bluuebunny/crossref_metadata_2025 huggingface dataset:
Contesting the crisis narrative: epidemic accounts in Sierra Leone, Tanzania, and Democratic Republic of the Congo
Authors: Lees Shelley , Enria Luisa , James Myfanwy
Published: March 2022

Scientists and global commentators watched African countries closely in the early months of the COVID‐19 pandemic, predicting an impending disaster: the virus was projected to overwhelm already weak health systems. These expectations were informed by imaginaries of Africa as an inevitable site of epidemic disaster. This paper draws on accounts from Sierra Leone, Tanzania, and Democratic Republic of the Congo to contrast global catastrophe framings with everyday imaginations and experiences of crisis and crisis management. Utilising ethnographic research, the paper initially explores how COVID‐19 was understood in relation to previous epidemics, from HIV (human immunodeficiency virus) to Ebola, as well as political conflict. It then considers how global crisis narratives both inform and are in tension with everyday collective and personal experiences. The paper brings these empirical reflections into a conversation with theoretical debates on the discursive construction of crisis and its effects, and argues that these tensions matter because crisis framings have consequences.
Immediate PrEP when accessing PEP: A service evaluation
Authors: Cockbain Beatrice , Whitlock Gary ,   the Dean Street Collaborative Group
Published: March 2022

Objectives

In January 2021, 56 Dean Street, a London sexual health clinic, changed clinic policy so that all those attending for post‐exposure prophylaxis (PEP) were offered quick‐start opt‐out pre‐exposure prophylaxis (PrEP) following completion of the 28‐day PEP course. We assessed the uptake of this quick‐start PrEP in service users attending for PEP.

Methods

We undertook a case note review of those who received PEP during the 2‐week period from 17 February to 1 March 2021, assessing the data and comparing them to those from the same period in 2020 (15 February–28 February 2020) before quick‐start opt‐out PrEP was introduced.

Results

The number of service users receiving PEP was 82 in 2020 and 42 in 2021, of which an unmet PrEP need was demonstrated in 81.7% (67/82) in 2020 and 78.6% (33/42) in 2021 (p = 0.8106). Of those with an unmet need, a higher proportion (97.0% [32/33]) were offered PrEP in 2021 following the introduction of opt‐out PrEP compared with the 85.1% (57/67) in 2020 (p = 0.0953). Of those eligible for PrEP who were offered it during their PEP consultation, 53.1% (17/32) in 2021 were dispensed PrEP compared with 17.5% (10/57) in 2020 (p = 0.0007).

Conclusion

Since the introduction of quick‐start opt‐out PrEP, uptake in eligible candidates increased from 17.5% to 53.1%. This suggests that this strategy was acceptable to service users.
Vital pulp treatment for traumatized permanent teeth: A systematic review
Authors: Matoug‐Elwerfelli Manal , ElSheshtawy Ahmed S. , Duggal Monty , Tong Huei Jinn , Nazzal Hani
Published: March 2022

Background

Traumatic dental injuries involving the pulp are quite common and there is a need to evaluate the quality of evidence on the success of vital pulp treatment (VPT) interventions in traumatised permanent teeth.

Objectives

The aim of this systematic review was to assess the success of VPT in the management of traumatised human vital permanent teeth diagnosed with complicated crown or crown‐root fractures.

Methods

An electronic search of the following databases: Web of Science, Scopus, PubMed, MEDLINE, EMBASE, LILACS, Clinical Trial Registries and the grey literature was performed until 25th/8/2021. Controlled clinical trials, cohort studies, case‐control studies, case series with at least five cases and a minimum of 12‐months follow‐up were included. Non‐English language literature was excluded. Two independent assessors performed study selection, data extraction and quality assessment using the National Institutes of Health’s quality assessment tool. Disagreements were resolved through consensus/with a third assessor.

Results

A total of 14‐studies (2‐controlled clinical trials, 1‐case‐control, and 11‐case series) published between 1978–2020, with a total of 1081 permanent teeth and an age range between 6–42 years‐old were included. Bias analysis ranged considerably from ‘good’ to ‘poor’. Meta‐analysis was not performed due to data heterogeneity, unclear reporting, and limited number of controlled clinical studies. Partial pulpotomy was the main reported clinical procedure with an overall success rate between 82.9–100%. Complete pulpotomy and direct pulp capping were associated with lower success rates of 79.4–85.7% and 19.5%, respectively. Calcium hydroxide was the main pulp capping material with favourable clinical and radiographic success (79.4–100%). Biodentine®, mineral trioxide aggregate and IRoot® BP were also associated with a high clinical and radiographic success, 80–91%, 80–100%, and 90–100%, respectively, albeit in fewer studies.

Discussion

Although a high success rate has been reported when using VPT in managing pulpally involved traumatised teeth, the results of this systematic review clearly highlighted a paucity and low quality of the available evidence.

Conclusions

Overall high success of VPT in the management of traumatised vital permanent teeth were reported, although based on limited evidence of well‐conducted clinical studies.

Registration

PROSPERO database (CRD42020205213).
Lepromatous leprosy with dermatofibroma features: colonization or morphological variant of histoid leprosy with epidermal induction?
Authors: Outi Pontes Cinthia Maria , Lourenco Pontes Alexandre Lizardo , Ocanha‐Xavier Juliana Polizel , Xavier‐Júnior José Cândido Caldeira
Published: March 2022

Background

Leprosy is one of the main health problems in developing countries. It can show many different clinical presentations.

