bluuebunny/crossref_metadata_2025 huggingface dataset:
Continued Relevance of Initial Temperature Measurement in Trauma Patients
Authors: Balmer Jacob C. , Hieb Nathan , Daley Brian J. , Many Heath R. , Heidel Eric , Rowe Shaun , McKnight Catherine L.
Published: November 2021

Objectives

Hypothermia occurs in 30-50% of severely injured trauma patients and is associated with multiple metabolic derangements and worsened outcomes. However, hypothermia continues to be under-diagnosed which leads to inadequate triage and treatment in trauma patients. Our study set out to determine if hypothermia is an independent predictor of mortality in trauma patients.

Methods

We retrospectively reviewed data of all trauma activation patients over a 5-year period. Data were collected on patient demographics, initial core temperature, Glasgow Coma Scale (GCS) on presentation, and injury severity score (ISS). Patients were then stratified into groups based on presenting temperature, ISS, and GCS. Outcomes compared were mortality, blood products received, and intensive care unit (ICU) length of stay. Correlations and logistic regression were used to test the hypotheses.

Results

Survival and temperature data were reviewed on 15,567 patients. Initial temperature was not significantly associated with ICU length of stay or blood products transfused ( P = .21 and P = .08, respectively). However, odds ratio of mortality in hypothermic patients (<35°C) compared to normothermic patients (35-39°C) was 3.95 (95% CI 2.90-5.41). When controlling for GCS and ISS, separately, temperature remained an independent predictor of mortality.

Conclusions

Hypothermia is an independent risk factor for mortality in trauma patients. It remains crucial to obtain accurate presenting temperatures in trauma patients in order to triage and treat hypothermia. Based on our data, obtaining core temperatures and rapidly treating hypothermia continues to be a vital part of the secondary survey of trauma patients.
Trampoline Injuries in a Statewide Trauma System
Authors: Sullivan Megan C. , Morgan Madison E. , Bradburn Eric , Perea Lindsey L.
Published: November 2021

Introduction

It is well known that trampolines can be a particular source of danger, especially in children. We sought to examine the profile of those patients with trampoline injuries. We hypothesized there would be certain injury patterns predicative of trampoline injuries.

Methods

All patients submitted to Pennsylvania Trauma Outcome Study database from 2016 to 2018 were analyzed. Trampoline injury was determined by ICD-10 activity code. Injury patterns in the form of abbreviated injury scale body regions were examined. Patient demographics and clinical variables were compared between those with trampoline injury vs those without.

Results

There were 107 patients with a trampoline injury. All of these patients were discharged alive and had a blunt mechanism of injury. The most common injury type was injury to the extremities (n=90,[84.1%]) with 54(50.5%) upper extremity injuries and 36(33.6%) lower extremity injuries. Ten (9.35%) patients had injury to the spine and five (4.67%) had head injury. Those with trampoline injuries were significantly younger (13y vs. 48.6y) and more likely to be white or of Hispanic ethnicity. Almost half of the patients injured (49.5%) were under 10 years. Patients with trampoline injuries had significantly lower Injury Severity Scores and significantly higher shock index.

Discussion

The majority of patients with trampoline injuries had injury to an extremity. These results help better understand the demographic, physiologic, and anatomic patterns surrounding trampoline injuries. Current government standards recommend that no child under age six should use a full-sized trampoline; however, based of this study, we advise that this age be increased to ten.
Open Abdomen after Two Trauma Laparotomies: Do Diuretics Help?
Authors: Williamson Sigrid , Qatanani Anas , Muller Alison , Martin Anthony , Geng Thomas A. , Ong Adrian W.
Published: November 2021

Data are lacking regarding the use of diuretics in facilitating closure of the open abdomen (OA). For patients with an OA after 2 laparotomies, we hypothesized that diuretic use was associated with a higher rate of primary fascial closure than no diuretic use. A retrospective review of patients with trauma laparotomies over 7 years was performed. Primary fascial closure (PFC) was defined as apposition of fascial edges without interposition mesh. Of 321 patients, 30 (9%) remained with an OA after 2 laparotomies. Prior to the third laparotomy, median cumulative fluid balance was +12.6 L. Thirteen (43%) received diuretics. Primary fascial closure rates were similar for diuretic use vs no diuretic (38% vs 59%, P = .46). Primary fascial closure was not associated with age ( P = .2), gender ( P = 0.7), cumulative fluid balance ( P = .3), or units of packed cells ( P = .4). Diuretic use in trauma patients with an OA after 2 laparotomies was not associated with successful PFC.
Reconstruction After Grizzly Bear Attack in Wyoming
Authors: Ingram Bryce M. , Colosimo Christina M. , Weaver John S. , Mentzer Caleb J. , Yon James R.
Published: November 2021

