bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of drug interventions on cerebral hemodynamics in ischemic stroke patients
Authors: Llwyd Osian , Fan Jui-Lin , Müller Martin
Published: November 2021

The ischemic penumbra is sensitive to alterations in cerebral perfusion. A myriad of drugs are used in acute ischemic stroke (AIS) management, yet their impact on cerebral hemodynamics is poorly understood. As part of the Cerebral Autoregulation Network led INFOMATAS project ( Identifying New Targets for Management and Therapy in Acute Stroke), this paper reviews some of the most common drugs a patient with AIS will come across and their potential influence on cerebral hemodynamics with a particular focus being on cerebral autoregulation (CA). We first discuss how compounds that promote clot lysis and prevent clot formation could potentially impact cerebral hemodynamics, before focusing on how the different classes of antihypertensive drugs can influence cerebral hemodynamics. We discuss the different properties of each drug and their potential impact on cerebral perfusion and CA. With emerging interest in CA status of AIS patients, either during or soon after treatment when timely reperfusion and salvageable tissue is at its most critical, the properties of these pharmacological agents may be relevant for modelling cerebral perfusion accuracy and for setting individualised treatment strategies.
The influence of surface roughness on the damage of von Willebrand Factor under shear flow condition
Authors: Mei Xu , Lu Bin , Zhong Min , Zhu Yuxin , Zhang Liudi , Ge Wanning
Published: November 2021

Despite technological advances in mechanical circulatory support devices to treat end-stage heart failure, blood damage induced by non-physiological shear stress in operation often triggered clinical hemocompatibility complications. The loss of high molecular weight von Willebrand Factor (HMW-VWF) has been considered as an essential cause of gastrointestinal bleeding. In addition to the mechanics factors, interface factors may also affect blood damage, especially the surface characteristics. In this study, the effect of surface roughness on VWF damage under flow condition was investigated. A roller pump circulation experimental platform with a roughness embedded sample chamber was constructed to provide blood shearing flow condition. VWF molecular weight analysis, VWF antigen (VWF-Ag) concentration assay, and VWF ristocetin cofactor activity (VWF-Rico) assay were performed on the sheared blood samples. These variables are the main functional indicators of VWF. It was found that the surface roughness induced VWF damage is mainly caused by the loss of HMW-VWF rather than reducing the total amount of VWF. The threshold value of surface roughness for a rapid increase in the degradation of HMW-VWF under low flow rate was obtained between Ra 0.4 and 0.6 μm, which was smaller than the threshold for hemolysis. Our findings indicated that VWF is more sensitive to the interface factor of surface roughness than red blood cells, thus has a higher requirement for blood pump design. It could provide reference for the material design and processing in developing mechanical circulatory support devices.
Ethics of Health Information Sharing and Social Relationships at End of Life in Assisted Living
Authors: Cooke Emma , Perkins Molly M. , Doyle Patrick , Kinlaw Kathy , Wack Kevin , Vandenberg Ann E.
Published: November 2021

Given an observed tension between perceived privacy restrictions and meaningful social connection in assisted living (AL) and using a relational perspective, we conducted a secondary thematic analysis of health information sharing practices among residents and their care partners in one large urban AL community in metropolitan Atlanta. Data included in-depth interviews with residents ( n = 26), family members ( n = 20), AL staff ( n = 11), and external care workers ( n = 4) as well as ethnographic data from observations and informal conversations conducted with these participants and others. Findings showed that health information sharing among residents was helpful in building social relationships; barriers to this communication contributed to isolation. Inappropriate public exchange of residents’ healthcare information hindered building these relationships. Negotiating privacy boundaries for health information sharing was an ongoing confusing process across the community. Based on the findings, we propose new guidelines for health information sharing and additional privacy training for residents and care partners.
“A Lot of Students Are Already There”: Repositioning Language-Minoritized Students as “Writers in Residence” in English Classrooms
Authors: Seltzer Kate
Published: November 2021

This article centers on Faith, a Latinx bilingual student who, because of her failure to pass a standardized exam in English language arts, had to repeat 11th-grade English. Despite this stigma of being a “repeater,” during the year-long ethnographic study I conducted in her classroom, Faith proved to be an insightful and critical reader and self-described poet who shared her writing with her peers as well as with other poets in online forums. Drawing from that more expansive classroom study, this article features Faith’s metacommentary on language and her own writing process and explores how her insights (1) disrupt monoglossic, raciolinguistic ideologies by highlighting the disconnect between her sophisticated understandings of language and the writing process and her status as a “struggling” student; (2) draw attention her wayfinding, which chronicles her navigation of those ideologies that complicate her search for a writerly identity and obscure the translingual nature of all texts and all writers; and (3) can move teachers and researchers of writing to reimagine the writing classroom so that it (re)positions students like Faith as “writers in residence,” whose existing translingual writing practices and wayfinding can serve as mentors and guides for others.
Learning Through Academic Collaborations In/With the East: North American Adult Education Scholars’ Insights
Authors: Sun Qi , Kang Haijun
Published: November 2021

