bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of hot surfaces generated by friction contacts of titanium alloy and steel
Authors: Pan He , Zhang Yang
Published: September 2020

When light alloys used in coal mine, the sparks generated by mechanical friction and impacts are the main effective ignition source. While the hot surfaces are concomitant in friction process, prior to the occurrence of mechanical sparks, whether the hot surfaces will be an effective ignition source. Then this paper focuses on the development of hot surfaces generated by TC4 titanium alloy at the low friction velocities. Experiments and finite element simulation methods were used together to describe the temperature field of TC4 titanium alloy. It was found that the temperature of hot surfaces increased with the load and increased much faster at higher relative speed. By means of regression analysis, the variation law of friction coefficient and contact pressure with loads and the variation law of hot surface temperature with friction coefficient and pressure were studied, then the fitting curve of hot surface temperature was obtained. The results of calculations and experiments indicate that hot surfaces generated by light alloy was possible to be an effective ignition source for methane air mixture in coal mine.
PIM-1 may function as an oncogene in cervical cancer via activating the EGFR signaling
Authors: Yang Hongwen , He Kui , Dong Weile , Fang Jinchuan , Zhong Suyun , Tang Lixia , Long Lihua
Published: September 2020

Background:

This work was designed to explore the roles of PIM-1 in the development of cervical cancer.

Methods:

There were 90 paired cervical tumor samples and the non-tumor adjacent tissue. The levels of PIM-1 in different samples were examined using quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) methods. The potential diagnostic value of PIM-1 was analyzed by the receiver operating characteristic (ROC) curve; furthermore, the expression of EGFR in tumor samples was detected, and Pearson’s correlation analysis was performed to analyze the relationship between the expression of PIM-1 and EGFR. Finally, cervical cancer cell line Hela cells were cultured and treated by PIM-1 siRNA, and MTT assay and Pi/Annexin V assay were performed to explore the effects of PIM-1 siRNA on the growth and apoptosis ability of the Hela cells.

Results:

PIM-1 was significantly up-regulated in cervical cancer tissue compared to adjacent tissue, and the expression of PIM-1 in patients with cervical cancer is positively associated with the size and metastasis of the tumor. ROC analysis showed PIM-1 is a sensitive biomarker for the diagnosis of cervical cancer. Furthermore, EGFR was over-expressed in cervical cancer tumor tissues, and the levels of PIM-1 and EGFR in cervical cancer tissue were positively correlated. Finally, PIM-1 siRNA dramatically inhibited the viability and promoted the apoptosis of the Hela cells.

Conclusion:

Our findings prove that PIM-1 may function as an oncogene in cervical cancer and can regulate the EGFR signaling in cervical cancer.
Governing roles? Integrating philanthropic foundations with governance boards in German educational collaborative networks
Authors: Koranyi Franz , Kolleck Nina
Published: September 2020

Educational collaborative networks (ECNs), as instruments for achieving educational goals through the integration of non-governmental organisations (NGOs), have become frequent elements of public education worldwide. Despite their contribution of additional resources to the education enterprise, the roles of philanthropic foundations in ECNs are particularly controversial. Research suggests that leaders of ECNs such as policy makers, administrators, and school principals design and coordinate governance structures to guide participants’ behaviour. However, the importance of governance design and coordination in ECNs for governing philanthropic roles is yet to be systematically analysed. This article centres on the relationship between the design and coordination of governance boards and role-related participation of philanthropic foundations. A mixed methods design is implemented based on secondary analysis of a German large-scale standardised survey and an in-depth case study conducted in a south German municipality. Results confirm that leaders of ECNs impact philanthropic engagement via the design and coordination of governance boards. Participation in ECNs can take on diverse roles of representing particular interests, pursuing innovation, or providing services and are explained by underlying governance-related mechanisms. Identified associations within governance boards and role-related participation of philanthropic foundations in ECNs offer valuable insights for leadership in education.
Fecal incontinence in women: Causes and treatment
Authors: Makol Ashima , Grovet Madhusudan , Whitehead William E
Published: September 2020

Fecal incontinence is a common problem in women, which often enforces life changes owing to embarrassment and social stigma. It is frequently not reported or diagnosed. Age, obstetric trauma, pelvic surgery, chronic diarrhea, obesity and other medical conditions, such as diabetes and stroke, increase the risk of fecal incontinence. Preventive strategies include avoiding diarrheal triggers, discouraging the routine use of episiotomies, early recognition and management of obstetric injuries and possibly pelvic floor muscle exercises after childbirth. Treatment options are available and should be discussed with the patient. These, in order of progression, are education and medications for diarrhea or constipation, supportive care, biofeedback training and surgery.
Oropharyngeal cancer
Authors: Watters Carolina , Brar Sabrina , Richards Claire , Niziol Rafal
Published: September 2020