Case report

A 37‐yr‐old woman with multiple reddish‐brown papules on the lower and upper limbs, including the palms. The initial clinical impression was pityriasis lichenoides chronica. Biopsies were taken. The specimen from the left shin showed classical histological features of lepromatous leprosy. The specimen from the left thigh was similar to lipidized dermatofibroma showing epidermal hyperplasia with basal layer hyperpigmentation, a narrow Grenz zone, and spindle xanthomatous cells among dermal fibers. Fite‐Faraco staining revealed many bacilli.

Discussion

No matter the clinical presentation, in the presence of lipidized macrophages, Fite‐Faraco staining (an inexpensive method available worldwide) should be performed to rule out leprosy, even in nonendemic areas or associated with a tumor.
Frames of reference in managing employment from the perspective of economics of conventions
Authors: Brandl Julia
Published: March 2022

In their contribution to this symposium, John W. Budd, Dionne Pohler, and Wei Huang provided directions for understanding how conflicts and human resource (HR) practices are influenced by framing processes. The current literature on frames in the field of human resources and industrial relations tends to view individual actors as representatives of theories on employment relationship, and it focuses on the formal side of HR practices. These features limit scholars’ scope and ability to address the agency of the actors involved in framing processes, particularly employees. Therefore, this article develops an analytical perspective based on the economics of conventions to help realize the promise of Budd, Pohler, and Huang's work for a deeper understanding of the co‐construction of frames and changes in HR practices in work organizations.
Midwives and Liability: Results of the 2018 National Midwives and Liability Survey
Authors: Page Katie , Aryal Subhash , Guidera Mamie
Published: March 2022

Introduction

This is the third national survey about the incidence of midwifery involvement in malpractice litigation, case outcome, methods of coping, and the influence of fear of liability or actual litigation on midwifery practice and professional liability insurance. Incidence of disciplinary action was also included.

Methods

A link to a web‐based survey was sent to all American College of Nurse‐Midwives members with an active email address in January 2018. Students and associate members were excluded from analysis. Logistic regression was used to identify predictors of involvement in lawsuit.

Results

Of 6199 email links sent, 880 midwives responded (14%). One‐third of participants (n = 280, 32%) have been named in at least one lawsuit after a median of 7 years in practice. Claims most often involved intrapartum hospital‐based care and resulted from fetal heart rate interpretation. The most common outcome of a case was settlement prior to court or arbitration (n = 117, 42%). Significant predictors of litigation included older age of the midwife and region of practice (increased in Northeastern states, decreased in Midwestern states). Midwives’ most common source of emotional support was their attorney. Only 6% (n = 53) of participants experienced disciplinary action against their state license. Half of the actions by a state governing board were unrelated to a lawsuit.

Discussion

Midwives may experience litigation the longer they are in practice, but there has not been a significant change in the incidence since the previous survey in 2009. More resources and education are needed for midwives to provide adequate peer support to colleagues following adverse events or when named in a lawsuit. Continued education is also needed for midwives regarding types of professional liability insurance, affordability, and how policy terms and limits influence clinical practice.
Triple steps acne scar revision technique: A new combination therapeutic modality for atrophic acne scars
Authors: Mohammed Ghada F. , Al‐Dhubaibi Mohammed Saleh
Published: March 2022

Background

Atrophic acne scarring is an unfortunate, permanent complication of acne vulgaris, associated with significant psychological distress.

Objective

A new complementary treatment of atrophic acne scars using subcision and injection of hybrid cooperative complexes of high and low molecular weight hyaluronan (hybrid H‐HA/L‐HA).

Methods

This study included eighty‐two patients divided into two groups with predominantly atrophic acne scarring. Group 1 received subcision with saline injection, while group 2 received triple steps acne scar revision technique (TSASRT). After topical anesthesia, the procedure of combining subcision and hybrid H‐HA/L‐HA technique was done in which the first step started using subcision technique done to release fibrous cords at the dermal or deep dermal, subcutaneous plane using Nokor needles‐18 g. The second step is to inject the scar's atrophic dermal component with a 29 g needle, applying an average amount of hybrid H‐HA/L‐HA (0.02–0.1 mL) to the dermal component. The third step was to fill the subcisied space with hybrid H‐HA/L‐HA (0.02–0.1 mL) using a 25 g cannula.

Results

Clinical improvement was achieved in both groups. There were statistically significant improvements in the TSASRT versus subcision (p ≤ 0.05) in acne scar severity index and qualitative scarring grading system.

Conclusion

The triple step acne scar revision technique appears to be a safe and effective way to treat atrophic acne scars on the face.
Understanding opioid use within a Southwestern American Indian Reservation Community: A qualitative study
Authors: Waugh Emma , Ivanich Jerreed , O'Keefe Victoria , Usher Jason , Haroz Emily , Goklish Novalene , Kastler Gloria , Nestadt Paul , Cwik Mary
Published: March 2022

Purpose

Morbidity and mortality due to nonprescription use of opioids has been well documented following the significant increase in the availability of prescription opioids in the early 2000s. The aim of this paper is to explore community beliefs about correlates of opioid risk, protective factors, and behavioral functions of opioid misuse among American Indian youth and young adults living on or near a reservation.

