bluuebunny/crossref_metadata_2025 huggingface dataset:
Group Medical Visits and Clinician Wellbeing
Authors: Thompson-Lastad Ariana , Gardiner Paula
Published: November 2020

There is strong evidence for clinical benefits of group medical visits (GMVs) (also known as shared medical appointments) for prenatal care, diabetes, chronic pain, and a wide range of other conditions. GMVs can increase access to integrative care while providing additional benefits including increased clinician-patient contact time, cost savings, and support with prevention and self-management of chronic conditions. During the COVID-19 pandemic, many clinical sites are experimenting with new models of care delivery including virtual GMVs using telehealth. Little research has focused on which clinicians offer this type of care, how the GMV approach affects the ways they practice, and their job satisfaction. Workplace-based interventions have been shown to decrease burnout in individual physicians. We argue that more research is needed to understand if GMVs should be considered among these workplace-based interventions, given their potential benefits to clinician wellbeing. GMVs can benefit clinician wellbeing in multiple ways, including: (1) Extended time with patients; (2) Increased ability to provide team-based care; (3) Understanding patients’ social context and addressing social determinants of health. GMVs can be implemented in a variety of settings in many different ways depending on institutional context, patient needs and clinician preferences. We suggest that GMV programs with adequate institutional support may be beneficial for preventing burnout and improving retention among clinicians and health care teams more broadly, including in integrative health care. Just as group support benefits patients struggling with loneliness and social isolation, GMVs can help address these and other concerns in overwhelmed clinicians.
Ethnic-Racial Life Scripts: Relations With Ethnic-Racial Identity and Psychological Health
Authors: Wilkinson Dulce E. , Dunlop William L.
Published: November 2020

Life scripts dictate the culturally appropriate order, content, and timing of autobiographical events. In the current study, we examined the ethnic-racial life scripts of American emerging adults from three ethnic-racial backgrounds. One hundred ninety-five Asian, 165 Latinx, and 45 White undergraduates produced and rated seven life events they believed to be prototypical of their ethnic-racial group and self-reported desired and perceived script normality, ethnic-racial identity (ERI), and psychological health. The resulting life scripts differed in meaningful ways between the three ethnic-racial groups. Relations between script normality, ERI, and psychological health were similarly varied between groups. These findings provide a descriptive basis for understanding the normative expectations associated with certain ethnic-racial enclaves and how life scripts may vary across these and other such groups. Moreover, the manner in which these scripts are perceived may carry divergent implications for adjustment, across ethnic-racial groups.
Nerve Block on Pain After Mammaplasty: A Meta-Analysis of randomized controlled studies
Authors: Li Xiaoxia , Li Ying
Published: November 2020

Background:

Nerve block showed some potential in alleviating pain after mammaplasty. This systematic review and meta-analysis was conducted to investigate the efficacy of nerve block for pain control after mammaplasty.

Methods:

The databases including PubMed, Embase, Web of Science, EBSCO, and Cochrane library databases were systematically searched for collecting the randomized controlled trials (RCTs) regarding the impact of nerve block on pain intensity after mammaplasty.

Results:

This meta-analysis included 4 RCTs. Compared with control group after mammaplasty, nerve block resulted in remarkably reduced pain scores at 1 hour (mean difference [MD] = −1.84; 95% CI = −2.49 to −1.20; P < .00001), 3 hours (MD = −1.04; 95% CI = −1.47 to −0.62; P < .00001), 6 hours (MD = −0.96; 95% CI = −1.48 to −0.43; P = .0004), and analgesic consumption (standard mean difference = −1.27; 95% CI = −1.73 to −0.82; P < .00001), but showed no significant impact on pain scores within 24 hours (MD = −0.31; 95% CI = −1.05 to 0.43; P = .41).

Conclusions:

Nerve block was associated with substantially reduced pain intensity after mammaplasty.
Acromioclavicular Joint Injuries in Professional Ice Hockey Players: Epidemiologic and MRI Findings and Association With Return to Play
Authors: White Lawrence M. , Ehmann Jonathan , Bleakney Robert R. , Griffin Anthony M. , Theodoropoulos John
Published: November 2020

Background:

Acromioclavicular joint (ACJ) injuries are common in ice hockey players and are traditionally evaluated with conventional radiography, which has recognized limitations in the accurate characterization of the spectrum of soft tissue injuries and severity/grade of injury sustained.

Purpose:

To evaluate the epidemiologic, clinical, and magnetic resonance imaging (MRI) findings in professional ice hockey players who have sustained acute ACJ injuries.

Study Design:

Case series; Level of evidence, 4.

Methods:

A retrospective review was performed of professional National Hockey League (NHL) players referred for MRI evaluation of acute ACJ injuries. All MRI scans were assessed for status of the ACJ, ligamentous stabilizers, and surrounding musculature. MRI-based overall grade of ACJ injury (modified Rockwood grade 1-6) was assigned to each case. Data regarding mechanism of injury, player handedness, clinical features, and return to play were evaluated.

