bluuebunny/crossref_metadata_2025 huggingface dataset:
De novo ZIC2 frameshift variant associated with frontonasal dysplasia in a Limousin calf
Authors: Braun Marina , Lehmbecker Annika , Eikelberg Deborah , Hellige Maren , Beineke Andreas , Metzger Julia , Distl Ottmar
Published: January 2021

Background

Bovine frontonasal dysplasias like arhinencephaly, synophthalmia, cyclopia and anophthalmia are sporadic congenital facial malformations. In this study, computed tomography, necropsy, histopathological examinations and whole genome sequencing on an Illumina NextSeq500 were performed to characterize a stillborn Limousin calf with frontonasal dysplasia. In order to identify private genetic and structural variants, we screened whole genome sequencing data of the affected calf and unaffected relatives including parents, a maternal and paternal halfsibling.

Results

The stillborn calf exhibited severe craniofacial malformations. Nose and maxilla were absent, mandibles were upwardly curved and a median cleft palate was evident. Eyes, optic nerve and orbital cavities were not developed and the rudimentary orbita showed hypotelorism. A defect centrally in the front skull covered with a membrane extended into the intracranial cavity. Aprosencephaly affected telencephalic and diencephalic structures and cerebellum. In addition, a shortened tail was seen. Filtering whole genome sequencing data revealed a private frameshift variant within the candidate gene ZIC2 in the affected calf. This variant was heterozygous mutant in this case and homozygous wild type in parents, half-siblings and controls.

Conclusions

We found a novel ZIC2 frameshift mutation in an aprosencephalic Limousin calf. The origin of this variant is most likely due to a de novo mutation in the germline of one parent or during very early embryonic development. To the authors’ best knowledge, this is the first identified mutation in cattle associated with bovine frontonasal dysplasia.
Screening and quantification of anti-quorum sensing and antibiofilm activity of Actinomycetes isolates against food spoilage biofilm-forming bacteria
Authors: Mulya Erika , Waturangi Diana Elizabeth
Published: January 2021

Background

Biofilms can form in many industries, one of them is the food industry. The formation of biofilms in this industry could cause immense economic losses and endanger public health. Biofilms formation is mainly triggered by quorum sensing. Therefore, inhibition of quorum sensing could be an innovative approach to inhibit the formation of biofilms. One way to inhibit quorum sensing is by using anti-quorum sensing compounds. Actinomycetes are a group of bacteria that is acknowledged to produce these compounds.

Results

There were eight crude extracts of Actinomycetes isolates that showed promising anti-quorum sensing activity against Chromobacterium violaceum. The concentration of the crude extracts was 20 mg/mL. All the crude extracts showed no antibacterial activity against food spoilage bacteria, except for crude extracts of isolate 18 PM that showed antibacterial activity against Bacillus subtilis. They also showed various antibiofilm activity, both inhibition and destruction. The highest inhibition and destruction activity sequentially was done by crude extracts of isolate 12 AC with 89.60% against Bacillus cereus and crude extracts of isolate SW03 with 93.06% against Shewanella putrefaciens.

Conclusions

Actinomycetes isolates that isolated from different regions in Indonesia can be used as potential candidates to overcome biofilms formed by food spoilage bacteria using their ability to produce anti-quorum sensing compounds.
Adaptive work in the primary health care response to domestic violence in occupied Palestinian territory: a qualitative evaluation using Extended Normalisation Process Theory
Authors: Bacchus Loraine J. , Alkaiyat Abdulsalam , Shaheen Amira , Alkhayyat Ahmed S. , Owda Heba , Halaseh Rana , Jeries Ibrahim , Feder Gene , Sandouka Rihab , Colombini Manuela
Published: January 2021

Background

A health system response to domestic violence against women is a global priority. However, little is known about how these health system interventions work in low-and-middle-income countries where there are greater structural barriers. Studies have failed to explore how context-intervention interactions affect implementation processes. Healthcare Responding to Violence and Abuse aimed to strengthen the primary healthcare response to domestic violence in occupied Palestinian territory. We explored the adaptive work that participants engaged in to negotiate contextual constraints.

Methods

The qualitative study involved 18 participants at two primary health care clinics and included five women patients, seven primary health care providers, two clinic case managers, two Ministry of Health based gender-based violence focal points and two domestic violence trainers. Semi-structured interviews were used to elicit participants’ experiences of engaging with HERA, challenges encountered and how these were negotiated. Data were analysed using thematic analysis drawing on Extended Normalisation Process Theory. We collected clinic data on identification and referral of domestic violence cases and training attendance.

Results

HERA interacted with political, sociocultural and economic aspects of the context in Palestine. The political occupation restricted women’s movement and access to support services, whilst the concomitant lack of police protection left providers and women feeling exposed to acts of family retaliation. This was interwoven with cultural values that influenced participants’ choices as they negotiated normative structures that reinforce violence against women. Participants engaged in adaptive work to negotiate these challenges and ensure that implementation was safe and workable. Narratives highlight the use of subterfuge, hidden forms of agency, governing behaviours, controls over knowledge and discretionary actions. The care pathway did not work as anticipated, as most women chose not to access external support. An emergent feature of the intervention was the ability of the clinic case managers to improvise their role.

