bluuebunny/crossref_metadata_2025 huggingface dataset:
Do biometric parameters improve the quality of optic nerve head measurements with spectral domain optical coherence tomography?
Authors: Elksne E. , Stingl J. V. , Schuster A. K. , Wagner F. M. , Hoffmann E. M.
Published: February 2022

Background

Spectral domain optical coherence tomography (SD-OCT) is a widely applied non-invasive technique for evaluating optic nerve head parameters. The aim of this study was to evaluate the impact of biometric parameters such as the spherical equivalent (SE) and the anterior corneal curvature (ACC) on the peripapillary retinal nerve fiber layer (pRNFL), Bruch’s membrane opening (BMO), and the minimum rim width (MRW) measurements performed by spectral domain optical coherence tomography (SD-OCT) in glaucomatous and healthy eyes.

Methods

In this cross-sectional, case–control prospective pilot study, the glaucoma group consisted of 50 patients with previously diagnosed and treated glaucoma and one healthy group of 50 subjects. Two consecutive examinations of pRNFL, BMO, and MRW with SD-OCT for every patient were performed without ACC and objective refraction (imaging 1) and with them (imaging 2).

Results

The interclass correlation coefficient (ICC) reflected high agreement between imaging 1 and imaging 2 in both groups. The ICC in the glaucoma and healthy groups for pRNFL (0.99 vs. 0.98), BMO (0.95 vs. 0.97), and MRW (1.0 vs. 1.0) was comparable.

Conclusions

Our preliminary data from a small number of eyes showed that the measurements of pRNFL, MRW, and BMO reflected high agreement between both imaging techniques with ACC and objective refraction and without these parameters in subjects with a refractive error up to ± 6.0 diopters. Further studies with participants with higher refractive error are necessary to evaluate the impact of biometric parameters such as SE and ACC on measurements with SD-OCT.
An innovative approach in monitoring oral cholera vaccination campaign: integration of a between-round survey
Authors: Ateudjieu Jerôme , Yakum Martin Ndinakie , Goura André Pascal , Tembei Ayok Maureen , Guenou Etienne , Kangmo Sielinou Corine Blondo , Kiadjieu Frank Forex , Tsafack Marcellin , Douanla Koutio Ingrid Marcelle , Tchio-Nighie Ketina Hirma , Tchokomeni Hervé , Ntsekendio Paul Nyibio , Sack David A.
Published: February 2022

Background

Monitoring and Evaluation (M&E) is essential in ensuring population’s access to immunization. Surveys are part of this M&E approach but its timing limits the use of its results to improve the coverage of the evaluated campaign. An oral cholera vaccination campaign was organized in a health district of the Far North region of Cameroon and involved an innovative M&E approach. The aim of this project was to assess the feasibility and effect of using recommendations of a community-based immunization and communication coverage survey conducted after the first round of an OCV campaign on the coverage of the second-round of the campaign.

Methods

Two community-based surveys were included in the M&E plan and conducted at the end of each of the campaign rounds. Data were collected by trained and closely supervised surveyors and reported using smartphones. Key results of the first-round survey were disseminated to campaign implementing team prior to the second round. The two rounds of the pre-emptive campaign were organized by the Cameroon Ministry of Public Health and partners with a two-week interval in the Mogode Health District of the Far North region of Cameroon in May and June 2017.

Results

Of 120 targeted clusters, 119 (99.1%) and 117 (97.5%) were reached for the first and second rounds respectively. Among the Mogode population eligible for vaccination, the immunization coverage based on evidence (card or finger mark) were estimated at 81.0% in the first round and increased to 88.8% in the second round (X2=69.0 and p <0.00). For the second round, we estimated 80.1% and 4.3% of persons who were administered 2 doses and 1 dose of OCV with evidence respectively, and 3.8% of persons who have not been vaccinated. The distribution of campaign communication coverage per health area was shared with the campaign coordination team for better planning of the second round campaign activities.

Conclusions

It is feasible to plan and implement coverage survey after first round OCV campaign and use its results for the better planning of the second round. For the present study, this is associated to the improvement of OCV coverage in the second-round vaccination. If this is persistent in other contexts, it may apply to improve coverage of any health campaign that is organized in more than one round.
Development of an intervention for the social reintegration of adolescents and young adults affected by cancer
Authors: Broholm-Jørgensen Marie , Tjørnhøj-Thomsen Tine , Pedersen Pia Vivian
Published: February 2022

Background

In Denmark, around 500 adolescents and young adults (AYAs) aged 15–29 are diagnosed with cancer each year. AYAs affected by cancer constitute a vulnerable group in need of special support in pursuing everyday life as young people. These needs are, however, not currently being adequately met. This study explores the distinctive needs of AYAs aged 15–25 and affected by cancer with the aim of developing and designing an intervention that accommodates these needs and allows AYAs to pursue everyday life following active cancer treatment.