Results:

Overall, 24 MRI examinations of acute ACJ injuries (23 patients; mean age, 24 years) were reviewed. We found that 50% of injuries were sustained during the first period of play, and in 75% of cases, injuries involved the same side as player shooting handedness. Analysis of MRI scans revealed 29% (7/24) grade 1 ACJ injuries, 46% (11/24) grade 2 injuries, 21% (5/24) grade 3 injuries, and 4% (1/24) grade 5 injuries. Trapezius muscle strains were seen in 79% and deltoid muscle strain in 50% of cases. Nonoperative management was used for 23 injuries; 1 patient (grade 5 injury) underwent acute reconstructive surgery. All players successfully returned to professional NHL competition. Excluding cases with additional injuries or surgery (n = 3) or convalescence extending into the offseason (n = 3), we found that the mean return to play was 21.4 days (7.2 games missed). No statistically significant difference was observed in return to play between nonoperatively treated grade 3 injuries (mean, 28.3 days) and grade 1 or 2 injuries (mean, 20.1 days). However, grade 3 injuries were associated with a greater number of NHL scheduled games missed (mean, 12.7) compared with lower grade injuries (mean, 6.1) ( P = .027).

Conclusion:

The spectrum of pathology and grading of acute ACJ injuries sustained in professional ice hockey can be accurately assessed with MRI; the majority of injuries observed in this study were low grade (grades 1 and 2). Although grade 3 injuries were associated with a greater number of games missed, similar return-to-play results were observed between nonoperatively treated grade 3 and grade 1 or 2 ACJ injuries.
Barriers and Value Co-Destruction in a B2B Project Management Context: Agile Software Development Adoption and Rejection in Japanese Organizations
Authors: Seki Nobuhiko , Kohda Youji
Published: November 2020

A new service concept meets some resistance from those who face it prior to adoption. If the resistance cannot be overcome, the new service will not be diffused. There have been many studies of business-to-consumer (B2C) contexts on adoption and rejection of product and service innovation. The question remains, what barriers should be overcome in the diffusion process of new services in the business-to-business (B2B) contexts? For example, if you implement a new service concept to your organization to create new value with your customers, what barriers does your organization need to overcome? Few studies to date have revealed the issue. To identify barriers for adoption, this study focuses on the diffusion process of the Agile software development method in Japanese organizations, which is still in progress, and attempts to approach the adoption barriers for service innovation in the B2B context to understand the barriers and leverage point for overcoming them.

The Agile software development method is an innovation of software development. But there is a possibility that its diffusion will be stopped due to the resistance of project managers involved in a software development. This may lead service systems to value co-destruction as well.
Catholic clerical responses to climate change and Pope Francis’s Laudato Si’
Authors: Wilkins Dominic
Published: November 2020

The 2015 release of Pope Francis’s encyclical on the environment—Laudato Si’—was met with widespread praise by many who hoped this document would spur Catholics around the world to join movements struggling against climate change. Frequently, these hopes were accompanied by expectations that leaders in the Catholic Church would begin greening their churches and help integrate their parishioners into broader environmental movements. However, while there are strong theoretical rationales supporting Catholic environmental action, few studies have examined what—if anything—is actually happening. This paper responds to this gap by assessing how Catholic clergy in one U.S. diocese are engaging environmental concerns. Drawing upon 31 interviews with priests and deacons across the Diocese of Syracuse, N.Y., this study finds that few clergy are substantively engaging environmental issues. In addition, this paper identifies and discusses several personal and systemic barriers hampering Catholic clerical efforts to further green their churches.
Information Overload and the Entrepreneurs’ Behaviour: Mediating Role of Entrepreneurial Self-Efficacy
Authors: Karia Manisha , Bathula Hanoku , Gaur Sanjaya Singh
Published: November 2020

Undoubtedly, the entrepreneur is the key to the initiation of the entrepreneurial process and firm performance. Since entrepreneurs vary in their background and abilities, researchers have examined the factors impacting their performance. Previous results show that personality characteristics and self-efficacy of entrepreneurs had a positive impact on their performance. In this study, we consider that entrepreneurs’ self-efficacy (ESE) is a multi-dimensional concept and identify six inherent dimensions. Further, we include two other variables that have not received adequate attention in the literature so far, namely, entrepreneurial information overload (EIO) and entrepreneurs’ human resources management (HRM) behaviour. To undertake empirical analysis, we developed a conceptual framework that proposes a negative impact of entrepreneurial information overload on entrepreneurial self-efficacy and entrepreneurs’ HRM behaviour. Responses from 403 entrepreneurs of a large emerging economy were subjected to path-based multiple regression analysis. The results reveal that information overload has a direct impact on all the ESE dimensions, except on planning tasks. Although there is no direct effect of EIO on entrepreneurs’ HRM behaviour, there is an indirect effect through the mediating role of ESE. These results suggest the need for appropriate strategies to help entrepreneurs to deal with information overload and ways to improve specific dimensions of ESE as necessary. Further, this study provides a platform for empirical research for future studies.
The Effect of Market Orientation on the Performance of Small and Medium Enterprises in Case of Amhara Region, Ethiopia
Authors: Hassen Yissa , Singh Amanpreet
Published: November 2020