Applying Culture and Appreciative Education lenses, this qualitative study, eliciting detailed descriptions, examines six North American adult and higher education scholars’ lived learning experiences and insights gained from their academic collaborations in and with the East. Our findings indicate that participants hold unique international collaboration experiences with commonalities. Most participants experienced language and cultural barriers in real-time, on-site collaborations that they would not have considered otherwise without these experiences. Many differences made them realize the fundamentals for intercultural collaborations. They consciously learned to reposition with appreciative mindsets and co-construct goals and solutions with counterparts. All participants indicated that transnational contexts enable profound reflective and authentic learning, renewed understandings of cross-cultural sensitivity, and different ways of thinking and doing. This study demonstrates that international collaborations promote adult learning with self-awareness for a new dimension of global learning and cultural competency in the internationalization of adult education.
Shared Determinants for Human Papillomavirus and COVID-19 Vaccination Intention: An Opportunity for Resource Consolidation
Authors: Olagoke Ayokunle A. , Carnahan Leslie R. , Olagoke Olakanmi , Molina Yamilé
Published: November 2021

Purpose

This study aimed at targeting shared factors that influence the prevention of multiple diseases, which can help address various health problems simultaneously. We identified correlates of human papillomavirus (HPV) vaccination that overlap with COVID-19 vaccination.

Design

Cross-sectional survey data.

Setting

Online Qualtrics recruitment panel.

Subject

Religious parents of 342 adolescents who were unvaccinated for HPV (response rate was 68.1%).

Measures

Outcome variables were COVID-19 vaccination intention for (1) self, (2) child, and (3) HPV vaccination intention for child. Independent variables were psychological factors. Covariates were sociodemographic and socioeconomic factors.

Analysis

We conducted multivariate linear regressions on each outcome variable after controlling for covariates.

Result

Some psychological correlates of HPV overlapped as protective factors for all three outcomes. Higher perceived vulnerability of child to HPV was associated with higher vaccination intention against COVID-19 for self (β = .37, 95% confidence interval [CI] = .25–.48), child (β = .32, .21–.44), and HPV for child (β = .38, .27–.49). Higher perceived response efficacy of HPV vaccine was associated with greater vaccination intention against COVID-19 for self (β = .46, .33–.59), child (β = .41, .28–.53), and HPV for child (β = .75, .64–.85).

Conclusion

Given the overlap in HPV and COVID-19 vaccination correlates, interventions should target shared factors that address both diseases to maximize public health efforts. A major limitation of this study is the inability to measure the actual vaccination behavior.
Values-led governance and parental and community engagement in the Co-operative Academies Trust: An alternative in the neoliberal context of education?
Authors: Hetherington Janet E , Forrester Gillian
Published: November 2021

This article examines the nature of governance in the Co-operative Academies Trust which comprises academy schools in England sponsored by the Co-operative Group. The historical and political context for the study is summarised, the research methodology is explained, and data are drawn upon from one case study academy. Structural, organisational and operational deviations of the Co-operative Academies Trust are outlined. The findings illustrate a values-led, branding message and strategic identity, and the placement of senior Co-operative Group employees in the Local Governing Body to ensure the strategic direction is focused upon co-operative values and community. Operationally, the engagement with stakeholders privileges a rational-goal approach, but signs of cultural shift are occurring concurrently with parent forum members demanding deliberation and voice in decision-making.
Correlation of Fracture Resistance of Dental Implants and Bite Force in Dogs described in the literature: An In Vitro Study
Authors: Aramburú Jaime Sarda , Gehrke Sergio Alexandre , Dedavid Berenice Anina , Treichel Tiago Luis Eilers , Pippi Ney Luis
Published: November 2021

Dental implants are not routinely used for rehabilitation in veterinary dentistry. For some veterinarians, further studies are necessary to be considered for clinical use in animals. The objective of the present in vitro study was to evaluate static fatigue of dental implants and to correlate that with the bite strength of dogs described in the literature. Sixty implants and abutments were used with the smallest diameter of each brand of implant utilized in the study. Three groups ( n  =  20) were created on the basis of the implant diameter, all with external hex connector: 3.30 mm (group 1), 4.0 mm (group 2) and 5.0 mm (group 3). All groups were subjected to quasi-static loading at 30° to the implant's long axis in a universal machine (model AME-5 kN). The mean fracture strength for group 1 was 964 ± 187 N, for group 2 was 1618 ± 149 N and for group 3 was 2595 ± 161 N. Significant differences between the groups with respect to resistance after the load applications were observed ( P < .05). The diameter of implants affects the resistance to external forces during the application of non-axial strength (off-axis loading) and must be considered during the planning of rehabilitation to avoid problems.
Event-triggered discrete extended state observer–based model-free controller for quadrotor position and attitude trajectory tracking
Authors: He Dingxin , Wang Haoping , Tian Yang , Zimenko Konstantin
Published: November 2021