Bear attacks are rare, although global incidents have been increasing. Injury patterns of bear attacks against humans consistently include injuries to the face, head, neck, chest, and upper extremities. Here, we have a brief report of a 59-year-old male hunter who was attacked by a grizzly bear in Wyoming. He sustained multiple lacerations to his face which included an avulsion of his nose and upper lip, as well as extensive associated facial fractures. Additional injuries included soft tissue and bony injuries to the upper extremities. He underwent 53 operations during his first hospitalization, primarily of facial reconstruction, which required nose and upper lip replant to his arm. His course was complicated by pressure ulcers, bacteria, acute kidney injury, and a urinary tract infection. After successful coordinated multidisciplinary care and a prolonged hospitalization, he was ultimately discharged to his home.
Pediatric Mild Traumatic Brain Injury: Who Can Be Managed at a Non-pediatric Trauma Center Hospital? A Systematic Review of the Literature
Authors: Keane Olivia A. , Escobar Mauricio A. , Neff Lucas P. , Mitchell Ian C. , Chern Joshua J. , Santore Matthew T.
Published: November 2021

Background

Pediatric traumatic brain injury (TBI) affects about 475,000 children in the United States annually. Studies from the 1990s showed worse mortality in pediatric TBI patients not transferred to a pediatric trauma center (PTC), but did not examine mild pediatric TBI. Evidence-based guidelines used to identify children with clinically insignificant TBI who do not require head CT were developed by the Pediatric Emergency Care Applied Research Network (PECARN). However, which patients can be safely observed at a non-PTC is not directly addressed.

Methods

A systematic review of the literature was conducted, focusing on management of pediatric TBI and transfer decisions from 1990 to 2020.

Results

Pediatric TBI patients make up a great majority of preventable transfers and admissions, and comprise a significant portion of avoidable costs to the health care system. Majority of mild TBI patients admitted to a PTC following transfer do not require ICU care, surgical intervention, or additional imaging. Studies have shown that as high as 83% of mild pediatric TBI patients are discharged within 24 hrs.

Conclusions

An evidence-based clinical practice algorithm was derived through synthesis of the data reviewed to guide transfer decision. The papers discussed in our systematic review largely concluded that transfer and admission was unnecessary and costly in pediatric patients with mild TBI who met the following criteria: blunt, no concern for NAT, low risk on PECARN assessment, or intermediate risk on PECARN with negative imaging or imaging with either isolated, nondisplaced skull fractures without ICH and/or EDH, or SDH <0.3 cm with no midline shift.
Giant Paraesophageal Hernia With Obstructing Splenic Flexure Mass in the Left Hemithorax
Authors: Fleming Andrew M. , Scheckel Brent V. , Harmon Kristin E. , Yakoub Danny
Published: November 2021

Giant paraesophageal hernias contain greater than fifty percent of the stomach above the diaphragm. Over fifty percent of large bowel obstructions are due to colorectal adenocarcinoma. Here, we present a rare case of a 69-year-old female patient who developed a closed loop colonic obstruction caused by a colonic mass in the distal transverse colon within a giant paraesophageal hernia. We successfully performed emergent paraesophageal hernia reduction and mesh repair with extended right hemicolectomy and ileocolonic anastomosis. Emergent hernia repair via an abdominal approach can be used in this setting.
Prolonged Emergency Department Stay at Referring Facilities: A Poor Trauma Performance Improvement Tool
Authors: Udekwu Pascal , Simonson Brian , Stiles Anquonette , Mclntyre Sarah , Tann Kimberly , Schiro Sharon
Published: November 2021

Background

Delays in the transfers of injured patients are perceived to increase morbidity and mortality and drive initiatives to limit the emergency department length of stay (LOS) at referring facilities (RF). RF LOS >4 hours is used for performance improvement (PI) with a large review burden with few improvement opportunities.

Methods

A statewide trauma registry 2013-2018 was used. Descriptive and inferential statistics including logistic regression were used to evaluate nongeriatric adult patients with ED LOS <12 hours. Paired data analyses utilizing prehospital (PH) and RF variables, vital signs (VS), Glasgow Coma Score–Motor component (GCS-M), RF LOS, mortality, trauma center hospital LOS (HLOS), and intensive care unit (ICU) LOS were performed.

Results

13,721 of 56,702 transfer patients were selected. Mortality fell over time in all abbreviated injury score groups. GCS-M and systolic blood pressure (SBP) were correlated with mortality in both prehospital and RF data and highest in patients with abnormal GCS-M or SBP in both settings (38.0%, 30.1%). Examination of mortality over time in the group with abnormal VS showed SBP as the only variable with increasing mortality related to RF LOS. Average HLOS and ICU LOS were longest in patients with abnormal PH and RF SBP and GCS-M.

Discussion

Support for PI evaluation of RF LOS >4 hours was not identified. Increased survival over time is explained by early transfers of high mortality patients. Our data support existing efficient statewide transfers and recommend PI review of transfer patients with abnormal GCS-M and SBP in a narrower timeframe.
Does Adding a Fissurectomy to Botox Sphincterotomy Increase Success Rate or Just Cost?
Authors: Winter Kelly A. , Savolt Todd , Quinn Karson R. , Helmer Stephen D. , Porter Michael G. , Sanchez Noel C.
Published: November 2021

Background

While Botox sphincterotomy with or without fissurectomy has been proven effective in healing anal fissures, they have not been directly compared. We evaluated cost-effectiveness and outcomes between Botox sphincterotomies with and without fissurectomy.

Methods

A 5-year retrospective review was conducted comparing all patients undergoing Botox sphincterotomy for anal fissure with or without fissurectomy. Outcomes including recurrence/persistence, additional treatments, complications, and total charges were compared between study groups.

