bluuebunny/crossref_metadata_2025 huggingface dataset:
The Limits of Memory in Disavowed: Interference, Military Execution, and the Dishonored Dead
Authors: Young Andrew P.
Published: April 2021

In looking at the history of U.S. military execution during World War II, this article explores the relationship between memory and psychological interference in the browser-based game Disavowed (2021). As an interesting example of the palimpsestuous negotiation between individual identity, narrativity, and cultural memory, Disavowed structures itself through the misremembering of an actual historical encounter. In such a way, it reconstructs a false history of events misconstrued within the memory of the game designer, put into dissonance with historical documentation of what “really happened” – an execution witnessed by tens of thousands of soldiers, but that seems largely erased from the record. The result is an interplay between the memories of veteran Theodore “Ted” Eaker, the public awareness of Private Eddie Slovik’s execution, and the journey to piece together what is a fractured, unreliable and racially problematic history of the practice of military execution.
Destructive Arthropathy of the Interphalangeal Joint Following Revascularization After Degloving Hand Injury: A Case Report
Authors: Hirakawa Akihiro , Komura Shingo , Masuda Tomihiro , Matsumoto Kazu , Akiyama Haruhiko
Published: April 2021

It is difficult to achieve satisfactory results in the treatment of advanced degloving injury, which is one of the most challenging injuries in hand surgery. In this report, we present a case of marked destructive arthropathy of the interphalangeal joint that developed following revascularization after degloving hand injury. A 37-year-old, right-handed female manual worker sustained a degloving injury of her fingers, including the dorsal hand. We performed revascularization and secondary surgery, which included tenolysis and a tendon graft, to obtain functional improvement. These 2 procedures provided significant improvement in the active range of motion of the respective fingers. However, the patient complained of postoperative pain in the proximal interphalangeal joint. X-ray revealed destructive changes in the interphalangeal joint, which advanced progressively. Destructive changes in the interphalangeal joint following advanced degloving injury should be recognized as a potential complication that could be a limitation of functional restoration. Follow-up X-ray examination is necessary, even in cases with no fracture of the phalanges at the time of injury. In the management of degloving injury, patients should be informed of the potential risk of destructive arthropathy, which could result in restricted motion with pain.
Evaluation of Clinical Recovery After Surgical Treatment for Hand Ischemia From Vasospastic and Occlusive Disease Using PROMIS
Authors: Bernstein David N. , Cliburn John A. , Lachant Daniel J. , White R. James , Hammert Warren C.
Published: April 2021

Background

There is a paucity of literature describing the recovery trajectory after surgery for upper extremity ischemia. Using Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF), Upper Extremity (UE), Pain Interference (PI), and Depression domains, we aimed to describe the postoperative recovery of such patients.

Methods

We queried our PROMIS database for patients undergoing surgery for vasospastic or occlusive disease over a 4.5-year period. Inclusion criteria were preoperative, early (average 3 weeks) and late (average 6 months) postoperative PROMIS PF and/or UE, PI, and Depression scores. The change in PROMIS scores was calculated for each time point. Changes in PROMIS scores were compared with minimal clinically important difference estimates.

Results

We identified 13 patients undergoing 13 surgical interventions that met inclusion criteria. More than one-half of our patients were men (n = 7 [54%]), and more than one-half of the surgeries (n = 7 [54%]) were for isolated occlusive diagnoses, with the remainder for vasospastic disease. At short-term postoperative follow-up, the change in PROMIS PF, UE, PI, and Depression scores was −6.34 (SD: 9.13), −6.81 (SD: 9.61), 3.16 (SD: 5.78), and −3.05 (SD: 8.37), respectively. At mid-term postoperative follow-up, the change in PROMIS PF, UE, PI, and Depression scores was 4.45 (SD: 10.33), 8.04 (SD: 13.84), −7.03 (SD: 7.06), and −12.27 (SD: 10.85), respectively.

Conclusions

Our findings suggest patients undergoing surgical treatment for upper extremity ischemia experience a worsening of functional symptoms initially, as expected, followed by notable improvement.
Beyond the Interview Guide: Experiences of Practically and Mindfully Implementing Interview Guidelines When Conducting Research With Children and Adolescents With Chronic Conditions and Their Siblings
Authors: Rogers Laura G. , Shearer Kathleen , Hryniuk Sarah Southon , Ray Lynne , Rempel Gwen R.
Published: April 2021