In this article, an event-triggered discrete extended state observer–based model-free controller is developed for the position and attitude trajectory tracking of a quadrotor with uncertainties and external disturbances. The referred event-triggered discrete extended state observer–based model-free controller is composed of two event-triggered mechanisms, ultra-local model-based discrete extended state observer and proportional-derivative sub-controller. To reduce system output signal transmission, the event-triggered mechanism of output signal which owns dynamic and static threshold is designed. Based on event-triggered output signals, the discrete extended state observer is constructed to obtain the estimations of state values which are utilized as controller’s variables and to compensate for the lumped disturbances. The proportional-derivative sub-controller is adopted to guarantee the convergence of trajectory tracking error. To decrease control input signal transmission, the event-triggered mechanism of input signal that processes static threshold is constructed. Moreover, the stability analysis of overall quadrotor system with the proposed control strategy is investigated using Lyapunov theorem and the Zeno behavior is avoided. Finally, corresponding control scheme for quadrotor system is structured and the numerical comparative simulation and co-simulation experiment are given to demonstrate the effectiveness and performance of the proposed approach.
Factors detrimental to work productivity and daily activities in systemic lupus erythematosus patients – Analysis of the German LuLa study
Authors: Kernder Anna , Düsing Christina , Richter Jutta , Brinks Ralph , Fischer-Betz Rebecca , Winkler-Rohlfing Borgi , Aringer Martin , Schneider Matthias , Chehab Gamal
Published: November 2021

Objective

The aim of this study was to identify factors associated with impaired work productivity and impaired daily activities in patients with systemic lupus erythematosus (SLE).

Methods

The LuLa study is a longitudinal patient-reported study. Beyond sociodemographic data, work productivity, daily activities and fatigue, several other clinical outcome parameters (e.g. mental health–related quality of life and physical functioning, disease activity, damage and pain) were surveyed with validated questionnaires. The effects of confounders on work productivity (WPAI 2) and daily activity domains (WPAI 4) were studied by multivariate regression analysis.

Results

A total of 585 patients completed the questionnaire of whom 259 were employed and analysed. The median impairment in work productivity (WPAI 2) was 20% (Q1–3 0–40), and the median impairment in daily activities (WPAI 4) was 30% (Q1–3 10–50%). Multivariate regression analysis revealed that fatigue, pain, disease activity and health-related quality of life affected WPAI 2 and 4. Furthermore, we observed distinct synergistic effects of fatigue, disease activity and pain on both work productivity and daily activities: a higher impact of fatigue was associated with the reported extent of pain or disease activity.

Conclusion

In employed patients with SLE, impaired work productivity and impaired daily activities were frequently reported. Fatigue, pain, disease activity and health-related quality of life demonstrated a detrimental impact, with a synergistic effect of fatigue, disease activity and pain. Hence, both optimized pain management and targeted immunomodulatory therapy are important for preserving active participation in life among patients with fatigue.
The Sentient, Skilled and Situated of Sustaining a Physical Activity Career: Pleasurable Interpretations of Corporeal Ambiguity
Authors: Day John , Burns Jan , Weed Mike
Published: November 2021

In comparison to the natural sciences, there is a lack of empirically grounded social scientific research which addresses how people arrive at forming pleasurable interpretations of physical activity participation. Both social and natural conceptualisations of the bodily sensations evoked via physical activity involvement have also been restricted to pain and pleasure and pleasure-displeasure dualisms. Nevertheless, there is general agreement across these disciplines that pleasurable interpretations of physical activity participation encourage regular and sustained future involvement. We draw on carnal sociology to explain life history interview data from 30 varied physical activity careers to argue that corporeal experiences of being physically active are more ambiguous than existing pleasure-pain dualisms suggest. Furthermore, interpreting these ambiguous corporeal senses as pleasurable was of central importance to sustaining a prolonged physical activity career, which we argue is a carnal skill that can be learned. This skill, possessed by those interviewees with the most prolonged physical activity careers, had been acquired through becoming accustomed to the unique situated sensual ambiguities of particular physical activities, as a type of existential connoisseurship. Future research might pay more attention to the ambiguity of physical activity involvement, the carnal interpretation of which carries important consequences for the likelihood of long-term participation.
Calibration of piezoresistive shape-memory alloy strain sensors
Authors: Mäder Thomas , Heusinger Jonas v , Senf Björn , Zoch Martin , Winkler Anja , Drossel Welf-Guntram
Published: November 2021

Continuous strain measurement on fibre-reinforced structures demands mechanical sensors with superior fatigue resistance. Shape-memory alloy wires are predestined for strain sensors utilising their strong piezo-resistance. Calibration of these sensors is necessary in order to extract mechanical data. Therefore, four-point bending of glass-fibre reinforced plastic specimens with applied strain sensors and an optical reference measuring system is used to calibrate and compare shape-memory alloy sensors and standard strain gauges. The gauge factor and its standard deviation is successfully measured by this calibration method. Shape-memory alloy sensors show strain-dependent gauge factor whilst standard strain gauges show a constant strain sensitivity, both with a narrow stochastic distribution. Shape-memory alloy mechanical sensors are reliable to determine strain of fibre-reinforced structures. This offers the possibility to use them in structural health monitoring applications of such structures. Consequently, the four-point bending calibration using glass-fibre reinforced specimens represents a suitable possibility for calibration of strain sensors exposed to higher strain amplitudes.
“My Skill Is Putting on a Mask and Convincing People Not to Look Closer”: Silence, Secrecy and Self-Reliance in Men’s Accounts of Troubles-Telling in an Online Discussion Forum for Anxiety
Authors: Drioli-Phillips Phoebe G. , Oxlad Melissa , Scholz Brett , Lecouteur Amanda , Feo Rebecca
Published: November 2021