Methods

Qualitative in‐depth interviews were conducted with N = 18 youth and young adults who were enrolled in a parent research trial focused on American Indian youth suicide prevention. Participants were eligible if they endorsed the use of opioids themselves or by close friends or family members at any point during their trial participation.

Findings

Major themes discussed include: (1) description of opioid use and those who use opioids; (2) acquisition; (3) initiation; (4) motivation to continue using; (5) consequences; and (6) possibilities for intervention. Family played an important role in the initiation of use, but was also highlighted as an important factor in treatment and recovery. A need for upstream prevention methods, including increased employment and after‐school activities, was described.

Conclusions

The insights gained through this work could help to inform treatment and prevention programs in the community. This work is timely due to the pressing urgency of the opioid epidemic nationally, and community capacity to address opioid use locally.
Structural and functional comparisons of the environmental microbiota of pond and tank environments at different locations for the commercial aquaculture of American shad
Authors: Du J. , Liu Q.H. , Liu J.S. , Zhang K.-Q. , Huang W.F.
Published: March 2022

The environmental microbiota plays a significant role in the growth and development of aquatic life. In recent years, American shad has become an important economic aquaculture species in China. However, information on the correlation between the growth of American shad and the aquaculture environment is limited. Through 16S rDNA-based sequencing, the microbiota communities in ponds at different locations (Jiangyin and Yancheng in Jiangsu, China) were investigated. The results showed that the richness and diversity of the microbiota in the pond were greater than those in the tank at the same location. At the phylum level, Proteobacteria and Firmicutes were more abundant in the samples from Jiangyin than in those from Yancheng. In addition, the ratio of Firmicutes to Bacteroidetes was larger in the JYT samples than in the YCT samples, which implied that the American shad cultured in the Jiangyin environment tended to be fatter than those cultured in Yancheng. The body weight data also confirmed this finding. Moreover, the proportions of functional annotations in the samples from the Jiangyin and Yancheng environments were similar, but there were differences between the overall levels. Our results highlighted the correlations between the environmental microbiome and the growth tendency of American shad.
Prophylactic effects of hyperforin on anhedonia-like phenotype in chronic restrain stress model: A role of gut microbiota
Authors: Zhang Zheng , Yao Chuan , Li Min , Wang Li-chuang , Huang Wei , Chen Qing-jie
Published: March 2022

Anhedonia is the core symptom of depression, which largely reflects the therapeutic effect of depression. Hypericum perforatum is one of the most important antidepressant herb that has fewer side effects than traditional antidepressants. Considering the antibacterial effect of Hypericum perforatum, we verified whether this antidepressant activity was related to intestinal microbiomics. So we established anhedonia mouse model to explore the underlying treatment mechanism of hyperforin, the key antidepressant ingredient of Hypericum perforatum and to screen new psychobiotics based on hyperforin. It was found that hyperforin prevented anhedonia induced by chronic restraint stress in mice and altered the richness and evenness of bacteria populations compared with stressed mice. Metastat analysis showed that Akkermansia muciniphila and Muribaculum intestinale were the bacterial species obviously affected by hyperforin, and their abundance in hyperforin-treated group significantly increased. The results suggest that the effect of hyperforin on anhedonia may be partly assisted by Akkermansia muciniphila. These also indicate that Muribaculum intestinale may be another important intestinal bacteria involved in the pathogenesis of anhedonia symptom and depression.
The red flesh of kiwifruit is differentially controlled by specific activation–repression systems
Authors: Wang Wen‐qiu , Moss Sarah M. A. , Zeng Lihui , Espley Richard V. , Wang Tianchi , Lin‐Wang Kui , Fu Bei‐ling , Schwinn Kathy E. , Allan Andrew C. , Yin Xue‐ren
Published: March 2022

Anthocyanins are visual cues for pollination and seed dispersal. Fruit containing anthocyanins also appeals to consumers due to its appearance and health benefits. In kiwifruit (Actinidia spp.) studies have identified at least two MYB activators of anthocyanin, but their functions in fruit and the mechanisms by which they act are not fully understood.

Here, transcriptome and small RNA high‐throughput sequencing were used to comprehensively identify contributors to anthocyanin accumulation in kiwifruit.

Stable overexpression in vines showed that both 35S::MYB10 and MYB110 can upregulate anthocyanin biosynthesis in Actinidia chinensis fruit, and that MYB10 overexpression resulted in anthocyanin accumulation which was limited to the inner pericarp, suggesting that repressive mechanisms underlie anthocyanin biosynthesis in this species. Furthermore, motifs in the C‐terminal region of MYB10/110 were shown to be responsible for the strength of activation of the anthocyanic response. Transient assays showed that both MYB10 and MYB110 were not directly cleaved by miRNAs, but that miR828 and its phased small RNA AcTAS4‐D4(−) efficiently targeted MYB110. Other miRNAs were identified, which were differentially expressed between the inner and outer pericarp, and cleavage of SPL13, ARF16, SCL6 and F‐box1, all of which are repressors of MYB10, was observed.