Children and adolescents who live with chronic conditions are rarely participants in research specifically focused on meeting their needs, nor in intervention planning research. There are, however, special considerations required when conducting research with children and adolescents. This article offers Interview Guidelines designed to ensure children and adolescents’ control of and comfort with interviewing and to maximize the caliber of ethically co-constructed data. We developed, tested, and revised these guidelines with 80 children and adolescents aged 5 to 17 years: 27 with complex Congenital Heart Disease (CCHD) (5–17 years) and 13 with Early Onset Scoliosis (5–12 years) and 28 siblings (7–17 years). The guidelines were further tested with 12 adolescents with Adolescent Idiopathic Scoliosis (10–16 years) and 10 children and adolescents with CCHD (8–12 years). The children and adolescents recounted stories about their everyday life and activities through digitally recorded face-to-face interviews that were transcribed. Detailed field notes were recorded before and after the interview. Our Interview Guidelines address ethics, informed assent and consent, pre-interview planning, establishing trust, and engaging children and adolescents in research. Special attention is given to involving parents in pre-interview planning and disclosing sensitive information post interview. Involving children and adolescents as research participants to gain information from them, not only about them, will assist those in planning appropriate intervention research to meet the needs of children and adolescents living with chronic conditions and their siblings.
Review of complex regional pain syndrome and the role of the neuroimmune axis
Authors: Prasad, MD Amrita , Chakravarthy, MD Krishnan
Published: April 2021

Background

Complex regional pain syndrome (CRPS) is a progressive and painful disease of the extremities that is characterized by continuous pain inconsistent with the initial trauma. CRPS is caused by a multi-mechanism process that involves both the peripheral and central nervous system, with a prominent role of inflammation in CRPS pathophysiology. This review examines what is currently known about the CRPS inflammatory and pain mechanisms, as well as the possible impact of neurostimulation therapies on the neuroimmune axis of CRPS.

Study design

A narrative review of preclinical and clinical studies provided an overview of the pain and inflammatory mechanisms in CRPS and addressed the effect of neurostimulation on immunomodulation.

Methods

A systematic literature search was conducted based on the PRISMA guidelines between September 2015 to September 2020. Data sources included relevant literature identified through searches of PubMed, Embase and the Cochrane Database of Systematic Reviews.

Results

Sixteen preclinical and eight clinical studies were reviewed. Preclinical studies identified different mechanisms of pain development in the acute and chronic CRPS phases. Several preclinical and clinical studies investigating inflammatory mechanisms, autoimmunity, and genetic profiles in CRPS, supported a role of neuroinflammation in the pathophysiology of CRPS. The immunomodulatory effects of neurostimulation therapy is still unclear, despite clinical improvement in the CRPS patients.

Conclusions

Increasing evidence supports a role for inflammation and neuroinflammation in CRPS pathophysiology. Preliminary neurostimulation findings, together with the role of (neuro)inflammation in CRPS, seems to provide a compelling rationale for its use in CRPS pain treatment. The possible immunomodulatory effects of neurostimulation opens new therapeutic possibilities, however further research is needed to gain a better understanding of the working mechanisms.
Partitioning risk factors for embolic stroke of undetermined source using exploratory factor analysis
Authors: Perkins Jon D , Akhtar Naveed , Singh Rajvir , Kamran Asad , Ilyas Saadat
Published: April 2021

Background

Embolic stroke of undetermined source (ESUS) accounts for up to 25% of strokes. Understanding risk factors associated with ESUS is important in reducing stroke burden worldwide. However, ESUS patients are younger and present with fewer traditional risk factors. Significant global variation in ESUS populations also exists making the clinical picture of this type of stroke unclear.

Methods and results

ESUS patients were pair matched for age, sex, and ethnicity with a group of all other strokes (both n = 331). Exploratory factor analysis was applied in both groups to 14 risk and clinical factors to identify latent factors. In ESUS patients, two latent factors emerged consisting primarily of heart-related variables such as left ventricular wall motion abnormalities, reduced ejection fraction, and increased left atrial volume index, as well as aortic arch atherosclerosis. This is in comparison to the all other strokes group, which was dominated by traditional stroke risk factors.

Conclusions

Our findings support the existence of a unique pattern of risk factors specific to ESUS. We show that LVWMA and corresponding changes in left heart function are a potential source of emboli in these patients. In addition, the clustering of aortic arch atherosclerosis with left heart factors suggests a causal link. Through the application of exploratory factor analysis, this work contributes to a further understanding of stroke mechanisms in ESUS.
Quantitative measurements of prostatic zones by MRI and their dependence on prostate size: possible clinical implications in prostate cancer
Authors: Sellers Jake , Wagstaff Rachel G. , Helo Naseem , de Riese Werner T. W.
Published: April 2021

Aim:

Many studies support an inverse relationship between benign prostate hypertrophy (BPH) size and incidence of prostate cancer (PCa), but the causal link between these conditions is poorly understood. Recent studies suggest that a growing transition zone (TZ) in the prostate may induce pressure on the outer peripheral zone (PZ), leading to atrophy of the glandular tissue where PCa often originates, providing a possible explanation for this interaction. To further investigate this phenomenon, our pilot study uses magnetic resonance imaging (MRI) to examine quantitative zonal changes in a consecutive cohort of prostates.

Methods:

MRI scans of male patients [ n = 204, 61.57 ± 13.90 years, average body mass index (BMI) 29.05 kg/m2] with various prostate sizes were analyzed statistically to identify possible associations between prostate parameters, such as total prostate volume (TPV) and peripheral zone thickness (PZT).