Although anxiety disorders are the most prevalent mental health disorder in Australia, little is known about men’s anxiety help-seeking practices. This study investigates how male users of an online discussion forum accounted for engaging in troubles-telling in an online community. Posts on an online discussion forum written by men who identify as experiencing anxiety were analysed using discursive psychology, through the identification of four interpretative repertoires: (1) orienting to troubles-telling as their purpose for posting, (2) troubles-talk as a necessary form of self-help, (3) the online community as a last resort and (4) anxiety as a hidden, secret experience. Findings demonstrate how men reproduced hegemonic masculine ideals of strength, self-reliance and emotional stoicism, while also sharing their experiences of anxiety online. This research highlights the relevance of masculine social norms in understanding anxiety help-seeking practices, and also illustrates the value of online communities in offering support to men in need.
A Modified Extra-articular Lateral Column Lengthening Procedure for Adult Acquired Flatfoot Deformity
Authors: Shih Yin-Chuan , Farn Chui Jia , Wang Chen-Chie , Wang Chung-Li , Chen Pei-Yu
Published: November 2021

Background:

Lateral column lengthening (LCL), originally described by Evans, is an established procedure to correct stage II adult acquired flatfoot deformity (AAFD). However, the relative position between the facets is violated, and other problems may include nonunion, malunion, and calcaneocuboid (CC) joint subluxation. Herein, we report a modified extra-articular technique of LCL with hockey-stick osteotomy, which preserves the subtalar joint as a whole, increases bony apposition to enhance healing ability, and preserves the insertion of the calcaneofibular ligament to stabilize the posterior fragment to promote adduction of the forefoot.

Methods:

We retrospectively recruited 24 patients (26 feet) with stage II AAFD who underwent extra-articular LCL. The mean age was 55.7 ± 15.7 years, and the mean follow-up period was 33.4 ± 12.1 months. Associated procedures of spring ligament repair/reconstruction and posterior tibial tendon plication or flexor digitorum longus transfer were routinely performed and may also include a Cotton osteotomy, heel cord lengthening, or hallux valgus correction. Clinical and radiographic outcomes at the final follow-up were compared with the preoperative assessments.

Results:

All patients achieved calcaneus union within 3 months of operation. The VAS pain score improved from 5.3 ± 0.75 preoperatively to 1.2 ± 0.79 at the final follow-up ( P < .001), and the AOFAS Ankle-Hindfoot Scale from 63.5 ± 8.5 to 85.8 ± 4.8 points ( P < .001). The radiographic measurements significantly improved in terms of the preoperative vs final angles of 8.9 ± 5.3 vs 15.2 ± 3.6 degrees for calcaneal pitch ( P < .001), 20.5 ± 9.2 vs 4.9 ± 4.8 degrees for Meary angle ( P < .001), 46.5 ± 5.2 vs 41.9 ± 3.2 degrees for lateral talocalcaneal angle ( P < .001), 23.9 ± 8.5 vs 3.9 ± 3.1 degrees for talonavicular coverage angle ( P < .001), and 18.2 ± 9.2 vs 7.3 ± 5.0 degrees for talus-first metatarsal angle ( P = .002). The CC joint subluxation percentage was 7.0% ± 5.4% preoperatively compared with 8.5% ± 2.4% at the final follow-up ( P = .101). No case showed progression of CC joint arthritis or CC joint subluxation (>15% CC joint subluxation percentage). One case showed transient sural nerve territory paresthesia, and 1 had pin tract infection. Three cases had lateral foot pain, which could be relieved by custom insoles.

Conclusion:

Modified extra-articular LCL as part of AAFD correction is a feasible alternative technique without subtalar joint invasion and may be associated with less CC joint subluxation compared with the Evans osteotomy.

Level of Evidence:

Level IV, retrospective case series.
Evaluation of denosumab in adult oncology patients for the prevention of skeletal related events across a large academic health system
Authors: Sproat Michelle R. , Burton Bradley , Burdalski Catherine , Porter Timothy , Proctor Celia , Goldenhorn Michael , Andoh Kofi , Gilmore Steven
Published: November 2021

Introduction

Denosumab (Xgeva®) and zoledronic acid (Zometa®) are widely utilized for prevention of skeletal related events (SREs) in oncology patients. Drug costs, renal function, ease and logistics of administration, and adverse effect profile are factors frequently considered by patients and/or providers when selecting an optimal agent. Given the significantly higher drug cost of denosumab compared to zoledronic acid, an evaluation of our institution's denosumab use and investigation into opportunities to shift denosumab administrations to zoledronic acid and/or to lower cost sites-of-care was warranted.

Methods

A single-center, multi-site, retrospective, observational analysis of the electronic medical record (EMR) was conducted for adult oncology patients who received denosumab 120 mg for prevention of SREs from October 1st, 2018 to September 30th, 2019 at three institutions within our health system. Additional information was collected to characterize the patient population based on cancer diagnosis, renal function, and concomitant calcium and vitamin D supplementation. Our primary objective was to evaluate if the use of denosumab met current formulary restrictions of the health system.

