bluuebunny/crossref_metadata_2025 huggingface dataset:
Machine learning reveals that Mycobacterium tuberculosis genotypes and anatomic disease site impacts drug resistance and disease transmission among patients with proven extra-pulmonary tuberculosis
Authors: Sibandze Doctor Busizwe , Magazi Beki Themba , Malinga Lesibana Anthony , Maningi Nontuthuko Excellent , Shey Bong Akee , Pasipanodya Jotam G , Mbelle Nontombi N
Published: April 2020

Background
There is a general dearth of information on extrapulmonary tuberculosis (EPTB). We investigated Mycobacterium tuberculosis (Mtb) drug resistance and transmission patterns in EPTB patients treated in the Tshwane metropolitan area, South Africa.
Methods
Consecutive Mtb culture-positive non-pulmonary samples from unique EPTB patients underwent mycobacterial genotyping and were assigned to phylogenetic lineages and transmission clusters based on spoligotypes. MTBDRplus assay was used to search mutations for isoniazid and rifampin resistance. Machine learning algorithms were used to identify clinically meaningful patterns in data. We computed odds ratio (OR), attributable risk (AR) and corresponding 95% confidence intervals (CI).
Results
Of the 70 isolates examined, the largest cluster comprised of 25 (36%) Mtb strains that belonged to the East Asian lineage. East Asian lineage was significantly more likely to occur within chains of transmission when compared to the Euro-American and East-African Indian lineages: OR= 10.11 (95% CI: 1.56-116). Lymphadenitis, meningitis and cutaneous TB, were significantly more likely to be associated with drug resistance: OR=12.69 (95% CI: 1.82-141.60) and AR = 0.25 (95% CI: 0.06-0.43) when compared with other EPTB sites, which suggests that poor rifampin penetration might be a contributing factor.
Conclusions
The majority of Mtb strains circulating in the Tshwane metropolis belongs to East Asian, Euro-American and East-African Indian lineages. Each of these are likely to be clustered, suggesting on-going EPTB transmission. Since 25% of the drug resistance was attributable to sanctuary EPTB sites notorious for poor rifampin penetration, we hypothesize that poor anti-tuberculosis drug dosing might have a role in the development of resistance.
A novel predictive model based on inflammatory markers to assess the prognosis of patients with HBV-related acute-on-chronic liver failure：a retrospective cohort study
Authors: Qiang Li , Qin Jiao , Sun Changfeng , Sheng Yunjian , Chen Wen , Qiu Bangdong , Chen Xin , Chen Yuanfang , Liu Fei , wu gang
Published: April 2020

Background: Systemic inflammatory response is closely related to the development and prognosis of liver failure. This study aimed to establish a new model combing the inflammatory markers including neutrophil/lymphocyte ratio (NLR) and red blood cell distribution width (RDW) with several hematological testing indicators to assess the prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). Methods: A derivation cohort with 421 patients and a validation cohort with 156 patients were recruited from three hospitals. Retrospectively collecting their clinical data and laboratory testing indicators. Medcalc-15.10 software was employed for Data analyses.Results: Multivariate analysis indicated that RDW, NLR, INR, TBIL and Cr were risk factors for 90-day mortality in patients with HBV-ACLF. The risk assessment model isCOXRNTIC=0.053×RDW+0.027×NLR+0.003×TBIL+0.317×INR+0.003×Cr (RNTIC) with a cut-off value of 3.08 (sensitivity: 77.89%, specificity: 86.04%). The area under the receiver operating characteristics curve (AUC) of the RNTIC was 0.873 [95%CI(0.837–0.903)], better than the predictive value of MELD score [0.732, 95%CI(0.687–0.774)], MELD-Na [0.714, 95%CI(0.668-0.757)], CTP[0.703, 95%CI(0.657-0.747)]. In the validation cohort, RNTIC also performed a better prediction value than MELD score, MELD-Na and CTP with the AUC of [0.845, 95%CI(0.778-0.898)], [0.768, 95%CI (0.694-0.832)], [0.759, 95%CI(0.684-0.824)] and [0.718, 95%CI(0.641-0.787)] respectively. Conclusions: The inflammatory markers RDW and NLR could be used as independent predictors of 90-day mortality in patients with HBV-ACLF. Compared with MELD score, RNTIC had a more powerful predictive value for prognosis of patients with HBV-ACLF.
Communication mediums used by clients and health professionals in accessing and providing healthcare in low resource settings: A descriptive cross-sectional study
Authors: Dongyele Mathias , Ansong Daniel , Osei Francis Adjei , Newton Sam , New Evans Xorse Amusu , New Nicholas Karikari Mensah , New Alfred Kwame Owusu , New Bright Atta Dunkwa , Frimpong Samuel Odoom , Bonney Joseph , Adjei Duncan , Amusu Anne , Akowuah Emmanuel Kofi , Lartey Kelvin , Appiah Christopher Seth Yaw
Published: April 2020