Results:

TPV and PZT demonstrated a weak, inverse correlation ( r = −0.21, p = 0.002). However, when examining the plotted data, the relationship between TPV and PZT was significantly different when the cohort was divided into two groups; lower TPV: ⩽87.5 ml ( n = 188, TPV xˉ = 36.01 ± 18.18 ml), and higher TPV: >87.5 ml ( n = 17, TPV xˉ = 125.69 ± 41.13 ml). Average PZT differed significantly between these groups (z = −3.5554, p = 0.0004).

Conclusions:

PZT was significantly different for patients with lower versus higher TPVs, suggesting that, above a certain point of BPH growth, the PZ is unable to withstand pressure from an expanding TZ, supporting the notion that growing BPH causes compression of the PZ glandular tissue, and, therefore, BPH may be protective against PCa.
Desiccation of Wetlands and Their Influence on the Regional Climate. Case Study: Ciénaga de Aguablanca, Cali, Colombia
Authors: Ocampo-Marulanda Camilo , Carvajal-Escobar Yesid , Perafán-Cabrera Aceneth , Restrepo-Jiménez Lina María
Published: April 2021

The desiccation of wetlands is a process associated with the dynamics of urban growth and expansion of the agricultural frontier. This article aims to evaluate the influence of the desiccation of the Ciénaga de Aguablanca on regional climate. The periodization of the desiccation and urban growth of Cali was reconstructed under the theoretical contributions of environmental history. As complementary sources, maps, aerial photographs, and diagrams of the city were obtained from 1944 to 2020, with which the hydromorphological changes in the Ciénaga de Aguablanca were represented. Data from six hydroclimatological stations were statistically analyzed with Pettitt’s test, trend analysis, and Rclimdex. The results indicate a reduction of 99% in the area of the wetlands, from 19.2 km2 in 1944 to 0.2 km2 by 2020. Additionally, a break point was observed in 1970, preceded by the process of wetland desiccation and waterproofing of the eastern part of Cali, along with significant differences between temperature series inside and outside the urban perimeter. Another break point was detected in 1985 in the flow series, associated with the construction of the La Salvajina dam. Monthly rainfall showed a tendency to increase, but its temporal distribution was uneven, given that rainfall volume showed a tendency to increase over short times. Regional climate changes can occur at a much faster rate than global variations due to the anthropogenic actions of wetland intervention.
Between surveillance and recognition: Rethinking digital identity in aid
Authors: Weitzberg Keren , Cheesman Margie , Martin Aaron , Schoemaker Emrys
Published: April 2021

Identification technologies like biometrics have long been associated with securitisation, coercion and surveillance but have also, in recent years, become constitutive of a politics of empowerment, particularly in contexts of international aid. Aid organisations tend to see digital identification technologies as tools of recognition and inclusion rather than oppressive forms of monitoring, tracking and top-down control. In addition, practices that many critical scholars describe as aiding surveillance are often experienced differently by humanitarian subjects. This commentary examines the fraught questions this raises for scholars of international aid, surveillance studies and critical data studies. We put forward a research agenda that tackles head-on how critical theories of data and society can better account for the ambivalent dynamics of ‘power over’ and ‘power to’ that digital aid interventions instantiate.
Paraneoplastic ganglioradiculoneuritis in a cat with a plasma cell tumour
Authors: Marsh Oliver , Destri Alessandra , Di Palma Stefano , Mari Lorenzo , De Risio Luisa , Stabile Fabio
Published: April 2021

Case summary

An 8-year-old neutered female domestic longhair cat was presented for investigation of a 48 h history of lethargy and pelvic limb ataxia. MRI of the spinal cord and vertebral column (C1 to sacrum) and brain was unremarkable. Lumbar cerebrospinal fluid analysis revealed pleocytosis and increased protein concentration. Thoracic radiographs and abdominal ultrasound were unremarkable. Anti-inflammatory doses of prednisolone were administered. Clinical deterioration occurred over the following 2 days, with the development of lower motor neuron deficits in both thoracic limbs. On repetition of the MRI, bilateral enlargement, T2-weighted hyperintensity, and marked contrast enhancement of the C7, C8 and T1 nerve roots, spinal nerves and brachial plexuses were observed. Infectious disease testing was negative. An immune-mediated inflammatory process was suspected and immunosuppressive doses of prednisolone were commenced. The clinical signs improved transiently, but marked deterioration occurred after 2 weeks. The patient was euthanased and a post-mortem examination was performed. A lymphocytic inflammatory infiltrate was detected in the C7, C8 and T1 nerve roots and dorsal root ganglia, and neoplastic plasma cells were identified in multiple organs. A diagnosis of non-cutaneous extramedullary plasmacytoma with multiorgan involvement and paraneoplastic ganglioradiculoneuritis was reached.

Relevance and novel information

Paraneoplastic ganglioradiculoneuritis in association with a plasma cell neoplasia has not been previously reported in the cat and should be considered as a differential diagnosis for cats with clinical or imaging evidence of an inflammatory process affecting the nerve roots, spinal nerves or brachial plexuses.
Implementing online patient feedback in a ‘special measures’ acute hospital: A case study using Normalisation Process Theory
Authors: Baines Rebecca , Underwood Frazer , O’Keeffe Kim , Saunders Jessica , Jones Ray B
Published: April 2021

Objective

Online patient feedback is becoming increasingly prevalent on an international scale. However, limited research has explored how healthcare organisations implement such feedback. This research sought to explore how an acute hospital, recently placed into ‘special measures’ by a regulatory body implemented online feedback to support its improvement journey.