Results

In total, 304 adult oncology patients received 1411 doses of denosumab for the prevention of SREs. The majority of reviewed patients had a primary oncology diagnosis of breast (35%) or lung (24%) cancer. Of the patients who received denosumab, 278 (93%) met the health system's current formulary restrictions. The majority of patients who did not meet formulary restrictions were those with multiple myeloma (MM) (20/22; 91%). Of the 304 patients reviewed, 70 had the appropriate parameters in the EMR to calculate creatinine clearance (CrCl) using Cockcroft-Gault Equation. Of those 70 patients, 59 (84%) would have been eligible to receive zoledronic acid instead of denosumab given that their CrCl >30 mL/min with no documented intolerance to bisphosphonates. Concurrent use of calcium and vitamin D is recommended when using denosumab. Based on the most recent prior to admission (PTA) medication list obtained from the 304 patients evaluated, 222 (73%) had both calcium and vitamin D listed as “taking”.

Conclusions

Within our health system, denosumab is restricted to those who meet formulary restrictions. Additional education is recommended to help limit the use of denosumab, specifically in MM, to reduce drug costs when zoledronic acid is also an appropriate first-line agent.
Identifying inclusions in a non-uniform thermally conductive plate under external flows and internal heat sources using topological optimization
Authors: Krysko AV , Awrejcewicz J , Bodyagina KS , Makseev A , Zhigalov MV , Krysko VA
Published: November 2021

We propose applying topological optimization methods based on measuring temperature and heat fluxes to estimate the thermal conductivity of inhomogeneous thermally conductive plates and determine the shape and location of foreign inclusions. Examples of plates subjected to external heat fluxes and heat sources are considered. The solutions are obtained with the help of the finite element method combined with the method of moving asymptotes. The results show that identification accuracy depends on the defined boundary conditions, the source intensity value, heat fluxes, temperature distribution and the shape of the inclusions. For the problem of 18 circular inclusions under different heat fluxes, identification accuracy increases with increasing source intensity values.
Challenging the Idea That Humans Are Not Designed to Solve Climate Change
Authors: Atkinson Quentin D. , Jacquet Jennifer
Published: November 2021

In the face of a slow and inadequate global response to anthropogenic climate change, scholars and journalists frequently claim that human psychology is not designed or evolved to solve the problem, and they highlight a range of “psychological barriers” to climate action. Here, we critically examine this claim and the evidence on which it is based. We identify four key problems with attributing climate inaction to “human nature” or evolved psychological barriers: (a) It minimizes variability within and between populations; (b) it oversimplifies psychological research and its implications for policy; (c) it frames responsibility for climate change in terms of the individual at the expense of the role of other aspects of culture, including institutional actors; and (d) it rationalizes inaction. For these reasons, the message from social scientists must be clear—humans’ current collective failure to tackle climate change on the scale required cannot be explained as a product of a universal and fixed human nature because it is a fundamentally cultural phenomenon, reflecting culturally evolved values, norms, institutions, and technologies that can and must change rapidly.
Timing and burden of persistent critical illnessin UK intensive care units: An observational cohort study
Authors: Harrison David A , Creagh-Brown Ben C , Rowan Kathryn M
Published: November 2021

Background

Persistent critical illness is a recognisable clinical syndrome defined conceptually as when the patient’s reason for being in the intensive care unit (ICU) is more related to their ongoing critical illness than their original reason for admission. Our objectives were: (1) to assess the day in ICU on which chronic factors (e.g., age, gender and comorbidities) were more predictive of survival than acute factors (e.g. admission diagnosis, physiological derangements) measured on the day of admission; (2) to assess the consistency of this finding across major patient subgroups and over time and (3) to compare case mix characteristics and outcomes for patients determined to develop persistent critical illness (based on ICU length of stay) with other patients.

Methods

Observational cohort study using a high-quality clinical database from the national clinical audit of adult critical care. 217 adult ICUs in England, Wales and Northern Ireland. 835,946 adult patients admitted to participating ICUs between 1 April 2009 and 31 March 2016. The main outcome measure was mortality at discharge from acute hospital.

Results

We fitted two statistical models (‘chronic’ and ‘acute’) and updated these based upon patients with an ICU length of stay of at least 1, 2, etc., up to 28 days. The discrimination of the chronic model first exceeded that of the acute model on day 11. Patients with longer stays (>10 days) comprised 9% of admissions but used 45% of ICU bed-days. After a mean ICU length of stay of 22 days and a subsequent 28 days in hospital, 30% died.