We conclude that it is the differential expression and subsequent repression of MYB activators that is responsible for variation in anthocyanin accumulation in kiwifruit species.
Visualization of phosphorus re‐translocation and phosphate transporter expression profiles in a shortened annual cycle system of poplar
Authors: Kurita Yuko , Kanno Satomi , Sugita Ryohei , Hirose Atsushi , Ohnishi Miwa , Tezuka Ayumi , Deguchi Ayumi , Ishizaki Kimitsune , Fukaki Hidehiro , Baba Kei'ichi , Nagano Atsushi J. , Tanoi Keitaro , Nakanishi Tomoko M. , Mimura Tetsuro
Published: March 2022

Phosphorus (P) is an essential macronutrient for plant growth. In deciduous trees, P is remobilized from senescing leaves and stored in perennial tissues during winter for further growth. Annual internal recycling and accumulation of P are considered an important strategy to support the vigorous growth of trees. However, the pathways of seasonal re‐translocation of P and the molecular mechanisms of this transport have not been clarified. Here we show the seasonal P re‐translocation route visualized using real‐time radioisotope imaging and the macro‐ and micro‐autoradiography. We analysed the seasonal re‐translocation P in poplar (Populus alba. L) cultivated under ‘a shortened annual cycle system’, which mimicked seasonal phenology in a laboratory. From growing to senescing season, sink tissues of 32P and/or 33P shifted from young leaves and the apex to the lower stem and roots. The radioisotope P re‐translocated from a leaf was stored in phloem and xylem parenchyma cells and redistributed to new shoots after dormancy. Seasonal expression profile of phosphate transporters (PHT1, PHT5 and PHO1 family) was obtained in the same system. Our results reveal the seasonal P re‐translocation routes at the organ and tissue levels and provide a foothold for elucidating its molecular mechanisms.
Clinical implications of facial psoriasis in children and adolescents
Authors: Jung Joon Min , Jung Chang Jin , Yang Hee Joo , Lee Woo Jin , Won Chong Hyun , Lee Mi Woo , Chang Sung Eun
Published: March 2022

Background/Objectives

The clinical implications of facial involvement in pediatric patients with psoriasis have not been adequately studied. The objectives of this study are to evaluate the association between facial involvement and clinical features including disease severity of psoriasis in children and adolescents.

Methods

The clinical features of patients aged below 20 years diagnosed with psoriasis were retrospectively evaluated and grouped based on the presence or absence of facial involvement at presentation. Demographic and clinical data were compared between groups.

Results

Of the 175 patients, 110 patients (62.9%) had facial involvement of psoriasis at presentation. The group with facial involvement was significantly younger at disease onset (p = .032) and had a higher body mass index (BMI) (p = .043) and psoriasis area and severity index (PASI) score (p <.001). The severity of pruritus was significantly higher in the facial than in the non‐facial group (p = .020). Involvement of the nose was associated with the highest disease severity as assessed by the PASI score and affected body surface area. A significantly higher number of treatment modalities were used in the facial group than in the non‐facial group (p = .013). The BMI (odds ratio (OR), 1.39; 95% CI (confidence interval), 1.07–1.80) and PASI score (OR, 1.45; 95% CI, 1.03–2.03) were independent factors associated with facial involvement of psoriasis.

Conclusions

Facial involvement in psoriasis was associated with higher disease severity and more treatment modalities in children and adolescents.
Value after death
Authors: Frugé Christopher
Published: March 2022

Does our life have value for us after we die? Despite the importance of such a question, many would find it absurd, even incoherent. Once we are dead, the thought goes, we are no longer around to have any wellbeing at all. However, in this paper I argue that this common thought is mistaken. In order to make sense of some of our most central normative thoughts and practices, we must hold that a person can have wellbeing after they die. I provide two arguments for this claim on the basis of postmortem harms and benefits as well as the lasting significance of death. I suggest two ways of underwriting posthumous wellbeing.
Radiographic characteristics of canine subungual keratoacanthoma
Authors: Toshima Atsushi , Fulkerson Caroline V. , Oetelaar Garret S. , Kagawa Yumiko , Aoki Hajime , Higuchi Masami , Sawa Kotomi , Kawamura Yozo , Seino Kaji , Sugiyama Atsushi , Otaki Shogo , Murakami Masahiro
Published: March 2022

Subungual keratoacanthoma (SKA) is a rare benign nail bed tumor in dogs, and its radiographic characteristics have not been reported based on the authors’ review of the literature. The purpose of this multicenter, retrospective, observational, descriptive study was to describe the radiographic features of SKA in dogs. Twelve dogs for a total of 12 digits with histologically confirmed SKA met the inclusion criteria. The radiographs of the manus or pes were reviewed by two veterinary radiologists and one veterinarian. The radiology reports were interpreted based on a consensus. In six dogs, there was lysis of both the middle phalanx (P2) and the distal phalanx (P3), whereas in the other six dogs, there was only lysis of P3. In all dogs with osteolysis of P2, the lysis involved the distal articular surface. Osteolysis of P3 was more severe in the ungual process than in the ungual crest in all dogs. The margins of the lytic regions of P2 and P3 were well defined and smoothly marginated in most dogs. Expansile changes in the P3 crest were observed in 83.3% (10/12 dogs), and the nail of the affected digit was enlarged and deformed in 91.6% (11/12 dogs). In summary, the radiographic features of canine SKA include severe pressure resorption of the P3 ungual process, expansile change of the P3 ungual crest, and nail enlargement and deformation. With these radiographic features, SKA should be considered as a differential diagnosis.
Outcomes of 25 female dogs treated for ectopic ureters by open surgery or cystoscopic‐guided laser ablation
Authors: Dekerle Bastien , Maurice Emeline , Decambron Adeline , Viateau Véronique , Maurey Christelle , Manassero Mathieu
Published: March 2022

Objective

To report outcomes after the correction of ectopic ureter (EU) by open surgery or cystoscopic‐guided laser ablation (CLA) in female dogs.