Methods

Semi-structured interviews were conducted with eleven key stakeholders involved in the implementation and/or use of online patient feedback. Data was analysed using deductive thematic analysis with Normalisation Process Theory used as the analytical framework. Research findings are translated into the Engage, Support and Promote (ESP) model, a model of rapid feedback adoption.

Results

Participants viewed the implementation of online feedback as an opportunity to learn, change and improve. Factors found to facilitate implementation were often linked to engagement, support and promotion. Although less frequently described, barriers to implementation included staff anxieties about time pressures, moderation processes and responding responsibilities. Such anxieties were often addressed by activities including the provision of evidence based responder training. Overall, staff were overwhelmingly positive about the value of online feedback with 24 impacts identified at an individual and organisational level, including the ability to boost staff morale, resilience and pride.

Conclusions

The rapid implementation of online patient feedback can be achieved in a ‘special measures’ organisation. However, the difficulties of implementing such feedback should not be underestimated. In order to embed online feedback, staff members need to be engaged and feel supported, with opportunities to provide, respond and invite patient feedback frequently promoted to both patients and staff members.
Challenges to state control of territory: Comparative analysis of Yemen, Afghanistan and Myanmar
Authors: Korishetti Sumedha
Published: April 2021

States around the world have lost control over their territory to armed non-state actors, including states like Yemen, Afghanistan and Myanmar in the Asian region. This article aims to understand why these states are unable to exercise control over all of their territory. The study identifies and examines four major challenges faced by states in maintaining control over their territory – lack of state legitimacy and effectiveness, strategic motives of armed non-state actors, socio-economic motives of armed non-state actors and external intervention. A comparative analysis of the cases of Yemen, Afghanistan and Myanmar illustrates the wide relevance of these challenges faced by the states with respect to territorial control.
Factitious Disorder Masquerading as a Life-Threatening Anaphylaxis
Authors: Khanal Resha , Sendil Selin , Oli Sharad , Bhandari Binita , Atrash Anas
Published: April 2021

Factitious disorder is a psychiatric disorder in which sufferers intentionally fabricate physical or psychological symptoms in order to assume the role of the patient, without any obvious gain. We present a case of a 23-year-old female with chronic urticaria who presented with dyspnea, dysphasia, mild generalized erythema, abdominal cramps, and headache. She was tachypneic and hypotensive. This was her third admission with similar symptoms within the last 7 months. Tryptase, complement, anti-SM/RNP, Sjogren, Scl-70, C3, and C4 were negative. Computed tomography–guided bone marrow biopsy showed no mast cells. Flow cytometry did not show any immunophenotypic reaction. Other possible differentials including pregnancy, autoimmune disorders, and infections including hepatitis, thyroid disorder, and age-related malignancies were ruled out. After a thorough review, malingering disorder was ruled out, but we noticed the patient’s intent of assuming a sick role. Later, the patient was diagnosed with major depressive disorder. Factitious anaphylaxis can present with multiple presentations including a life-threatening condition that mimics true anaphylaxis. A better approach would be thorough clinical evaluation and early multidisciplinary involvement. This case highlights the importance of further evidence-based studies in factitious disorder to decrease the disease burden and reduce the health care cost.
Facilitating Identity Compatibility in Mentorships: Implications for Diversity in Medicine
Authors: Kaundinya Trisha
Published: April 2021

Despite intentional efforts to improve diversity in medicine, there is pronounced underrepresentation of minority groups and non-disclosure of minority identities by medical students due to societal stigmas and fears of acceptance. One way that medical schools address this challenge in supporting diverse student backgrounds is by facilitating faculty mentorship programs with underrepresented minority (URM) students. These efforts are valuable, but they are unfortunately not available at all institutions and do not always allow URM students to engage in the process of choosing a mentor confidentially. Medical schools largely do not make self-reported information from faculty about their various identities and allyships available to medical students, which limits the resources that students have to independently forge these connections. Helping students form their own mentor-mentee relationships by making faculty demographics available can lead students to find individualized support across their medical training. Identity compatibility between students and their role models has shown to correlate with academic achievement and senses of belonging. Enforcing that all medical schools share the identities of faculty who choose to disclose this information with students will thus be helpful to further diversity as a continuous commitment in medical education.
Cassia Abbreviata Enhances Glucose Uptake and Glucose Transporter 4 Translocation in C2C12 Mouse Skeletal Muscle Cells
Authors: Kamga-Simo F. D. Y. , Kamatou G. P. , Ssemakalu C. , Shai L. J.
Published: April 2021

Background.

This study aim at assessing C. abbreviata aqueous extracts for its potential to exhibit anti-diabetic activity in skeletal muscle cells. In addition to the toxicological and glucose absorption studies, the action of C. abbreviata extracts on some major genes involved in the insulin signaling pathway was established.

Methods.