Conclusions

Persistent critical illness is commonly encountered in clinical practice and is associated with increased healthcare utilisation and adverse outcomes. Improvements in our understanding of the longer term outcomes and in the development of tools to aid prognostication are urgently required – for humane as well as health economic reasons.
Can You Escape? Using Mobile App Escape Games to Create a Holistic Experiential Learning Process Online
Authors: Trinh Mai P.
Published: November 2021

Mobile app escape games are excellent tools to create an experiential learning process in online contexts. Through the act of solving puzzles to escape the rooms, students experience a process in which they need to discover new information and clues, adjust their strategies repeatedly, and become more aware of the way they learn. Their emotional and behavioral reactions when they encounter difficulties can shed light on their learning identity and learning flexibility. The experiential learning cycle is complete with the addition of after-game reflection, debrief, and discussion. Escape games are versatile and can be used to teach a variety of topics, such as problem-solving, creative thinking, teamwork, and leadership, in any kind of classroom, with any population of students. This article provides an overview of mobile app escape games, how instructors could use them in class, and examples of topics, games, and debrief questions to use.
Nuclear receptors: a bridge linking the gut microbiome and the host
Authors: Wang Zixuan , Chen Wei-Dong , Wang Yan-Dong
Published: November 2021

Background

The gut microbiome is the totality of microorganisms, bacteria, viruses, protozoa, and fungi within the gastrointestinal tract. The gut microbiome plays key roles in various physiological and pathological processes through regulating varieties of metabolic factors such as short-chain fatty acids, bile acids and amino acids. Nuclear receptors, as metabolic mediators, act as a series of intermediates between the microbiome and the host and help the microbiome regulate diverse processes in the host. Recently, nuclear receptors such as farnesoid X receptor, peroxisome proliferator-activated receptors, aryl hydrocarbon receptor and vitamin D receptor have been identified as key regulators of the microbiome-host crosstalk. These nuclear receptors regulate metabolic processes, immune activity, autophagy, non-alcoholic and alcoholic fatty liver disease, inflammatory bowel disease, cancer, obesity, and type-2 diabetes.

Conclusion

In this review, we have summarized the functions of the nuclear receptors in the gut microbiome-host axis in different physiological and pathological conditions, indicating that the nuclear receptors may be the good targets for treatment of different diseases through the crosstalk with the gut microbiome.
Organization and expression analysis of 5S and 45S ribosomal DNA clusters in autotetraploid Carassius auratus
Authors: Zhao Chun , Zhang Yuxin , Qin Huan , Wang Chongqing , Huang Xu , Yang Li , Yu Tingting , Xu Xidan , Luo Xiang , Qin Qinbo , Liu Shaojun
Published: November 2021

Background

Autotetraploid Carassius auratus (4n = 200, RRRR) (abbreviated as 4nRR) is derived from whole genome duplication of Carassius auratus red var. (2n = 100, RR) (abbreviated as RCC). Ribosome DNA (rDNA) is often used to study molecular evolution of repeated sequences because it has high copy number and special conserved coding regions in genomes. In this study, we analysed the sequences (5S, ITS1-5.8S-ITS2 region), structure, methylation level (NTS and IGS), and expression level (5S and 18S) of 5S and 45S ribosomal RNA (rRNA) genes in 4nRR and RCC in order to elucidate the effects of autotetraploidization on rDNA in fish.

Results

Results showed that there was high sequence similarity of 5S, 5.8S and ITS1 region between 4nRR and RCC. This study also identified two different types of ITS2 region in 4nRR and predicted the secondary structure of ITS2. It turns out that both secondary structures are functional. Compared with RCC, there was no significant difference in NTS (5S rRNA) methylation level, but the expression level of 5S rRNA was lower in 4nRR, indicating that methylation had little effect on the expression level in 4nRR. IGS (45S rRNA) was hypermethylated in 4nRR compared to RCC, but the expression of 18S rRNA gene was no significantly different from that in RCC, indicating that methylation regulation affected gene expression in 4nRR.

Conclusion

The above studies initially revealed the effects of autotetraploidization on the structure and function of 5S and 45S rRNA in Carassius auratus, and provided a theoretical support for the systematic study of the evolution pattern and characteristics of rDNA in vertebrates.
A whole genome duplication drives the genome evolution of Phytophthora betacei, a closely related species to Phytophthora infestans
Authors: Ayala-Usma David A. , Cárdenas Martha , Guyot Romain , Mares Maryam Chaib De , Bernal Adriana , Muñoz Alejandro Reyes , Restrepo Silvia
Published: November 2021

Background

Pathogens of the genus Phytophthora are the etiological agents of many devastating diseases in several high-value crops and forestry species such as potato, tomato, cocoa, and oak, among many others. Phytophthora betacei is a recently described species that causes late blight almost exclusively in tree tomatoes, and it is closely related to Phytophthora infestans that causes the disease in potato crops and other Solanaceae. This study reports the assembly and annotation of the genomes of P. betacei P8084, the first of its species, and P. infestans RC1-10, a Colombian strain from the EC-1 lineage, using long-read SMRT sequencing technology.

Results

Our results show that P. betacei has the largest sequenced genome size of the Phytophthora genus so far with 270 Mb. A moderate transposable element invasion and a whole genome duplication likely explain its genome size expansion when compared to P. infestans, whereas P. infestans RC1-10 has expanded its genome under the activity of transposable elements. The high diversity and abundance (in terms of copy number) of classified and unclassified transposable elements in P. infestans RC1-10 relative to P. betacei bears testimony of the power of long-read technologies to discover novel repetitive elements in the genomes of organisms. Our data also provides support for the phylogenetic placement of P. betacei as a standalone species and as a sister group of P. infestans. Finally, we found no evidence to support the idea that the genome of P. betacei P8084 follows the same gene-dense/gense-sparse architecture proposed for P. infestans and other filamentous plant pathogens.