The incidence of oropharyngeal cancer in the UK has almost trebled in the last few decades and continues to climb. It is expected that its associated symptoms will become increasingly common presenting complaints in primary care, where early recognition is hugely advantageous for patient outcomes. Thorough history and examination, plus a sound knowledge of associated risk factors, is vital in identifying potential cases, and an understanding of the correct referral pathways ensures patients are appropriately referred to head and neck cancer services. A broad overview of benign differential diagnoses, subsequent investigation and management of oropharyngeal cancers is helpful in order to properly inform and support patients in their next steps.
Safe and Sufficient Glycemic Control by Using a Digital Clinical Decision Support System for Patients With Type 2 Diabetes in a Routine Setting on General Hospital Wards
Authors: Lichtenegger Katharina M. , Aberer Felix , Tuca Alexandru C. , Donsa Klaus , Höll Bernhard , Schaupp Lukas , Plank Johannes , Beck Peter , Fruhwald Friedrich M , Kamolz Lars-Peter , Pieber Thomas R. , Mader Julia K.
Published: September 2020

The aim was to investigate the applicability of a clinical decision support system in a real-world inpatient setting for patients with type 2 diabetes on general hospital wards.

A total of 150 patients with type 2 diabetes requiring subcutaneous insulin therapy were treated with basal-bolus insulin therapy guided by a decision support system (GlucoTab) providing automated workflow tasks and suggestions for insulin dosing to health care professionals.

By using the system, a mean daily blood glucose (BG) of 159 ± 32 mg/dL was achieved. 68.8% of measurements were in the target range (70 to <180 mg/dL). The percentage of BG values <40, <70, and ≥300 mg/dL was 0.02%, 2.2%, and 2.3%, respectively. Health care professionals’ adherence to suggested insulin doses and workflow tasks was high (>93% and 91%, respectively).

The decision support system facilitates safe and efficacious inpatient diabetes care by standardizing treatment workflow and providing decision support for basal-bolus insulin dosing.
Success factors in high-effect, low-cost eHealth programs for patients with hypertension: a systematic review and meta-analysis
Authors: Blok Sebastiaan , van der Linden Eva L , Somsen G Aernout , Tulevski Igor I , Winter Michiel M , van den Born Bert-Jan H
Published: September 2020

Background

eHealth programs can lower blood pressure but also drive healthcare costs. This study aims to review the evidence on the effectiveness and costs of eHealth for hypertension and assess commonalities in programs with high effect and low additional cost.

Results

Overall, the incremental decrease in systolic blood pressure using eHealth, compared to usual care, was 3.87 (95% confidence interval (CI) 2.98–4.77) mmHg at 6 months and 5.68 (95% CI 4.77–6.59) mmHg at 12 months’ follow-up. High intensity interventions were more effective, resulting in a 2.6 (95% CI 0.5–4.7) (at 6 months) and 3.3 (95% CI 1.4–5.1) (at 12 months) lower systolic blood pressure, but were also more costly, resulting in €170 (95% CI 56–284) higher costs at 6 months and €342 (95% CI 128–556) at 12 months. Programs that included a high volume of participants showed €203 (95% CI 99–307) less costs than those with a low volume at 6 months, and €525 (95% CI 299–751) at 12 months without showing a difference in systolic blood pressure. Studies that implemented eHealth as a partial replacement, rather than addition to usual care, were also less costly (€119 (95% CI –38–201 at 6 months) and €346 (95% CI 261–430 at 12 months)) without being less effective. Evidence on eHealth programs for hypertension is ambiguous, heterogeneity on effectiveness and costs is high (I2 = 56–98%).

Conclusion

Effective eHealth with limited additional costs should focus on high intensity interventions, involve a large number of participants and use eHealth as a partial replacement for usual care.
Quality of life among newly admitted patients to cancer hospital in Vietnam and associated factors
Authors: Quang Bui Vinh , Minh Le Dai , Quyen Le Thi Le , Mai Duong Ngoc Le , Dat Nguyen Tien , Giang Kim Bao
Published: September 2020

A cross-sectional study was conducted among 262 newly admitted patients of a cancer hospital in Vietnam. The Vietnamese version EORTC-30 questionnaire 3.0 was used to interviews patients during the first week after their admission. Lower global quality of life and physical functioning scores were significantly associated with older age, lung and gastrointestinal cancers. Emotional functioning score was lower among female patients as compared to males. Financial difficulty was an important preditor for almost all functional scales. Management of early symptoms, providing early emotional supports and appropriate policies to reduce financial difficulty are important to improve cancer patients’ quality of life.
Health information seeking behaviour using mobile devices among people with diabetes: A comparison between Middle and high income country
Authors: Lee Jason WY , Theng Yin-Leng , Lee Shaun WH
Published: September 2020

Objective

The internet has become a primary source of information for many individuals especially those with chronic diseases. This study aims to understand and compare the health seeking behaviour using mobile devices among individuals with diabetes and between a high (Singapore) and middle (Malaysia) income country.

Methods

A cross sectional survey was conducted among people with diabetes in Malaysia and Singapore. Participants attending the primary health clinic for the treatment of diabetes were approached to participate in this survey. Data on demographics, health status and beliefs to health were collected and compared.

Results

A total of 673 respondents were included in the study. Most of the respondents reported to have access to the Internet, with a high ownership of mobile phones (99.3%). However, only one in every three respondents sought information online. Younger individuals (≤50 years) and those with higher education more likely to seek information using mobile devices. Respondents in Singapore reported to be more likely to use mobile devices to monitor their health as compared to respondents in Malaysia. However, most respondents would seek health information from their healthcare professionals’ especially physicians.