Study design

Retrospective study from 2011 to 2018.

Animals

Twenty‐five female dogs.

Methods

Data collected included signalment, clinicopathologic data, procedural data, complications, and short‐term and long‐term outcomes. Complications were graded as minor or major if a surgical revision was required. Continence status was scored subjectively (1 = completely incontinent to 10 = fully continent).

Results

Fifteen dogs had bilateral EU and 24 had intramural EU (iEU). Open surgical correction included 13 neoureterostomies, 2 neocystoureterostomies, and a combination of these in 2 dogs. Eight dogs underwent CLA. Eighteen dogs experienced minor complications (72%), and 2 experienced major complications (8%). One‐month postoperative continence was achieved in 20/25 (80%) dogs (median score of 10). Incontinence recurred at a median time of 24.9 months in 5 dogs but responded to medical treatment. Overall, dogs remained continent for 66 months (median) and 22/25 (88%) dogs achieved continence with adjunction of medical/surgical treatment in incontinent ones. Fewer minor complications and postoperative recurrences of incontinence were documented after CLA than neoureterostomy (P < .01 andP < .05).

Conclusion

Ectopic ureter correction by open surgery or CLA resulted in a subjectively good prognosis, most dogs reaching continence within a month of surgery, although incontinence occasionally recurred in the long term. CLA was associated with fewer complications and incontinence recurrences than neoureterostomy.

Clinical significance

Cystoscopic‐guided laser ablation should be preferred to correct iEU to prevent short‐term complications and the recurrence of incontinence. Further studies should investigate the cause of postoperative recurrence of urinary incontinence.
The effectiveness of telemedicine interventions on women with postpartum depression: A systematic review and meta‐analysis
Authors: Liu Xueyan , Huang Sasa , Hu Ying , Wang Guangpeng
Published: March 2022

Background

Postpartum depression (PPD) is a public health problem that has significant adverse effects on mothers, couple's relationships, newborn neurodevelopment, and child emotional and cognitive development. This study reviewed the effectiveness of telemedicine interventions in postparturient women with postpartum depression.

Aims

To evaluate the effectiveness of telemedicine intervention in women with postpartum depression.

Methods

Cochrane Library, PubMed, EMBASE, Web of Science, CINAHL, and PsycINFO were searched for relevant articles published between 2003 and March 2021. We also manually reviewed the reference lists of the retrieved articles. The present study followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. The risk of bias for individual studies was evaluated according to the Cochrane Handbook. RevMan 5.4 software was used to carry out the meta‐analysis.

Results

The meta‐analysis included 20 randomized controlled trials with a total of 3252 patients. The results demonstrated that telemedicine was an effective intervention for treating PPD and anxiety and for improving functional impairment in women during their postpartum period.

Linking Evidence to Action

This meta‐analysis provided evidence that telemedicine was an effective intervention for treating PPD in women. Telemedicine also has significant effects on anxiety and improved functional impairment in women during their postpartum period. Our findings may provide accurate evidence‐based guidance for postpartum women's mental health management. In the future, more high‐quality studies are required for verifying these results.
The good, the bad and the ugly: the impact of extracellular vesicles on the cardiovascular system
Authors: Martins‐Marques Tânia , Girão Henrique
Published: March 2022

Cardiovascular diseases (CVDs), which encompass a myriad of pathological conditions that affect the heart and/or the blood vessels, remain the major cause of morbidity and mortality worldwide. By transferring a wide variety of bioactive molecules, including proteins and microRNAs (miRNAs), extracellular vesicles (EVs) are recognized as key players in long‐range communication across the cardiovascular system. It has been demonstrated that these highly heterogeneous nanosized vesicles participate both in the maintenance of homeostasis of the heart and vessels, and contribute to the pathophysiology of CVDs, thus emerging as promising tools for diagnosis, prognosis and treatment of multiple CVDs. In this review, we highlight the beneficial roles of EV‐mediated communication in regulating vascular homeostasis, and inter‐organ crosstalk as a potential mechanism controlling systemic metabolic fitness. In addition, the impact of EV secretion in disease development is described, particularly focusing on cardiac remodelling following ischaemia, atherogenesis and atrial fibrillation progression. Finally, we discuss the potential of endogenous and bioengineered EVs as therapeutic tools for CVDs, as well as the suitability of assessing the molecular signature of circulating EVs as a non‐invasive predictive marker of CVD onset and progression. This rapidly expanding field of research has established the role of EVs as key conveyors of both cardioprotective and detrimental signals, which might be of relevance in uncovering novel therapeutic targets and biomarkers of CVDs.