Results

Patients treated without fissurectomy (n = 53) had recurrent/persistent fissure more often (56.6 vs 31.0%, P = .001), and required more Botox treatments. Those treated with fissurectomy (n = 154) had more complications (13.5 vs 0%, P = .003). Patients initially treated without fissurectomy had a median total charge of $2 973, while median total charge for those initially treated with fissurectomy was $17 925 (P < .001).

Conclusions

Botox sphincterotomy in an office without fissurectomy is a viable option. It may result in longer healing times but is associated with reduced cost, lower complication rates, and no need for anesthesia or operative intervention in most cases. But the choice of treatment route must be individualized.
Increasing lengths of rank order lists of applicants and programs of US medical residencies
Authors: Newsome Kevin , Sen-Crowe Brendon , Fanfan Dino , McKenny Mark , Elkbuli Adel
Published: November 2021

Background

To match medical students into residency training programs, both the program and student create rank order lists (ROLs). We aim to investigate temporal trends in ROL lengths across 7 match cycles between 2014 and 2021 for both matched and unmatched residency applicants and programs.

Methods

retrospective study of ROLs of 7 match cycles, 2014-2021. Residency match and ROL data were extracted from the NRMP database to assess the number of programs filled and unfilled, length of ROLs, position matched, and average ranks per position for osteopathic (DO) and allopathic (MD) medical programs.

Results

For filled residency programs, the average ROL length consistently increased from 70.72 in 2015 to 88.73 in 2021 ( P = .003), with ROL lengths consistently longer for filled vs unfilled residency programs ( P < .001). The average ROL length for matched applicants increased consistently from 10.41 in 2015 to 12.35 in 2021 ( P = .002), with matched applicants having consistently longer ROLs than unmatched applicants ( P < .001). From 2015 to 2021, in both MD and DO applicants, progressively lower proportions of applicants matched their first and second choices.

Conclusion

Trends across the past 7 residency match cycles suggest that ROL lengths for both programs and applicants have been increasing with matched programs and applicants submitting significantly longer ROLs than unmatched applicants. Additionally, fewer applicants are matching at their preferred programs over time. Our findings support the mounting evidence that the Match has become increasingly congested and we discuss the possible factors that may be contributing to the current state of the Match as well as potential solutions.
Resuscitative Endovascular Balloon Occlusion of the Aorta in the Management of a Gunshot Wound and Rupture of the Uterus
Authors: Raza Syed Sikandar , Tyler Kevin , Najjar Rony J.
Published: November 2021

Trauma is the leading cause of non-obstetrical maternal death. A 19-year-old woman at 20 weeks’ gestation was brought to the emergency room after suffering a gunshot wound to the lower abdomen. Upon arrival, she was hemodynamically stable and imaging was obtained. CT revealed a rupture of the uterus with a partially extrauterine fetus, and the patient was immediately taken for an explorative laparotomy. Prior to the surgical start, the patient’s blood pressure declined and, subsequently, a resuscitative endovascular balloon occlusion of the aorta (REBOA) was placed. The fetus and placenta were delivered and both uterine arteries and the inferior epigastric artery were ligated. Following an unremarkable postoperative course, she was discharged on hospital day 17. The mainstay approach to trauma in pregnancy should be to utilize focused imaging techniques to assess extent of trauma and provide adequate circulation to vital organs. Aortic balloon occlusion may be considered as a viable strategy to enhance resuscitation.
Damage Control Laparotomy Wound Incisions Can Be Closed With Low Rates of Superficial Surgical Site Infections
Authors: Cull John D. , Spoor Kristen A. , Pellizzeri Katherine F. , Manning Benjamin M.
Published: November 2021

Due to high rates of surgical site infections (SSIs) in damage control laparotomies (DCLs), many surgeons leave wounds to heal by secondary intention. We hypothesize that patients after DCL can have their wounds primarily closed with wicks/Penrose drains with low rates of superficial surgical site infections. A retrospective review of a prospectively maintained DCL database was performed for all patients who underwent DCL from January 2016 to June 2018. From January 2016 to June 2018, a total of 171 patients underwent DCL. After exclusions, 107 patients were reviewed to assess for SSI. 57 patients were closed with wicks/Penrose drains, 3 were closed with delayed primary closure, and 47 patients were closed completely at time of fascial closure. There were 4 (3.7%) superficial SSIs, 13 (12.1%) organ space infections, and 14 surgical site occurrences (3 of which required opening the skin). Primary closure of incisions after DCL has low superficial SSI rates.
Experimental analysis on the bonding conditions of thermoset-thermoplastic composite parts manufactured by the hybrid single shot method
Authors: Kazan Hakan , Farahani Saeed , Zheng Ting , Pilla Srikanth
Published: November 2021