Conclusions

This study provides the first genome-wide picture of P. betacei and expands the genomic resources available for P. infestans. This is a contribution towards the understanding of the genome biology and evolutionary history of Phytophthora species belonging to the subclade 1c.
Incidental operating room fire from a breathing circuit warmer system: a case report
Authors: Do Wangseok , Kang Dahyun , Hong Purna , Kim Hyae-Jin , Baik Jiseok , Lee Dowon
Published: November 2021

Background

An airway-associated fire in an operating room can have devastating consequences for patients. Breathing circuit warmers (BCWs) are widely used to provide heated and humidified anesthetic gases and eventually prevent hypothermia during general anesthesia. Herein, we describe a case of a BCW-related airway fire.

Case presentation

In this case, an electrical short within a BCW wire caused a fire inside the circuit. Simultaneously, the fire was extinguished, ventilation was stopped, and the endotracheal tube was disconnected from the BCW. The patient was exposed to the fire for less than 10 s, resulting in burns to the trachea and bronchi. Immediately after airway burn, bronchoscopy showed no edema or narrowing except for soot in the trachea and both main bronchus. After the inhalation burn event, prophylactic antibiotics, bronchodilator, mucolytics nebulizer, and corticosteroid nebulizer were started. On bronchoscopy 3 days after the inhalation burn, mucosal erythematous edema was observed and the inflammatory reaction worsened. The inflammatory reaction showed aggravation for up to 2 weeks, and then gradually recovered, and the epithelium and mucous membrane of the upper respiratory tract returned to normal after 4 weeks. Eventually, the patient recovered without long-term complications and was successfully discharged.

Conclusions

This is the first report of a fire caused by BCW. We wanted to share our experience of how we responded to an airway-related fire in an OR and treated the patient. It cannot be overemphasized that the electrical medical appliance associated with the airways are fatal to the patient in the event of a fire, so caution should always be exercised.
Influence of fluid balance on the prognosis of patients with sepsis
Authors: Zhang Luming , Xu Fengshuo , Li Shaojin , Zheng Xiaoyu , Zheng Shuai , Liu Hui , Lyu Jun , Yin Haiyan
Published: November 2021

Background

Early and timely fluid treatment or resuscitation are the basic measures for the active treatment of sepsis. Our aim is to further explore the relationship between fluid balance and prognosis in patients with sepsis on a daily basis for 5 days.

Methods

Sepsis patients in eICU Collaborative Research Database were divided into the negative balance group (NB/−) and the positive balance group (PB/+) according to daily fluid balance. The primary outcome was in-hospital mortality. Survival differences between the groups were analyzed by using Cox regression. Then dose-response relationship between fluid balance and in-hospital mortality was studied using restricted cubic splines (RCSs). Furthermore, patients with fluid balance data for the previous three consecutive days were selected and divided into eight groups (“+/+/+”, “+/+/−”, “+/ −/−”, “+/ −/+”, “−/ −/−”, “−/ −/+”, “−/+/+”, and “−/+/−”). Kaplan–Meier curves and Cox regression were used to show the survival difference between groups.

Results

Our study, which included 19,557 patients in a multicenter database, showed that positive fluid balances on days 1, 2, and 3 after sepsis diagnosis were associated with poor prognosis with the HRs of 1.29 (1.20,1.40), 1.13 (1.01,1.27), and 1.25 (1.08,1.44), respectively, while the fluid balance on days 4 and 5 had no effect on the primary outcome. Then RCSs showed an overall trend that the risk of in-hospital mortality on days 1, 2, and 3 increased with increasing fluid balance. For three consecutive days of fluid balance, we studied 9205 patients and Kaplan–Meier curves revealed survival differences among patients in the eight groups. The cox model demonstrated that compared with the “+/+/+” group, the “+/ −/−”, “−/ −/−”, “−/ −/+”, “−/+/+”, and “−/+/−” groups had a lower risk of in-hospital mortality, with HRs of 0.65 (0.45,0.93), 0.72 (0.60,0.86), 0.63 (0.43,0.93), 0.69 (0.48,0.98), and 0.63 (0.42,0.96), respectively.

Conclusions

In patients with sepsis, positive fluid balance on days 1, 2, and 3 was associated with adverse outcomes. For patients with fluid balance for three consecutive days, the “+/−/−”, “−/ −/−”, “−/−/+”, “−/+/+”, and “−/+/−” groups were less likely to die in hospital than the “+/+/+” group.
Contrast-induced encephalopathy mimicking stroke after a second cerebral DSA: an unusual case report
Authors: Li Jiaying , Qi Guanshu , Zhang Huani , Chen Gang , Wang Shuting , Yan Minli , Sun Zhichao
Published: November 2021

Background

Contrast-induced encephalopathy (CIE) is a rare complication of the angiography process. CIE may mimic stroke symptoms clinically and subarachnoid hemorrhage radiologically. Previous CIE cases occurred after the initial digital subtraction angiography (DSA) scan. Here, we encountered an unusual case of CIE mimicking a stroke with an internal carotid artery (ICA) aneurysm and ipsilateral ICA stenosis that occurred after a second DSA procedure.