Methods

We combined multiple qualitative methods to conduct six sub-studies: 1) participant observation among support groups for AYAs affected by cancer, 2) field visit at a large Danish hospital, 3) qualitative interviews with AYAs currently or previously diagnosed with cancer, 4) qualitative interviews with practitioners working with young cancer patients or AYAs with chronic conditions, 5) an interactive workshop with practitioners, and 6) an interactive workshop with AYAs. The empirical material was collected between May 2016 and April 2019. The empirical material was read, analysed thematically and coded into the themes; 1) diagnosis and treatment, 2) form of education and 3) age, financial challenges and legal entitlements.

Results

Across the empirical material, we found that AYAs’ cancer experience was heterogeneous. The needs of AYAs differed according to 1) diagnosis and treatment, 2) type of education and 3) age, financial situation and legal entitlements. The findings demonstrate a need for a tailored intervention accommodating the variety of opportunities, requirements and challenges of AYAs with cancer. We propose an intervention consisting of a multidisciplinary team sited at the hospital where the individual AYA receives treatment. The team’s main task will be to maintain AYAs’ social competences and ease their return to everyday life after serious illness by balancing educational requirements with cancer treatment.

Conclusion

Based on the perspectives of practitioners and AYAs affected by cancer, this study outlines an intervention designed as a care pathway in which a multidisciplinary team provides individual and tailored support to AYAs with cancer from the time of diagnosis during and beyond active cancer treatment.
Health-seeking behavior of COVID-19 cases during the first eight weeks of the outbreak in Singapore: differences between local community and imported cases and having visits to single or multiple healthcare providers
Authors: Tay Min Zhi , Ang Li Wei , Wei Wycliffe Enli , Lee Vernon J. M. , Leo Yee-Sin , Toh Matthias Paul H. S.
Published: February 2022

Background

COVID-19 is a novel pandemic affecting almost all countries leading to lockdowns worldwide. In Singapore, locally-acquired cases emerged after the first wave of imported cases, and these two groups of cases may have different health-seeking behavior affecting disease transmission. We investigated differences in health-seeking behavior between locally-acquired cases and imported cases, and within the locally-acquired cases, those who saw single versus multiple healthcare providers.

Methods

We conducted a retrospective study of 258 patients who were diagnosed with COVID-19 from 23 January to 17 March 2020. Variables related to health-seeking behavior included number of visits prior to hospitalization, timing of the first visit, duration from symptom onset to admission, and places where the cases had at least one visit.

Results

Locally-acquired cases had longer duration from onset of symptoms to hospital admission (median 6 days, interquartile range [IQR] 4–9) than imported cases (median 4 days, IQR 2–7) (p < 0.001). Singapore residents were more likely to have at least one visit to private clinics and/or government-subsidized public clinics than non-residents (84.0% vs. 58.7%,p < 0.001). Among locally-acquired cases, those who sought care from a single healthcare provider had fewer visits before their hospital admissions compared with those who went to multiple providers (median 2 vs. 3,p = 0.001).

Conclusion

Our study indicates the need to encourage individuals to seek medical attention early on in their patient journey, particularly from the same healthcare provider. This in turn, would facilitate early detection and isolation, hence limiting local transmission and enabling better control of the COVID-19 outbreak.
Is the pre-natal period a missed opportunity for communicating with parents about immunizations? Evidence from a longitudinal qualitative study in Victoria, British Columbia
Authors: Rubincam Clara , Greyson Devon , Haselden Constance , Saunders Robin , Bettinger Julie A.
Published: February 2022

Background

Growing evidence shows that many parents begin the decision-making process about infant vaccination during pregnancy and these decisions – once established – may be resistant to change. Despite this, many interventions targeting vaccination are focused on communicating with parents after their baby is born. This suggests that the prenatal period may constitute a missed opportunity for communicating with expectant parents about infant vaccination.

Methods

Using a longitudinal qualitative design, we conducted two interviews (prepartum and postpartum) with women (n = 19) to explore the optimal timing of vaccination information. The data were analyzed thematically, and examined across all sets of pre- and post-partum interviews as well as within each individual participant to draw out salient themes.

Results

Most participants formed their intentions to vaccinate before the baby was born and indicated that they would welcome information about vaccination from their maternity care providers. However, few individuals recalled their maternity care providers initiating vaccination-related conversations with them.

Conclusion

The prenatal period is an important time to begin conversations with expectant parents about vaccinating their infants, particularly if these conversations are initiated by trusted maternity care providers. More information is needed on how maternity care providers can be better supported to have these conversations with their patients.
Study protocol ROTATE-trial: anterior cruciate ligament rupture, the influence of a treatment algorithm and shared decision making on clinical outcome– a cluster randomized controlled trial
Authors: de Vos Floris H. , Meuffels Duncan E. , de Mul Marleen , Askari Marjan , Ista Erwin , Polinder Suzanne , Waarsing Erwin , Bierma-Zeinstra Sita M. , Reijman Max ,   on behalf of the ROTATE study group, van Arkel E. R. A. , Brouwer R. W. , Langeveld A. R. J. , Riedijk R. , Zijl J. A. C. , Janssen R. P. A. , Hofstee D. J. , Zuurmond R. G. , van Rhee M. A.
Published: February 2022

Background

Anterior cruciate ligament (ACL) rupture is a very common knee injury in the sport active population. There is much debate on which treatment (operative or non-operative) is best for the individual patient. In order to give a more personalized recommendation we aim to evaluate the effectiveness and cost-effectiveness of a treatment algorithm for patients with a complete primary ACL rupture.