The hybrid single shot method is an innovative manufacturing technique that allows thermoset composite sheets to be formed and cured while they are also bonded into an injected thermoplastic body all in a single integrated operation. This integration concept is complex in nature but promising to overcome the drawbacks of the traditional procedures for manufacturing such multi-material structures by reducing the cycle time, energy consumption, and cost of the required tools and machinery. In this study, CF/Epoxy prepreg sheets are selected as the inserted material which is then later deformed and bonded to an injected body made of a polypropylene compound. The bonding between these two dissimilar materials is mostly achieved by taking the advantages of the melt penetration and the tackiness of the prepreg sheet. Therefore, an experimental study is here designed and carried out to evaluate the bonding conditions of the final hybrid parts regarding several influential process parameters. To better monitor the process and analyze the physics behind this integration, a set of real-time process variables are measured and analyzed using an instrumented experimental setup. The results show that the pre-heating time has the largest effect on the bonding strength, and the best combination of the deformation and bonding strength is achieved when the cavity pressure and temperature are at the highest level compared to the other experiments. The maximum bonding strength attained in the optimum process settings was 6.8 MPa which shows a 51% improvement compared to the average value of the other experiments.
Ultrasound and Sialogram Correlates to Parotid Immunoglobulin G4-Related Disease
Authors: Moore Abigail E. , Marcus Kathryn S. , Rajan KD Anand , Maley Joan E. , Hoffman Henry T.
Published: November 2021

Immunoglobulin G4 (IgG4)-related disease is an immune-mediated disorder that commonly manifests in the salivary glands. As a recently described disorder, the description and classification of IgG4-related disease is an ongoing process. Diagnosis of IgG4-related disease requires integration of clinical history, histopathology, and radiographic findings, including ultrasonography and sialography. In this case report, we correlate parotid ultrasonographic and sialographic findings in a patient with proven IgG4-related disorder confirmed from analysis of previous submandibular gland resections. We aim to highlight the utility of multimodality imaging in the diagnosis of IgG4-related disease.
Disentangling the Protection Suit: Images, Artefacts, and the Making of the Health-Security Nexus
Authors: Krause Katharina
Published: November 2021

The protection suit is the icon of infectious disease outbreaks. I argue that the protection suit has performative power not only by shaping the daily tasks of health workers and their interaction with patients, but also as a visual artefact and as a two-dimensional image determining how health crises and their security implications are understood and dealt with. The article proceeds in three steps: it firstly highlights the current absence of visuality in the academic literature on health security and makes the case for including it in the debate. Secondly, with recourse to Actor-Network Theory (ANT) it theoretically locates visual representations, as images and artefacts, as actors that act and enact each other in the health-security nexus. The third part of the article follows the protection suit during the Ebola epidemic in West Africa and maps the visual network it creates. In doing so this article demonstrates how the suit as artefact and image constitutes a network that visually and sensually links the bodies of patients, health workers and distant viewers in complex and at times competing makings of health security.
Influence of charge carrier density, mobility and diffusivity on conductivity–temperature dependence in polyethylene oxide–based gel polymer electrolytes
Authors: Abdukarimov Abdullaziz , Noor Ikhwan Syafiq Mohd , Mamatkarimov Odiljon , Arof Abdul Kariem Mohd
Published: November 2021

Determining the transport properties of charge carriers is essential to understand the factors that affect the conductivity trend of a polymer electrolyte system. In this work, charge carrier transport parameters of polyethylene oxide–based gel polymer electrolytes were estimated from fitting the Nyquist plot with the impedance equation, derived from the equivalent circuit that consists of a resistor in series with a constant phase element. The increase in electrolyte conductivity with temperatures from 303 K to 373 K is attributed to the increase of free ions, n (TPA+ cations and I¯ anions) and not to ionic mobility, μ. The decrease in μ with temperature is associated with the increase in the Stokes drag coefficient due to increase in ion collisions. This work explains how conductivity changes with number density of ions and mobility at various temperatures.
Sexism, Moral Disengagement, and Dark Triad Traits on Perpetrators of Sexual Violence Against Women and Community Men
Authors: Navas María Patricia , Maneiro Lorena , Cutrín Olalla , Gómez-Fraguela José A. , Sobral Jorge
Published: November 2021

The field of criminal psychology involves delving into psychological profiles prone to accepting and justifying sexist attitudes that support sexual violence against adult women (SVAW). The aim of the current study is to analyze the mediating role of moral disengagement in the relationships between dark triad personality traits (Machiavellianism, psychopathy, and narcissism) and ambivalent sexism in a sample of 74 male perpetrators of sexual violence against women ( M = 40.58; SD = 10.05) convicted of intimate partner violence (IPV) and sexual assault and 160 community men ( M = 43.54; SD = 10.63). Since there were no significant differences in the measured variables between individuals convicted of IPV and those convicted of sexual assault, these two groups were combined into a single group of perpetrators of sexual violence against women. A comparison of incarcerated and community men showed that perpetrators of sexual violence against women reported significantly higher levels of ambivalent sexism, moral disengagement, and psychopathy than community men. The moderated mediational model showed that the dark triad was not directly associated with ambivalent sexism, but the relationship was fully mediated by moral disengagement mechanisms. Moreover, the interdependence of the variables evaluated was moderated by group. The moral disengagement mechanisms that explain both hostile and benevolent sexism were associated with Machiavellianism and psychopathy among perpetrators of sexual violence against women, whereas among community men, these mechanisms were associated with Machiavellianism and narcissism. These findings are discussed as they pertain to the treatment of perpetrators of sexual violence against women.
Online Grocery Sales after the Pandemic
Authors: East Robert
Published: November 2021