Conclusions

Flexible use of ENPT helped to surface practices the providers and women patients engaged in to make HERA workable. The findings have implications for the transferability of evidenced based interventions on health system response to violence against women in diverse contexts, and how HERA can be sustained in the long-term.
Characteristics of patients who access zero, one or multiple general practices and reasons for their choices: a study in regional Australia
Authors: Glenister Kristen M. , Guymer John , Bourke Lisa , Simmons David
Published: January 2021

Background

Most people in Australia visit a General Practitioner each year and are free to choose their General Practitioner and/or practice on each occasion. A proportion of people visit multiple general practices, which can reduce continuity of care, a core value of general practice. Utilisation of multiple general practices is associated with metropolitan residence and younger age. However, it is unclear which factors are associated with utilisation of multiple general practices in rural areas, where there are often General Practitioner workforce shortages and higher proportions of patients who may benefit from continuity of care, including older people and people living with chronic disease. The aim of this study was to compare the characteristics of people in a rural Australian area who accessed multiple general practices in the previous year with people who had accessed one practice, or none.

Methods

A cross-sectional survey assessed self-reported utilisation and perspective of general practice services, uses of multiple practices, associated reasons, lifestyle advice and screening services received in four regional Victorian towns. Households were randomly selected and residents aged 16+ were eligible to participate in the adult survey.

Results

Most people had attended a single general practice (78.9%), while 14.4% attended more than one practice and 6.7% attended no practices in the previous 12 months. Compared with utilisation of a single general practice, multiple general practice attendance in the previous year was associated with younger age (adjusted odds ratio (aOR 95% confidence interval) 0.98 per year (0.97–0.99), residence in the regional centre aOR 2.90(2.22–3.78), emergency department (ED) attendance in the last 12 months aOR 1.65(1.22–2.21) and no out of pocket costs aOR 1.36(1.04–1.79)). Reasons for multiple general practice attendance included availability of appointments, cost and access to specific services. Compared with multiple general practice attendance, those attending single practices reported more screening tests but similar frequency of lifestyle advice. People who accessed multiple practices were less likely to report very high satisfaction (51.7% vs 62.9% p < 0.001) or excellent degree of confidence in their doctor (42.0% vs 49.8% p = 0.006) than single practice attendees.

Conclusions

Those attending single practices report higher satisfaction and confidence in their GP and were less likely to attend ED. Further studies are required to test whether increasing availability of appointments and reducing out-of-pocket expenses would increase single practice attendance and/or decrease healthcare costs overall.
Factors influencing variation in implementation outcomes of the redesigned community health fund in the Dodoma region of Tanzania: a mixed-methods study
Authors: Kalolo Albino , Gautier Lara , Radermacher Ralf , Srivastava Siddharth , Meshack Menoris , De Allegri Manuela
Published: January 2021

Introduction

Micro-health insurance (MHI) has been identified as a possible interim solution to foster progress towards Universal Health Coverage (UHC) in low- and middle- income countries (LMICs). Still, MHI schemes suffer from chronically low penetration rates, especially in sub-Saharan Africa. Initiatives to promote and sustain enrolment have yielded limited effect, yet little effort has been channelled towards understanding how such initiatives are implemented. We aimed to fill this gap in knowledge by examining heterogeneity in implementation outcomes and their moderating factors within the context of the Redesigned Community Health Fund in the Dodoma region in Tanzania.

Methods

We adopted a mixed-methods design to examine implementation outcomes, defined as adoption and fidelity of implementation (FOI) as well as their moderating factors. A survey questionnaire collected individual level data and a document review checklist and in-depth interview guide collected district level data. We relied on descriptive statistics, a chi square test and thematic analysis to analyse our data.

Results

A review of district level data revealed high adoption (78%) and FOI (77%) supported also by qualitative interviews. In contrast, survey participants reported relatively low adoption (55%) and FOI (58%). Heterogeneity in adoption and FOI was observed across the districts and was attributed to organisational weakness or strengths, communication and facilitation strategies, resource availability (fiscal capacity, human resources and materials), reward systems, the number of stakeholders, leadership engagement, and implementer’s skills.

At an individual level, heterogeneity in adoption and FOI of scheme components was explained by the survey participant’s level of education, occupation, years of stay in the district and duration of working in the scheme. For example, the adoption of job description was statistically associated with occupation (p = 0.001) and wworking in the scheme for more than 20 months had marginal significant association with FOI (p = 0.04).

Conclusion

The study demonstrates that assessing the implementation processes helps to detect implementation weaknesses and therefore address such weaknesses as the interventions are implemented or rolled out to other settings. Attention to contextual and individual implementer elements should be paid in advance to adjust implementation strategies and ensure greater adoption and fidelity of implementation.
Design and validation of brucellosis prevention questionnaire focused on animal vaccination
Authors: Bahadori Farhad , Ghofranipour Fazlollah , Ghaffarifar Saeideh , Ziaei Reza
Published: January 2021

Background

The inadequate awareness of livestock breeders on brucellosis transmission, as well as their improper knowledge about preventing brucellosis is considered as one of the important barriers to animal vaccination against brucellosis. The present study aimed to design and validate a brucellosis prevention questionnaire focused on animal vaccination. The valid questionnaire was used to design, implement, and evaluate an interventional training program.