The study investigated the effect of market orientation on the performance of small and medium enterprises in case of Amhara Region, Ethiopia. Primary data was collected from a total of 250 owners/managers of small and medium enterprises using structured questionnaire. A multivariate data analysis technique of structural equation modelling was employed to analyse the data. The result indicated that customer orientation and interfunctional coordination dimensions of MO are significantly and positively affected small and medium enterprises performance. However, competitor orientation dimension was not found to have a positive and significant effect on the performance. The findings revealed that small and medium enterprises need to be more market oriented to realize superior performance. In addition, the different beta coefficient of market orientation indicated that new business ventures are highly recommended to conduct a market orientation profile and take care in investing their scarce resources. Moreover, the mixed results indicate that firms are advised to replicate market orientation to score superior performance with due care in considering the contexts and time in the industry they are operating and match strategies with their internal resources and core competencies. Finally, this study contributed to the almost wholly overlooked research on market orientation and performance linkages in Ethiopian case and the empirical context of this study is quite novel and helpful for developed nations firms who are trying to operate in emerging economies such as Ethiopia.
Assessing the Service Quality Attributes Affecting the Satisfaction of the Northern Railway Passengers: An Empirical Study
Authors: ‘Ranjan’ Rajeev Kumar , Thapar Nitin , Siddiqui Shoaib Alam , Painoli Arun Kant
Published: November 2020

The present study aims to assess the intangible attributes of the service that have an impact on customer satisfaction. The Intangible attributes attached to the service, are difficult to determine. The Indian Railway network is one of the largest railway networks in the world. It is spread over 115,000 km having 21,617 passenger trains carrying 23 million passengers every day. In terms of revenue generation, it is a major contributor to the Indian economy but even then, the service level is very poor as compared to the other parts of the world. Due to increased competition in the modes of transportation, the Service attributes of Indian Railway acts as a strong influencer on Passenger Satisfaction. Indian Railways has a huge potential in terms of economic benefits if their service quality is improved. Various studies have tried to identify the important attributes regarding the Service Quality of Indian Railway. The SERVQUAL model provided important insights into the service attributes. The study attempts to identify the gap that exists in the service level, that is, service offered by the Indian Railway and expectation of the customers. In the study, only internal aspects like facilities (attributes) which make the journey comfortable and the absence of these attributes makes the passengers’ journey uncomfortable are included. The result indicates that there exists a considerable gap in Reliability and Assurance dimensions of Railway service quality and the most important factors determining satisfaction of passengers are basic facilities, safety and security, cleanliness and employee behaviour towards passengers.
Startup Entrepreneurial Creativity and Impact in Armenia: Case Study (2015–2018)
Authors: Keshishyan Elizabeth , Boghosian Mary-Hrachoohi
Published: November 2020

The entrepreneurial creativity (EC) is an important factor for measuring the health and the well-being of the entrepreneurial ecosystem in any country. The purpose of our study was to examine the status of the Armenia’s entrepreneurial ecosystem through entrepreneurial creativity (EC) framework. The ‘Entrepreneurial Creativity and Growth’ (EC&G) model developed by Petrakis and Kafka (2016) was adopted. This model puts forward seven factors affecting the entrepreneurial creativity (EC), therefore, no other factor outside this framework was considered. Partial least square (PLS) methodology was applied to construct a predictive model of the seven factors dependencies on the (EC) and on each other. To increase granularity of the model, two to four sub-factors were constructed for each factor sufficient to affect the main dependent variable, the EC. Only two of the factors ‘Culture and Personal Characteristics of the entrepreneurs’ ( p = 0.001) and the ‘Availability of Relevant Institutions’ ( p = 0.007) were shown to have significant effect on the EC. The ‘Culture and Personality’ of entrepreneurs was significantly and positively correlated to the EC ( b = 0.444), which indicated that flexibility and risk-taking is the highest characteristics of Armenia’s entrepreneurs; thus, more creative. This article reports these findings and more of a study aimed at analysing the EC among the Armenian startup founders who established businesses within the years 2015–2018.
Capturing epistemic uncertainty in site response
Authors: Rodriguez-Marek Adrian , Bommer Julian J , Youngs Robert R , Crespo Maria J , Stafford Peter J , Bahrampouri Mahdi
Published: November 2020

The incorporation of local amplification factors (AFs) determined through site response analyses has become standard practice in site-specific probabilistic seismic hazard analysis (PSHA). Another indispensable feature of the current state of practice in site-specific PSHA is the identification and quantification of all epistemic uncertainties that influence the final hazard estimates. Consequently, logic trees are constructed not only for seismic source characteristics and ground-motion models (GMMs) but also for the site AFs, the latter generally characterized by branches for alternative shear-wave velocity ( VS) profiles. However, in the same way that branch weights on alternative GMMs can give rise to unintentionally narrow distributions of predicted ground-motion amplitudes, the distribution of AFs obtained from a small number of weighted VS profiles will often be quite narrow at some oscillator frequencies. We propose an alternative approach to capturing epistemic uncertainty in site response in order to avoid such unintentionally constricted distributions of AFs using more complete logic trees for site response analyses. Nodes are included for all the factors that influence the calculated AFs, which may include shallow VS profiles, deeper VS profiles, depth of impedance contrasts, low-strain soil damping, and choice of modulus reduction and damping curves. Site response analyses are then executed for all branch combinations to generate a large number of frequency-dependent AFs. Finally, these are re-sampled as a discrete distribution with enough branches to capture the underlying distribution of AFs. While this approach improves the representation of epistemic uncertainty in the dynamic site response characteristics, modeling uncertainty in the AFs is not automatically captured in this way, for which reason it is also proposed that a minimum level of epistemic uncertainty should be imposed on the final distribution.
A new role of glutathione peroxidase 4 during human erythroblast enucleation
Authors: Ouled-Haddou Hakim , Messaoudi Kahia , Demont Yohann , Lopes dos Santos Rogiéro , Carola Candice , Caulier Alexis , Vong Pascal , Jankovsky Nicolas , Lebon Delphine , Willaume Alexandre , Demagny Julien , Boyer Thomas , Marolleau Jean-Pierre , Rochette Jacques , Garçon Loïc
Published: November 2020