Background: There exist continuing challenges with communication media used during health service provision. These challenges relate to clients and health institution, intra and inter-health institution communications. This study reviewed the existing healthcare communication media from the perspectives of clients and health professionals at a tertiary hospital in Ghana.
Method: cross-sectional design was employed with a multilevel sampling method to select a total of 651 participants consisting of 304 clients, 303 health workers and 44 hospital directorate managers for the study. A well-structured survey questionnaire was used to collect data from respondents.
Results: Two thirds of the hospital staff (66.4%) used a blend of social media and direct means (face-to-face medium) to communicate among themselves. The majority (89.8%) of the staff communicated with management through meetings sections. Nearly all healthcare providers (97.4%) communicated with clients through direct means (face-to-face medium). Almost all forms of communication between the hospital management members and the general public was done through letters and official memos.
Conclusions: The study revealed blended forms of communication media used by health providers and health service consumers. Delayed information flow and poor feedbacks contributed to the dissatisfaction levels associated with the traditional communication media platforms used.
A survey of the working status of family medicine physicians in clinics and hospitals in Korea
Authors: Shin Hyun-Young
Published: April 2020

Background In the approximately 35 years since family medicine was established in South Korea, family medicine physicians have sought to expand their expertise to cover clinical fields beyond primary medicine. This study examines their working status and compares the working conditions of family medicine physicians in clinics and hospitals in Korea. Methods We conducted an online survey with 4,057 family medicine physicians in Korea in 2016. The results were analyzed using descriptive statistics. Results Of the respondents, 572 doctors were working in clinics and 441 in hospitals. In the analysis of treatment pattern by doctors, the rate of chronic disease management was 84.7% in clinics and 93.4% in hospitals ( p < 0.001), and the rate of diseases covered by national insurance was 74.8% in clinics and 76.9% in hospitals ( p = 0.005). Among physicians younger than 40 years, the rate of chronic disease management and diseases covered by national insurance were 64.6% and 68.0% in clinics and 93.6% and 78.5% in hospitals, retrospectively. Conclusions Family medicine physicians working in hospitals have higher rates of chronic disease management and diseases covered by national insurance. This discrepancy of treatment pattern became larger for doctors younger than 40 years. More in-depth studies of the treatment pattern and its tendencies between family medicine physicians in clinics and hospitals are needed in the future.
Decomposing the educational inequalities in the factors associated with severe acute malnutrition among under-five children in Low- and Middle-Income Countries
Authors: Fagbamigbe Adeniyi Francis , Kandala Ngianga-Bakwin , Uthman Olalekan A.
Published: April 2020

Background: Low- and Middle-Income Countries (LMIC) have remained plagued with the burden of severe acute malnutrition (SAM). The decomposition of the educational inequalities in SAM across individual, neighbourhood and national level characteristics in LMIC has not been explored. This study aims to decompose educational-related inequalities in the development of SAM among under-five children in LMIC and identify the risk factors that contribute to the inequalities.
Methods: We pooled successive secondary data from the Demographic and Health Survey conducted between 2010 and 2018 in 51 LMIC. We analysed data of 532,680 under-five children nested within 55,823 neighbourhoods. Severe acute malnutrition was the outcome variable while the literacy status of mothers was the main exposure variable. The explanatory variables cut across the individual-, household- and neighbourhood-level factors of the mother-child pair. Oaxaca-Blinder decomposition method was used at p=0.05.
Results: The proportion of children whose mothers were not educated ranged from 0.1 % in Armenia and Kyrgyz to as much as 86.1 % in Niger. The overall prevalence of SAM in the group of children whose mothers had no education was 5.8 % compared with 4.2 % among those whose mothers were educated, this varied within each country. Fourteen countries (Cameroon(p<0.001), Chad(p<0.001), Comoro(p=0.047), Burkina Faso(p<0.001), Ethiopia(p<0.001), India(p<0.001), Kenya(p<0.001), Mozambique(p=0.012), Namibia(p=0.001), Nigeria(p<0.001), Pakistan(p<0.001), Senegal(p=0.003), Togo(p=0.013), and Timor Leste(p<0.001) had statistically significant pro-illiterate inequality while no country showed statistically significant pro-literate inequality. We found significant differences in SAM prevalence across child’s age (p<0.001), child’s sex(p<0.001), maternal age(p=0.001), household wealth quintile(p=0.001), mother’s access to media(p=0.001), birth weight(p<0.001) and neighbourhood socioeconomic status disadvantage(p<0.001). On the average, neighbourhood socioeconomic status disadvantage, location of residence were the most important factors in most countries. Other contributors to the explanation of educational inequalities are birth weight, maternal age and toilet type.
Conclusions: SAM is prevalent in most LMIC with wide educational inequalities explained by individual, household and community-level factors. Promotion of women education should be strengthened as better education among women will close the gaps and reduce the burden of SAM generally. We recommend further studies of other determinate causes of inequalities in severe acute malnutrition in LMIC.
Submicromolar copper (II) ions stimulate transretinal signaling in the isolated retina from wild type but not fromCav2.3-deficient mice
Authors: Lüke Jan Niklas , Neumaier Felix , Alpdogan Serdar , Hescheler Jürgen , Schneider Toni , Albanna Walid , Akhtar-Schäfer Isha
Published: April 2020