Method

A brucellosis prevention questionnaire (BPQ) was developed in the exploratory psychometric study. In addition, face-to-face interviews were conducted to formulate its initial items, the results of which were merged with those obtained from literature review. Further, the face, content, and construct validity of the questionnaire were assessed by co-operating livestock breeders, veterinarians, and health educationists. The impact score (IS), and content validity ratio (CVR) and index (CVI) of the items were calculated, and the construct validity of the questionnaire was evaluated through factor analysis. Furthermore, the reliability of the results related to the questionnaire was measured by using Cronbach’s alpha, intra-class correlation coefficient (ICC), and composite reliability, as well as the standard error of measurement (SEM).

Results

The questionnaire was finalized with 53 items and its validity was confirmed by CVI (0.90), CVR (0.74), and IS (4.30). Additionally, the items were loaded into three constructs of awareness, attitude, and practice. Further, the predictive power of awareness, attitude, and practice was determined as 43.43, 15.81, and 15.78%, respectively. Furthermore, the fitness of the proposed model among the constructs was confirmed by the root mean square error of approximation (RMSEA) < 0.08, as well as normed chi-square (× 2/ df) < 5.0, comparative fit index (CFI) ≥ 0.90, and Tucker- Lewis index (TLI) ≥ 0.9.

Conclusion

The brucellosis prevention questionnaire represented acceptable psychometric properties. The factors influencing the preventive behavior of livestock breeders can be identified by applying the questionnaire, and co-operating veterinarians and educational planners.
Intraoperative hypotension is not associated with adverse short-term postoperative outcomes after esophagectomy in esophageal cancer patients
Authors: Yeheyis Ephraim Teffera , Kassa Seyoum , Yeshitela Hiwot , Bekele Abebe
Published: January 2021

Background

The effect of low systolic blood pressure and its subsequent postoperative outcome during esophagectomy for esophageal cancer is not well studied.

Methods

A prospective study was conducted and data were collected on patients who underwent esophagectomy and esophagogastric anastomosis for esophageal cancer. Intraoperative hypotension (IOH), defined as systolic blood pressure (SBP) < 90 mm Hg lasting more than 5 min, was recorded. Patients’ 30 days post-operative composite outcome of mortality, anastomotic leak, and prolonged hospital stay were analyzed as outcome variables.

Result

A total of 54 patients underwent esophagectomy for esophageal cancer during the study period. The mean age was 54 years. The mean duration of the surgery was 208 min. Intraoperative mean low SBP was 80 mmHg while the lowest record was 55 mmHg. IOH occurred in 51% (n = 29) of patients. Anastomotic leak occurred in 7% (n = 4) (OR 1.2, 95% CI 0.26–6.3; p = 0.76). In-hospital mortality was 5% (n = 3) (OR 1.44, 95% CI 0.22–9.3; p = 0.7) and 33% (n = 18) had prolonged hospital stay (OR 0.53, 95% CI 0.14–1.9; p = 0.34). The overall anastomotic leak rate was 13% (n = 7). Multivariate analysis (logistic regression model) showed SBP < 90 mmHg for more than 5 min was not significantly associated either with individual or composite outcomes of mortality, anastomotic leak, and prolonged hospital stay (AOR 1.06, 95% CI 0.98–1.14; p = 0.16)

Conclusion

In patients undergoing esophagectomy for esophageal cancer, a systolic blood pressure < 90 mm Hg for greater than 5 min during surgery has no significant statistical association with composite adverse outcomes of mortality, anastomotic leak, and prolonged hospital stay.
Assessment of the reproducibility and precision of milling and 3D printing surgical guides
Authors: Mukai Sueli , Mukai Eduardo , Santos-Junior José Arnaldo , Shibli Jamil Awad , Faveri Marcelo , Giro Gabriela
Published: January 2021

Background

Technology advancement has rising in the past decade and brought several innovations and improvements. In dentistry, this advances provided more comfortable and quick procedures to both the patient and the dental surgeon, generating less predictability in the final result. Several techniques has been developed for the preparation of surgical guides aiming at the optimization of surgical procedures. The present study aimed to evaluate the reproducibility and precision of two types of surgical guides obtained using 3D printing and milling methods.

Methods

A virtual model was developed that allowed the virtual design of milled (n = 10) or 3D printed (n = 10) surgical guides. The surgical guides were digitally oriented and overlapped on the virtual model. For the milling guides, the Sirona Dentsply system was used, while the 3D printing guides were produced using EnvisionTEC’s Perfactory P4K Life Series 3D printer and E-Guide Tint, a biocompatible Class I certified material. The precision and trueness of each group during overlap were assessed. The data were analyzed with GraphPad software using the Kolmogorov–Smirnov test for normality and Student’s t test for the variables.