Conclusion

There was limited differences in the health-seeking behaviour among the respondents from both countries, suggesting for a need to identify for more effective means of distribution of health related information.
“They Would Do Just Fine Without Me”: Experiences of Private Tutoring in Denmark
Authors: Cone Lucas
Published: September 2020

Purpose:

Building on a qualitative case study of parents and tutors previously involved with a large commercial tutoring company, this article investigates experiences of private tutoring in Denmark.

Design/Approach/Methods:

The case study centers around an affective analysis of eight interviews—three parents and five tutors—centering on why and how the interlocutors decided to hire services from or work for the tutoring company.

Findings:

The article illustrates how the parents’ and tutors’ experiences of private tutoring are colored by a series of affective patterns that set the tone for how the parents and tutors make sense of and feel about the phenomenon. Three patterns are drawn forth which together sustain the “mood” in which the parents and tutors encounter the tutoring phenomenon: teacher intimacy, institutional professionalism, and nonexclusivity.

Originality/Value:

The article provides an empirically grounded perspective on the stakes of commercializing education in spaces characterized by egalitarian ideals in education.
Factors Affecting the Decision to Initiate Anticoagulation After Spine Surgery: Findings From the AOSpine Anticoagulation Global Initiative
Authors: Gandhi Sapan D. , Khanna Krishn , Harada Garrett , Louie Philip , Harrop James , Mroz Thomas , Al-Saleh Khalid , Brodano Giovanni Barbanti , Chapman Jens , Fehlings Michael G. , Hu Serena S. , Kawaguchi Yoshiharu , Mayer Michael , Menon Venugopal , Park Jong-Beom , Rajasekaran Shanmuganathan , Valacco Marcelo , Vialle Luiz , Wang Jeffrey C. , Wiechert Karsten , Riew K. Daniel , Samartzis Dino
Published: September 2020

Study Design:

Cross-sectional, international survey.

Objectives:

To identify factors influencing pharmacologic anticoagulation initiation after spine surgery based on the AOSpine Anticoagulation Global Survey.

Methods:

This survey was distributed to the international membership of AOSpine (n = 3805). A Likert-type scale described grade practice-specific factors on a scale from low (1) to high (5) importance, and patient-specific factors a scale from low (0) to high (3) importance. Analysis was performed to determine which factors were significant in the decision making surrounding the initiation of pharmacologic anticoagulation.

Results:

A total of 316 spine surgeons from 64 countries completed the survey. In terms of practice-specific factors considered to initiate treatment, expert opinion was graded the highest (mean grade ± SD = 3.2 ± 1.3), followed by fellowship training (3.2 ± 1.3). Conversely, previous studies (2.7 ± 1.2) and unspecified guidelines were considered least important (2.6 ± 1.6). Patient body mass index (2.0 ± 1.0) and postoperative mobilization (2.3 ± 1.0) were deemed most important and graded highly overall. Those who rated estimated blood loss with greater importance in anticoagulation initiation decision making were more likely to administer thromboprophylaxis at later times (hazard ratio [HR] = 0.68-0.71), while those who rated drain output with greater importance were likely to administer thromboprophylaxis at earlier times (HR = 1.32-1.43).

Conclusion:

Among our global cohort of spine surgeons, certain patient factors (ie, patient mobilization and body mass index) and practice-specific factors (ie, expert opinion and fellowship training) were considered to be most important when considering anticoagulation start times.
Factors Related to Pain in Patients With Retorn Rotator Cuffs: Early Postoperative Pain Predicts Pain at 12 Months Postoperatively
Authors: Kim Yang-Soo , Kang Ki-Ho , Lee Hyo-Jin
Published: September 2020

Background:

Retearing of a repaired rotator cuff leads to diverse symptoms, including pain, regardless of the degree of the tear, but the relationship between pain and retears is poorly understood.

Purpose:

To determine which factors are correlated with shoulder pain in retears of a repaired rotator cuff.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

We retrospectively reviewed a cohort of patients who were diagnosed as having a retear on magnetic resonance imaging after primary rotator cuff repair. The primary outcome variable of interest was the visual analog scale (VAS) for pain score at 12-month and final follow-up (mean, 25.2 months). We evaluated the relationship of pain at 12-month and final follow-up with preoperative patient factors (age, sex, and underlying conditions), preoperative range of motion, and preoperative pain; postoperative pain at 3 and 6 months; and perioperative conditions (tear extent, tear size, accompanying lesions, and procedures other than rotator cuff repair).

Results:

A total of 48 patients were reviewed. The VAS score at 3 months postoperatively showed a positive correlation with the VAS score at 12 months postoperatively (ρ = 0.537; P < .001) and at final follow-up (ρ = 0.537; P < .001). Univariate and multivariate regression analyses revealed that the VAS score at 3 months postoperatively ( P = .0001 and P = .0017, respectively), hypertension ( P = .0108 and P = .0073, respectively), and late detection of the retear ( P = .0091 and P = .0208, respectively) were significant predictors of pain at 12 months postoperatively.