The in vitro cytotoxic effects C. abbreviata was evaluated on muscle cells using the MTT assay and the in vitro glucose uptake assay conducted using a modified glucose oxidase method described by Van de Venter et al. (2008). The amount of GLUT-4 on cell surfaces was estimated quantitatively using the flow cytometry technique. Real time quantitative PCR (RT-qPCR) was used to determine the expression of GLUT-4, IRS-1, PI3 K, Akt1, Akt2, PPAR-γ.

Results.

Cytotoxicity tests revealed that all extracts tested at various concentrations were non-toxic (LC50 > 5000). Aqueous extracts of leaves, bark and seeds resulted in a dose-dependent increase in glucose absorption by cells, after 1 h, 3 h and 6 h incubation period. Extracts of all three plant parts had the best effect after 3 h incubation, with the leaf extract showing the best activity across time (Glucose uptake of 29%, 56% and 42% higher than untreated control cells after treatment with 1 mg/ml extract at 1 h, 3 h and 6 h, respectively). All extracts, with the exception 500 µg/ml seed extract, induced a two-fold increase in GLUT-4 translocation while marginally inducing GLUT-10 translocation in the muscle cells. The indirect immunofluorescence confirmed that GLUT-4 translocation indeed occurred. There was an increased expression of GLUT-4, IRS1 and PI3 K in cells treated with insulin and bark extract as determined by the RT-qPCR.

Conclusion.

The study reveals that glucose uptake involves GLUT-4 translocation through a mechanism that is likely to involve the upstream effectors of the PI3-K/Akt pathway.
Family perceptions of quality of end of life in LGBTQ+ individuals: a comparative study
Authors: Kemery S. Alexander
Published: April 2021

Background:

Members of the lesbian, gay, bisexual, transgender, and queer community have encountered discrimination and stigmatization related to sexual orientation and/or gender identity both within healthcare establishments and in the larger community. Despite the literature describing inequities in healthcare, very little published research exists on the experiences of lesbian, gay, bisexual, transgender, and queer patients and family members in hospice care.

Methods:

A quantitative comparative descriptive design explored the difference in end-of-life experiences between a lesbian, gay, bisexual, transgender, and queer and non-lesbian, gay, bisexual, transgender, and queer cohort. One hundred and twenty-two family members of individuals who have died while under hospice care in the past 5 years completed the Quality of Dying and Death Version 3.2a Family Member/Friend After-Death Self-Administered Questionnaire.

Results:

Comparison of the experiences of the lesbian, gay, bisexual, transgender, and queer cohort ( n = 56) and non-LGBTQ cohort ( n = 66) yielded varying results, with the LGBTQ cohort experiencing lower quality end of life in some Quality of Dying and Death measures and no statistically significant difference from the non-LGBTQ cohort in others.

Discussion:

The findings from this study in combination with previously published works on lesbian, gay, bisexual, transgender, and queer health support the position that hospice providers must take concrete steps to ensure that professional caregivers and office staff are qualified to meet the needs of this marginalized population.
Children’s interactive storytelling in Virtual Reality
Authors: Yamada-Rice Dylan
Published: April 2021

This article reports on one stage of a project that considered twenty 8–12-years-olds use of Virtual Reality (VR) for entertainment. The entire project considered this in relation to interaction and engagement, health and safety and how VR play fitted into children’s everyday home lives. The specific focus of this article is solely on children’s interaction and engagement with a range of VR content on both a low-end and high-end head mounted display (HMD). The data were analysed using novel multimodal methods that included stop-motion animation and graphic narratives to develop multimodal means for analysis within the context of VR. The data highlighted core design elements in VR content that promoted or inhibited children’s storytelling in virtual worlds. These are visual style, movement and sound which are described in relation to three core points of the user’s journey through the virtual story; (1) entering the virtual environment, (2) being in the virtual story world, and (3) affecting the story through interactive objects. The findings offer research-based design implications for the improvement of virtual content for children, specifically in relation to creating content that promotes creativity and storytelling, thereby extending the benefits that have previously been highlighted in the field of interactive storytelling with other digital media.
Insights into phylogenetic relationships and genome evolution of subfamily Commelinoideae (Commelinaceae Mirb.) inferred from complete chloroplast genomes
Authors: Jung Joonhyung , Kim Changkyun , Kim Joo-Hwan
Published: April 2021

Background

Commelinaceae (Commelinales) comprise 41 genera and are widely distributed in both the Old and New Worlds, except in Europe. The relationships among genera in this family have been suggested in several morphological and molecular studies. However, it is difficult to explain their relationships due to high morphological variations and low support values. Currently, many researchers have been using complete chloroplast genome data for inferring the evolution of land plants. In this study, we completed 15 new plastid genome sequences of subfamily Commelinoideae using the Mi-seq platform. We utilized genome data to reveal the structural variations and reconstruct the problematic positions of genera for the first time.