Results

The Kolmogorov–Smirnov test showed a normal distribution of the data. Comparisons between groups showed no statistically significant differences for trueness (p = 0.529) or precision (p = 0.3021). However, a significant difference was observed in the standard deviation of mismatches regarding accuracy from the master model (p < 0.0001).

Conclusions

Within the limits of this study, surgical guides fabricated by milling or prototyped processes achieved similar results.
Pelvic organ prolapse surgery and health-related quality of life: a follow-up study
Authors: Belayneh Tadesse , Gebeyehu Abebaw , Adefris Mulat , Rortveit Guri , Gjerde Janne Lillelid , Ayele Tadesse Awoke
Published: January 2021

Background

Symptomatic prolapse impairs quality of life. Health-related quality of life (HRQoL) is considered an important outcome of pelvic organ prolapse (POP) surgery. However, it is rarely reported, and measures are inadequately used. Thus, studies reporting patient-reported surgical outcomes in low-income contexts are needed. This study aims to evaluate the effect of prolapse surgery on patient HRQoL and determine the predictive factors for change in HRQoL.

Methods

A total of 215 patients who had prolapse stage III or IV were enrolled. Patients underwent vaginal native tissue repair, and their HRQoL was evaluated at baseline, 3 and 6 months postoperatively. Effect of surgery on subjective outcomes were measured using validated Prolapse Quality of Life (P-QoL-20), Prolapse Symptom Score (POP-SS), Body Image in Prolapse (BIPOP), Patient Health Questionnaire (PHQ-9), and Patient Global Index of Improvement (PGI-I) tools. A linear mixed-effect model was used to compare pre- and postoperative P-QoL scores and investigate potential predictors of the changes in P-QoL scores.

Results

In total, 193 (89.7%) patients were eligible for analysis at 3 months, and 185 (86.0%) at 6 months. Participant’s mean age was 49.3 ± 9.4 years. The majority of patients had prolapse stage III (81.9%) and underwent vaginal hysterectomy (55.3%). All domains of P-QoL improved significantly after surgery. Altogether more than 72% of patients reported clinically meaningful improvement in condition-specific quality of life measured with P-QoL-20 at 6 months. An improvement in POP-SS, BIPOP, and the PHQ-9 scores were also observed during both follow-up assessments. At 6 months after surgery, only 2.7% of patients reported the presence of bulge symptoms. A total of 97.8% of patients had reported improvement in comparison to the preoperative state, according to PGI-I. The change in P-QoL score after surgery was associated with the change in POP-SS, PHQ, BIPOP scores and marital status (p < 0.001). However, age, type of surgery, and prolapse stage were not associated with the improvement of P-QoL scores.

Conclusions

Surgical repair for prolapse effectively improves patient’s HRQoL, and patient satisfaction is high. The result could be useful for patient counselling on the expected HRQoL outcomes of surgical treatment. Surgical service should be accessible for patients suffering from POP to improve HRQoL.
Addressing the interaction between food insecurity, depression risk and informal work: findings of a cross-sectional survey among informal women workers with young children in South Africa
Authors: Horwood Christiane , Haskins Lyn , Hinton Rachael , Connolly Catherine , Luthuli Silondile , Rollins Nigel
Published: January 2021

Background

There is a high burden of depression globally, including in South Africa. Maternal depression is associated with poverty, unstable income, food insecurity, and lack of partner support, and may lead to poor outcomes for mothers and children. In South Africa one-third of working women are in informal work, which is associated with socioeconomic vulnerability.

Methods

A cross sectional survey explored work setting and conditions, food security and risk of depression among informal working women with young children (0–3 years). Depression risk was assessed using the Edinburgh Postnatal Depression Score (EPDS) and Whooley score. Food insecurity was evaluated using Household Food Insecurity Access Scale. Data was analysed using SPSS and Stata.

Results

Interviews were conducted with 265 informal women workers. Types of work included domestic work, home-based work, informal employees and own account workers, most of whom were informal traders. Most participants (149/265; 56.2%) earned between US$70–200 per month, but some participants (79/265; 29.8%) earned < US$70 per month, and few earned > US$200 per month (37/265; 14.0%). Many participants experienced mild (38/267; 14.3%), moderate (72/265; 27.2%) or severe (43/265; 16%) food insecurity. Severe food insecurity was significantly higher among participants with the lowest income compared to those with the highest income (p = 0.027). Women who received financial support from the baby’s father were less likely to be food insecure (p = 0.03). Using EPDS scores, 22/265 (8.3%) women were designated as being at risk of depression. This was similar among postnatal women and women with older children. Household food insecurity was significantly associated with depression risk (p < 0.001).

Conclusions

Informal women workers were shown to be vulnerable with low incomes and high rates of food insecurity, thus increasing the risk for poor maternal health. However, levels of depression risk were low compared to previous estimates in South Africa, suggesting that informal workers may have high levels of resilience. Interventions to improve social protection, access to health services, and support for safe childcare in the workplace could improve the health and wellbeing of these mothers and support them to care for their children.
Lay persons’ perception of the requirements for research in emergency obstetric and newborn care
Authors: Kaye Dan Kabonge
Published: January 2021

Background

Factors that could potentially act as facilitators and barriers to successful recruitment strategies in perinatal clinical trials are not well documented. The objective was to assess lay persons’ understanding of the informed consent for randomized clinical trial in emergency obstetric and newborn care.