Conclusion:

The presence of pain in the early postoperative period, underlying hypertension, and late detection of the retear were related to pain severity in patients 12 months after rotator cuff surgery.
Geometry and thickness dependant anomalous mechanical behavior of fabricated SU-8 thin film micro-cantilevers
Authors: Basu Aviru Kumar , Basak Anup , Bhattacharya Shantanu
Published: September 2020

SU-8 micro-cantilever arrays consisting of V- and M-shaped structures fabricated using a simplified single hard mask step. Bending tests were performed under similar peak loads (ranging 2–10 µN), with thickness ranging between micron (3.5 µm) and sub-micron (0.2 µm) scales. Various mechanical properties such as stiffness and hysteresis are determined from the load versus deflection curves. When the thickness of the V-shaped beam is decreased from 2 µm to 0.2 µm, the stiffness increases by a factor of 2.7, which is in contradiction with the classical beam theory according to which the stiffness for 0.2 µm beam should be three orders of magnitude less than that of 2 µm beam. Micropolar elasticity theory with a variable-intrinsic length scale (thickness dependant) is used to explain such an anomalous response. Experimentally obtained stiffness of two M-shaped beams of thickness 2 µm and 0.2 µm are almost identical. Reason behind this contradictory result is that the thicker beam has a residual strain with a large plastic deformation which usually increases the cross-linking network density, leading to increase in elastic modulus, hardness and thus stiffness of polymers. But the thinner beam has undergone an elastic deformation. The size effect of V- and M-shaped cantilever beams is discussed.
Overview of bariatric and metabolic endoscopy interventions
Authors: Tawadros Augustine , Makar Michael , Kahaleh Michel , Sarkar Avik
Published: September 2020

The rise of endoscopic techniques allowing weight loss offers an attractive alternative to surgical interventions in Western countries where the obesity epidemic has risen dramatically. Endoscopists are well positioned to manage obesity given their broad-based medical knowledge, understanding of gastrointestinal physiology, and training in endoscopic technique. The field of bariatric and metabolic endoscopy has permitted the development of several efficacious and safe technologies. This review focuses on techniques and devices used for endoscopic management of obesity, as well as the fundamental justifications to offer those therapies to obese patients.
Reduced phosphorus intake throughout gestation and lactation of sows is mitigated by transcriptional adaptations in kidney and intestine
Authors: Wubuli Aisanjiang , Gerlinger Christian , Reyer Henry , Oster Michael , Muráni Eduard , Trakooljul Nares , Ponsuksili Siriluck , Wolf Petra , Wimmers Klaus
Published: September 2020

Background

The environmental impact of pig farming need to be reduced, with phosphorus (P) being of particular interest. Specified dietary regimens and management systems contribute to meet environmental concerns and reduce economic constrains. However, pregnant and lactating sows represent vulnerable individuals, whose reproductive potential and metabolic health status relies on adequate supply of macro- and micronutrients. The aim of this study was to investigate, whether sows fed with a dietary P content that is below or above current recommendations are capable to maintain mineral homeostasis during the reproduction cycle and which endogenous mechanisms are retrieved therefore in kidney and jejunum. Nulliparous gilts were fed iso-energetic diets with recommended (M), reduced (L), or high (H) amounts of mineral P supplements throughout gestation and lactation periods. Blood metabolites and hormones referring to the P homeostasis were retrieved prior to term (110 days of gestation) and at weaning (28 days of lactation). Transcriptional responses in kidney cortex and jejunal mucosa were analyzed using RNA sequencing.

Results

The variable dietary P content neither led to an aberration on fertility traits such as total weaned piglets nor to an effect on the weight pattern throughout gestation and lactation. Serum parameters revealed a maintained P homeostasis as reflected by unaltered inorganic P and calcium levels in L and H fed groups. The serum calcitriol levels were increased in lactating L sows. The endocrine responses to the dietary challenge were reflected at the transcriptional level. L diets led to an increase in CYP27B1 expression in the kidney compared to the H group and to an altered gene expression associated with lipid metabolism in the kidney and immune response in the jejunum.

Conclusions

Our results suggest that current P requirements for gestating and lactating sows are sufficient and over supplementation of mineral P is not required. Shifts in renal and jejunal expression patterns between L and H groups indicate an affected intermediate metabolism, which long-term relevance needs to be further clarified.
Oral Lactobacillus strains reduce cytotoxicity and cytokine release from peripheral blood mononuclear cells exposed to Aggregatibacter actinomycetemcomitans subtypes in vitro
Authors: Pahumunto Nuntiya , Basic Amina , Östberg Anna-Karin , Teanpaisan Rawee , Dahlen Gunnar
Published: September 2020

Background

This study evaluated the effect of oral lactobacilli on the cytotoxicity and cytokine release from peripheral blood mononuclear cells (PBMCs) when exposed to Aggregatibacter actinomycetemcomitans subtypes in vitro. The supernatants and cell wall extracts (CWEs) of eight A. actinomycetemcomitans strains, representing different subtypes, and three Lactobacillus strains were used. The PBMCs from six blood donors were exposed to supernatants and CWEs of A. actinomycetemcomitans or Lactobacillus strains alone or combinations and untreated cells as control. The cytotoxicity was determined by trypan blue exclusion method and IL-1β secretion by ELISA. TNF-α, IL-6, and IL-8 secretions were measured using Bioplex Multiplex Immunoassay.