Methods

The ROTATE-trial is a multicenter, open-labeled cluster randomized controlled trial with superiority design. Randomization will take place on hospital level (n = 10). Patients must meet all the following criteria: aged 18 year or older, with a complete primary ACL rupture (confirmed by MRI and physical examination) and maximum of 6 weeks of non-operative treatment. Exclusion criteria consists of multi ligament trauma indicated for surgical intervention, presence of another disorder that affects the activity level of the lower limb, pregnancy, and insufficient command of the Dutch language. The intervention to be investigated will be an adjusted treatment decision strategy, including an advice from our treatment algorithm. Patient reported outcomes will be conducted at baseline, 3, 6, 12 and 24 months. Physical examination of the knee at baseline, 12 and 24 months. Primary outcome will be function of the knee measured by the International Knee Documentation Committee (IKDC) questionnaire. Secondary outcomes are, among others, the Tegner activity score, the Knee injury and Osteoarthritis Outcome Score (KOOS) and the 9-item Shared Decision Making Questionnaire (SDM-Q-9). Healthcare use, productivity and satisfaction with ((non-)operative) care are also measured by means of questionnaires. In total 230 patients will be included, resulting in 23 patients per hospital.

Discussion

The ROTATE study aims to evaluate the effectiveness and cost-effectiveness of a treatment algorithm for patients with a complete primary ACL rupture compared to current used treatment strategy. Using a treatment algorithm might give the much-wanted personalized treatment recommendation.

Trial registration

This study is approved by the Medical Research Ethics Committee of Erasmus Medical Center in Rotterdam and prospectively registered at the Dutch Trial Registry on May 13th, 2020. Registration number: NL8637.
Effects of workplace upper extremity resistance exercises on function and symptoms of workers at a tertiary hospital: a randomized controlled trial protocol
Authors: da Silva Natália Claro , Ricci Flávia Pessoni Faleiros Macedo , de Castro Vinícius Restani , de Lima Alessandra Cristina Ramos , do Carmo Lopes Ester R. , de Salvo Mauad Leonardo Dutra , Kawano Suzuki Karen A. , de Oliveira Medeiros Maria Eloísa , de Santana Joyce Silva , Rocha Fernanda Ludmilla Rossi , de Cássia Registro Fonseca Marisa
Published: February 2022

Background

Work-related musculoskeletal disorders (WRMDs) are often caused by inadequate use of the musculoskeletal system during work. Evidence suggests that multimodal intervention through exercises, massage, education, and ergonomic guidelines reduces pain and symptoms in the neck and upper extremities and help to prevent musculoskeletal disorders. The purpose of this study will be to assess the additive effectiveness of a specific and individualized workplace strengthening exercise program to an ergonomic guidance in reducing fatigue, pain and discomfort in the upper extremities and neck perceived by workers.

Methods

This trial was designed according to the Consolidated Standards of Reporting Trials - CONSORT guidelines. Participants will be employees of a tertiary hospital, with any complaints of pain or discomfort in the upper extremities during the past 12 months, without clinical musculoskeletal diagnosis. 166 participants will be randomized into parallels groups as control and workplace exercises. The primary outcomes will be Numerical Pain Scale, isokinetic muscle strength of abduction and isometric handgrip strength. Secondary outcomes on discomfort, fatigue, work capacity and dysfunction will be assessed by QuickDASH, Patient Specific Functional Scale, Neck Disability Index, Need for recovery, Work Ability Index self-report questionnaires and FIT-HANSA performance test. The Ergonomic Work Analysis will be done by Quick Expose Check, RULA, REBA, RARME, ROSA and HARM risk assessment ergonomic tools. We will analyze the difference between baseline and 12 weeks of intervention by T test of independent samples (95% confidence interval,p < 0.05). Clinical significance will be analyzed by the minimum clinically important difference and effect size by Cohen index. The association between the variables will be analyzed by construct validity with the hypothesis of correlations between pain and muscle strength, strength and functionality and strength and fatigue.

Discussion

Although studies have shown promise outcomes for workplace exercises as an available therapeutic resource used to minimize complaints of pain and discomfort related to work, the results of this study aim to bring evidence about the benefit of a specific resistance exercise as an effective modality to facilitate mechanisms of neuromuscular adaptations, with gradual and posterior hypertrophy in the later phases.

Trial registration

(NCT04047056,https://clinicaltrials.gov/ct2/show/NCT04047056?term=NCT04047056&draw=2&rank=1) on Dec 03, 2020.
Evaluation of MR-derived simulated CT-like images and simulated radiographs compared to conventional radiography in patients with shoulder pain: a proof-of-concept study
Authors: Feuerriegel Georg C. , Kopp Felix K. , Pfeiffer Daniela , Pogorzelski Jonas , Wurm Markus , Leonhardt Yannik , Boehm Christof , Kronthaler Sophia , Karampinos Dimitrios C. , Neumann Jan , Schwaiger Benedikt J. , Makowski Marcus R. , Woertler Klaus , Gersing Alexandra S.
Published: February 2022

Background

To evaluate the diagnostic value of MR-derived CT-like images and simulated radiographs compared with conventional radiographs in patients with suspected shoulder pathology.