Background: So far, only indirect evidence exists for the pharmacoresistant R-type voltage-gated Ca2+ channel (VGCC) to be involved in transretinal signaling by triggering GABA-release onto ON-bipolar neurons. This release of inhibitory neurotransmitters was deduced from the sensitivity of the b-wave to stimulation by Ni2+, Zn2+ and Cu2+. To further confirm the interpretation of these findings, we compared the effects of Cu2+ application and chelation (using kainic acid, KA) on the neural retina from wild type and Cav2.3-deficient mice. Furthermore, the immediately effect of KA on the ERG b-wave modulation was assessed.Methods: Transretinal signaling was recorded as an ERG from the superfused murine retina isolated from wildtype and Cav2.3-deficient miceResults: In mice, the stimulating effect of 100 nM CuCl2 is absent in the retinae from Cav2.3-deficient mice, but prominent in Cav2.3-competent mice. Application of up to 3 mM tricine does not affect the murine b-wave in both genotypes, most likely because of chelating amino acids present in the murine nutrient solution. Application of 27 µM KA significantly increased the b-wave amplitude in wild type and Cav2.3 (-|-) mice. This effect can most likely be explained by the stimulation of endogenous KA-receptors described in horizontal, OFF-bipolar, amacrine or ganglion cells, which could not be fully blocked in the present study.Conclusion: Cu2+ dependent modulation of transretinal signaling only occurs in the murine retina from Cav2.3 competent mice, supporting the ideas derived from previous work in the bovine retina that R-type Ca2+ channels are involved in shaping transretinal responses during light perception.
How do older adults understand and manage distress? A qualitative study
Authors: Moult Alice , Kingstone Tom , Chew-Graham Carolyn
Published: April 2020

Background Distress is an expected emotional response to a negative life event. Experiences common in later life may trigger distress such as bereavement or loss of physical mobility. Distress is considered to be distinct to anxiety and/or depression and is not diagnostically labelled as a mental health problem. Older adults will often manage their own distress. Previous literature has focused on how younger adults self-manage mental health problems, however little research has explored the self-management strategies used by older people. There is a need to clarify the role of primary care in the context of distressed older adults who may consult healthcare services. This study seeks to address these gaps through qualitative methods. Methods This study was approved by Keele University’s ethical review panel. Older adults who self-identified as distressed were recruited from community groups in North Staffordshire, England. Data were generated through semi-structured interviews and analysed thematically using constant comparison methods. A patient and public involvement and engagement group contributed to development of the research questions and methods, and offered their perspectives on the findings. Results Data saturation was achieved after 18 interviews. Key themes were: experiences of distress, actions taken, help-seeking from healthcare services and perceptions of treatments offered in primary care. Various forms of loss contributed to participants’ distress. Participants initiated their own self-management strategies which included: pursuing independent activities, seeking social support and attending community groups and church. Five participants reported having consulted a GP when distressed but described a lack of acceptable treatments offered. Conclusions To support older adults who are distressed, healthcare professionals in primary care should consider exploring how patients currently manage their mood problems, provide a broad range of information about potential management options and consider sign-posting older adults to community resources.
Methotrexate impaired in-vivo matured mouse oocyte quality and the possible mechanisms
Authors: Tian Ning , Lv Dan-yu , Yu Ji , Ma Wan-yun
Published: April 2020

Background: Methotrexate (MTX) is an antifolate agent which is widely used in clinic for treating malignancies, rheumatoid arthritis and ectopic pregnancy. As reported, MTX has side effects on gastrointestinal system, nervous system and reproductive system, while its potential damages on oocyte quality are still unclear. It is known that oocyte quality is essential for healthy conception and the forthcoming embryo development. Thus, this work studied the effects of MTX on the oocyte quality. Results: We established MTX model mice by single treatment with 5 mg/Kg MTX. Both morphological and molecular biology studies were performed to assess the in-vivo matured oocytes quality and to analyze the related mechanisms. The in-vivo matured oocytes from MTX-treated mice had poor in-vitro fertilization ability, and the resulting embryo formation rates and blastocyst quality were lower than the control group. We found that the in-vivo matured MTX-treated mouse oocytes displayed abnormal transcript expressions for genes of key enzymes in the folate cycles. MTX increased the rate of abnormal chromosome alignment and affected the regulation of chromosome separation via disrupting the spindle morphology and reducing the mRNA expressions of MAD2 and Sgo1. MTX reduced the DNA methylation levels in the in-vivo matured oocytes, and further studies showed that MTX altered the expressions of DNMT1 and DNMT 3b, and may also affect the levels of the methyl donor and its metabolite. Conclusions: MTX impaired the in-vivo matured mouse oocyte quality by disturbing folate metabolism and affecting chromosome stability and methylation modification.
Associations of CXCL1 gene 5’UTR variations with ovarian cancer
Authors: Guo Man , Xu Chao , Chen Yan-Zhe , Sun Qi-Wen , Zhao Xin-Ying , Liu Xin , Yang Yi , Hu Yi-Yan , Li Fei-Feng , Liu Shu-Lin
Published: April 2020