Results

Supernatants or CWEs from all bacterial strains showed cytotoxicity and IL-1β secretion and the subtypes of A. actinomycetemcomitans showed generally a significantly higher effect on PBMCs than that of the Lactobacillus strains. Two highly toxic A. actinomycetemcomitans strains (JP2 and JP2-like) induced a higher response than all other strains. When combined, Lactobacillus significantly reduced the toxicity and the IL-1β secretion induced by A. acinomycetemcomitans. The effect varied between the subtypes and the reduction was highest for the JP2 and JP2-like strains. The Lactobacillus paracasei strain SD1 had a higher reducing effect than the other Lactobacillus strains. This strain had a consistent reducing effect on all subtypes of A. actinomycetemcomitans cytotoxicity, and release of IL-1β, IL-6, IL-8, and TNF-α from PBMCs of the blood donors. A strong and significant variation in cytokine release between the six blood donors was noticed.

Conclusions

Lactobacillus spp. and L. paracasei SD1 in particular, showed a limited but statistically significant reducing interaction with A. actinomycetemcomitans toxicity and release of cytokines in vitro.
Younger age of patients with myocardial infarction is associated with a higher number of relatives with a history of premature atherosclerosis
Authors: Ambroziak Michał , Niewczas-Wieprzowska Katarzyna , Maicka Agnieszka , Budaj Andrzej
Published: September 2020

Background

Premature coronary artery disease is one of the most pressing global issues in modern cardiology. The aim of the study was to investigate the role of family history of premature cardiovascular disease (CVD) in patients aged < 50 years with myocardial infarction (MI) compared to that in patients aged ≥50 years with MI and to that in young people without MI (no-MI < 50).

Methods

The studied group (MI < 50) consisted of 240 patients aged 26–49 years with MI. The control groups consisted of 240 patients (MI ≥ 50) with MI aged 50–92 years and 240 healthy people aged 30–49 years without a history of MI (no-MI < 50).

Results

There were statistically significant differences between the MI < 50 and MI ≥ 50 and no-MI < 50 groups regarding the family history of premature MI/ischaemic stroke and the percentage of patients with ≥2 relatives affected (10.8, 2.9, and 3.7%, respectively; p < 0.0001). There was a statistically significant difference in the patient age at the first MI occurrence among patients without a family history of premature CVD, those with 1 affected relative, and those with ≥2 affected first-degree relatives (56.6, 48.6 and 41.8 years, respectively) as well as those with affected first- and second-degree relatives (56.5, 50.7 and 47.0 years, respectively).

Conclusions

A younger age of patients with myocardial infarction is associated with a higher number of relatives with a history of premature MI/ischaemic stroke. Thus, the family history of premature atherosclerosis involving not only first- but also second-degree relatives seems to be a valuable factor in CVD risk evaluation in young people.

Graphical Abstract
Temporal trends in behavioral risk and protective factors and their association with mortality rates: results from Brazil and Argentina
Authors: Santos Leonardo Pozza , de Oliveira Meller Fernanda , Amann Valeria Romina , Schäfer Antônio Augusto
Published: September 2020

Background

Despite available information on trends in behavioral factors for Brazil and Argentina, little is known about the association of these trends with mortality. Understanding this association is important to avoid early deaths. Therefore, we aimed to evaluate temporal trends in behavioral risk and protective factors in Brazil and Argentina, and to assess their association with overall and cause-specific mortality rates.

Methods

Ecological study with data from two population surveys from Brazil and Argentina. Weighted prevalence of tobacco smoking, excessive alcohol consumption, fruit and vegetable consumption and physical activity for the 27 Brazilian state capitals and for the 23 Argentinean provinces were used as behavioral factors. Information on overall mortality as well as cardiovascular diseases and cancer mortality for the year 2015 was collected from national mortality banks of both countries. Estimated prevalence rates were used to describe trends in behavioral factors from 2006 to 2014 in Brazil, and from 2005 to 2013 in Argentina, while Pearson’s correlation and linear regression models were used to assess their association with overall and cause-specific mortality rates.

Results

Brazil presented improvements in behavioral risk and protective factors: sharp decrease in tobacco smoking prevalence (from 15 to 9%), increase in regular fruit and vegetable consumption (from 28 to 36%), and increase in physical activity (45 to 51%). In Argentina, results were more disappointing: small reduction in tobacco smoking (from 55 to 50%) and decrease in physical activity (from 55 to 45%). In both countries, excessive alcohol consumption remained stable, with increase only among women. The association between behavioral factors and mortality showed that in those Brazilian capitals with higher prevalence of regular consumption of fruits and vegetables, there were lower overall mortality rates. Stratification by gender revealed that significant results were only found among women.