In this paper, the increase in online grocery ordering in the UK during the COVID-19 pandemic is examined, and a prediction is made that is opposed to the balance of opinion expressed online. In their online comments, most practitioners claim that the increased use of the Internet for ordering groceries for home delivery will be sustained and will continue to grow after the risk of disease has subsided. Given the pattern of consumer behaviour in another field, discount purchasing, it seems more likely that online grocery ordering will fall back and then continue to grow at a modest pace, as it did before the pandemic.
Addressing Marine Wildlife Entanglement in Derelict Fishing Nets Using Community-Based Social Marketing: Case Study and Lessons Learnt
Authors: Sarrouf Willson Maïa , Turley Craig , Daar Lamees A. , Al Masroori Hussein , Al Muscati Hussain , Al Aufi Madrak , Al Bulushi Asma , Al Harthi Suaad , Willson Andrew
Published: November 2021

Background

Entanglement of marine species, particularly endangered sea turtles and cetaceans, in abandoned, lost or otherwise discarded fishing gear is a major conservation concern.

Focus of the Article

This case study applies Community-Based Social Marketing (CBSM) to reduce marine wildlife net entanglement in the waters surrounding Masirah Island, a marine biodiversity hotspot in Oman.

Importance to the Social Marketing Field

The study demonstrates the use of social marketing tools in biodiversity conservation, bringing new knowledge to the cross-application of these two fields.

Methods

The CBSM methodology was applied to select behaviours, identify barriers and benefits, develop strategies and design a pilot study. The responsible disposal of derelict nets in skip bins was selected as the target behaviour, and a mix of behavioural change tools was applied to achieve change: convenience (installation of three skip bins), education (installation of informative signs, distribution of awareness posters, one-to-one engagement with fishers on the beaches), prompts (installation of signs and posters on vessels) and social norms (one-to-one engagement with key influencers and decision makers). The monitoring of behaviour change took place through structured observations over 23 weeks, focussing on the number of nets disposed of in the allocated skip bins.

Results

Results showed a low level of behaviour adoption rate by skiff and launch vessel fisheries, respectively, 5.36% and 2.58%. Positive results were observed for a short time but did not reach the estimated target value throughout the study period.

Recommendations for Research

Our pilot study did not lead to broad-scale implementation and we recommend further awareness and engagement with the target audience, trials of various behaviour change tools and increase field monitoring time. We further recommend the application and funding of behaviour change methods applied to fishers with the incorporation of conventional financial, conservation and regulatory tools to support resource management.

Limitations

Our results show that focussing on specific behaviours with appropriate measurement is both resource and time demanding to solve pressing conservation problems, particularly ones generated by complex industries such as fishing. Various lessons, useful for other social marketers, have been drawn from our evaluation of the overall study.
Retailer Volunteerism as a Plastic Shopping Bag Governance Tool: Shoppers’ Reflections and Contributions to Environmental Social Marketing
Authors: Muposhi Asphat , Shamhuyenhanzva Roy
Published: November 2021

Introduction

The pollution of landscapes and coastal environments with plastic shopping bag litter is an escalating global problem. The introduction of plastic bag tax aimed at addressing this challenge achieved limited success in South Africa. This study explores South African shoppers’ perceptions towards social marketing anchored retailer voluntary initiatives, which is an emerging plastic bag policy option.

Literature

Adverse environmental and social effects of plastic shopping bags are discussed. Retailer voluntary initiatives used to de-market plastic shopping bags, including jurisdictions where they were implemented, are also reviewed. The focus is on retailer anti-plastic bag initiatives such as ‘reusable shopping bags’ and ‘plastic bag-free’ shops.

Methods

This study is situated within a constructivist research paradigm and a qualitative methodology. Data were collected from a sample of 31 grocery shoppers recruited from retailer outlets in South Africa’s metropolitan cities, Johannesburg and Pretoria. In-depth interviews were conducted to explore shoppers’ perceptions towards retailer-driven anti-plastic bag voluntary initiatives. Thematic content analysis was used to analyse interview data.

Findings

The findings of this study highlight shoppers’ negative perceptions towards retailer anti-plastic bag voluntary initiatives. Shoppers perceived retailer anti-plastic bag voluntary initiatives as forms of green capitalism, green entrepreneurship, symbolic corporate social responsibility, strategic business posture, commandeered green consumerism, measured environmental morality, masked green washing and calculated pre-emptive behaviour. Future studies may seek to extend the generalisability of these findings by using a larger sample size.