Results

All examined species of Commelinoideae have three pseudogenes (accD, rpoA, and ycf15), and the former two might be a synapomorphy within Commelinales. Only four species in tribe Commelineae presented IR expansion, which affected duplication of the rpl22 gene. We identified inversions that range from approximately 3 to 15 kb in four taxa (Amischotolype, Belosynapsis, Murdannia, and Streptolirion). The phylogenetic analysis using 77 chloroplast protein-coding genes with maximum parsimony, maximum likelihood, and Bayesian inference suggests that Palisota is most closely related to tribe Commelineae, supported by high support values. This result differs significantly from the current classification of Commelinaceae. Also, we resolved the unclear position of Streptoliriinae and the monophyly of Dichorisandrinae. Among the ten CDS (ndhH, rpoC2, ndhA, rps3, ndhG, ndhD, ccsA, ndhF, matK, and ycf1), which have high nucleotide diversity values (Pi > 0.045) and over 500 bp length, four CDS (ndhH, rpoC2, matK, and ycf1) show that they are congruent with the topology derived from 77 chloroplast protein-coding genes.

Conclusions

In this study, we provide detailed information on the 15 complete plastid genomes of Commelinoideae taxa. We identified characteristic pseudogenes and nucleotide diversity, which can be used to infer the family evolutionary history. Also, further research is needed to revise the position of Palisota in the current classification of Commelinaceae.
Integrated early childhood development policy in Iran: a qualitative policy process analysis
Authors: Atashbahar Omolbanin , Sari Ali Akbari , Takian Amirhossein , Olyaeemanesh Alireza , Mohamadi Efat , Barakati Sayyed Hamed
Published: April 2021

Background

Integrated early childhood development (IECD) is a comprehensive approach to optimal development of children in different developmental domains from fetal stage to eight years of age. The aim of this study was to identify the factors affecting the process of policy-making for early childhood development and to clarify how these factors affect decision-making and create challenges in this regard.

Method

In a qualitative study, we used two main data sources including document analyses and interviews. Using purposive sampling, forty semi-structured interviews with policymakers and informants in the fields related to children were conducted in Tehran from October 2017 to June 2018. Also, 62 national and 10 international relevant documents were reviewed. A deductive-inductive approach was used to analyze the data. We used the MAXQDA11 software for data management.

Results

we identified 13 themes and 29 subthemes related to the stages of policymaking process including: Agenda setting (problem stream, policy stream, politics stream), Policy formulation (formulation and approval process, policy sustainability, mechanisms of stakeholders’ participation in policymaking), Policy implementation (conceptual ambiguity, intersectoral and trans-sectoral issues, structural capacities, mobilization of resources), and Policy evaluation (continuous and routine data registry system, comprehensiveness of indexes). We propose 19 policy recommendations to improve the situation.

Conclusion

As a multidisciplinary and multi-sectoral field with different domains, early childhood development (ECD) requires a more active role on the part of policymakers in governmental levels in supporting the related policies. Unless policymakers change their approach to decrease nonintegrated and non-comprehensive policymaking for ECD, child development will be compromised, which endangers the eventual sustainability of the society since improved IECD policy-making process improves developmental outcomes in children. In this regard, attention should be paid to the role of reinforcing intersectoral collaboration through incorporating it in the missions and the evaluation items of organizations, creating commitment in high organizational levels, and developing an inter-ministerial policymaking framework that clearly specifies the roles and responsibilities of every single sector and their interactions and collaborations.
Factors associated with coverage of vitamin a supplementation among Bangladeshi children: mixed modelling approach
Authors: Marjan Nahyatul , Rahman Atikur , Rois Rumana , Rahman Azizur
Published: April 2021

Background

Vitamin A deficiency (VAD) is a prominent and widespread public health problem in developing countries, including Bangladesh. About 2% of all deaths among under-five children are attributable to VAD. Evidence-based information is required to understand the influential factors to increase vitamin A supplementation (VAS) coverage and reduce VAD. We investigated the potential factors affecting VAS coverage and its significant predictors among Bangladeshi children aged 6 to 59 months using the VAS clustered data extracted from the latest Bangladesh Demographic and Health Survey 2014.

Methods

Data were analysed using mixed logistic regression (MLR) modelling approach in the generalised linear mixed model framework. The MLR model performs better than logistic regression for analysing the clustered data because of its minimum Akaike information criterion value. The likelihood ratio test showed that the variance component was significant. Therefore, the clustering effect among children was inevitable to use.

Results

VAS coverage among under-five children was 63.6%, which is not optimal and below the WHO’s recommendation and the country’s target of 90%. Children aged 25 to 36 months (AOR = 2.07, 95% CI: 1.711 to 2.513), who had higher educated mothers (AOR = 1.37,p = 0.033, 95% CI: 1.026–1.820) and fathers (AOR = 1.32,p = 0.027, 95% CI: 1.032–1.683), whose mothers had media exposure (AOR = 1.22,p = 0.006, 95% CI: 1.059–1.408) and NGO membership (AOR = 1.24,p = 0.002, 95% CI: 1.089–1.422) were more likely to consume VAS.