Conclusion

Prevalence of regular consumption of fruits and vegetables increased in Brazilian capitals and was associated with lower overall mortality rate, suggesting a positive impact of Brazilian policies to improve dietary intake patterns on its population’s mortality. Approaches focusing on behavioral factors are especially needed in Argentina to reach similar results of those seen in Brazil.
A rare case of bowel intussusception due to adenocarcinomatous polyp in a 14 year-old child: case report
Authors: Sankari Tarabishi Ahmad , Aljarad Ziad , Shebli Baraa , Masri Ahmad Humam , Anadani Rami , Shabouk Muhammad Besher , Trissi Mazen
Published: September 2020

Background

Intussusception is a form of intestinal obstruction in which a segment of the bowel prolapses into a more distal segment. It is an uncommon condition in children older than 2 years and causes intestinal obstruction. On the contrary of adult intussusception, childhood intussusception does not usually happen on a lead point of a malignant organic lesion.

Case presentation

A 14-year-old male presented with complaints of heavy, bilious emesis and periumbilical colicky pain. Ultrasonography showed a dilated intestinal loop with absent bowel movement. CT scan revealed two masses in the abdomen.

We performed an exploratory laparotomy that revealed invaginated intestines and showed a polyp near the area of interest. Necrotic segments and the polyp were removed and examined pathologically. Pathology showed adenocarcinoma in the polyp.

After surgery, the general condition of the patient was normal and no complications occurred.

Conclusions

Intussusception mainly occurs during infancy and early childhood. Mostly it is an idiopathic ileo-colic invagination. In our case, the patient had a jejuno-jejunal intussusception in his late childhood, and the lead point was an adenocarcinomatous polyp, which is rare in children. Amongst the many types of treatment, we chose surgical resection because of patient’s age.
The change of teeth color, whiteness variations and its psychosocial and self-perception effects when using low vs. high concentration bleaching gels: a one-year follow-up
Authors: Estay J. , Angel P. , Bersezio C. , Tonetto M. , Jorquera G. , Peña M. , Fernández E.
Published: September 2020

Background

Dental bleaching in traditional concentrations generates greater sensitivity. In this respect, new systems of lower concentration of hydrogen peroxide for tooth bleaching appeared, with color stability unknown over time. The aim of this study was to compare the change and stability of color with low-concentration (6%) hydrogen peroxide gel in an in-office bleaching setting relative to conventional 37.5% gel, including their effects on psychosocial and esthetic self-perception, after 1 year.

Methods

Patients (n = 25) were assessed at 12 months post bleaching treatment (whitening with 6% chemo-activated alkaline formula gel versus 37.5% traditional concentration gel). Color changes were measured objectively using total variation in color (ΔE), and subjectively using Vita Classical and Vita Bleached scale (ΔSGU) by calibrated evaluators (Kappa = 0.85). The Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) and Oral Health Impact Profile (OHIP-14) aesthetic questionnaires were used to measure the self-perception and the psychosocial impact of the bleaching protocols.

Results

The effect (ΔE) of 37.5% HP (8.37 ± 2.73) was significantly better than that of 6% HP (5.27 ± 2.53) in terms of color rebound after 1 year of follow-up. There were significant differences in psychosocial impact and esthetic self-perception measurements prior to bleaching versus one-year post-whitening time points; positive effects were maintained.

Conclusions

Low concentration (6%) achieved effective bleaching with good stability after 1 year, accompanied by a positive psychosocial impact and enhanced self-perception at follow-up.

Trial registration

NCT03217994 (before enrollment of the first participant). Data register: July 14, 2017.
Identification of motives and barriers to physical activity of polish young mothers
Authors: Soroka Andrzej , Godlewska Agnieszka , Krzęcio-Nieczyporuk Elżbieta , Kozioł Paulina
Published: September 2020

Background

The purpose of the study was to determine the level of physical activity of young mothers living in rural and urban areas and their free time budget. The article also aims to indicate motivating factors and barriers encountered during physical activity.

Methods

A diagnostic survey method, including two survey IPAQ questionnaires – the long version and author’s questionnaire, has been applied in the study. A representative sample consisted of 1064 young mothers who gave birth in 2017. Student T test and discriminate function analysis have been used in statistical analysis.

Results

No significant difference appeared between young mothers from rural areas and urban areas in the level of physical activity. At the same time, the authors of the study identified several smaller differences when analyzing particular aspects of physical activity. Young mothers from rural areas more often declared their participation in physical activity to improve their physical condition and reduce pain complaints. On the other hand, young mothers from urban areas emphasized that physical activity helps them to strengthen self-confidence and improve their position in the family. In case of the main barriers to physical activity, both group of respondents pointed to the lack of money and interest in occasional events.

Conclusions

The main conclusion is that more efforts are needed is to strengthen family support and material status of young families. It is also important to eliminate infrastructure barriers, mostly in rural areas and raise awareness on the importance of health education.
The leaf aqueous extract of Myrianthus arboreus P. Beauv. (Cecropiaceae) improved letrozole-induced polycystic ovarian syndrome associated conditions and infertility in female Wistar rats
Authors: Mvondo Marie Alfrede , Mzemdem Tsoplfack Flavie Ingrid , Awounfack Charline Florence , Njamen Dieudonné
Published: September 2020

Background

Myrianthus arboreus P. Beauv. (Cecropiaceae) is a medicinal plant used to treat female infertility. The aqueous extract of M. arboreus leaves was found to improve the fertility of healthy female Wistar rats. In the present study, we proposed evaluating the effects of such an extract on an animal model of infertility caused by polycystic ovary syndrome (PCOS), in order to bring scientific evidence to the curative action of this plant against female infertility.