Case presentation

A 77-year-old female with a history of hypertension and coronary heart disease underwent two cerebral DSA procedures over 1 week. She was given the same nonionic and iso-osmolar Visipaque agent (smaller than 200 ml) for both procedures. However, neurological complications only occurred after the second DSA procedure. On the first diagnostic cerebral DSA, she was diagnosed with an intracranial aneurysm of the left ICA with moderate stenosis (approximately 50%) in the initial part of the ipsilateral ICA. However, after the second aneurysm embolization procedure by DSA, she developed right hemiplegia, aphasia, and epilepsy, mimicking left middle cerebral artery occlusion. An emergency CT showed a diffuse hyperdensity in the left subarachnoid space, mimicking SAH. MRI demonstrated that the lesion was hyperintense on T2WI, FLAIR imaging, and DWI but was normal on ADC mapping. On postoperative Day 6, her neurologic deficits had completely resolved after initial fluid restriction, corticosteroid treatment, and rehydration.

Conclusion

This case indicates that clinicians should consider the occurrence of CIE following any angiography procedure, even if the initial cerebral DSA procedure is successful and without complications.
The association between obesity and quality of life: a retrospective analysis of a large-scale population-based cohort study
Authors: Stephenson J. , Smith C. M. , Kearns B. , Haywood A. , Bissell P.
Published: November 2021

Background

The relationship between obesity and health-related quality of life (HRQoL) may be confounded by factors such as multimorbidity. The aim of the study was to explore this relationship, controlling for long-term conditions and other health, lifestyle and demographic factors in a general adult population. There was specific interest in the impact of high weight status, measured by body mass index (BMI) levels (obesity, morbid obesity) compared with individuals of normal weight.

Methods

Health, lifestyle and demographic data were collected from 64,631 individuals aged 16 years and over registered in the Yorkshire Health Study; a long-term cohort study. Data were collected in 2 waves: from patients attending GP surgeries in the South Yorkshire region; and using online recruitment across the entire Yorkshire and Humber area. Univariable and multivariable regression methods were utilised to identify factors associated with HRQoL as measured by the EQ-5D summary score. Long-term conditions were tested as both covariates and mediating factors on the causal pathway between obesity and HRQoL.

Results

Increasing levels of obesity are associated with reduced HRQoL, although this difference is negligible between those of normal weight and those who are overweight. Individuals with obesity and morbid obesity score 4.9 and 11.3 percentage points less on the EQ-5D summary scale respectively than those of normal weight. Concurrent physical, and particularly mental health-related long-term conditions are substantively related to HRQoL: those with 3 or more reported mental or physical health conditions score 29.8 and 14.6 percentage points less on the EQ-5D summary scale respectively than those with fewer conditions. Long-term conditions can be conceptualised as lying on the causal path between obesity and HRQoL, but there is weak evidence for a partial mediating relationship only.

Conclusions

To conclude, in agreement with the established literature we have found a clear inverse relationship between increasing weight status and decreasing HRQoL and confirmed the mediating role of long-term conditions in the reduction of HRQoL in people with obesity. Nevertheless, a high BMI remains independently related to HRQoL, suggesting that ‘healthy people with obesity’ may be in transition to an unhealthy future.
Determinants and levels of cervical Cancer screening uptake among women of reproductive age in South Africa: evidence from South Africa Demographic and health survey data, 2016
Authors: Akokuwebe Monica Ewomazino , Idemudia Erhabor Sunday , Lekulo Abiel M. , Motlogeloa Ogone Warona
Published: November 2021

Background

Cervical cancer (CC) is the cancer with the most incidents and the leading cause of cancer mortality among women in South Africa. CC screening is one of the most cost-effective control approaches for the disease burden. This study assessed the determinants and individual-level indicators of cervical cancer screening uptake among women of reproductive age in South Africa.

Methods

We analyzed data from the 2016 South Africa Demographic Health Survey. Our analysis focused on 5903 women (15–49 years). We conducted Chi-square test for bivariate analysis, and multivariate binary logistics regression was used to analyze independent association between individual-level factors and women who have had Pap smear testing. Statistical significance was set at p < 0.05.

Results

The mean age at cervical cancer screening uptake among women in South Africa was 40.8 years (SD 18.6, range 15–95 years). A majority of the women (39.3%) were aged 45 years and above and 54.6% of them resides in urban settlements. About 35.4% of women (n = 2098) have had a Pap smear test, with 66.5% of them who had a Pap smear test resides in Western Cape province. The proportion of women who had a Pap smear test was significantly higher among those with higher educational attainment (68.7%, p = 0.000), in the rich wealth index (50.1%, p = 0.000), and those with health insurance cover (60.3%, p = 0.000). Pap smear testing was found to be more prevalent among women aged 45+ years, were in the white population group, had higher education, were divorced, and had health insurance cover. The predominance of Pap smear test was 14% higher among women who are working in the professional/formal sector (AOR; 1.38, 95% CI; 1.14–1.69). The uptake of Pap smear test was also higher among women aged 35–44 years.

Conclusions

The prevalence of cervical cancer uptake is substantially low among women aged 15–24 years in South Africa and shows a degree of between-provinces differences. Therefore, heath educational interventions aimed at increasing the uptake of cervical cancer screening services in South Africa are critically needed.