Background: There are about 2.4 hundred thousand new cases and 1.5 hundred thousand deaths of ovarian cancer (OC) annually in the world. Chronic inflammation is a risk factor for OC. C-X-C motif chemokine ligand 1 (CXCL1) defects may facilitate inflammation and transactivate EGFR in ovarian cancer, but the precise haplotypes associated with the potential diseases remained largely unknown. In this work, we characterized CXCL1 gene variations to elucidate their possible associations with OC.
Methods: We analyzed the CXCL1 gene for 300 OC patients with 400 healthy participants as controls. The statistical analyses and Hardy-Weinberg equilibrium tests of the patients and control populations were conducted using the SPSS software (version 19.0) and Plink (version 1.9).
Results: The variants rs11547681, rs201090116, rs199791199, rs181868085, rs4074 and rs1814092 within or near the CXCL1 gene were characterized. The genetic heterozygosity of rs11547681 and rs4074 was very high. Statistical analysis showed that the variant rs11547681 in the gene was closely associated with the risk of OC in the Chinese Han population, although this variant was not associated with FIGO stages or pathological grades of the patients.
Conclusions: Rs11547681 in CXCL1 gene was associated with the risk of OC in the Chinese Han population.
Undesirable Perioperative Anesthesia Outcomes at Two National Referral Hospitals, a cross sectional study in Eritrea
Authors: Andemeskel Yonatan Mehari , Elsholz Traudl , Gebreyohannes Ghidey , Tesfamariam Eyasu H.
Published: April 2020

Background: Perioperative undesirable anesthesia outcomes are common among patients undergoing surgery. They may affect body systems and lead into more serious intraoperative and postoperative problems. This research is conducted in the Eritrean National Referral Hospitals with the aim of assessing the prevalence of undesirable anesthesia outcomes during the perioperative period. Method: A cross sectional study design was applied on 470 patient who underwent different types of surgeries with in a three month period. Patients were interviewed 24 hours after operation using the Leiden preoperative care patient satisfaction questionnaire (LPPSq). This study reports one component of a large study conducted. The dimension “Discomfort and needs” of the LPPSq was considered and the measurement of that dimension are presented in this report. Items of the dimension were standardized and measured using a five point Likert scale from “Not at all” to “Extremely”. Multivariable logistic regression was used to look for the association of the outcomes with the types of surgery and types of anesthesia using SPSS (Version 22). Statistical significance level was set at p< 0.05. Results: The prevalence of undesirable anesthesia outcomes were computed in two manners; prevalence of those with ‘at least a little bit’ outcomes which was computed to see the total occurrence of these outcomes and prevalence of those having ‘more than moderate’ outcomes to see the severe experience of these outcomes. Prevalence of the predominant undesirable outcome, post-operative pain, for ‘at least a little bit’ and ‘more than moderate’ were 82.6% and 43.6% respectively. The rest post-operative undesirable outcomes were less frequently reported. Conclusion: Postoperative pain was found to be the most prevalent undesirable outcome. Enhancement of the proper assessment and management of postoperative pain through the development and implementation of specific pain management modalities is needed. Local guidelines should also be available in these settings for the treatment of acute postoperative pain or other outcomes. Keywords: Leiden preoperative care patient satisfaction questionnaire (LPPSq), Perioperative care, Surgery, Undesirable anesthesia outcomes.
Cell-division pattern and phylogenetic analyses of a new ciliate genus Parasincirra n. g. (Protista, Ciliophora, Hypotrichia), with report of a new soil species, P. sinica n. sp. found from northwest China
Authors: Shao Chen , Ma Jiyang , Zhao Yan , Zhang Tengyue , Al-Rasheid Khaled A.S. , Song Weibo
Published: April 2020

Background: Ciliated protists, a huge assemblage of unicellular eukaryotes, are extremely diverse and play important roles in ecosystem in almost all kinds of habitats. Even though there is a growing recognition that those organisms associate with many ecological or environmental processes, their biodiversity, due to many reasons, is poorly understood and many biotopes (e.g. the soil in desert area in Asia) remain largely unknown or unconsidered. Here we document an undescribed form found in sludge soil in a halt-desert inland in China and the taxonomic/ morphogenetic surveys indicate that it represents a new genus and new species, Parasincirra sinica n. g., n. sp. which is supported also by molecular data.Results: This new, monotypic genus Parasincirra n. g. is defined by having three frontal cirri, an amphisiellid median cirral row about as long as the adoral zone, one short frontoventral cirral row, cirrus III/2 and transverse cirri present, buccal and caudal cirri absent, one right and one left marginal row and three dorsal kineties. The main morphogenetic features of the new taxon are: (1) frontoventral-transverse cirral anlagen II to VI are formed in primary mode; (2) the amphisiellid median cirral row is formed by anlagen V and VI, while the frontoventral row is generated from anlage IV; (3) cirral streaks IV to VI generate one transverse cirrus each; (4) frontoventral-transverse cirral anlage II generates one or two cirri, while the posterior one will be absorbed in late stages, that is, no buccal cirrus is formed; (5) the posterior part of the parental adoral zone of membranelles is renewed; (6) dorsal morphogenesis follows a typical Gonostomum-pattern; and (7) the macronuclear nodules fuse to form a single mass. Based on the SSU rDNA information, analyses of the phylogenetic relationship inferred from Bayesian inference and maximum likelihood analyses were unable to outline the exact position of this new form among some other species of related genera which are generally assigned in the family Amphisiellidae Jankowski, 1979. The morphological/ morphogenetical differences between the new genus/species and Uroleptoides Wenzel, 1953/ Parabistichella Jiang et al., 2013, as well as other amphisiellids, clearly support the validity of the establishment of this new genus Parasincirra.
Spatial variation in the frequency of knockdown resistance genotypes in Florida Aedes aegypti populations
Authors: Mundis Stephanie Jane , Estep Alden S. , Waits Christy M. , Ryan Sadie J.
Published: April 2020