Methods

Following a 21-day administration (gavage) of letrozole (1 mg/kg), animals with PCOS, indicated by overweight and an estrous cycle blocked in the diestrus phase, were co-treated with letrozole (1 mg/kg) and the aqueous extract of M. arboreus leaves at doses of 20, 110 and 200 mg/kg. The positive control received clomiphene citrate (1 mg/kg) and metformin (200 mg/kg). The negative control received distilled water. Each group of animals was made up of 10 female rats. Vaginal smear was examined 7 days before and during co-treatments. Co-treatments were orally administered for 30 consecutive days and 5 animals per group were sacrificed thereafter for biochemical and histological analyses. The 5 remaining animals in each group were crossbred with males of proven fertility for 5 consecutive days. The daily examination of vaginal smears allowed evaluating fertility index. Following parturition, gestation rate was calculated.

Results

The aqueous extract of M. arboreus leaves reversed letrozole effects by decreasing body weight, abdominal fat accumulation, and serum levels of LH and testosterone (p < 0.001). Ovarian dynamic was improved and the number of tertiary, Graafian follicles (p < 0.001) and corpus luteum increased while that of cystic (p < 0.001) and atretic follicles (p < 0.01) decreased. These effects were associated with increased serum levels of estradiol, decreased ovarian oxidative stress, the resumption of the estrous cycle, the hypertrophy of uterine epithelial cells and increased fertility index and gestation rate.

Conclusions

These results justify at least in part, the traditional use of M. arboreus against female infertility and suggest that this plant could be a promising alternative treatment to improve symptoms associated with different PCOS phenotypes.
Identifying integration and differentiation in a Hospital’s logistical system: a social network analysis of a case study
Authors: van der Ham Annelies , van Merode Frits , Ruwaard Dirk , van Raak Arno
Published: September 2020

Background

Integration, the coordination and alignment of tasks, has been promoted widely in order to improve the performance of hospitals. Both organization theory and social network analysis offer perspectives on integration. This exploratory study research aims to understand how a hospital’s logistical system works, and in particular to what extent there is integration and differentiation. More specifically, it first describes how a hospital organizes logistical processes; second, it identifies the agents and the interactions for organizing logistical processes, and, third, it establishes the extent to which tasks are segmented into subsystems, which is referred to as differentiation, and whether these tasks are coordinated and aligned, thus achieving integration.

Methods

The study is based on case study research carried out in a hospital in the Netherlands. All logistical tasks that are executed for surgery patients were studied. Using a mixed method, data were collected from the Hospital Information System (HIS), documentation, observations and interviews. These data were used to perform a social network analysis and calculate the network metrics of the hospital network.

Results

This paper shows that 23 tasks are executed by 635 different agents who interact through 31,499 interaction links. The social network of the hospital demonstrates both integration and differentiation. The network appears to function differently from what is assumed in literature, as the network does not reflect the formal organizational structure of the hospital, and tasks are mainly executed across functional silos. Nurses and physicians perform integrative tasks and two agents who mainly coordinate the tasks in the network, have no hierarchical position towards other agents. The HIS does not seem to fulfill the interactional needs of agents.

Conclusions

This exploratory study reveals the network structure of a hospital. The cross-functional collaboration, the integration found, and position of managers, coordinators, nurses and doctors suggests a possible gap between organizational perspectives on hospitals and reality. This research sets a basis for further research that should focus on the relation between network structure and performance, on how integration is achieved and in what way organization theory concepts and social network analysis could be used in conjunction with one another.
Exploring variation in the use of feedback from national clinical audits: a realist investigation
Authors: Alvarado Natasha , McVey Lynn , Greenhalgh Joanne , Dowding Dawn , Mamas Mamas , Gale Chris , Doherty Patrick , Randell Rebecca
Published: September 2020

Background

National Clinical Audits (NCAs) are a well-established quality improvement strategy used in healthcare settings. Significant resources, including clinicians’ time, are invested in participating in NCAs, yet there is variation in the extent to which the resulting feedback stimulates quality improvement. The aim of this study was to explore the reasons behind this variation.

Methods

We used realist evaluation to interrogate how context shapes the mechanisms through which NCAs work (or not) to stimulate quality improvement. Fifty-four interviews were conducted with doctors, nurses, audit clerks and other staff working with NCAs across five healthcare providers in England. In line with realist principles we scrutinised the data to identify how and why providers responded to NCA feedback (mechanisms), the circumstances that supported or constrained provider responses (context), and what happened as a result of the interactions between mechanisms and context (outcomes). We summarised our findings as Context+Mechanism = Outcome configurations.