Methods

This was a qualitative study conducted among survivors of severe obstetric complications who were attending the post-natal clinic of Kawempe National Referral Hospital, Uganda, 6–8 weeks after surviving severe obstetric complications during pregnancy or childbirth. The study that involved 18 in-depth interviews was conducted from June 1, 2019 to July 6, 2019. The issues explored included perceptions of the purpose and necessity to conduct such research how research-related information would be disclosed, and what could be the potential benefits and risks of participation. The data was analyzed by thematic analysis.

Results

Respondents felt that research was necessary to investigate the cause, prevention or complications of an illness, especially as much was known about some pregnancy and newborn complications. Most believed that the emergency contexts affects whether and what prospective participants may understand if information about research was disclosed. Whereas they did not see the value of procedures like randomization, they felt that if these and any other procedures necessary should be done transparently and fairly. The decisions to participate would significantly be influenced by possibility of risk to the unborn baby or the newborn. Solidarity was an important influence on decision-making.

Conclusions

Respondents valued participation in RCTs in emergency obstetric and newborn care. However, they expressed concerns and valued openness, transparency and accountability with regard to how clinical trials information is disclosed and the decision-making process for clinical trial participation. While autonomy and solidarity are contradictory values, they complement each other during decision-making for informed consent.
CNFE-SE: a novel approach combining complex network-based feature engineering and stacked ensemble to predict the success of intrauterine insemination and ranking the features
Authors: Ranjbari Sima , Khatibi Toktam , Vosough Dizaji Ahmad , Sajadi Hesamoddin , Totonchi Mehdi , Ghaffari Firouzeh
Published: January 2021

Background

Intrauterine Insemination (IUI) outcome prediction is a challenging issue which the assisted reproductive technology (ART) practitioners are dealing with. Predicting the success or failure of IUI based on the couples' features can assist the physicians to make the appropriate decision for suggesting IUI to the couples or not and/or continuing the treatment or not for them. Many previous studies have been focused on predicting the in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) outcome using machine learning algorithms. But, to the best of our knowledge, a few studies have been focused on predicting the outcome of IUI. The main aim of this study is to propose an automatic classification and feature scoring method to predict intrauterine insemination (IUI) outcome and ranking the most significant features.

Methods

For this purpose, a novel approach combining complex network-based feature engineering and stacked ensemble (CNFE-SE) is proposed. Three complex networks are extracted considering the patients' data similarities. The feature engineering step is performed on the complex networks. The original feature set and/or the features engineered are fed to the proposed stacked ensemble to classify and predict IUI outcome for couples per IUI treatment cycle. Our study is a retrospective study of a 5-year couples' data undergoing IUI. Data is collected from Reproductive Biomedicine Research Center, Royan Institute describing 11,255 IUI treatment cycles for 8,360 couples. Our dataset includes the couples' demographic characteristics, historical data about the patients' diseases, the clinical diagnosis, the treatment plans and the prescribed drugs during the cycles, semen quality, laboratory tests and the clinical pregnancy outcome.

Results

Experimental results show that the proposed method outperforms the compared methods with Area under receiver operating characteristics curve (AUC) of 0.84 ± 0.01, sensitivity of 0.79 ± 0.01, specificity of 0.91 ± 0.01, and accuracy of 0.85 ± 0.01 for the prediction of IUI outcome.

Conclusions

The most important predictors for predicting IUI outcome are semen parameters (sperm motility and concentration) as well as female body mass index (BMI).
Flipped classroom improves Omani nursing students performance and satisfaction in anatomy and physiology
Authors: Joseph Mickaël Antoine , Roach Erna Judith , Natarajan Jansirani , Karkada Suja , Cayaban Arcalyd Rose Ramos
Published: January 2021

Background

Nursing students struggle with anatomy and physiology course because of the complicated terminology and the difficulty in handling large amounts of information. New, innovative instructional strategies must be integrated into nursing education to improve nursing students’ performance in this challenging bioscience course. The aim of this study was to determine the impact of an innovative teaching strategy, the flipped classroom, on the performance and satisfaction of Omani nursing students in an anatomy and physiology course.

Methods

A quasi-experimental design was used with two classes of 112 first-year nursing students at the College of Nursing, Sultan Qaboos University, Oman. Online videos and active-learning activities about the respiratory system were developed and implemented in an anatomy and physiology course with 53 first-semester nursing students. The control group consisted of a previous cohort of 59 students enrolled in the same course but taught with a traditional lecture approach. The impact of the flipped classroom strategy was measured by students’ performance on the final examination and students’ self-reported satisfaction. Wilcoxon signed-rank and Mann-Whitney U tests were used to compare students’ academic performance.

Results

Our results showed that the performance of the flipped classroom group was better than that of the traditional lecture group. The mean scores of students instructed with the flipped classroom method on the respiratory system items in the final examination were significantly higher than those of the control group, U = 1089.00, z = − 2.789, p < .005. Moreover, the results of a survey showed that nursing students were satisfied with the flipped classroom method. Overall, 68 to 78% of students agreed or strongly agreed that the flipped classroom method improved their learning and increased their interest in the course.