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Quantification of Behind Shield Blunt Impacts Using a Modified Upper Extremity Anthropomorphic Test Device
Authors: Steinmann Noah , de Lange Julia E. , Binette Jean-Sébastien , Quenneville Cheryl E.
Published: March 2022

Ballistic shields are used by military and police members in dangerous situations to protect the user against threats such as gunfire. When struck, the shield material deforms to absorb the incoming kinetic energy of the projectile. If the rapid back-face deformation contacts the arm, it can potentially impart a large force, leading to injury risk, termed behind armor blunt trauma (BABT). This work characterized the loading profiles due to the contact between the deforming back-face of the shield and the arm using a modified upper extremity anthropomorphic test device (ATD). This ATD measured forces at the hand, wrist, forearm, and elbow to compare the locational effects of the force transfer for future investigations of fracture risk. Two composite ballistic shields, both with the same ballistic protection rating, were investigated and had statistically different responses to the same impact conditions, indicating a further need for shield safety evaluation. Additionally, ballistic force curves were compared among stand-off distances, defined as the distance between the back-face of the shield and the front of the force sensor, where the peak impact force significantly decreased with increased stand-off. This study presents the first highly instrumented ATD upper limb capable of evaluating BABT and characterization of these loading profiles. This work demonstrates the importance of realistic boundary conditions as loading varies by anatomical location. Stand-off distance is an effective method to reduce loading and should be considered in future shield design iterations and standards that are developed using this device.
Relating Metabolism Suppression and Nucleation Probability During Supercooled Biopreservation
Authors: Consiglio Anthony N. , Rubinsky Boris , Powell-Palm Matthew J.
Published: March 2022

Aqueous supercooling provides a method by which to preserve biological matter at subfreezing temperatures without the deleterious effects of ice formation. The extended longevity of the preserved biologic is a direct result of a reduction in the rate of metabolism with decreasing temperature. However, because the nucleation of ice from a supercooled solution is a stochastic process, supercooled preservation carries the risk of random ice nucleation. Theoretical supercooled biopreservation research to date has largely treated these biological and thermophysical phenomena separately. Here, we apply a statistical model of stochastic ice nucleation to demonstrate how the possible reduction in metabolic rate is inherently related to supercooling stability (i.e., the likelihood of ice nucleation). We develop a quantitative approach by which to weigh supercooling stability versus potential metabolic reduction, and further show how the stability–metabolism relationship varies with system size for two assumed modes of nucleation. Ultimately, this study presents a generalizable framework for the informed design of supercooled biopreservation protocols that considers both phase transformation kinetics and biochemical or biophysical kinetics.
Kurtosis loss as a metric for hearing protection evaluation in impulsive noise environments
Authors: Anderson David A. , Argo Theodore F.
Published: March 2022

Hearing loss standards depend on noise power and duration but are incomplete when the noise is primarily impulsive in nature rather than maintaining a continuous power level. Calculating the kurtosis of a noise exposure captures information about its impulsivity, and high kurtosis values cause additional hearing damage. In this paper, a method for measuring the reduction of noise kurtosis through hearing protection is outlined, and measurements demonstrate that spectral insertion loss is independent of the noise kurtosis and that kurtosis loss is not related to either the mean or standard deviation of spectral attenuation.
A homogenization model for the rheology and local field statistics of suspensions of particles in yield stress fluids
Authors: Kammer Christoph , Blackwell Brendan , Arratia Paulo E. , Ponte Castañeda Pedro
Published: March 2022

We investigate the rheological behavior of athermal particle suspensions using experiments and theory. A generalized version of the homogenization estimates of Ponte Castañeda and Willis [J. Mech. Phys. Solids, 43(12), 1919–1951 (1995)] is presented for the effective viscosity of athermal suspensions accounting for additional microstructural features (e.g., polydispersity) via an empirical parameter, λ. For the case of identically sized spheres dispersed with statistical isotropy in a Newtonian fluid, the parameter λ is estimated from the results of Batchelor and Green [J. Fluid Mech. 56(2), 375–400 (1972)] for the Huggins coefficient. Predictions for the macroscopic viscosity are found to be in good agreement with measurements for monodisperse polymethyl methacrylate (PMMA) spheres in glycerol, as well as for the empirical Krieger–Dougherty equation for the shear viscosity. The proposed estimates have the added benefit that they can also be used to get information on the statistics of the stress and strain-rate fields in the fluid and particle phases. In addition, results for the effective shear viscosity are used in combination with the linear comparison method of Ponte Castañeda [J. Mech. Phys. Solids 39(1), 45–71 (1991)] to generate the corresponding estimates for the effective macroscopic behavior and field statistics of particle suspensions in (viscoplastic) yield stress fluids. Good agreement is also found between the theoretical estimates and experimental results for the effective yield and flow stress of suspensions with monodisperse PMMA spheres in Carbopol. Finally, it is argued that the results for the phase averages and fluctuations of the stress and strain-rate fields can be used to provide a physical interpretation for the parameter λ in terms of the polydispersity of the suspension and its implications for the percolation threshold.
Markedly Increasing Antibiotic Resistance and Dual Treatment of Neisseria gonorrhoeae Isolates in Guangdong, China, from 2013 to 2020
Authors: Lin Xiaomian , Qin Xiaolin , Wu Xingzhong , Liao Yiwen , Yu Yuqi , Xie Qinghui , Tang Sanmei , Guo Chixing , Pei Junming , Wu Zhizhou , Cai Changhui , Wang Feng , Wu Shanghua , Chen Heyong , Liu Xiaofeng , Li Ming , Cao Wenling , Zheng Heping
Published: March 2022