Results

We identified five mechanisms that explained provider interactions with NCA feedback: reputation, professionalism, competition, incentives, and professional development. Professionalism and incentives underpinned most frequent interaction with feedback, providing opportunities to stimulate quality improvement. Feedback was used routinely in these ways where it was generated from data stored in local databases before upload to NCA suppliers. Local databases enabled staff to access data easily, customise feedback and, importantly, the data were trusted as accurate, due to the skills and experience of staff supporting audit participation. Feedback produced by NCA suppliers, which included national comparator data, was used in a more limited capacity across providers. Challenges accessing supplier data in a timely way and concerns about the quality of data submitted across providers were reported to constrain use of this mode of feedback.

Conclusion

The findings suggest that there are a number of mechanisms that underpin healthcare providers’ interactions with NCA feedback. However, there is variation in the mode, frequency and impact of these interactions. Feedback was used most routinely, providing opportunities to stimulate quality improvement, within clinical services resourced to collect accurate data and to maintain local databases from which feedback could be customised for the needs of the service.
Testing proposed quality measures for treatment of carpal tunnel syndrome: feasibility, magnitude of quality gaps, and reliability
Authors: Harris Alex H. S. , Meerwijk Esther L. , Ding Qian , Trickey Amber W. , Finlay Andrea K. , Schmidt Eric M. , Curtin Catherine M. , Sears Erika D. , Nuckols Teryl K. , Kamal Robin N.
Published: September 2020

Background

The American Academy of Orthopaedic Surgeons and American Society for Surgery of the Hand recently proposed three quality measures for carpal tunnel syndrome (CTS): Measure 1 - Discouraging routine use of Magnetic resonance imaging (MRI) for diagnosis of CTS; Measure 2 - Discouraging the use of adjunctive surgical procedures during carpal tunnel release (CTR); and Measure 3 - Discouraging the routine use of occupational and/or physical therapy after CTR. The goal of this study were to 1) Assess the feasibility of using the specifications to calculate the measures in real-world healthcare data and identify aspects of the specifications that might be clarified or improved; 2) Determine if the measures identify important variation in treatment quality that justifies expending resources for their further development and implementation; 3) Assess the facility- and surgeon-level reliability of measures.

Methods

The measures were calculated using national data from the Veterans Health Administration (VA) Corporate Data Warehouse for three fiscal years (FY; 2016–18). Facility- and surgeon-level performance and reliability were examined. To expand the testing context, the measures were also tested using data from an academic medical center.

Results

The denominator of Measure 1 was 132,049 VA patients newly diagnosed with CTS. The denominators of Measures 2 and 3 were 20,813 CTRs received by VA patients. The median facility-level performances on the three measures were 96.5, 100, and 94.7%, respectively. Of 130 VA facilities, none had < 90% performance on Measure 1. Among 111 facilities that performed CTRs, only 1 facility had < 90% performance on Measure 2. In contrast, 21 facilities (18.9%) and 333 surgeons (17.8%) had lower than 90% performance on Measure 3 (Median facility- and surgeon-level reliability for Measure 3 were very high (0.95 and 0.96 respectively).

Conclusions

Measure 3 displayed adequate facility- and surgeon-level variability and reliability to justify its use for quality monitoring and improvement purposes. Measures 1 and 2 lacked quality gaps, suggesting they should not be implemented in VA and need to be tested in other healthcare settings. Opportunities exist to refine the specifications of Measure 3 to ensure that different organizations calculate the measure in the same way.
Factors influencing the use of video interpretation compared to in-person interpretation in hospitals: a qualitative study
Authors: Feiring Eli , Westdahl Stine
Published: September 2020

Background

Facilitating access to professional interpretation services is key to equitable hospital care for migrants with limited language proficiency; however, interpreter underuse has been documented. The factors that potentially enable or hinder professional interpreter use are not well understood. We aimed to compare perceptions held by hospital managers and healthcare practitioners of the factors influencing the use of remote video interpretation and in-person interpretation.

Methods

This study employed a retrospective qualitative design. Two hospitals, located in Austria and Norway, with adequately similar baseline characteristics were purposively selected. Both hospitals used in-person interpreters, and the Austrian hospital had recently introduced remote video interpretation as an alternative and supplement. Fifteen managers and healthcare practitioners participated in focus groups and individual interviews. Data were thematically analysed with the aid of behavioural system theory.

Results

Across sites, the facilitators of interpreter use included individual factors (knowledge about interpreter services, skills to assess when/how to use an interpreter, beliefs about favourable consequences), as well as organisational factors (soft budget constraints). Barriers were identified at the individual level (lack of interpersonal skills to handle difficult provider-interpreter situations, lack of skills to persuade patients to accept interpreter use, lack of trust in service professionalism), and at the organisational level (limited interpreter availability, time constraints). The introduction of remote video interpretation services seemed to counteract the organisational barriers. Video interpretation was further perceived to enable patient confidentiality, which was regarded as a facilitator. However, video interpretation introduced specific barriers, including perceived communication deficiencies.

Conclusion

This study has identified a range of factors that are perceived to influence the use of interpreters in hospitals. The research suggests that-implementing remote video interpretation services lessens the barriers to use and that such services should be introduced in hospital settings as an alternative or supplement to in-person interpreters. Further intervention functions should be considered to bring about change in the use of interpretation services, including developing guidelines for interpreter use, educating staff in the appropriate use of video technology, and training staff in communicating with interpreter and patients with limited language proficiency.