Conclusion

The study’s findings highlight the trust deficit associated with retailer anti-plastic bags voluntary initiatives and the importance of enhancing market acceptance and legitimacy. Mistrust and cynicism directed towards retailer anti-plastic bag voluntary initiatives point to the importance of consumer education aimed at emphasising the negative effects of single-use plastic shopping bags. This study concludes that reliance on retailer self-regulation may not be the best approach to solve the escalating problem of plastic bag litter. We argue that national governments need to implement interventions that strike a balance between environmental sustainability and economic development.
Identification of Hub Genes Related to Alzheimer’s Disease and Major Depressive Disorder
Authors: Cheng Yajing , Sun Meiyue , Wang Feng , Geng Xin , Wang Fei
Published: November 2021

Background

Although many studies reported a close relationship between depression and Alzheimer’s disease (AD), the underlying pathophysiological mechanism remains unclear. The present study aimed to investigate the mechanism of AD and major depressive disorder (MDD). Method: The datasets were downloaded from the Gene Expression Omnibus. After screening differentially expressed genes (DEGs), gene ontology and pathway analysis were performed and protein–protein interaction, TF-target gene, and miRNA-target gene networks were established. Results: 171 DEGs of AD-related datasets and 79 DEGs shared by AD and MDD were detected. Functional analysis revealed that AD and MDD common genes were significantly enriched in circadian entrainment and long-term depression signaling pathways. Five hub genes were identified after construction of networks and validation of hub gene signatures. In conclusion, DYNC1H1, MAPRE3, TTBK2, ITGB1, and WASL may be potential targets for the diagnosis and treatment of AD and MDD.
The long and winding road
Authors: Cox Kevin R
Published: November 2021

Growing up in a capitalist society means induction into a set of taken for granted concepts that seemingly get realized through the way that world works. As a result, a grasp of the very different fundamentals of Marxism has to be a lifetime pursuit. For the author, it started in secondary school for reasons that were both personal and intellectual. In terms of the overall geohistorical trajectory of the author’s life, it bears emphasis that it is unlikely that that would have occurred in the US as it was at that time. Nevertheless, the American university system would then allow, often unintendedly, a deepening of that understanding. There have been diversions and distractions, most notably the distributional emphasis of much critical work in the 1970s and then critical realism in the 1980s, but overcoming them served to further enhance a critical grasp. A visit to South Africa in 1982 played a part in that. The trajectory has been simultaneously geohistorical and dialectical.
Lung function trajectory in progressive fibrosing interstitial lung disease
Authors: Oldham Justin M. , Lee Cathryn T. , Wu Zhe , Bowman Willis S. , Pugashetti Janelle Vu , Dao Nam , Tonkin James , Seede Hasan , Echt Gabrielle , Adegunsoye Ayodeji , Chua Felix , Maher Toby M. , Garcia Christine K. , Strek Mary E. , Newton Chad A. , Molyneaux Philip L.
Published: November 2021

Background

Proposed criteria for progressive fibrosing interstitial lung disease (PF-ILD) have been linked to increased mortality risk, but lung function trajectory after satisfying individual criteria remains unknown. Because survival is rarely employed as the primary end-point in therapeutic trials, identifying PF-ILD criteria that best predict subsequent change in forced vital capacity (FVC) could improve clinical trial design.

Methods

A retrospective, multicentre longitudinal cohort analysis was performed in consecutive patients with fibrotic connective tissue disease-associated ILD (CTD-ILD), chronic hypersensitivity pneumonitis and idiopathic interstitial pneumonia at three US centres (test cohort) and one UK centre (validation cohort). 1-year change in FVC after satisfying proposed PF-ILD criteria was estimated using joint modelling. Subgroup analyses were performed to determine whether results varied across key subgroups.

Results

1227 patients were included, with CTD-ILD predominating. Six out of nine PF-ILD criteria were associated with differential 1-year change in FVC, with radiological progression of fibrosis, alone and in combination with other features, associated with the largest subsequent decline in FVC. Findings varied significantly by ILD subtype, with CTD-ILD demonstrating little change in FVC after satisfying most PF-ILD criteria, while other ILDs showed significantly larger changes. Findings did not vary after stratification by radiological pattern or exposure to immunosuppressant therapy. Near-term change in FVC after satisfying proposed PF-ILD criteria was heterogeneous depending on the criterion assessed and was strongly influenced by ILD subtype.

Conclusions

These findings may inform future clinical trial design and suggest ILD subtype should be taken into consideration when applying PF-ILD criteria.
LncRNA-ATB participates in the regulation of calcium oxalate crystal-induced renal injury by sponging the miR-200 family
Authors: Li Yinhui , Ding Tao , Hu Haiyan , Zhao Tingting , Zhu Chao , Ding Jiarong , Yuan Jihang , Guo Zhiyong
Published: November 2021

Background

LncRNA-ATB is a long noncoding RNA (lncRNA) activated by transforming growth factor β (TGF-β) and it has important biological functions in tumours and nontumour diseases. Meanwhile, TGF-β is the most critical regulatory factor in the process of nephrotic fibrosis and calcium oxalate (CaOx) crystal-induced renal injury. The present study aimed to investigate the biological function and mechanism of lncRNA-ATB in CaOx crystal-induced renal injury.

Methods

The expression level of lncRNA-ATB was detected by quantitative reverse-transcription polymerase chain reaction (qRT-PCR), the expression levels of epithelial-mesenchymal transition (EMT) markers, TGF-β1 and Kidney Injury Molecule-1 (KIM-1) were detected by qRT-PCR, immunofluorescence staining or western blot analysis, cell proliferation was measured with a CCK-8 kit, cell apoptosis was measured by flow cytometry and TUNEL staining, and cell injury was detected with the Cytotoxicity lactate dehydrogenase (LDH) Assay kit and the expression level of KIM-1.

