact relation between the coupling strengths of the honeycomb and the triangular lattices is presented. Using the honeycomb and the triangular duality relation, the critical coupling values of honeycomb and triangular lattices are calculated exactly by the simultaneous solution of the renormalized relation and the duality relation, without using the so-called star-triangular transformation. Apparently, the obtained coupling relation is unique. It not only takes place the role of the star triangular relation, but it is also the only exact relation obtained from renormalization group theory other than the 1D Ising chain. An exact pair correlation function expression relating the nearest neighbors and the next nearest neighbor correlation functions are also obtained for the honeycomb lattice. Utilizing this correlation relation, an exact expression of the correlation length of the honeycomb lattice is calculated analytically for the coupling constant values less than the critical value in the realm of the scaling theory. The critical exponents [Formula: see text] and [Formula: see text] are also calculated as [Formula: see text] and [Formula: see text].
Investigation of structural and energetic behavior of 55-atom Pt–Ag–Au ternary nanoalloys
Authors: Yıldırım Hüseyin , Garip Ali Kemal
Published: July 2021

A systematic theoretical investigation of structural and energetic behaviors of 55-atom Pt–Ag–Au ternary nanoalloys has been performed in two different composition systems. We have performed Gupta and Density Functional Theory (DFT) approaches on chosen systems. The Basin-Hopping algorithm is used for structural optimizations of PtnAg[Formula: see text]Au[Formula: see text] ([Formula: see text]–13) and PtnAu[Formula: see text]Ag[Formula: see text] ([Formula: see text]–13) ternary nanoalloys with Gupta many-body potential to model interatomic interactions. Local optimization results show that while the tendency of Au atoms to be located varies according to the composition system, the tendency of Pt and Ag atoms to be located does not change in both. For all compositions of Pt–Ag–Au nanoalloys, the structures with the best chemical ordering were then reoptimized by DFT relaxations and the mixing energies of the Gupta and DFT levels were compared. Our mixing energy analysis showed that PtnAg[Formula: see text]Au[Formula: see text] ([Formula: see text]–13) nanoalloys are not energetically suitable for mixing at both Gupta and DFT level. Also, mixing energy variations of PtnAu[Formula: see text]Ag[Formula: see text] ([Formula: see text]–13) nanoalloys obtained at Gupta level does not agree with the one obtained at DFT level. In addition, it has been found that the minimization energy changes when an atom in the central site is exchanging by an atom in the second shell and surface.
IMPLICATIONS OF LOW INTEREST RATES ON BANK PROFITABILITY AND RISK-TAKING
Authors: ENDER MANUELA , NEUHOFER CORINNA
Published: July 2021

This paper investigates the effect of low interest rates on bank profitability and risk-taking. A comprehensive depiction of the current state of research was developed based on systematic literature review and qualitative content analysis. A low interest rate environment, as present in many economies, has various implications on bank profitability and risk-taking. A positive relationship is found between interest rates and net interest income, while the relationship with non-interest income is negative. Also, banks increase risk-taking in search for yield. The influence on bank profitability is highly dependent on several factors, but in most papers a negative influence is found. Throughout the world banks have managed to limit the impact through mitigation strategies, such as diversification, which are presented as guidance.
Clinicoradiographic Features and Histopathologic Variations of Intraosseous Lipoma: Report of a Case and Review of the Literature
Authors: Atarbashi-Moghadam Saede , Lotfi Ali , Mehdizadeh Mohammad , Atarbashi-Moghadam Fazele
Published: July 2021

Intraosseous lipoma is a very rare lesion, and the jaw is its least common bone location. Fibrolipoma is a microscopic variant of lipoma which is characterized by a significant fibrous component intermixed with lobules of fat cells. Intraosseous fibrolipoma of the jaw is a rare lesion, and to the best of our knowledge, only two cases have been reported from 1948 in English literature. This paper presents a 39-year-old man with a chief complaint of tooth displacement in the anterior region of the mandible. Radiographic evaluation revealed a unilocular radiolucent lesion with sclerotic borders located between the left lateral incisor and canine. Histopathologic evaluation after an excisional biopsy confirmed the diagnosis of intraosseous fibrolipoma. We also reviewed the literature on this rare lesion.