The selenoprotein glutathione peroxidase 4 (GPX4), the only member of the glutathione peroxidase family able to directly reduce cell membrane–oxidized fatty acids and cholesterol, was recently identified as the central regulator of ferroptosis. GPX4 knockdown in mouse hematopoietic cells leads to hemolytic anemia and to increased spleen erythroid progenitor death. The role of GPX4 during human erythropoiesis is unknown. Using in vitro erythroid differentiation, we show here that GPX4-irreversible inhibition by 1S,3R-RSL3 (RSL3) and its short hairpin RNA–mediated knockdown strongly impaired enucleation in a ferroptosis-independent manner not restored by tocopherol or iron chelators. During enucleation, GPX4 localized with lipid rafts at the cleavage furrows between reticulocytes and pyrenocytes. Its inhibition impacted enucleation after nuclear condensation and polarization and was associated with a defect in lipid raft clustering (cholera toxin staining) and myosin-regulatory light-chain phosphorylation. Because selenoprotein translation and cholesterol synthesis share a common precursor, we investigated whether the enucleation defect could represent a compensatory mechanism favoring GPX4 synthesis at the expense of cholesterol, known to be abundant in lipid rafts. Lipidomics and filipin staining failed to show any quantitative difference in cholesterol content after RSL3 exposure. However, addition of cholesterol increased cholera toxin staining and myosin-regulatory light-chain phosphorylation, and improved enucleation despite GPX4 knockdown. In summary, we identified GPX4 as a new actor of human erythroid enucleation, independent of its function in ferroptosis control. We described its involvement in lipid raft organization required for contractile ring assembly and cytokinesis, leading in fine to nucleus extrusion.
Correction to: The role of the antigorite + brucite to olivine reaction in subducted serpentinites (Zermatt, Switzerland)
Authors: Kempf Elias D. , Hermann Jörg , Reusser Eric , Baumgartner Lukas P. , Lanari Pierre
Published: November 2020

An amendment to this paper has been published and can be accessed via the original article.
Interrelations between migraine-like headache and persistent post-traumatic headache attributed to mild traumatic brain injury: a prospective diary study
Authors: Ashina Håkan , Iljazi Afrim , Amin Faisal M. , Ashina Messoud , Lipton Richard B. , Schytz Henrik W.
Published: November 2020

Background

Persistent post-traumatic headache (PTH) is a common sequela of mild traumatic brain injury (TBI) and retrospective assessments have found a migraine-like phenotype to be very frequent. This has raised a discussion of shared underlying mechanisms and whether persistent PTH is simply trauma-triggered migraine.

Methods

A 28-day prospective diary study with daily entries and acquisition of data on headache characteristics, associated symptoms, and acute medication use. A total of 64 patients with persistent PTH were enrolled from April 2019 to August 2019. Outcomes were the proportion of monthly headache days of any intensity that met the criteria for a migraine-like day or TTH-like day, as well as the corresponding figures for monthly headache days of moderate to severe intensity. Headache phenotypes were initially assigned based on diagnostic evaluation by semi-structured interview, whilst final headache phenotypes were assigned by diary review.

Results

After diary review, we found that monthly headache days were exclusively migraine-like in 24 of 64 patients (38%) and exclusively TTH-like days in 8 of 64 patients (13%). Considering only monthly headache days of moderate to severe intensity, the corresponding figures were 35 of 64 patients (55%) for migraine-like days and 8 of 64 patients (13%) for TTH-like days. The following headache phenotypes were assigned based on diary review: chronic migraine-like (n = 47, 73%), combined episodic migraine-like and chronic TTH-like (n = 9, 13%), and ‘pure’ chronic TTH-like (n = 8, 13%).

Conclusions

A migraine-like phenotype is common in patients most adversely affected by persistent PTH, although some patients did have a pure chronic TTH-like phenotype. At minimum, these findings suggest that persistent PTH is – at least in some – not ‘trauma-triggered migraine’.
A genome-wide scan study identifies a single nucleotide substitution in MC1R gene associated with white coat colour in fallow deer (Dama dama)
Authors: Reiner Gerald , Weber Tim , Nietfeld Florian , Fischer Dominik , Wurmser Christine , Fries Ruedi , Willems Hermann
Published: November 2020

Background

The coat colour of fallow deer is highly variable and even white animals can regularly be observed in game farming and in the wild. Affected animals do not show complete albinism but rather some residual pigmentation resembling a very pale beige dilution of coat colour. The eyes and claws of the animals are pigmented. To facilitate the conservation and management of such animals, it would be helpful to know the responsible gene and causative variant. We collected 102 samples from 22 white animals and from 80 animals with wildtype coat colour. The samples came from 12 different wild flocks or game conservations located in different regions of Germany, at the border to Luxembourg and in Poland. The genomes of one white hind and her brown calf were sequenced.