Results

The expression levels of lncRNA-ATB and TGF-β1 were significantly increased in HK-2 cells after coincubation with calcium oxalate monohydrate (COM). COM stimulation caused significant injury in the HK-2 cells, induced cell apoptosis, inhibited cell proliferation, and induced EMT changes. After COM stimulation, the expression levels of the epithelial cell markers E-cadherin and zonula occludens (ZO)-1 in HK-2 cells significantly decreased, whereas the levels of the mesenchymal cell markers N-cadherin, vimentin and α-smooth muscle actin (α-SMA) significantly increased. Interference with lncRNA-ATB expression significantly relieved the COM-induced cell injury, cell apoptosis, proliferation inhibition, and EMT changes. The expression levels of the microRNA-200 (miR-200) family in the HK-2 cells after coincubation with COM were significantly decreased. MiR-200a mimics relieved the COM-induced cell injury, apoptosis, proliferation inhibition, and EMT changes, whereas miR-200a inhibitors abolished the lncRNA-ATB interference-induced relief of the COM-induced cell injury, apoptosis, proliferation inhibition, and EMT.

Conclusion

LncRNA-ATB promoted the COM-induced cell injury, cell apoptosis, proliferation inhibition, and EMT to participate in the process of CaOx crystal-induced renal injury by sponging miR-200s.
Physiological and proteomic analyses revealed the response mechanisms of two different drought-resistant maize varieties
Authors: Li Hongjie , Yang Mei , Zhao Chengfeng , Wang Yifan , Zhang Renhe
Published: November 2021

Background

Drought stress severely limits maize seedling growth and crop yield. Previous studies have elucidated the mechanisms by which maize acquires drought resistance and contends with water deficiency. However, the link between the physiological and molecular variations among maize cultivars are unknown. Here, physiological and proteomic analyses were conducted to compare the stress responses of two maize cultivars with contrasting drought stress tolerance.

Results

The physiological analysis showed that the drought-tolerant SD609 maize variety maintains relatively high photochemical efficiency by enhancing its protective cyclic electron flow (CEF) mechanism and antioxidative enzymes activities. Proteomics analysis revealed that 198 and 102 proteins were differentially expressed in SD609 and the drought-sensitive SD902 cultivar, respectively. GO and KEGG enrichments indicated that SD609 upregulated proteins associated with photosynthesis, antioxidants/detoxifying enzymes, molecular chaperones and metabolic enzymes. Upregulation of the proteins related to PSII repair and photoprotection improved photochemical capacity in SD609 subjected to moderate drought stress. In SD902, however, only the molecular chaperones and sucrose synthesis pathways were induced and they failed to protect the impaired photosystem. Further analysis demonstrated that proteins related to the electron transport chain (ETC) and redox homeostasis as well as heat shock proteins (HSPs) may be important in protecting plants from drought stress.

Conclusions

Our experiments explored the mechanism of drought tolerance and clarified the interconnections between the physiological and proteomic factors contributing to it. In summary, our findings aid in further understanding of the drought tolerance mechanisms in maize.
Barriers and facilitators for implementation of a complex health services intervention in long-term care homes: a qualitative study using focus groups
Authors: von der Warth Rieka , Kaiser Vanessa , Reese Christina , Brühmann Boris A. , Farin-Glattacker Erik
Published: November 2021

Background

With rising numbers of elderly people living in nursing homes in Germany, the need for on-site primary care is increasing. A lack of primary care in nursing homes can lead to unnecessary hospitalization, higher mortality, and morbidity in the elderly. The project CoCare (“coordinated medical care”) has therefore implemented a complex health intervention in nursing homes, using inter alia, regular medical rounds, a shared patient medical record and medication checks, with the aim of improving the coordination of medical care. This study reports upon the results of a qualitative study assessing the perceived barriers and facilitators of the implementation of CoCare by stakeholders.

Methods

Focus group interviews were held between October 2018 and November 2019 with nurses, general practitioners and GP’s assistants working or consulting in a participating nursing home. A semi-structured modular guideline was used to ask participants for their opinion on different aspects of CoCare and which barriers and facilitators they perceived. Focus groups were analyzed using qualitative content analysis.

Results

In total, N = 11 focus group interviews with N = 74 participants were conducted. We found six themes describing barriers and facilitators in respect of the implementation of CoCare: understaffing, bureaucracy, complexity, structural barriers, financial compensation, communication and collaboration. Furthermore, participants described the incorporation of the intervention into standard care.

Conclusion

Barriers perceived by stakeholders are well known in the literature (e.g. understaffing and complexity). However, CoCare provides a good structure to overcome barriers and some barriers will dissolve after implementation into routine care (e.g. bureaucracy). In contrast, especially communication and collaboration were perceived as facilitators in CoCare, with the project being received as a team building intervention itself.

Trial registration

WHO UTN: U1111–1196-6611; DRKS-ID: DRKS00012703 (Date of Registration in DRKS: 2017 Aug 23).
Optimum dose of spinal ropivacaine with or without single intravenous bolus of S-ketamine during elective cesarean delivery: a randomized, double-blind, sequential dose-finding study
Authors: Zhang Xiaoyu , Wang Jianwei , An Xiao-Hu , Chao Yu-Chieh , Bian Yong , Xu Zifeng , Xu Tao
Published: November 2021

Background

Maternal hypotension after spinal anaesthesia occurs at a high rate during caesarean delivery and can lead to adverse maternal or foetal outcomes. The aim of this study was to determine the optimal dose of spinal ropivacaine for caesarean section with or without intravenous single bolus of S-ketamine and to observe the rates of hypotension associated with both methods.