Methods

3 T MRI of the shoulder including a 3D T1-weighted gradient echo sequence was performed in 25 patients (mean age 52.4 ± 18 years, 13 women) with suspected shoulder pathology. Subsequently a cone-beam forward projection algorithm was used to obtain intensity-inverted CT-like images and simulated radiographs. Two radiologists evaluated the simulated images separately and independently using the conventional radiographs as the standard of reference, including measurements of the image quality, acromiohumeral distance, critical shoulder angle, degenerative joint changes and the acromial type. Additionally, the CT-like MR images were evaluated for glenoid defects, subcortical cysts and calcifications. Agreement between the MR-derived simulated radiographs and conventional radiographs was calculated using Cohen’s Kappa.

Results

Measurements on simulated radiographs and conventional radiographs overall showed a substantial to almost perfect inter- and intra-rater agreement (κ = 0.69–1.00 and κ = 0.65–0.85, respectively). Image quality of the simulated radiographs was rated good to excellent (1.6 ± 0.7 and 1.8 ± 0.6, respectively) by the radiologists. A substantial agreement was found regarding diagnostically relevant features, assessed on Y- and anteroposterior projections (κ = 0.84 and κ = 0.69 for the measurement of the CSA; κ = 0.95 and κ = 0.60 for the measurement of the AHD; κ = 0.77 and κ = 0.77 for grading of the Samilson-Prieto classification; κ = 0.83 and κ = 0.67 for the grading of the Bigliani classification, respectively).

Conclusion

In this proof-of-concept study, clinically relevant features of the shoulder joint were assessed reliably using MR-derived CT-like images and simulated radiographs with an image quality equivalent to conventional radiographs. MR-derived CT-like images and simulated radiographs may provide useful diagnostic information while reducing the amount of radiation exposure.
Long-term outcomes of transanal endoscopic microsurgery for the treatment of rectal neuroendocrine tumors
Authors: Shi Wei-Kun , Hou Rui , Li Yun-Hao , Qiu Xiao-Yuan , Liu Yu-Xin , Wu Bin , Xiao Yi , Zhou Jiao-Lin , Lin Guo-Le
Published: February 2022

Background

Transanal endoscopic microsurgery (TEM) has been accepted worldwide for the treatment of local rectal lesions. We aimed to assess the efficacy and safety of TEM in the treatment of rectal neuroendocrine tumors (RNET).

Methods

A retrospective study of patients who had undergone TEM for RNET at our institution between December 2006 and June 2019 was performed. Demographic and tumor characteristics, operative and pathological details, complications, anal function questionnaires, and follow-up data were included.

Results

A total of 144 patients was included. TEM was performed as primary excision in 54 patients, after endoscopic forceps biopsy in 57 patients, and after incomplete resection by endoscopic excision in 33 patients. The median size of all primary tumors was 0.6 cm (range, 0.3–2.0 cm), and the negative resection margin was achieved in 142 (98.6%) patients. Postoperative complications (referring to only bleeding) occurred in 3 (2.1%) patients and was successfully managed with conservative method. After a median follow-up of 75.5 months after surgery, 3 patients died of other causes, and 2 patients suffered metastasis. An anal function questionnaire was posted 24 months after TEM. Among the results, 3 (2.1%) patients complained of major low anterior resection syndrome (LARS), including 1 (0.7%) who suffered from complete incontinence, while 6 (4.2%) patients had minor LARS.

Conclusions

TEM has satisfying long-term outcomes and relatively low anal function disturbance as for the treatment of small RNET. TEM also acts as a preferred salvage treatment for incomplete endoscopic excision.
Morphological changes of the root apex in anterior teeth with periapical periodontitis: an in-vivo study
Authors: Zhang Chen-chen , Liu Ya-jing , Yang Wei-dong , Zhang Qian-nan , Zha Ming-zhu , Wen Shan-hui , Wang Qi
Published: February 2022

Introduction

The aim was to analyze the morphological changes of root apex in anterior teeth with periapical periodontitis.

Methods

32 untreated anterior teeth with periapical periodontitis were enrolled, compared with the healthy contralateral teeth. Two-dimensional measurement of Cone-beam computed tomography was used to determine the location and measure diameter of the apical constriction according to Schell’s methods. An open-source software (3D Slicer) was used to reconstruct the teeth. The apical constriction form was analysis according to Schell’s topography. The distances of apical constriction to apical foramen and anatomical apex were measured respectively.

Results

The difference value between buccolingual and mesiodistal diameter was (0.06 ± 0.09) mm and (0.04 ± 0.04) mm in periapical periodontitis and controls (p < 0.05). The mean distance between apical constriction and anatomical apex was significantly shorter in periapical periodontitis than controls, so was the mean distance of apical constriction to apical foramen. The most common form of apical constriction was flaring (65.6%) in periapical periodontitis.