Background The development of insecticide resistance in disease-vectoring mosquito species can lead to vector control failure and disease resurgence. However, insecticide applications remain an essential public health intervention. In Florida, insecticide resistance in Aedes aegypti , an anthropophilic mosquito species capable of transmitting dengue, chikungunya, and Zika virus, is a major concern. Understanding the location, scale, and driving factors of insecticide resistance can enhance the ability of vector control organizations to target populations effectively. Methods We used previously collected data on frequencies of mutations that confer resistance to commonly used pyrethroid insecticides in Aedes aegypti specimens from 62 sites distributed across 18 counties in Florida. To determine the scale of clustering for the most resistant variant, we used a Ripley’s K function. We also used a spatial scanning statistic technique to identify the locations of clusters where higher than expected frequencies of susceptible or resistant mosquitoes occurred. We then tested for associations between landscape, demographic, and insecticide-use factors using a beta regression modelling approach and evaluated the effect of spatial lag and spatial error terms on overall explanatory power of these models. Results The scale at which maximum clustering of the most resistant variant occurs is approximately 20 kilometers. We identified statistically significant clusters of genotypes associated with resistancein several coastal cities, although some of these clusters were near significant clusters of susceptible mosquitoes, indicating selection pressures vary at the local scale. Vegetation density, distance from roads, and pyrethroid-use by vector control districts were consistently significant predictors of knockdown resistance genotype frequency in the top-performing beta regression models, although pyrethroid-use surprisingly had a negatively associated with resistance. The incorporation of spatial lags resulted in improvements to the fit and explanatory power of the models, indicating an underlying diffusion process likely explains some of the spatial patterns observed. Conclusions The genetic mutations that confer resistance to pyrethroids in Aedes aegpyti mosquitoes in Florida exhibit spatial autocorrelation and patterns that can be partially explained by landscape and insecticide-use factors. Further work at local scales should be able to identify the mechanisms by which these variables influence selection for alleles associated with resistance.
Evaluation of 24 protocols for the production of platelet-rich fibrin
Authors: Miron Richard J , Chai Jihua , Fujioka-Kobayashi Masako , Sculean Anton , Zhang Yufeng
Published: April 2020

Background

The aim of this study was to evaluate 24 protocols for the production of platelet rich fibrin (PRF) produced via horizontal centrifugation to better understand cell separation following protocols at various times and speeds.

Methods

All protocols were compared utilizing a recent method to quantify cells in PRF in 1 mL sequential layers pipetted from the upper layer downwards until all 10 mL were harvested. In total, 960 complete blood counts (CBCs) were investigated. Both solid and liquid-based PRF protocols were investigated following 24 protocols involving 6 relative centrifugal force (RCF) values (100,200,400,700,1000 and 1200g) at 4 centrifugation times (3,5,8 and 12 minutes).

Results

In general, platelets could more easily accumulate in the upper 4 layers when compared to leukocytes owing to their lower cellular density. Protocol time seemed to have a greater impact on the final cell layer separation when compared to the effect of speed. Protocols of greater than 8 minutes at 400 g led to no leukocyte accumulation in the upper PRF layers (found specifically within the buffy coat). Protocols at or below 200 g were unable to effectively accumulate platelets/leukocytes. The optimal centrifugation speed and time for solid-PRF ranged between 400 -700 g for 8 minutes. It was noted that variability in patient baseline platelet/leukocyte/erythrocyte counts (hematocrit) significantly affected cell layer separation. This finding was more pronounced at lower centrifugation speeds.

Conclusions

Within the investigated ranges, a protocol of 700 g for 8 minutes presented the highest yield of platelets/leukocytes evenly distributed throughout the upper PRF layers.
Qualitative Study of Socio-Cultural Challenges in the Nursing Profession in Pakistan
Authors: Abbas Sidra , Zakar Rubeena , Fischer Florian
Published: April 2020

Background: In a patriarchal social system, a women-dominated profession like nursing is mostly seen as a disempowered group due to its stereotypical image and negative connotations. The low social prestige of this profession is based on the roles typically assigned to men and women to maintain gender identity according to their performance and embodiment. The aim of this study was to explore the social and cultural challenges faced by nurses while creating their professional image within the regional context of Lahore (Punjab) in Pakistan.

Methods: A qualitative research design was chosen to conduct one-to-one, in-depth interviews with twelve nurses. Recruitment was based on purposive sampling from three large public hospitals in Lahore to learn about nurses’ perceptions of social and cultural challenges in the nursing profession. A thematic analysis was conducted using the data analysis software package NVIVO 12 Plus.

Results: Cultural values give preference for female nurses. We have identified four major themes related to the social and cultural challenges facing the nursing profession: 1) gender-segregated profession, 2) inappropriate portrayals by the media, 3) issues around marriage settlement, and 4) identity from a religious perspective. These conflicts are affecting the professional status and changing perceptions of nurses, who either do not choose to remain in the nursing profession or do not recommend nursing as a career option. These ongoing constraints are still perpetuating and increasing shortage of nurses within the Pakistani healthcare system.