Conclusion

The relevant authorities should create proactive awareness programs for highly vulnerable local communities, specifically targeted to educate the children’s mothers about the necessity and benefits of childhood nutrition.
Factors influencing physical activity in adults with cystic fibrosis
Authors: Hurley Nicola , Moyna Niall M. , Kehoe Bróna , McCaffrey Noel , Redmond Karen , Hardcastle Sarah J.
Published: April 2021

Background

Physical activity (PA) is a well-documented and accepted adjunct therapy for the maintenance and improvement of long-term health in cystic fibrosis (CF). Although the benefits of PA for CF populations are well-established, adherence to PA programmes within this population remains low. This study aimed to investigate the factors that influence engagement in physical activity, and to explore exercise preferences, among adults with cystic fibrosis (CF).

Methods

Semi-structured telephone interviews were conducted. Participants were twenty-one adults (mean age 35 years, SD ± 8) with an established diagnosis of CF, living in Ireland. Interview scripts were digitally recorded and transcribed verbatim. Thematic analysis was used to analyse the data.

Results

Four main themes emerged: barriers, motives, value of exercise-related outcomes, and exercise preferences. The main barriers included: low energy levels, time, the weather, and exercise-related confidence. Enjoyment and perceived competence underpinned autonomous motivation. Participants who self-identified as being regularly active valued personally identified exercise-related outcomes such as, accomplishment and affect regulation. Participants indicated a preference for home-based physical activity programs compared to gym- or facility-based programs.

Conclusion

Interventions aimed at promoting physical activity among adults with CF should involve programs that foster autonomous motivation, enjoyable activities, personally identified outcomes, competence and that can be conducted from the home environment.

Clinical implications

To increase physical activity participation among adults with CF, interventions that can be conducted from the home environment, that pay attention to the patients’ personally-valued exercise outcomes may be required.
The importance of intervertebral disc material model on the prediction of mechanical function of the cervical spine
Authors: Komeili Amin , Rasoulian Akbar , Moghaddam Fatemeh , El-Rich Marwan , Li Le Ping
Published: April 2021

Background

Linear elastic, hyperelastic, and multiphasic material constitutive models are frequently used for spinal intervertebral disc simulations. While the characteristics of each model are known, their effect on spine mechanical response requires a careful investigation. The use of advanced material models may not be applicable when material constants are not available, model convergence is unlikely, and computational time is a concern. On the other hand, poor estimations of tissue’s mechanical response are likely if the spine model is oversimplified. In this study, discrepancies in load response introduced by material models will be investigated.

Methods

Three fiber-reinforced C2-C3 disc models were developed with linear elastic, hyperelastic, and biphasic behaviors. Three different loading modes were investigated: compression, flexion and extension in quasi-static and dynamic conditions. The deformed disc height, disc fluid pressure, range of motion, and stresses were compared.

Results

Results indicated that the intervertebral disc material model has a strong effect on load-sharing and disc height change when compression and flexion were applied. The predicted mechanical response of three models under extension had less discrepancy than its counterparts under flexion and compression. The fluid-solid interaction showed more relevance in dynamic than quasi-static loading conditions. The fiber-reinforced linear elastic and hyperelastic material models underestimated the load-sharing of the intervertebral disc annular collagen fibers.

Conclusion

This study confirmed the central role of the disc fluid pressure in spinal load-sharing and highlighted loading conditions where linear elastic and hyperelastic models predicted energy distribution different than that of the biphasic model.
Better short-term function after unicompartmental compared to total knee arthroplasty
Authors: Tille Eric , Beyer Franziska , Auerbach Kai , Tinius Marco , Lützner Jörg
Published: April 2021

Background

Unicompartmental knee arthroplasty (UKA) is an established treatment option for patients with unicompartmental osteoarthritis (OA). However, strict patient selection is crucial for its success. The proposed advantages include nearly natural knee kinematics, faster rehabilitation and better functional outcomes. Despite the aforementioned facts and it’s proven cost-effectiveness, there are still hesitations for the use of UKA as an alternative to total knee arthroplasty (TKA). Key objectives of this study were therefore to assess clinical and patient-reported outcome (PRO) as well as patient’s satisfaction after medial UKA in comparison to TKA.

Methods

To assess the outcome after UKA we conducted a prospective multi-center study. 116 patients with unicompartmental OA and indication for UKA were included. Overall 54 females and 62 males with an average age of 62.7 years (±9.8) and an average body mass index (BMI) of 29.2 (± 3.7) were recruited. Clinical results and PRO were assessed using the Knee Society Score (KSS). Follow-ups took place 3 months, 1 and 2 years after surgery including clinical examination, radiographs, assessment of PRO and adverse events. Pain and satisfaction was evaluated using a visual analog scale (VAS, 0 (worst) to 10 (best)).

For comparison with TKA a propensity score matched-pair analysis was performed to eliminate confounders. Matching criteria were gender, patient’s age, BMI and comorbidities. A total of 116 matched-pairs were analysed.

Results

There was no revision in the UKA group until 2 years after surgery. Revision rates were higher in the TKA group (0.6%).