Results

Based on a list of colour genes of the International Federation of Pigment Cell Societies (http://www.ifpcs.org/albinism/), a variant in the MC1R gene (NM_174108.2:c.143 T > C) resulting in an amino acid exchange from leucine to proline at position 48 of the MC1R receptor protein (NP_776533.1:p.L48P) was identified as a likely cause of coat colour dilution. A gene test revealed that all animals of the white phenotype were of genotype CC whereas all pigmented animals were of genotype TT or TC. The study showed that 14% of the pigmented (brown or dark pigmented) animals carried the white allele.

Conclusions

A genome-wide scan study led to a molecular test to determine the coat colour of fallow deer. Identification of the MC1R gene provides a deeper insight into the mechanism of dilution. The gene marker is now available for the conservation of white fallow deer in wild and farmed animals.
Comparative analysis of the transcriptomes of EDL, psoas, and soleus muscles from mice
Authors: Hettige Pabodha , Tahir Uzma , Nishikawa Kiisa C. , Gage Matthew J.
Published: November 2020

Background

Individual skeletal muscles have evolved to perform specific tasks based on their molecular composition. In general, muscle fibers are characterized as either fast-twitch or slow-twitch based on their myosin heavy chain isoform profiles. This approach made sense in the early days of muscle studies when SDS-PAGE was the primary tool for mapping fiber type. However, Next Generation Sequencing tools permit analysis of the entire muscle transcriptome in a single sample, which allows for more precise characterization of differences among fiber types, including distinguishing between different isoforms of specific proteins. We demonstrate the power of this approach by comparing the differential gene expression patterns of extensor digitorum longus (EDL), psoas, and soleus from mice using high throughput RNA sequencing.

Results

EDL and psoas are typically classified as fast-twitch muscles based on their myosin expression pattern, while soleus is considered a slow-twitch muscle. The majority of the transcriptomic variability aligns with the fast-twitch and slow-twitch characterization. However, psoas and EDL exhibit unique expression patterns associated with the genes coding for extracellular matrix, myofibril, transcription, translation, striated muscle adaptation, mitochondrion distribution, and metabolism. Furthermore, significant expression differences between psoas and EDL were observed in genes coding for myosin light chain, troponin, tropomyosin isoforms, and several genes encoding the constituents of the Z-disk.

Conclusions

The observations highlight the intricate molecular nature of skeletal muscles and demonstrate the importance of utilizing transcriptomic information as a tool for skeletal muscle characterization.
Tissue-specific Transcriptome analysis reveals lignocellulose synthesis regulation in elephant grass (Pennisetum purpureum Schum)
Authors: Zhang Wenqing , Zhang Shengkui , Lu Xianqin , Li Can , Liu Xingwang , Dong Geyu , Xia Tao
Published: November 2020

Background

The characteristics of elephant grass, especially its stem lignocellulose, are of great significance for its quality as feed or other industrial raw materials. However, the research on lignocellulose biosynthesis pathway and key genes is limited because the genome of elephant grass has not been deciphered.

Results

In this study, RNA sequencing (RNA-seq) combined with lignocellulose content analysis and cell wall morphology observation using elephant grass stems from different development stages as materials were applied to reveal the genes that regulate the synthesis of cellulose and lignin. A total of 3852 differentially expressed genes (DEGs) were identified in three periods of T1, T2, and T3 through RNA-seq analysis. Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis of all DEGs showed that the two most abundant metabolic pathways were phenylpropane metabolism, starch and sucrose metabolism, which were closely related to cell wall development, hemicellulose, lignin and cellulose synthesis. Through weighted gene co-expression network analysis (WGCNA) of DEGs, a ‘blue’ module highly associated with cellulose synthesis and a ‘turquoise’ module highly correlated with lignin synthesis were exhibited. A total of 43 candidate genes were screened, of which 17 had function annotations in other species. Besides, by analyzing the content of lignocellulose in the stem tissues of elephant grass at different developmental stages and the expression levels of genes such as CesA, PAL, CAD, C4H, COMT, CCoAMT, F5H and CCR, it was found that the content of lignocellulose was related to the expression level of these structural genes.

Conclusions

This study provides a basis for further understanding the molecular mechanisms of cellulose and lignin synthesis pathways of elephant grass, and offers a unique and extensive list of candidate genes for future specialized functional studies which may promote the development of high-quality elephant grass varieties with high cellulose and low lignin content.
Global prevalence of congenital heart disease in school-age children: a meta-analysis and systematic review
Authors: Liu Yingjuan , Chen Sen , Zühlke Liesl , Babu-Narayan Sonya V. , Black Graeme C. , Choy Mun-kit , Li Ningxiu , Keavney Bernard D.
Published: November 2020

Background

Congenital heart disease (CHD) is the commonest birth defect. Studies estimating the prevalence of CHD in school-age children could therefore contribute to quantifying unmet health needs for diagnosis and treatment, particularly in lower-income countries. Data at school age are considerably sparser, and individual studies have generally been of small size. We conducted a literature-based meta-analysis to investigate global trends over a 40-year period.