Conclusion: The present study solely highlights nurses’ perspectives on redefining gender roles and gender integration within the nursing profession. It argues that there is a need for positive portrayals in the media for the removal of public misperceptions related to nursing. This would reduce the shortage of nurses along with increasing retention and improving the quality of healthcare delivered to the public.
Gastric Artery Embolization: Studying Effects of Catheter Type and Injection Method on Bead Distributions within a Benchtop Arterial Model
Authors: Jernigan Shaphan R , Osborne Jason A , Buckner Gregory D
Published: April 2020

Aims: To investigate the effect of catheter type and injection method on microsphere distributions, specifically vessel targeting accuracy.
Materials and Methods: The study utilized three catheter types (a standard micro-catheter, a Surefire anti-reflux catheter, and an Endobar occlusion balloon catheter) and both manual and computer-controlled injection schemes. A closed-loop, dynamically pressurized surrogate arterial system was assembled to replicate arterial flow for bariatric embolization procedures. Four vessel branches immediately distal to the injection site were targeted for embolization. Embolic microspheres were injected into the model using three catheter types (a standard micro-catheter, a Surefire anti-reflux catheter, and an Endobar occlusion balloon catheter) and both manual and computer-controlled injections.
Results: Across all injection methods, the catheter effect on the proportion of microspheres to target vessels (vs. non-target vessels) was significant (p=0.005). The catheter effect on the number of non-target vessels embolized was significant (p=0.059). Across all catheter types, the injection method effect was not statistically significant for either of two outcome measures (percent microspheres to target vessels: p=0.265, number of non-target vessels embolized: p=0.148).
Conclusion: Catheter type had a significant effect on targeting accuracy across all injection methods. The Endobar catheter exhibited a higher targeting accuracy in pairwise comparisons with the other two injection catheters across all injection schemes and when considering the Endobar catheter with the manifold injection method vs. each of the catheters with the manual injection method; the differences were significant in 3 of 4 analyses. The injection method effect was not statistically significant across all catheter types and when considering the Endobar catheter/Endobar manifold combination vs. Endobar catheter injections with manual and pressure-replicated methods.
Is there a relationship between moral competencies and the formation of professional identity among nursing students?
Authors: Haghighat sahar , borhani fariba , ranjbar hadi
Published: April 2020

Background: Moral care provision is an essential part of nursing work. Nursing schools are responsible for developing moral competencies in nursing students. The aim of this study was to investigate the relationship between moral competencies and the formation of professional identity among nursing students .
Methods: This study was designed as a descriptive-correlational study. The study population consisted of nursing students who were enrolled in nursing schools at the time of the study. Two hundred and twenty-one nursing students completed the study tools. The research tools were a demographic questionnaire, Moral Development Scale for Professionals (MDSP), and Professional Identity Scale for Nursing Students (PISNS). Results: The mean (SD) of MDSP and PISNS scores were 45.69±5.90 and 55.61±12.75, respectively. There was a significant statistical relationship between MSDP and PISNS scores (p<0.05). A significant equation was found (f (2, 218) = 16.68, p<0.001) with an R2 of 0.113. The MSDP scores increased 0.136 for each score of PISNS, and married students had 2.452 scores higher than single students.
Conclusions: There was a significant correlation between the formation of professional identity and development of morality in nursing students. By supporting the formation of professional identity, nursing schools can help the development of moral competencies in nursing students.
A non-destructive method to quantify leaf starch content in red clover
Authors: Frey Lea Antonia , Baumann Philipp , Aasen Helge , Studer Bruno , Kölliker Roland
Published: April 2020

Background: Grassland-based ruminant livestock production provides a sustainable alternative to intensive production systems relying on concentrated feeds. However, grassland-based roughage often lacks the energy content required to meet the productivity potential of modern livestock breeds. Forage legumes, such as red clover, with increased starch content could partly replace maize and cereal supplements. However, breeding for increased starch content requires efficient phenotyping methods. This study is unique in evaluating a non-destructive hyperspectral imaging approach to estimate leaf starch content in red clover for enabling efficient development of high starch red clover genotypes.

Results: We assessed prediction performance of partial least square regression models (PLSR) using cross-validation, and validated model performance with an independent test set. Starch content of the training set ranged from 0.1 to 120.3 mg g-1 DW. The best cross-validated PLSR model explained 56% of the measured variation and yielded a root mean square error (RMSE) of 17 mg g-1 DW. Model performance decreased when applying the trained model on the independent test set (RMSE = 29 mg g-1 DW, R2 = 0.36). Different variable selection methods did not increase model performance.