Conclusion

Compared with the didactic lecture format, flipped classroom strategy improved Omani nursing students’ performance in and satisfaction with an anatomy and physiology course. These results show that the flipped classroom is an important teaching strategy in nursing education.
Evidence that collaborative action between local health departments and nonprofit hospitals helps foster healthy behaviors in communities: a multilevel study
Authors: Cramer Geri Rosen , Young Gary J. , Singh Simone , McGuire Jean , Kim Daniel
Published: January 2021

Background

The Patient Protection and Affordable Care Act of 2010 (ACA) encouraged nonprofit hospitals to collaborate with local public health experts in the conduct of community health needs assessments (CHNAs) for the larger goal of improving community health. Yet, little is known about whether collaborations between local health departments and hospitals may be beneficial to community health. In this study, we investigated whether individuals residing in communities with stronger collaboration between nonprofit hospitals and local public health departments (LHDs) reported healthier behaviors. We further explored whether social capital acts as a moderating factor of these relationships.

Methods

We used multilevel cross-sectional models, controlling for both individual and community-level factors to explore LHD-hospital collaboration (measured in the National Association of County and City Health Officials (NACCHO) Forces of Change Survey), in relation to individual-level health behaviors in 56,826 adults living in 32 metropolitan and micropolitan statistical areas, captured through the 2015 Behavioral Risk Factor Surveillance System (BRFSS) SMART dataset. Nine health behaviors were examined including vigorous exercise, eating fruits and vegetables, smoking and binge drinking. Social capital, measured using an index developed by the Northeast Regional Center for Rural Development, was also explored as an effect modifier of these relationships.

Results

Stronger collaboration between nonprofit hospitals and LHDs was associated with not smoking (odds ratio, OR 1.32, 95% CI 1.11 to 1.58), eating vegetables daily (OR 1.29; 95% CI 1.06 to 1.57), and vigorous exercise (OR 1.17; 95% CI 1.05 to 1.30). The presence of higher social capital also strengthened the relationships between LHD-hospital collaborations and wearing a seatbelt (p for interaction = 0.01) and general exercise (p for interaction = 0.03).

Conclusions

Stronger collaboration between nonprofit hospitals and LHDs was positively associated with healthier individual-level behaviors. Social capital may also play a moderating role in improving individual and population health.
Deletions of pfhrp2 and pfhrp3 genes were uncommon in rapid diagnostic test-negative Plasmodium falciparum isolates from Uganda
Authors: Nsobya Sam L. , Walakira Andrew , Namirembe Elizabeth , Kiggundu Moses , Nankabirwa Joaniter I. , Ruhamyankaka Emmanuel , Arinaitwe Emmanuel , Conrad Melissa D. , Kamya Moses R. , Dorsey Grant , Rosenthal Philip J.
Published: January 2021

Background

Rapid diagnostic tests (RDTs) play a key role in malaria case management. The most widely used RDT identifies Plasmodium falciparum based on immunochromatographic recognition of P. falciparum histidine-rich protein 2 (PfHRP2). Deletion of the paralogous pfhrp2 and pfhrp3 genes leads to false-negative PfHRP2-based RDTs, and has been reported in P. falciparum infections from South America and Africa. However, identification of pfhrp2/pfhrp3 deletions has usually been based only on failure to amplify these genes using PCR, without confirmation based on PfHRP2 protein expression, and understanding of the true prevalence of deletions is incomplete.

Methods

Deletions of pfhrp2/pfhrp3 in blood samples were investigated from cross-sectional surveys in 2012-13 in three regions of varied malaria transmission intensity in Uganda. Samples with positive Giemsa-stained thick blood smears, but negative PfHRP2-based RDTs were evaluated by PCR amplification of conserved subunit ribosomal DNA for Plasmodium species, PCR amplification of pfhrp2 and pfhrp3 genes to identify deletions, and bead-based immunoassays for expression of PfHRP2.

Results

Of 3516 samples collected in cross-sectional surveys, 1493 (42.5%) had positive blood smears, of which 96 (6.4%) were RDT-negative. Of these 96 RDT-negative samples, P. falciparum DNA was identified by PCR in 56 (58%) and only non-falciparum plasmodial DNA in 40 (42%). In all 56 P. falciparum-positive samples there was a failure to amplify pfhrp2 or pfhrp3: in 25 (45%) pfhrp2 was not amplified, in 39 (70%) pfhrp3 was not amplified, and in 19 (34%) neither gene was amplified. For the 39 P. falciparum-positive, RDT-negative samples available for analysis of protein expression, PfHRP2 was not identified by immunoassay in only four samples (10.3%); these four samples all had failure to amplify both pfhrp2 and pfhrp3 by PCR. Thus, only four of 96 (4.2%) smear-positive, RDT-negative samples had P. falciparum infections with deletion of pfhrp2 and pfhrp3 confirmed by failure to amplify the genes by PCR and lack of expression of PfHRP2 demonstrated by immunoassay.