Methods

Eighty women undergoing elective caesarean delivery were randomly allocated into either a ropivacaine only or ropivacaine with intravenous S-ketamine group. If the upper sensory level of the patient reached T6 and the visual analogue scale (VAS) scores remained below 3 points before delivery, the next patient had a 1/9th chance of receiving a lower dose or an 8/9th chance of receiving the same dose as the previous patient. If the patient had VAS scores of more than 2 points or needed an extra epidural rescue bolus before delivery, a higher dose was used for the next patient. The primary outcome was the successful use of spinal ropivacaine to maintain patient VAS score of < 3 points before delivery and the incidence of post-spinal hypotension in both groups. Secondary outcomes included the rates of hypotension-related symptoms and interventions, upper sensory level of anaesthesia, level of sedation, neonatal outcomes, Edinburgh Postnatal Depression Scale scores at admission and discharge, and post-operative analgesic effect. The 90% effective dose (ED90) and 95% confidence interval (95% CI) were estimated by isotonic regression.

Results

The estimated ED90 of ropivacaine was 11.8 mg (95% CI: 11.7–12.7) with and 14.7 mg (95% CI: 14.6–16.0) without intravenous S-ketamine, using biased coin up-down sequential dose-finding method. The rates of hypotension and associated symptoms were significantly lower in S-ketamine group than in the ropivacaine only group.

Conclusions

A spinal dose of ropivacaine 12 mg with a single intravenous 0.15 mg/kg bolus dose of S-ketamine may significantly reduce the risk of hypotension and induce sedation before delivery. This method may be used with appropriate caution for women undergoing elective caesarean delivery and at a high risk of hypotension or experiencing extreme nervousness.

Trial registration

http://www.chictr.org.cn (ChiCTR2000040375; 28/11/2020).
Multimodal imaging of indapamide-induced bilateral choroidal effusion: a case report
Authors: Takahashi Shizuka , Usui Shinichi , Hashida Noriyasu , Kubota Hiroshi , Nishida Kentaro , Sakaguchi Hirokazu , Nishida Kohji
Published: November 2021

Background

Indapamide, a sulfonamide diuretic used to treat hypertension, has been reported to have ocular side effects of acute angle-closure glaucoma, transient myopia and choroidal effusion whose immediate etiology is uncertain. This report aims to clarify the nature of indapamide-induced edema of the entire eyeball using multimodal imaging.

Case presentation

A 60-year-old woman who was following a long-term carbohydrate-restricted diet and receiving oral treatment for hypertension was referred to our department for eye pain. Indapamide (1 mg daily) was prescribed for uncontrolled hypertension 5 days before her visit; she took the medication for only 3 days and then stopped due to dry eye. However, she began to feel eye pain the day after her last dose, and the pain gradually intensified. She experienced no decrease in visual acuity at the initial visit; however, an extremely shallow anterior chamber was observed in both eyes, along with a slight increase in intraocular pressure. For differential diagnosis, ocular manifestations were evaluated with wide-field fundus photography, optical coherence tomography (OCT) of both anterior and posterior segments, fluorescein / indocyanine green angiography, ultrasound biomicroscopy and head magnetic resonance, showing edema of the entire eyeball. Treatment with tropicamide and phenylephrine hydrochloride drops resulted in rapid recovery of the anterior chamber depth and disappearance of the choroidal effusion within 3 days.

Conclusions

Multimodal imaging is useful for diagnosing drug-induced choroidal effusion by evaluating ocular conditions before and after treatment.
The application framework of big data technology in the COVID-19 epidemic emergency management in local government—a case study of Hainan Province, China
Authors: Mao Zijun , Zou Qi , Yao Hong , Wu Jingyi
Published: November 2021

Background

As COVID-19 continues to spread globally, traditional emergency management measures are facing many practical limitations. The application of big data analysis technology provides an opportunity for local governments to conduct the COVID-19 epidemic emergency management more scientifically. The present study, based on emergency management lifecycle theory, includes a comprehensive analysis of the application framework of China’s SARS epidemic emergency management lacked the support of big data technology in 2003. In contrast, this study first proposes a more agile and efficient application framework, supported by big data technology, for the COVID-19 epidemic emergency management and then analyses the differences between the two frameworks.

Methods

This study takes Hainan Province, China as its case study by using a file content analysis and semistructured interviews to systematically comprehend the strategy and mechanism of Hainan’s application of big data technology in its COVID-19 epidemic emergency management.

Results

Hainan Province adopted big data technology during the four stages, i.e., migration, preparedness, response, and recovery, of its COVID-19 epidemic emergency management. Hainan Province developed advanced big data management mechanisms and technologies for practical epidemic emergency management, thereby verifying the feasibility and value of the big data technology application framework we propose.

Conclusions

This study provides empirical evidence for certain aspects of the theory, mechanism, and technology for local governments in different countries and regions to apply, in a precise, agile, and evidence-based manner, big data technology in their formulations of comprehensive COVID-19 epidemic emergency management strategies.