Methods and results

Studies reporting on CHD prevalence in school-age children (4–18 years old) from 1970 to 2017 were identified from PubMed, EMBASE, Web of Science and Google Scholar. According to the inclusion criteria, 42 studies including 2,638,475 children, reporting the prevalence of unrepaired CHDs (both pre-school diagnoses and first-time school-age diagnoses), and nine studies including 395,571 children, specifically reporting the prevalence of CHD first diagnosed at school ages, were included. Data were combined using random-effects models. The prevalence of unrepaired CHD in school children during the entire period of study was 3.809 (95% confidence intervals 3.075–4.621)/1000. A lower proportion of male than female school children had unrepaired CHD (OR = 0.84 [95% CI 0.74–0.95]; p = 0.001). Between 1970–1974 and 1995–1999, there was no significant change in the prevalence of unrepaired CHD at school age; subsequently there was an approximately 2.5-fold increase from 1.985 (95% CI 1.074–3.173)/1000 in 1995–1999 to 4.832 (95% CI 3.425–6.480)/1000 in 2010–2014, (p = 0.009). Among all CHD conditions, atrial septal defects and ventricular septal defects chiefly accounted for this increasing trend. The summarised prevalence (1970–2017) of CHD diagnoses first made in childhood was 1.384 (0.955, 1.891)/1000; during this time there was a fall from 2.050 [1.362, 2.877]/1000 pre-1995 to 0.848 [0.626, 1.104]/1000 in 1995–2014 (p = 0.04).

Conclusions

Globally, these data show an increased prevalence of CHD (mainly mild CHD conditions) recognised at birth/infancy or early childhood, but remaining unrepaired at school-age. In parallel there has been a decrease of first-time CHD diagnoses in school-age children. These together imply a favourable shift of CHD recognition time to earlier in the life course. Despite this, substantial inequalities between higher and lower income countries remain. Increased healthcare resources for people born with CHD, particularly in poorer countries, are required.
The safety of Ramadan Fasting following Percutaneous Coronary Intervention
Authors: Amin Osama A. , Alaarag Ahmed
Published: November 2020

Background

This work aimed to assess the safety of Ramadan Fasting following the Percutaneous Coronary Intervention.

Methods

In our two centers’ Prospective Cohort Study, We included 303 patients who had successful Percutaneous Coronary Intervention before the first day of Ramadan. We advised the patients that recent Percutaneous Coronary Intervention could be a valid excuse for not fulfilling Ramadan Fasting. However, many patients intended to fast the following Ramadan, and we included them in the fasting Group I. We added the patients who decided not to fast the following Ramadan as a control Group II. We followed all the patients during Ramadan and for 6 months after Ramadan.

Results

The demographic data of both groups and the complexity of the coronary anatomy showed no statistically significant difference. Group I (n = 153) showed a statistically significant difference in the incidence of Major Adverse Cardiac Events compared to Group II with a P value (0.005). The logistic multivariate regression analysis showed that the duration from index PCI till the start of RF, SYNTAX score > 22, and Complex procedure were independent predictors of Major Adverse Cardiac Events in the fasting Group I with {P = 0.001, OR (2.302), P = 0.026, OR (2.419), and P = 0.032 OR (1.952)}, respectively. Major Adverse Cardiac Events in Group I occurred mainly during Ramadan Fasting, with 19 patients having Major Adverse Cardiac Events during Ramadan and four patients during the remaining of the follow-up period. The Receiver Operating Characteristic curve analysis showed the decline of the incidence of Major Adverse Cardiac Events after 90 days from Percutaneous Coronary Intervention till the start of Ramadan Fasting with Sensitivity and specificity (90% and 65%), respectively.

Conclusions

We suggest that low-risk patients with a normal systolic function who underwent Percutaneous Coronary Intervention may safely fast Ramadan. At the same time, Ramadan Fasting during the first 3 months following the Percutaneous Coronary Intervention may not be safe.
How to manage celiac disease and gluten-free diet during the COVID-19 era: proposals from a tertiary referral center in a high-incidence scenario
Authors: Elli Luca , Barisani Donatella , Vaira Valentina , Bardella Maria Teresa , Topa Matilde , Vecchi Maurizio , Doneda Luisa , Scricciolo Alice , Lombardo Vincenza , Roncoroni Leda
Published: November 2020

The outbreak of COVID-19 and SARS-CoV-2 infection is spreading worldwide as the first coronavirus pandemic. The clinical picture is variable but flu-like symptoms are common with bilateral interstitial pneumonia being the most frightening presentation. No specific therapies nor vaccine have been developed to date and the only way to limit the virus diffusion is by modifying one’s lifestyle limiting social life and following strict hygienic precautions. No data is available on the risk of COVID-19 and its outcomes in celiac disease (CeD). The restrictions applied to counter COVID-19 can impact on CeD treatment and gluten-free dieting, the only available therapy for CeD. With the present manuscript, we aim to support gastroenterologists and nutritionists in the management of CeD patients in the new pandemic scenario, being conscious that availability and local situations are extremely various.
Size measurements of hepatocellular carcinoma: comparisons between contrast and two-dimensional ultrasound
Authors: Chen Fei , Wang Fei , Sun Si , Zhu Mei , Liu Zheng
Published: November 2020

Background

Ultrasound (US) imaging is known to underestimate tumor size in clinical. This study is aimed to compare the size measurements of hepatocellular carcinoma (HCC) in three US imaging modalities, i.e. two-dimensional (2D) imaging, the arterial phase (AP) and the late phase (LP) imaging of contrast-enhanced US (CEUS).