The emergence of multidrug resistance in
Neisseria gonorrhoeae
is concerning, especially the cooccurrence of azithromycin resistance and decreased susceptibility to extended-spectrum cephalosporin. This study aimed to confirm the antibiotic resistance trends and provide a solution for
N. gonorrhoeae
treatment in Guangdong, China.
Synchronous visceral Kaposi sarcoma and extracavitary primary effusion lymphoma in a patient with AIDS
Authors: Bradshaw Stanley , Oertling Estelle , Rezigh Austin
Published: March 2022

While infection should always lead the differential when a patient with AIDS presents with fever, inflammatory and malignant aetiologies should also be considered. With profound immunocompromise, malignancies can develop as sequelae of viral oncogene expression. Human herpesvirus 8 (HHV-8) infection drives several AIDS-related cancers including Kaposi sarcoma (KS), multicentric Castleman disease and primary effusion lymphoma (PEL), which can present simultaneously with variable clinical features. Herein, we describe a case of synchronous visceral KS and extracavitary PEL in a patient with AIDS. The patient was treated with systemic chemotherapy and remains in remission after four cycles. We review other cases of copresenting HHV-8-related malignancies, explore the salient pathomechanisms and clinical features of these cancers and discuss treatment strategies.
Blunt thoracic aortic injury resulting in free rupture into the pleural space and cardiac arrest, managed successfully with endovascular stenting
Authors: Niranjan Nithya , Samarasinghe Priyadharshani , Di Mascio Delfino , Hsu Jeremy M
Published: March 2022

Blunt thoracic aortic injury (BTAI) is an uncommon yet serious diagnosis in trauma patients, with high on-scene mortality. BTAI typically occurs from rapid deceleration such as in motor vehicle collisions or high-altitude falls shearing the aorta just proximal to the ligamentum arteriosum. We report a case of a man in his 50s falling from a height of 15 m who presented hypotensive with retrosternal chest pain. Mobile chest X-ray showed a widened mediastinum with left-sided haemothorax. CT revealed a contained free aortic rupture just inferior to the origin of the left subclavian artery with bleeding into the mediastinum and left pleural space. The patient underwent urgent thoracic endovascular aortic repair (TEVAR) but arrested on-table due to a left-sided tension haemothorax requiring chest-drain decompression and haemostatic resuscitation. After return of spontaneous circulation, TEVAR was successfully performed. BTAI is a dynamic process; hence, timely imaging and minimally invasive surgical treatment are key to patients surviving grade III and IV aortic injuries.
A post-Flexner comparative case study of medical training responses to health system needs in Brazil and Germany
Authors: Koch Roland , Fuhr Hannah , Koifman Lilian , Sturm Heidrun , March Cláudia , Vianna Sobrinho Luiz , Joos Stefanie , Borges Fabiano Tonaco
Published: March 2022

Health systems need medical professionals who can and will work in outpatient settings, such as general practitioner practices or health centres. However, medical students complete only a small portion of their medical training there. Furthermore, this type of training is sometimes seen as inferior to training in academic medical centres and university hospitals. Hence, the healthcare system’s demand and the execution of medical curricula do not match. Robust concepts for better alignment of both these parts are lacking. This study aims to (1) describe decentral learning environments in the context of traditional medical curricula and (2) derive ideas for implementing such scenarios further in existing curricula in response to particular medicosocietal needs.

This study is designed as qualitative cross-national comparative education research. It comprises three steps: first, two author teams consisting of course managers from Brazil and Germany write a report on change management efforts in their respective faculty. Both teams then compare and comment on the other’s report. Emerging similarities and discrepancies are categorised. Third, a cross-national analysis is conducted on the category system.

Stakeholders of medical education (medical students, teaching faculty, teachers in decentral learning environments) have differing standards, ideals and goals that are influenced by their own socialisation—prominently, Flexner’s view of university hospital training as optimal training. We reiterate that both central and decentral learning environments provide meaningful complementary learning opportunities. Medical students must be prepared to navigate social aspects of learning and accept responsibility for communities. They are uniquely positioned to serve as visionaries and university ambassadors to communities. As such, they can bridge the gap between university hospitals and decentral learning environments.
Prevalence, factors and inequalities in chronic disease multimorbidity among older adults in India: analysis of cross-sectional data from the nationally representative Longitudinal Aging Study in India (LASI)
Authors: Chauhan Shekhar , Patel Ratna , Kumar Shubham
Published: March 2022

Objective

This study examines the prevalence, patterns and factors of chronic disease-related multimorbidity. Also, this study examines the inequality in the prevalence of multimorbidity among older adults in India.

Design

Cross-sectional study; large nationally representative survey data.