Conclusion

False negative RDTs were uncommon. Deletions in pfhrp2 and pfhrp3 explained some of these false negatives, but most false negatives were not due to deletion of the pfhrp2 and pfhrp3 genes.
Effect of a low-FODMAP diet for the management of functional abdominal pain disorders in children: a study protocol for a randomized controlled trial
Authors: Stróżyk Agata , Horvath Andrea , Muir Jane , Szajewska Hania
Published: January 2021

Background

Evidence from studies in adults documents that fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) may be triggers of symptoms in individuals with functional abdominal pain disorders (FAPDs). However, in children, the evidence is very limited. We aim to assess the effects of a low-FODMAP diet compared with a regular diet for the management of children with FAPDs.

Methods

We will perform a randomized, quadruple-blinded, controlled trial. Seventy-four children aged 8 to 18 years with a FAPD (Irritable Bowel Syndrome or Functional Abdominal Pain-Not Otherwise Specified), diagnosed according to the Rome IV criteria, will be randomly allocated to receive either a low-FODMAP diet or a regular diet for 4 weeks. The primary outcome will be the percentage of the responders, defined as the participants who have at least 30% improvement in abdominal pain intensity on a Visual Analogue Scale (VAS) during the last week of the trial compared with baseline, that is at least equal to the Reliable Change Index (≥ 25 mm change on VAS). Other outcomes will include changes in stool consistency, abdominal pain frequency, total scores on the Gastrointestinal Symptom Rating Scale, KIDSCREEN-10 Index and World Health Organization Five Well-Being Index, child’s school attendance and parents’ work absenteeism, and BMI-for-age z-score. Compliance, tolerability of the low-FODMAP diet, and adverse events also will be evaluated. Each FAPD subtype will be assessed separately.

Discussion

There is a need for high-quality evidence regarding the dietary management of children with FAPDs. This randomized controlled trial (RCT) of rigorous methodological design will help to establish the effectiveness, if any, of a low-FODMAP diet for the management of FAPDs in the pediatric population. The findings of this RCT will assist with the development of guidelines and influence the direction of further research.

Trial registration

NCT04528914

Data and protocol version identifier:24/08/2020
Correction to: circRIP2 accelerates bladder cancer progression via miR-1305/Tgf-β2/smad3 pathway
Authors: Su Yinjie , Feng Weilian , Shi Juanyi , Chen Luping , Huang Jian , Lin Tianxin
Published: January 2021

An amendment to this paper has been published and can be accessed via the original article.
Preoperative false-negative transthoracic echocardiographic results in native valve infective endocarditis patients: a retrospective study from 2001 to 2018
Authors: Ren Zuning , Zhang Jian , Chen Hongjie , Mo Xichao , Cai Shaohang , Peng Jie
Published: January 2021

Background

Infective endocarditis (IE) is a lethal disease that is difficult to diagnosis early. Although echocardiography is one of the most widely used diagnostic technique, it has limited sensitivity. This study surveyed the clinical features of IE patients who underwent surgery and compared transthoracic echocardiography and histological findings to explore the factors related to false-negative echocardiographic results.

Methods

Medical records were extracted from IE patients consecutively hospitalized between June 2001 and June 2018.

Results

A total of 182 patients with native valve IE who underwent surgery were included. Compared to the non-surgery group, the surgery group was more likely to have pre-existing valvular lesions and more serious cardiac conditions and a relative lack of signs of infection and cerebrovascular events, leading to a lower proportion of “definite cases” before surgery. The false-negative rate of echocardiography was 14.5%. Echocardiography has significant disadvantages in diagnosing perivalvular abscesses, valve perforations, and left-sided endocarditis, especially for subjects with both aortic and mitral valve infections. The multivariate analysis identified congenital heart disease and small vegetations (< 10 mm) as independent predictors of false-negative echocardiography results. Conversely, fever and heart murmurs on admission served as protective factors.

Conclusions

Under some circumstances, echocardiography provides inconsistent results compared with surgical findings, and negative echocardiography results do not rule out IE. The diagnosis of IE depends on comprehensive evaluations using multiple methods.
Safety and effects of volume loading during transesophageal echocardiography in the pre-procedural work-up for left atrial appendage closure
Authors: Freitas-Ferraz Afonso B. , Bernier Mathieu , O’Connor Kim , Beaudoin Jonathan , Champagne Jean , Paradis Jean-Michel , O’Hara Gilles , Muntané- Carol Guillem , Alperi Alberto , Faroux Laurent , Junquera Lucia , Rodés-Cabau Josep
Published: January 2021

Background

In patients undergoing left atrial appendage (LAA) closure, an accurate sizing of the LAA is key to optimize device sizing, procedural success and reduce complications. Previous studies have shown that intraprocedural volume loading increases LAA dimensions and improves device sizing. However, the safety and effects on LAA and device sizing of administering a fluid bolus during pre-procedural transesophageal echocardiography (TEE) are unknown. The aim of this study was to determine the safety and impact on LAA dimensions and device sizing of an intravenous (IV) fluid bolus administered during TEE in the setting of the pre-procedural work-up for LAA closure.