Conclusions

The anterior teeth with periapical periodontitis had shorter distances of apical constriction to anatomical apex and apical foramen, bigger disparities between the diameters of buccolingual and mesiodistal, and higher proportion of flaring apical constriction.
Influence of margin design and restorative material on the stress distribution of endocrowns: a 3D finite element analysis
Authors: Zheng Ziting , Sun Jieli , Jiang Lifang , Wu Yuan , He Jiahui , Ruan Wenhao , Yan Wenjuan
Published: February 2022

Background

This study aimed to evaluate the stress distributions in endocrown restorations as applied to endodontically treated teeth (ETT), according to the factors of “margin design” (four levels) and “restorative material” (six levels).

Methods

Four 3D-finite elements models were constructed for endocrown restored molars considering different margin designs. Model A was prepared with a flat butt joint margin and received an endocrown with a 2.0-mm occlusal thickness. Model B was prepared with a 20° bevel margin and received an endocrown with a 2.0-mm occlusal thickness. Model C was prepared with an axial reduction and 1-mm shoulder margin and received an endocrown with a 2.0-mm occlusal thickness. Model D was prepared with an anatomic margin and received an endocrown with a 2.0-mm occlusal thickness. The following endocrown materials were used: In-Ceram Zirconia (Zr), Vita Suprinity (VS), IPS Empress (IE), Grandio blocs (GR), VisCalor bulk (VS), and CopraPeek Light (CP). The Load application (600 N) was performed at the food bolus and tooth surface during the closing phase of the chewing cycle. The results for the endocrown and tooth remnants were determined according to the von Mises stress. The failure risk of the cement layer was also calculated based on the normal stress criterion.

Results

Model D (with an anatomic margin) showed the greatest stress concentrations, especially in the irregular and sharp angles of the restoration and tooth remnants. The stress concentrated on the dentin was significantly lower in Model B with a 20° bevel margin (20.86 MPa), i.e., 1.3 times lower than the other three margin designs (27.80 MPa). Restorative materials with higher elastic moduli present higher stress concentrations inside the endocrown and transmit less stress to the cement layer, resulting in lower bonding failure risks. In contrast, materials with an elastic modulus similar to that of dentin presented with a more homogeneous stress distribution on the whole structure.

Conclusions

An endocrown with a 20° bevel margin design could be a favorable preparation option for ETT. Composite resins (GR and VC) exhibit a more even stress distribution, and seem to be more promising materials for endocrown molars.
Cardiometabolic risk factors, physical activity, and postmenopausal breast cancer mortality: results from the Women’s Health Initiative
Authors: Dieli-Conwright Christina M. , Nelson Rebecca A. , Simon Michael S. , Irwin Melinda L. , Neuhouser Marian L. , Reding Kerryn W. , Crane Tracy E. , Manson JoAnn E. , Nassir Rami , Shadyab Aladdin H. , LaMonte Michael , Qi Lihing , Thomson Cynthia A. , Kroenke Candyce H. , Pan Kathy , Chlebowski Rowan T. , Mortimer Joanne
Published: February 2022

Background

Higher physical activity levels are associated with lower breast cancer-specific mortality. In addition, the metabolic syndrome is associated with higher breast cancer-specific mortality. Whether the physical activity association with breast cancer mortality is modified by number of metabolic syndrome components (cardiometabolic risk factors) in postmenopausal women with early-stage breast cancer remains unknown.

Methods

Cardiovascular risk factors included high waist circumference, hypertension, high cholesterol, and diabetes. Breast cancers were verified by medical record review. Mortality finding were enhanced by serial National Death Index queries. Cox proportional hazards regression models were used to estimate associations between baseline physical activity and subsequent breast cancer-specific and overall mortality following breast cancer diagnosis in Women’s Health Initiative participants. These associations were examined after stratifying by cardiometabolic risk factor group.

Results

Among 161,308 Women’s Health Initiative (WHI) participants, 8543 breast cancers occurred after 9.5 years (median) follow-up in women, additionally with information on cardiometabolic risk factors and physical activity at entry. In multi-variable analyses, as measured from cancer diagnosis, higher physical activity levels were associated with lower all-cause mortality risk (hazard ratio [HR] 0.86, 95% confidence interval [CI] 0.78–0.95, trend P < 0.001) but not with breast cancer-specific mortality (HR 0.85, 95% CI 0.70 to 1.04, trend P = 0.09). The physical activity and all-cause mortality association was not significantly modified by cardiometabolic risk factor number.

Conclusions

Among women with early-stage breast cancer, although higher antecedent physical activity was associated with lower risk of all-cause mortality, the association did not differ by cardiometabolic risk factor number.
Patient-physician communication in the emergency department in Taiwan: physicians’ perspectives
Authors: Wang Yi-Fen , Lee Ya-Hui , Lee Chen-Wei , Hsieh Chien-Hung , Lee Yi-Kung
Published: February 2022

Background

Effective patient-physician communication promotes trust and understanding between physicians and patients and reduces medical disputes. In this study, the Roter Interaction Analysis System was used to explore physician-patient communication behaviors in the emergency departments of Taiwanese hospitals.