Conclusion: The non-destructive spectral method presented here, provides a tool to detect large differences in leaf starch content of red clover. The major benefit of the method is that it can be repeatedly applied to the same plants, thus providing a means to follow starch concentrations over time and over a broad range of environments.
Percutaneous stent placement for malignant hilar biliary obstruction: side-by-side versus stent-in-stent technique
Authors: Zhou Wei-zhong , Liu Sheng , Yang Zheng-Qiang , Xian Yu-Tao , Xu Hong-Dou , Wu Jun-Zheng , Shi Hai-bin
Published: April 2020

Background: Currently, side-by-side (SBS) and stent-in-stent (SIS) are the two main techniques for stent deployment to treat hilar biliary obstructions. Previous studies comparing these two techniques are very limited, and thus, no consensus has been reached on which technique is better. The purpose of this study is to compare the clinical efficacy and safety of SBS and SIS deployment via a percutaneous approach for malignant hilar biliary obstruction.Methods: From July 2012 to April 2019, 65 patients with malignant hilar biliary obstruction who underwent bilateral stenting using either the SBS or SIS techniques were included in this study. Among them, 27 patients underwent SIS stent insertion (SIS group), and the remaining 38 patients underwent SBS stent insertion (SBS group). Technical success, improvement of jaundice, complications, duration of stent patency, and overall survival were evaluated.Results: Technical success was achieved in all patients in the two groups. The serum bilirubin level decreased more rapidly 1 week after the procedures in the SBS group than in the SIS group (P=0.02). Although the total complication rate did not differ between the two groups, cholangitis was found to be more frequent in the SIS group (P=0.04). The median stent patency was significantly longer in the SBS group (149 days) than in the SIS group (75 days; P=0.02). The median overall survival did not significantly differ between the two groups (SBS vs. SIS, 155 days vs. 143 days; P>0.05).Conclusions: Percutaneous transhepatic bilateral stenting using either the SBS or SIS technique is safe and effective in the management of malignant hilar biliary obstruction. However, SBS offers a quicker improvement of jaundice, a lower incidence of cholangitis after the procedure, and a longer stent patency period than SIS.
Posttraumatic stress disorder and depression of survivors 12 months after the outbreak of Middle East Respiratory Syndrome in South Korea
Authors: Park Hye Yoon , Park Wan Beom , Lee So Hee , Kim Jeong Lan , Lee Jung Jae , Lee Haewoo , Shin Hyoung-Shik
Published: April 2020

Background: The 2015 outbreak of Middle East Respiratory Syndrome (MERS) in the Republic of Korea is a recent and representative occurrence of nationwide outbreaks of Emerging Infectious Diseases (EIDs) . In addition to physical symptoms, posttraumatic stress disorder (PTSD) and depression are common following outbreaks of EID.
Methods: The present study investigated the long-term mental health outcomes and related risk factors in survivors of MERS. A prospective nationwide cohort study was conducted 12 months after the MERS outbreak at multi-centers throughout Korea. PTSD and depression as the main mental health outcomes were assessed with the Impact of Event Scale-Revised Korean version (IES-R-K) and the Patient Health Questionnaire-9 (PHQ-9) respectively.
Results: 42.9% of survivors reported PTSD (IES-R-K ≥ 25) and 27.0% reported depression (PHQ-9 ≥ 10) at 12 months post-MERS. A multivariate analysis revealed that anxiety (adjusted odds ratio [aOR], 5.76; 95%CI, 1.29–25.58; P = 0.021), and a greater recognition of stigma (aOR, 11.09, 95%CI, 2.28–53.90; P = 0.003) during the MERS-affected period were independent predictors of PTSD at 12 months after the MERS outbreak. Having a family member who died from MERS predicted the development of depression (aOR, 12.08, 95%CI, 1.47–99.19; P = 0.020).
Conclusion: This finding implies that psychosocial factors, particularly during the outbreak phase, influenced the mental health of patients over a long-term period. Mental health support among the infected subjects and efforts to reduce stigma may improve recovery from psychological distress in an EID outbreak.
Trans-Aortic or Pulmonary Artery-Based Drainage for Left Ventricular Unloading and Veno-Arterial Extracorporeal Life Support Management in a Porcine Cardiogenic Shock Model.
Authors: Meani Paolo , Mlcek Mikulas , Kowalewski Mariusz , Raffa Giuseppe Maria , Jiritano Federica , Matteucci Matteo , Fina Dario , Martucci Gennaro , Sels Jan Willem , Delnoij Thijs , Popkova Michaela , Pilato Michele , Arcadipane Antonio , Belohlavek Jan , Lorusso Roberto
Published: April 2020

The authors have requested that this preprint be withdrawn due to author disagreement.
Elucidating mitochondrial DNA-markers of Ogura-based CMS linesin Indian cauliflowers (Brassica oleracea var. botrytis L.) and their floral abnormalities due to diversity in cyto-nuclear interaction
Authors: Singh Saurabh , Bhatia Reeta , Kumar Raj , Behera Tusar K. , Kumari Khushboo , Pramanik Achintya , Ghemeray Hemant , Sharma Kanika , Bhattacharya R. C. , Dey Shyam Sundar
Published: April 2020