Methods

Fifty-eight clinically proved HCC patients were included. The 2D and CEUS imaging were performed with Siemens S2000, Philips iu22 and BioSound Twice. 2.5 mL of SonoVue® was injected for every CEUS performance. Two physicians measured the maximal longitudinal and the transverse diameters of the tumors in 2D, the AP and the LP of CEUS from one image section. The three measurements were compared by paired t test.

Results

The mean longitudinal diameter of HCC appeared to be maximal in the AP (4.73 ± 2.04 cm) of CEUS and minimal in the LP (3.98 ± 1.99 cm) of CEUS. The 2D diameter (4.26 ± 2.07 cm) was in the middle between two CEUS measurements. There were significant differences between any two measurements.

Conclusion

There is size difference between the three kinds of HCC measurement. It appeared to be maximal in the AP of CEUS and minimal in the LP. The 2D diameter was in the middle.
Measuring consumer access, appraisal and application of services and information for dementia (CAAASI-Dem): a key component of dementia literacy
Authors: Doherty Kathleen Veronica , Nguyen Hoang , Eccleston Claire E. A. , Tierney Laura , Mason Ron L. , Bindoff Aidan , Robinson Andrew , Vickers James , McInerney Fran
Published: November 2020

Background

The ability to locate, navigate and use dementia services and information, either for oneself or in providing care for others, is an essential component of dementia literacy. Despite dementia literacy being understood to be inadequate in many settings, no validated instrument exists to measure these elements. Here we describe the development and preliminary validation of the Consumer Access, Appraisal and Application of Services and Information for Dementia (CAAASI-Dem) tool.

Methods

Items were adapted from existing health literacy tools and guided by discussion posts in the Understanding Dementia Massive Open Online Course (UDMOOC). Following expert review and respondent debriefing, a modified CAAASI-Dem was administered to UDMOOC participants online. On the basis of descriptive statistics, inter-item and item total correlations and qualitative feedback, this was further refined and administered online to a second cohort of UDMOOC participants. Exploratory factor analysis identified underlying factor structure. Items were retained if they had significant factor loadings on one factor only. Each factor required at least three items with significant factor loadings. Internal consistency of factors in the final model was evaluated using Cronbach’s alpha coefficients.

Results

From a pool of 70 initial items with either a 5-point Likert scale (Not at all confident – Extremely confident; or Strongly agree – Strongly disagree) or a binary scale (Yes – No), 65 items were retained in CAAASI-Dem-V1. Statistical and qualitative analysis of 1412 responses led to a further 34 items being removed and 11 revised to improve clarity. The 31 item CAAASI-Dem-V2 tool was subsequently administered to 3146 participants, one item was removed due to redundancy and EFA resulted in the removal of an additional 4 items and determination of a five factor structure:Evaluation and engagement; Readiness; Social supports; Specific dementia services; andPractical aspects.

Conclusions

The five factors and 26 constituent items in CAAASI-Dem align with functional, critical, and communicative aspects of dementia health literacy from the perspective of the carer. As a screening tool for people living with dementia and their carers, CAAASI-Dem potentially provides a means to determine support needs and may be a key component of the dementia literacy assessment toolbox.
Risk factors for hospital-acquired influenza A and patient characteristics: a matched case-control study
Authors: Yang Kui , Zhang Ni , Gao Chunchen , Qin Hongyan , Wang Anhui , Song Liqiang
Published: November 2020

Background

While hospital-acquired influenza A results in an additional cost burden and considerable mortality in patients, its risk factors are unknown. We aimed to describe the characteristics of patients vulnerable to hospital-acquired influenza A and to identify its risk factors to assist clinicians control hospital-acquired infections and reduce the burden of treatment.

Methods

A case-control study was conducted among hospitalized patients aged ≥18 years at a tertiary level teaching hospital during the 2018–2019 influenza A season. Patient data were retrieved from hospital-based electronic medical records. Hospital-acquired influenza A was defined as a case of influenza A diagnosed 7 days or more after admission, in a patient with no evidence of influenza A infection on admission. The controls without influenza A were selected among patients exposed to the same setting and time period. We identified risk factors using conditional logistic regression and described the characteristics of hospital-acquired influenza A by comparing the clinical data of infected patients and the controls.