Preoperative KSS-Scores were higher within the UKA cohort (p <  0.001). After surgical treatment, PROMs displayed a significant improvement (p <  0,001) in both cohorts. Regarding the Knee-Score (Pain, Alignment, ROM) we observed no differences between cohorts after 12 months. The Function-Score demonstrated significantly better results in the UKA cohort (UKA vs. TKA 95 vs 80, p <  0.001). Patient satisfaction was also higher in UKA patients (UKA vs TKA 9.0 vs 8.8, p = 0.019).

Conclusion

Patients of both cohorts showed high satisfaction after knee arthroplasty. UKA resulted in higher function scores compared to TKA without increased revision rate during short-term follow-up. Therefore, UKA is a good treatment option for unicompartmental OA.

Trial registration

Clinicaltrials.gov, NCT04598568. Registered 22 October 2020 - Retrospectively registered.
Transanal fistulectomy for postoperative persistent rectourethral fistula in patients with ARM: is simple resection enough?
Authors: Huang Xinjie , Chen Yajun , Pang Wenbo , Peng Chunhui , Wu Dongyang
Published: April 2021

Background

Postoperative rectourethral fistula (RUF) in patients with congenital anorectal malformation (ARM) remains a challenge for paediatric surgeons, among them persistent fistula is the most common. Various techniques have been proposed, only a few reports based on different causes are available, and there is no consensus so far. This study is to evaluate the application, advantages and limitations of transanal fistulectomy approach in repairing persistent RUF in ARM patients.

Methods

From January 2007 to July 2019, 78 ARM patients who received revisional surgery for RUF were reviewed, 34 persistent fistulas were identified. Examination under anaesthesia included patients with fistulas that were located within 3 cm from the anus verge, good appearance of the anus and sphincter function, and no urethral and rectoanal obstruction. Three patients were excluded because of complex urologic pathologic defects. In total, thirty-one patients underwent transanal fistulectomy to repair RUF.

Results

All cases were approached with transanal incision and fistulectomy to repair RUF. The average operative time was 91 ± 35 min. At a minimum six-month follow-up, 29 patients healed after the first attempt, the success closure rate was 93.5%. Two patients received redo transanal fistulectomy and healed. Two patients had postoperative complications: one patient had urethral stenosis and it was managed by dilation; one patient had urethral diverticulum but it did not require revisional surgery. No patient in this study was incontinent because of the surgery.

Conclusions

Transanal fistulectomy provides a simple, straightforward, and safe approach to repair persistent RUF in ARM patients, especially in those with a low-lying fistula, good anus appearance and sphincter function without obstruction in the rectum or urethra.

Trial registration: Retrospectively registered.
Biosimilar recombinant follitropin alfa preparations versus the reference product (Gonal-F®) in couples undergoing assisted reproductive technology treatment: a systematic review and meta-analysis
Authors: Chua Su Jen , Mol Ben W. , Longobardi Salvatore , Orvieto Raoul , Venetis Christos A. , Lispi Monica , Storr Ashleigh , D’Hooghe Thomas
Published: April 2021

Background

Live birth has increasingly been identified as the standard clinical approach to measure the success of medically assisted reproduction (MAR). However, previous analyses comparing biosimilar preparations of follitropin alfa versus the reference product (GONAL-f®, Merck KGaA, Darmstadt, Germany or GONAL-f® RFF; EMD Serono, Inc., Rockland, MA), have had insufficient power to detect differences in clinically meaningful outcomes such as live birth.

Methods

Medline, Embase, the Cochrane Library, Web of Science and clinical trial registries were searched for randomised controlled trials (RCTs) and conference abstracts comparing biosimilar follitropin alfa versus the reference product in controlled ovarian stimulation (COS) cycles published before 31 October 2020. Only studies in humans and publications in English were included. Retrieved studies were screened independently by two authors based on titles and abstracts, and then by full text. Inclusion criteria: RCTs comparing follitropin alfa biosimilar preparations with the reference product in infertile patients of any age, with any type of infertility for any duration, undergoing COS for the purposes of MAR treatment (including frozen cycles). The primary outcome was live birth. Combined data for biosimilar preparations were analysed using a fixed-effects model.

Results

From 292 unique records identified, 17 studies were included in the systematic review, representing five unique RCTs that were included in the meta-analysis. Rates of live birth (RR = 0.83, 95% CI 0.71, 0.97; 4 RCTs, n = 1881, I2 = 0%), clinical pregnancy (RR = 0.82, 95% CI 0.72, 0.94; 4 RCTs, n = 2222, I2 = 0%) and ongoing pregnancy (RR = 0.81, 95% CI 0.68, 0.96; 4 RCTs, n = 1232, I2 = 0%) were significantly lower with biosimilar preparations versus the reference product. Rates of cumulative live birth and cumulative clinical pregnancy were also significantly lower with biosimilars versus the reference product. There was high risk of publication bias.

Conclusions

This meta-analysis included data from RCTs evaluating the efficacy and safety of the biosimilar follitropin alfa preparations and demonstrated lower probability of live birth and pregnancy (ongoing and clinical) in couples treated with biosimilar preparations compared with the reference product. This study provides more insight into the differences between biosimilar r-hFSH preparations and the reference product than previously reported.

Trial registration

Registration number: CRD42019121992.