Method

Data was collected from the dialogues between 8 emergency physicians and 54 patients through nonparticipant observation, and 675 pieces of data were quantitatively and qualitatively analyzed.

Results

The results showed that: 1. Emergency physicians’ communication behaviors are task-focused. They usually ask closed-ended questions to collect data to identify the symptoms quickly and provide medical treatment. 2. Socioemotion-oriented physician-patient communication behaviors are less common in the emergency department and only serve as an aid for health education and follow-up. Due to time constraints, it is difficult to establish relationships with patients and evoke their positivity.

Conclusions

It is suggested that future education programs on physician-patient communication in the emergency department should focus on strengthening physicians’ ability to communicate with patients in a more open way. They should adopt socioemotional-oriented communication skills, expressing respect and kindness, and allowing patients to briefly describe their symptoms and participate in the treatment process to achieve physician-patient consensus.
Implementation fidelity of a transition program for adolescents with congenital heart disease: the STEPSTONES project
Authors: Saarijärvi Markus , Wallin Lars , Moons Philip , Gyllensten Hanna , Bratt Ewa-Lena
Published: February 2022

Background

Although transition programs have been evaluated for adolescents with chronic conditions, these have rarely involved process evaluations. Indeed, outcomes of complex interventions are dependent on how the intervention is implemented in practice and evaluations of implementation process are therefore pivotal. The aim of this study was to evaluate the extent to which a transition program for adolescents with congenital heart disease was delivered as intended. Research questions were 1) to what level of fidelity was the program delivered? and 2) what potential moderating factors affected the delivery of the program and overall fidelity?

Methods

A mixed methods design was used, where a process evaluation was embedded in the STEPSTONES randomized controlled trial in Sweden. The implementation fidelity framework by Carrol (2007) and Hasson (2010) was used to design, collect and analyze data. Quantitative data consisted of intervention records on adherence and were analyzed with descriptive statistics. Qualitative data on moderators affecting fidelity were collected through interviews, log-books and focus group interviews with healthcare professionals implementing the intervention and participatory observations of the implementation process. Data were analyzed with deductive content analysis. Triangulation was used to integrate quantitative and qualitative data within the fidelity framework.

Results

Six out of eight components of the transition program were delivered to an extent that adhered to the program theory or achieved a high level of fidelity. However, components involving peer support had a low attendance by the participating sample (32.2%), and the joint transfer meeting was challenging to implement, despite achieving high adherence. Moderators affecting the implementation process were the adolescent’s and healthcare professional’s engagement in the intervention, contextual factors and a lack of standard operating procedures for all components in the program.

Conclusion

Barriers and facilitators for a future implementation of transition programs have been illuminated in this study. The use of an implementation fidelity framework in the process evaluation proved successful in providing a comprehensive evaluation of factors affecting the implementation process. However, implementation fidelity must be considered in relation to adaptations to the local and personal prerequisites in order to create interventions that can achieve fit.
Metabolic engineering of Escherichia coli BL21 strain using simplified CRISPR-Cas9 and asymmetric homology arms recombineering
Authors: Shukal Sudha , Lim Xiao Hui , Zhang Congqiang , Chen Xixian
Published: February 2022

Background

The recent CRISPR-Cas coupled with λ recombinase mediated genome recombineering has become a common laboratory practice to modify bacterial genomes. It requires supplying a template DNA with homology arms for precise genome editing. However, generation of homology arms is a time-consuming, costly and inefficient process that is often overlooked.

Results

In this study, we first optimized a CRISPR-Cas genome engineering protocol in the Escherichia coli (E. coli) BL21 strain and successfully deleted 10 kb of DNA from the genome in one round of editing. To further simplify the protocol, asymmetric homology arms were produced by PCR in a single step with two primers and then purified using a desalting column. Unlike conventional homology arms that are prepared through overlapping PCR, cloning into a plasmid or annealing synthetic DNA fragments, our method significantly both shortened the time taken and reduced the cost of homology arm preparation. To test the robustness of the optimized workflow, we successfully deleted 26 / 27 genes across the BL21 genome. Noteworthy, gRNA design is important for the CRISPR-Cas system and a general heuristic gRNA design has been proposed in this study. To apply our established protocol, we targeted 16 genes and iteratively deleted 7 genes from BL21 genome. The resulting strain increased lycopene yield by ~ threefold.

Conclusions

Our work has optimized the homology arms design for gene deletion in BL21. The protocol efficiently edited BL21 to improve lycopene production. The same workflow is applicable to any E. coli strain in which genome engineering would be useful to further increase metabolite production.
Multimodal approaches for the improvement of the cellular folding of a recombinant iron regulatory protein in E. coli
Authors: Ravitchandirane Gayathri , Bandhu Sheetal , Chaudhuri Tapan K.
Published: February 2022

Background

During the recombinant protein expression, most heterologous proteins expressed in E. coli cell factories are generated as insoluble and inactive aggregates, which prohibit E. coli from being employed as an expression host despite its numerous advantages and ease of use. The yeast mitochondrial aconitase protein, which has a tendency to aggregate when expressed in E. coli cells in the absence of heterologous chaperones GroEL/ES was utilised as a model to investigate how the modulation of physiological stimuli in the host cell can increase protein solubility. The presence of folding modulators such as exogenous molecular chaperones or osmolytes, as well as process variables such as incubation temperature, inducer concentrations, growth media are all important for cellular folding and are investigated in this study. This study also investigated how the cell's stress response system activates and protects the proteins from aggregation.