Results

Of the 412 hospitalized patients with influenza A from all the departments in the study hospital, 93 (22.6%) cases were classified as hospital-acquired. The most common comorbidities of the 93 cases were hypertension (41.9%), coronary heart disease (21.5%), and cerebrovascular disease (20.4%). Before the onset of hospital-acquired influenza A, patients presented more lymphocytopenia (51.6% vs 35.5%, P = 0.027), hypoalbuminemia (78.5% vs 57.0%, P = 0.002), and pleural effusion (26.9% vs 9.7%, P = 0.002) than the matched controls. Infected patients also had longer hospital stays (18 days vs 14 days, P = 0.002), and higher mortality rates (10.8% vs 2.2%, P = 0.017) than the matched controls. Lymphocytopenia (odds ratio [OR]: 3.11; 95% confidence interval [CI]: 1.24–7.80; P = 0.016), hypoalbuminemia (OR: 2.24; 95% CI: 1.10–4.57; P = 0.027), and pleural effusion (OR: 3.09; 95% CI: 1.26–7.58; P = 0.014) were independently associated with hospital-acquired influenza A.

Conclusions

Lymphocytopenia, hypoalbuminemia and pleural effusion are independent risk factors that can help identify patients at high risk of hospital-acquired influenza A, which can extend hospital stay and is associated with a high mortality.
Before-and-after online community survey on knowledge and perception of COVID-19 pandemic
Authors: Nazar Wojciech , Leszkowicz Julia , Pieńkowska Agata , Brzeziński Michał , Szlagatys-Sidorkiewicz Agnieszka , Plata-Nazar Katarzyna
Published: November 2020

Background

COVID-19 pandemic impacts many communities worldwide. In this study the Poles’ knowledge about COVID-19 as well as people’s behaviours, attitudes and fears during the pandemic were assessed. Changes in these between the outset of the pandemic and the imposition of the strictest lockdown measures in Poland were investigated.

Methods

Physicians, nurses, students of medicine-oriented faculties, non-medical professionals, students of non-medicine-oriented faculties and secondary school students were surveyed by an anonymous online questionnaire two times: at the onset of the pandemic and in the second week of the strictest lockdown. Statistical analyses were performed using non-parametric tests – Pearson Chi Square, Kruskal-Wallis tests.

Results

In total 2618 responses were collected. At the beginning people knew that the respiratory system was attacked (97.9%); correctly identified the major symptoms of COVID-19 (95.0%) and ways to prevent infection: hand washing (99.8%), covering mouth (85.9%) and the need to call sanitary-epidemiological services if one experienced COVID-19-like symptoms (92.1%).

The biggest changes between the first and second phase of the study concerned behaviours: more people wearing facial masks (+ 37.5%) and staying at home (+ 66.1%). Respondents in the second wave of the survey were also more scared of the pandemic (+ 19.6%), economic crisis (+ 64.1%), and worried about their families (+ 26.5%). However, they were less afraid of the quarantine (lockdown) (− 18.2%). Nurses and physicians were the most worried groups.

Conclusions

The study showed that even at the outset of the pandemic Polish population had a good initial knowledge about symptoms, transmission, and preventive behaviours regarding COVID-19. People revealed more short-term concerns, such as the worries about coping with quarantine and isolation. After a month, the knowledge and the concerns among the respondents changed. A shift towards long-term pandemic management issues was observed. Respondents reported to experience more fears concerning the pandemic in general, as well as economic and healthcare crises. Medical professionals reported higher level of fear of the pandemic than other groups included in this study. This study uses before-and-after approach which highlights the changes in people’s knowledge and perception of the COVID-19 pandemic during the pandemic’s progression.
The unusual experience of managing a severe COVID-19 case at home: what can we do and where do we go?
Authors: Chérrez-Ojeda Ivan , Vanegas Emanuel , Felix Miguel
Published: November 2020

Background

The speed and reach of the COVID-19 pandemic has created special scenarios to be considered, such as those in where patients who meet criteria for hospitalization due to moderate/severe disease cannot be hospitalized due to economic constraints and saturation of national health systems. The aim of this report is to present an unusual case of a severe COVID-19 patient managed at home in a developing country, and to discuss some of the available guidelines and potential therapeutic options for this type of cases.

Case presentation

A 60-year-old female seeking medical attention through teleconsultation presents with profound dyspnea, oppressive chest pain, fatigue, episodic hallucinations, and difficulty sleeping, for what she originally sought medical attention at an ER but could not be admitted due to saturation of the health system. A positive PCR test for COVID-19, and a CT scan of the chest showing bilateral consolidations with ground-glass opacities confirmed the diagnosis. The patient was managed at home, with corticosteroids, nitazoxanide and a single dose of 40 mg of subcutaneous enoxaparin. Colchicine was added at the third day of treatment. Standard oxygen therapy through nasal cannula was also recommended. Daily follow-ups were established to monitor for signs of clinical improvement. Two weeks later from the initial consultation the patient presents marked improvement in her symptoms, as well as in her CT scan, which prompted in discontinuation of the medications and the oxygen therapy.

Conclusions

There are several limitations in this report regarding the clinical data and the management, but such limitations do also reflect the state of emergency and the chaos that resides in the health care systems of developing nations. For the ambulatory care of COVID-19 patients, several aspects of disease management may differ from current guidelines and basic requirements may represent a huge challenge to cover. Further research is needed to assist physicians in the daily clinical decision making, to optimize patient outcomes, and to reduce the probability of adverse scenarios of patients with COVID-19 managed in the ambulatory setting.