Setting and participants

We have used the first wave of a Longitudinal Ageing Study in India conducted in 2017–2018 across all the 35 states (excluded Sikkim) and union territories in India. This study used information from 31 373 older people aged 60+years in India.

Primary and secondary outcome measures

The outcome variable for this study is multimorbidity. The study used multinomial logistic regression to examine the risk factors for multimorbidity among older adults. To measure the inequality in multimorbidity, the slope of index inequality and relative index of inequality have been used to understand the ranked-based inequality.

Results

Almost one-fourth (24.1%) reported multimorbidity. The relative risk ratio (RRR) of multimorbidity (RRR=2.12; 95% CI=1.49 to 3.04) was higher among higher educated older adults than uneducated older adults. Furthermore, the RRR of multimorbidity (RRR=2.35; 95% CI=2.02 to 2.74) was higher among urban older adults than their rural counterparts. Older adults in the richest wealth quintile were more likely to report multimorbidities (RRR=2.86; 95% CI=2.29 to 3.55) than the poorest older adults. Good self-rated health and no activities of daily living disability were associated with a lower risk of multimorbidities.

Conclusions

This study contributes to the comprehensive knowledge of the prevalence, factors and inequality of the chronic disease-related multimorbidity among older adults in India. Considering India’s ageing population and high prevalence of multimorbidity, the older adults must be preferred in disease prevention and health programmes, however, without compromising other subpopulations in the country. There is a need to develop geriatric healthcare services in India. Additionally, there is a need to disseminate awareness and management of multimorbidity among urban and highly educated older adults.
‘You’re kind of left to your own devices’: a qualitative focus group study of patients with breast, prostate or blood cancer at a hospital in the South West of England, exploring their engagement with exercise and physical activity during cancer treatment and in the months following standard care
Authors: Smith Sian Karen , Wiltshire Gareth , Brown Frankie F , Dhillon Haryana , Osborn Mike , Wexler Sarah , Beresford Mark , Tooley Mark A , Turner James E
Published: March 2022

Objectives

The aim of this study was to explore the experiences of patients with breast, prostate or blood cancer, regarding their (1) engagement with exercise and physical activity during treatment and in the months following standard care, and (2) the meanings attached to these lifestyle behaviours.

Design

A qualitative study using focus groups. The groups were audio recorded, transcribed and analysed using Framework analysis.

Setting

A hospital-based cancer treatment centre in the South-West of England.

Participants

Eighteen people who had either completed treatment or were currently on maintenance therapy for breast, prostate or blood cancer (non‐Hodgkin lymphoma or Hodgkin lymphoma).

Results

Participants reported treatment limiting their ability to engage in exercise and physical activity. However, participants were aware of the physiological, emotional and social benefits of exercise and expressed a desire to maintain a physically active lifestyle before, during and after treatment. They noted a lack of concrete guidance and appropriate exercise classes for people with cancer and felt poorly informed about the type, intensity, duration and frequency of exercise they should be undertaking. As such, participants reported making decisions on their own, relying on their intuition and listening to their bodies to gauge whether they were doing enough exercise (or not).

Conclusions

Participants were aware of the benefits of a physically active lifestyle during and following cancer treatment, but were not familiar with exercise and physical activity guidelines for people living with and beyond cancer. There is a need for healthcare professionals, academics and policy makers to determine how exercise and physical activity can be supported in clinical settings in realistic and meaningful ways accommodating individual patient circumstances.
Worker and manager perceptions of the utility of work-related mental health literacy programmes delivered by community organisations: a qualitative study based on the theory of planned behaviour
Authors: Crisan Corina , Van Dijk Pieter Andrew , Oxley Jennie , De Silva Andrea
Published: March 2022

Objectives

Reluctance to seek help is a leading contributor to escalating mental injury rates in Australian workplaces. We explored the benefit of using community organisations to deliver mental health literacy programmes to overcome workplace barriers to help-seeking behaviours.

Design

This study used a qualitative application of the theory of planned behaviour to examine underlying beliefs that may influence worker’s intentions to participate in mental health literacy programmes delivered by community organisations and manager support for them.

Setting

This study took place within three large white-collar organisations in the Australian state of Victoria.

Participants

Eighteen workers and 11 managers (n=29) were interviewed to explore perspectives of the benefits of such an approach.

Results

Community organisations have six attributes that make them suitable as an alternative mental health literacy programme provider including empathy, safety, relatability, trustworthiness, social support and inclusivity. Behavioural beliefs included accessibility, understanding and objectivity. The lack of suitability and legitimacy due to poor governance and leadership was disadvantages. Normative beliefs were that family and friends would most likely approve, while line managers and colleagues were viewed as most likely to disapprove. Control beliefs indicated that endorsements from relevant bodies were facilitators of participation. Distance/time constraints and the lack of skills, training and lived experiences of coordinators/facilitators were seen as barriers.

Conclusions

Identifying workers’ beliefs and perceptions of community organisations has significant implication for the development of effective community-based strategies to improve worker mental health literacy and help seeking. Organisations with formal governance structures, allied with government, peak bodies and work-related mental health organisations would be most suitable. Approaches should focus on lived experience and be delivered by qualified facilitators. Promoting supervisor and colleague support could improve participation. Models to guide cross-sector collaborations to equip community organisations to deliver work-related mental health literacy programmes need to be explored.