Results

The cells exposed to osmolytes plus a pre-induction heat shock showed a substantial increase in recombinant aconitase activity when combined with modulation of process conditions. The concomitant GroEL/ES expression further assists the folding of these soluble aggregates and increases the functional protein molecules in the cytoplasm of the recombinant E. coli cells.

Conclusions

The recombinant E. coli cells enduring physiological stress provide a cytosolic environment for the enhancement in the solubility and activity of the recombinant proteins. GroEL/ES-expressing cells not only aided in the folding of recombinant proteins, but also had an effect on the physiology of the expression host. The improvement in the specific growth rate and aconitase production during chaperone GroEL/ES co-expression is attributed to the reduction in overall cellular stress caused by the expression host's aggregation-prone recombinant protein expression.

Graphical Abstract
The effect of light and ventilation on house entry by Anopheles arabiensis sampled using light traps in Tanzania: an experimental hut study
Authors: Mmbando Arnold S. , Bradley John , Kazimbaya Deogratius , Kasubiri Robert , Knudsen Jakob , Siria Doreen , von Seidlein Lorenz , Okumu Fredros O. , Lindsay Steve W.
Published: February 2022

Background

In sub-Saharan Africa, house design and ventilation affects the number of malaria mosquito vectors entering houses. This study hypothesized that indoor light from a CDC-light trap, visible from outside a hut, would increase entry of Anopheles arabiensis, an important malaria vector, and examined whether ventilation modifies this effect.

Methods

Four inhabited experimental huts, each situated within a large chamber, were used to assess how light and ventilation affect the number of hut-entering mosquitoes in Tanzania. Each night, 300 female laboratory-reared An. arabiensis were released inside each chamber for 72 nights. Nightly mosquito collections were made using light traps placed indoors. Temperature and carbon dioxide concentrations were measured using data loggers. Treatments and sleepers were rotated between huts using a randomized block design.

Results

When indoor light was visible outside the huts, there was an 84% increase in the odds of collecting mosquitoes indoors (Odds ratio, OR = 1.84, 95% confidence intervals, 95% CI 1.74–1.95, p < 0.001) compared with when it was not. Although the odds of collecting mosquitoes in huts with closed eaves (OR = 0.54, 95% CI 0.41–0.72, p < 0.001) was less than those with open eaves, few mosquitoes entered either type of well-ventilated hut. The odds of collecting mosquitoes was 99% less in well-ventilated huts, compared with poorly-ventilated traditional huts (OR = 0.01, 95% CI 0.01–0.03, p < 0.001). In well-ventilated huts, indoor temperatures were 1.3 °C (95% CI 0.9–1.7, p < 0.001) cooler, with lower carbon dioxide (CO2) levels (mean difference = 97 ppm, 77.8–116.2, p < 0.001) than in poorly-ventilated huts.

Conclusion

Although light visible from outside a hut increased mosquito house entry, good natural ventilation reduces indoor carbon dioxide concentrations, a major mosquito attractant, thereby reducing mosquito-hut entry.
A novel hierarchical biofunctionalized 3D-printed porous Ti6Al4V scaffold with enhanced osteoporotic osseointegration through osteoimmunomodulation
Authors: Wang Wei , Xiong Yinze , Zhao Renliang , Li Xiang , Jia Weitao
Published: February 2022

Background

Femoral stem of titanium alloy has been widely used for hip arthroplasty with considerable efficacy; however, the application of this implant in patients with osteoporosis is limited due to excessive bone resorption. Macrophages participate in the regulation of inflammatory response and have been a topic of increasing research interest in implant field. However, few study has explored the link between macrophage polarization and osteogenic–osteoclastic differentiation. The present study aims to develop a novel hierarchical biofunctionalized 3D-printed porous Ti6Al4V scaffold with enhanced osteoporotic osseointegration through immunotherapy.

Method

To improve the osteointegration under osteoporosis, we developed a hierarchical biofunctionalized 3D-printed porous Ti6Al4V scaffold (PT). Biomimetic extracellular matrix (ECM) was constructed inside the interconnected pores of PT in micro-scale. And in nano-scale, a drug cargo icariin@Mg-MOF-74 (ICA@MOF) was wrapped in ECM-like structure that can control release of icariin and Mg2+.

Results

In this novel hierarchical biofunctionalized 3D-printed porous Ti6Al4V scaffold, the macroporous structure provides mechanical support, the microporous structure facilitates cell adhesion and enhances biocompatibility, and the nanostructure plays a biological effect. We also demonstrate the formation of abundant new bone at peripheral and internal sites after intramedullary implantation of the biofunctionalized PT into the distal femur in osteoporotic rats. We further find that the controlled-release of icariin and Mg2+from the biofunctionalized PT can significantly improve the polarization of M0 macrophages to M2-type by inhibiting notch1 signaling pathway and induce the secretion of anti-inflammatory cytokines; thus, it significantly ameliorates bone metabolism, which contributes to improving the osseointegration between the PT and osteoporotic bone.