Methods

The study included a total of 72 patients who underwent TEE to assess suitability for LAAC and received a 500 ml IV bolus of normal saline. The LAA landing zone (LZ) and depth were measured by TEE before and after volume loading, and these measurements were used to predict the device size implanted during a subsequent percutaneous LAAC procedure.

Results

There were no complications associated with volume loading. The baseline mean LZ was 19.6 ± 3.6 mm at 90o, and 20.2 ± 4.1 mm at 135o. Following fluid bolus, the maximum diameter increased 1.5 ± 1.0 mm at 90o (p<0.001), and 1.3 ± 1.0 mm at 135o (p<0.001). The baseline mean depth of the LAA was 26.5 ± 5.5 mm at 90o, and 23.9 ± 5.8 mm at 135o. After fluid bolus, the mean depth increased by 1.5 ± 1.8 mm (p<0.001) and 1.6 ± 2.0 (p<0.001), at 90o and 135o, respectively. Sizing based on post-bolus measurements of the LZ significantly improved the agreement with the final device size selection during the procedure in 71.0% of cases (vs. 42.0% with pre-bolus measurements).

Conclusions

Volume loading during ambulatory TEE as part of the pre-procedural work-up of LAAC is safe and significantly increases LAA dimensions. This strategy may become the new standard, particularly in centers performing LAAC with no TEE guidance, as it improves LAA sizing and more accurately predicts the final device size.
Left atrial functional assessment and mortality in patients with severe aortic stenosis with sinus rhythm
Authors: Ferreira João , Gonçalves Valdirene , Marques-Alves Patrícia , Martins Rui , Monteiro Sílvia , Teixeira Rogério , Gonçalves Lino
Published: January 2021

Background

Aortic valve stenosis (AS) is the most common primary valvular heart disease leading to surgical or percutaneous aortic valve replacement (AVR) in Europe and its prevalence keeps growing. While other risk factors in severe AS are well documented, little is known about the prognostic value of left atrial (LA) function in AS. Our aim is to clarify the relationship between LA function measured at severe AS diagnosis (evaluated by means of volumetric assessment) and all-cause mortality during follow-up.

Methods

We retrospectively evaluated patients diagnosed with severe AS for the first time at our echocardiography laboratory. We evaluated LA reservoir, conduit and pump function by measuring LA volumes at different timings of cardiac cycle. Treatment strategy was decided according to heart team consensus and patient decision. We divided patients into groups according to terciles of LA reservoir, conduit and pump function. Primary outcome was defined by the occurrence of all-cause mortality during follow-up.

Results

A total of 408 patients were included in the analysis, with a median follow-up time of 45 months (interquartile range 54 months). 57.9% of patients underwent AVR and 44.9% of patients registered the primary outcome during follow-up. Left atrial emptying fraction (LAEF) was the best LA functional parameter and the best overall parameter in discriminating primary outcome (AUC 0.845, 95%CI 0.81–0.88, P < 0.001). After adjustment for clinical, demographic and echocardiographic variables, cumulative survival of patients with LAEF < 37% and LAEF 37 to 53% relative to patients with LAEF ≥54% remained significantly lower (HR 13.91, 95%CI 6.20–31.19, P < 0.001 and HR 3.40, 95%CI 1.57–7.37, P = 0.002, respectively). After adjustment for AVR, excess risk of LAEF < 37% and LAEF 37 to 53% relative to LAEF ≥54% remained significant (HR 11.71, 95%CI 5.20–26.40, P < 0.001 and HR 3.59, 95%CI 1.65–7.78, P = 0.001, respectively).

Conclusions

In patients with a first diagnosis of severe AS, LA function, evaluated by means of volumetric assessment, is an independent predictor of all-cause mortality and a more potent predictor of death compared to classical severity parameters. These data can be useful to identify high-risk patients who might benefit of AVR.
Psychometric properties of a new self-report measure of medical student stress using classic and modern test theory approaches
Authors: Mosquera Matthew J. , Kaat Aaron , Ring Melinda , Agarwal Gaurava , Glickson Sydney , Victorson David
Published: January 2021

Background

Medical students face significant stressors related to the intense rigors of their training and education. Accurate measurement of their stress is important to quickly identify, characterize and ameliorate these challenges. Existing measures have limitations that modern measurement approaches, such as item response theory (IRT), are able to address. This study presents the calibration and validation of a new IRT-based measure called the Medical Student Stress Scale (MSSS).

Methods

Following rigorous measurement development procedures described elsewhere, the authors created and tested a pool of 35 items with 348 1st – 4th year medical students along with demographic and external validity measures. Psychometric analysis included exploratory and confirmatory factor analyses, IRT modeling, and correlations with legacy measures.

Results

Of the original 35 items, 22 were retained based on their ability to discriminate, provide meaningful information, and perform well against legacy measures. The MSSS differentiated stress scores between male and female students, as well as between year in school.

Conclusion

Developed with input from medical students, the MSSS represents a student-centered measurement tool that provides precise, relevant information about stress and holds potential for screening and outcomes-related applications.