Background: Mitochondrial markers can be used to differentiate diverse mitotypes as well as cytoplasms in angiosperms. In cauliflower, cultivation of hybrids is pivotal in remunerative agriculture and cytoplasmic male sterile lines constitute an important component of the hybrid breeding. Thus, the breeders look for utilizing diverse male sterile cytoplasms in hybrid progamme. In diversifying source of male sterility,it is essential to appropriately differentiate among the available male sterile cytoplasms in cauliflower.PCR polymorphism atthe key mitochondrial genes associated with male sterility will be useful in developing mitochondria specific markers for the different male sterile cytoplasms. Also, the auto and alloplasmic cytonuclear combinations result in complex floral abnormalities.Thus, the study aimed at developing mitotype specific markers of the sterile cytoplasms and to unravel thegenetic effects of the cytonuclear interactions on flower morphology in Indian cauliflowers.Results: In PCR based analysis using a set of primers targeted to orf-138, 76 Indian cauliflower lines showed presence of Ogura cytoplasm though amplicons showed polymorphism within the ofr-138 sequence. The polymorphic loci were found to be spanning over 200-280 bp and 410-470bp genomic regions of BnTR4 and orf125, respectively. Sequence analysis revealed that such cytoplasmic genetic variations could be due to single nucleotide polymorphisms and insertion or deletions of31/51 nucleotides.The cytoplasmic effects on varying nuclear-genetic backgrounds led to varying degree of floral malformations ranging from reduction in flower size, stamens and style length, modification in position of styleand anthers, absence of non-functional stamens to other floral abnormalities. These floral malformations caused dysplasia of flower structure affecting female fertility and inefficient nectar production.Conclusions: The mitochondria specific markers can distinguish ogurabased male sterile cytoplasm. Large number of Indian cauliflower lines showed mitotype variations even within the ogura based cytoplasm. Variable nucleo-cytoplasmic interactions resulted into diverse type of floral malformationsin addition to pollen sterility even within the group of ogura based CMS lines. The finding provide important reference ameliorate understanding of mechanism of cytonuclear interactions in floral organ development in Brassicas. The study will help the breeders in selecting CMS lines without any floral abnormalities in B. oleracea.
Neurotoxicity of bupivacaine and liposome bupivacaine after sciatic nerve block in healthy and streptozotocin-induced diabetic mice
Authors: Markova Liljana , Umek Nejc , Horvat Simon , Hadžić Admir , Kuroda Max , Pintarič Tatjana Stopar , Mrak Vesna , Cvetko Erika
Published: April 2020

Background

Diabetes mellitus and the associated neuropathic complications have become a steadily increasing global health burden. Diabetic patients are estimated to require surgery at least twice as often as nondiabetic patients. Neuropathy may change the way nerves respond to nerve blocks. There is currently no consensus on whether regional anaesthesia techniques should be adopted in these patients. Long-acting local anaesthetics ( e.g . bupivacaine HCl) or sustained-release formulations of bupivacaine ( e.g . liposomal bupivacaine) could prove neurotoxic in the presence of diabetic neuropathy. The aim of the study was to assess neurotoxicity of liposome bupivacaine in streptozotocin (STZ)-induced diabetic mice after sciatic nerve block using a reduction in fibre density and decreased myelination assessed by G-ratio as an indicator of local anaesthetic neurotoxicity.

Results

Prior to performing sciatic nerve block, higher levels of fasting glucose were recorded in diabetic mice compared to nondiabetic mice ( P < 0.001). Likewise, significant differences were noted in the tail flick and plantar test thermal latencies between the groups ( P < 0.001) which confirmed the presence of peripheral sensory neuropathy in diabetic mice. In both, diabetic and nondiabetic mice, sciatic nerve block with 0.25% bupivacaine HCl resulted in a significantly greater G-ratio (axon diameter/large fibre diameter) and an axon diameter compared to nerves treated with 1.3% liposomal bupivacaine or saline (0.9% sodium chloride) ( P < 0.01 ). Moreover, sciatic nerve block with 0.25% bupivacaine HCl resulted in higher fibre density and large fibre and axon diameters compared to the control (untreated) sciatic nerves in both STZ-induced diabetic ( P < 0.05 ) and nondiabetic mice ( P < 0.01 ). No evidence of acute or chronic inflammation was observed in any of the treatment groups.

Conclusions

Under the conditions of this study, sciatic nerve block with bupivacaine HCl, but not liposome bupivacaine or saline, resulted in histomorphometric indices of neurotoxicity. The presence of diabetes did not appear to affect the severity of the histologic findings.
Negative self-beliefs mediate the relationship between depression and suicide ideation among the elderly population: a cross-sectional study
Authors: Cheng Xinfeng , Bu He , Duan Wenjie
Published: April 2020

Background High suicide risk among the aged population is a growing concern. Research has linked depression symptoms to suicidal ideation in the general population. The present study examines whether negative self-beliefs mediate the cross-sectional association between depression symptoms and suicide ideation. Methods A sample of 67 elderly participants from nursing homes, ranging in age from 62 to 91 years ( M = 80.00, SD = 6.67 years; three participants did not indicate the age), completed the Negative Self Belief Inventory, the Geriatric Suicide Ideation Scale, and the 7-item depression subscale of the Depression Anxiety Stress Scale. Results The results show that the associations between depression symptom, negative self-beliefs and suicide ideation were positive ( r = .44 - .52, p < .001). Depression symptoms contributed another 13.70% explained variances. It independently explained another 5.7% variances beyond other variables to suicide ideation after the entering of negative self-belief ( B = 0.126, t = 2.183, p < .05). The indirect effect of depression symptoms on suicide ideation through negative self-belief was significant (Effect = 0.223, 95% BCa CI = [0.034, 0.468]). Conclusion Depression predicts suicide ideation via negative self -beliefs. The current study, incorporated theoretical assumptions and empirical findings in the context of Chinese culture into western prevalent suicide theories. Treatments focusing on restructuring negative self-beliefs are promising to reduce suicide in older adults in China. Future studies should test whether the mechanism in our study can transcend national and cultural boundaries.