Conclusion

The therapeutic potential of hierarchical PT implants containing controlled release system are effective in geriatric orthopaedic osseointegration.

Graphical Abstract
Tumor microenvironment-responsive fenton nanocatalysts for intensified anticancer treatment
Authors: Wang Yandong , Gao Fucheng , Li Xiaofeng , Niu Guiming , Yang Yufei , Li Hui , Jiang Yanyan
Published: February 2022

Chemodynamic therapy (CDT) based on Fenton or Fenton-like reactions is an emerging cancer treatment that can both effectively fight cancer and reduce side effects on normal cells and tissues, and it has made important progress in cancer treatment. The catalytic efficiency of Fenton nanocatalysts(F-NCs) directly determines the anticancer effect of CDT. To learn more about this new type of therapy, this review summarizes the recent development of F-NCs that are responsive to tumor microenvironment (TME), and detailedly introduces their material design and action mechanism. Based on the deficiencies of them, some effective strategies to significantly improve the anticancer efficacy of F-NCs are highlighted, which mainly includes increasing the temperature and hydrogen peroxide concentration, reducing the pH, glutathione (GSH) content, and the dependence of F-NCs on acidic environment in the TME. It also discusses the differences between the effect of multi-mode therapy with external energy (light and ultrasound) and the single-mode therapy of CDT. Finally, the challenges encountered in the treatment process, the future development direction of F-NCs, and some suggestions are analyzed to promote CDT to enter the clinical stage in the near future.

Graphical Abstract
Inhibitory effect and mechanism of gelatin stabilized ferrous sulfide nanoparticles on porcine reproductive and respiratory syndrome virus
Authors: Tong Ting , Deng Shuangfei , Zhang Xiaotong , Fang Liurong , Liang Jiangong , Xiao Shaobo
Published: February 2022

Background

The infection and spread of porcine reproductive and respiratory syndrome virus (PRRSV) pose a serious threat to the global pig industry, and inhibiting the viral infection process is a promising treatment strategy. Nanomaterials can interact with viruses and have attracted much attention due to their large specific surface area and unique physicochemical properties. Ferrous sulfide nanoparticles (FeS NPs) with the characteristics of high reactivity, large specific surface area, and low cost are widely applied to environmental remediation, catalysis, energy storage and medicine. However, there is no report on the application of FeS NPs in the antiviral field. In this study, gelatin stabilized FeS nanoparticles (Gel-FeS NPs) were large-scale synthesized rapidly by the one-pot method of co-precipitation of Fe2+ and S2‒.

Results

The prepared Gel-FeS NPs exhibited good stability and dispersibility with an average diameter of 47.3 nm. Additionally, they were characterized with good biocompatibility and high antiviral activity against PRRSV proliferation in the stages of adsorption, invasion, and replication.

Conclusions

We reported for the first time the virucidal and antiviral activity of Gel-FeS NPs. The synthesized Gel-FeS NPs exhibited good dispersibility and biocompatibility as well as effective inhibition on PRRSV proliferation. Moreover, the Fe2+ released from degraded Gel-FeS NPs still displayed an antiviral effect, demonstrating the advantage of Gel-FeS NPs as an antiviral nanomaterial compared to other nanomaterials. This work highlighted the antiviral effect of Gel-FeS NPs and provided a new strategy for ferrous-based nanoparticles against PRRSV.

Graphical Abstract
A qualitative investigation exploring why dance festivals are risky environments for drug use and potential adverse outcomes
Authors: Palamar Joseph J. , Sönmez İbrahim
Published: February 2022

Background

Dance festivals have been shown to be high-risk events for use of drugs such as ecstasy/MDMA and possible adverse effects associated with use. However, few studies have examined what makes festivals such risky environments. We aimed to determine festival-specific risk factors for adverse outcomes related to drug use.

Methods

In-depth interviews were conducted with 35 key informants in North America who deemed themselves experts in new psychoactive substances, and identified as drug checkers, sellers, or experienced users. Interviews were coded in an inductive manner, and we conducted thematic analysis to identify relevant themes.

Results

We identified four main themes focusing on festival attendance as a risk factor for risky drug use and related outcomes: attendees inexperienced with electronic dance music parties and party drugs, risky drug purchasing, risky drug use practices, and festival-specific environmental risk factors. Festivals attract a wide array of people not experienced with party drugs, yet drugs like ecstasy are commonly sought by such individuals inside festivals. Relying on strangers inside to purchase drugs is a risk factor for purchasing adulterated product. Fear of security/police at festivals leads to risky drug-taking such as ingesting one’s full batch of drugs at the entrance. These risks are compounded by environmental factors including crowding, hot temperature, and lack of water (which lead to dehydration), long/consecutive event days (which can lead to exhaustion), and inadequate medical emergency response.

Conclusions

We determined modifiable risk factors which can both inform future research and future prevention and harm reduction efforts in this scene.