bluuebunny/crossref_metadata_2025 huggingface dataset:
A reexamination of pre-service physical education teacher attitudes toward school-based health-related fitness testing in the USA
Authors: Liu Xiaolu , Keating Xiaofen D.
Published: April 2021

Pre-service physical education teachers (PPETs) may be implementing health-related fitness testing (HRFT) in schools in the future. Thus, exploring their attitudes toward HRFT would help us understand physical education (PE) teachers’ attitudes toward HRFT. This study investigated PPET attitudes toward HRFT in the USA and the effects of teacher characteristics (i.e. gender, ethnicity, year in university, and previous experience with fitness tests) on attitudes. A total of 501 PPETs (283 males, 56.5%; 218 females, 43.5%) aged 28.12 years (SD = 7.34) were included. The previously validated PPETs’ attitudes toward HRFT survey was used to collect the data using Amazon’s Mechanical Turk. Confirmatory factor analysis and Cronbach’s alpha were first used to examine the validity and reliability of the instrument. Then analysis of variance and multivariate analysis of variance were performed to test overall attitude differences and attitude subdomain differences in teacher characteristics, respectively. The results generated by the reliable and valid scale indicated that only slightly positive overall attitudes toward HRFT were found among PPETs. Year in university had a significant effect only on the cognitive component of attitude. PPETs’ previous experience with fitness tests had significant effects on all aspects of attitudes. No gender or ethnicity differences were found, however. More efforts are needed to improve fitness education in both higher education and K-12 PE programmes in order to help students develop positive attitudes and experiences toward HRFT. Future studies should focus on exploring how PETE programmes prepare PPETs for using HRFT in K-12 programmes.
An Exercise Mimetic Approach to Reduce Poststroke Deconditioning and Enhance Stroke Recovery
Authors: McDonald Matthew W. , Jeffers Matthew S. , Issa Lama , Carter Anthony , Ripley Allyson , Kuhl Lydia M. , Morse Cameron , Comin Cesar H. , Jasmin Bernard J. , Lacoste Baptiste , Corbett Dale
Published: April 2021

Evidence supports early rehabilitation after stroke to limit disability. However, stroke survivors are typically sedentary and experience significant cardiovascular and muscular deconditioning. Despite growing consensus that preclinical and clinical stroke recovery research should be aligned, there have been few attempts to incorporate cardiovascular and skeletal muscle deconditioning into animal models of stroke. Here, we demonstrate in rats that a hindlimb sensorimotor cortex stroke results in both cardiovascular and skeletal muscle deconditioning and impairments in gait akin to those observed in humans. To reduce poststroke behavioral, cardiovascular, and skeletal muscle perturbations, we then used a combinatorial intervention consisting of aerobic and resistance exercise in conjunction with administration of resveratrol (RESV), a drug with exercise mimetic properties. A combination of aerobic and resistance exercise mitigated decreases in cardiovascular fitness and attenuated skeletal muscle abnormalities. RESV, beginning 24 hours poststroke, reduced acute hindlimb impairments, improved recovery in hindlimb function, increased vascular density in the perilesional cortex, and attenuated skeletal muscle fiber changes. Early RESV treatment and aerobic and resistance exercise independently provided poststroke benefits, at a time when individuals are rapidly becoming deconditioned as a result of inactivity. Although no additive effects were observed in these experiments, this approach represents a promising strategy to reduce poststroke behavioral impairments and minimize deconditioning. As such, this treatment regime has potential for enabling patients to engage in more intensive rehabilitation at an earlier time following stroke when mechanisms of neuroplasticity are most prevalent.
A novel hierarchical nonlinear proportional-integral fast terminal sliding mode control for PMSM drives
Authors: Gao Peng , Zhang Guangming
Published: April 2021

This study proposes a novel hierarchical nonlinear proportional-integral fast terminal sliding mode (HNLPIFTSM) control for permanent magnet synchronous motor (PMSM) speed regulation system. A new type of sliding surface called HNLPIFTSM surface, which combines the benefits of a nonlinear proportional-integral (PI) sliding mode surface and a fast terminal sliding mode (FTSM) surface, is proposed to enhance the robustness and improved the dynamic response, whilst preserving the great property of the conventional hierarchical fast terminal sliding mode (HFTSM) control strategy. The proposed HNLPIFTSM surface uses the novel nonlinear PI sliding mode surface as its inner loop and uses the FTSM surface as its outer loop. Meanwhile, an extended state observer (ESO) is used to estimate the uncertain terms of the PMSM speed regulation system. Furthermore, the stability of the closed-loop control system under the ESO and the HNLPIFTSM control strategy is proved by the Lyapunov stability theorem. Finally, the simulations and experimental demonstrations verify the effectiveness and superiorities of our proposed HNLPIFTSM control strategy over the conventional HFTSM control strategy.
Virtual reality is a feasible intervention platform in multiple sclerosis: A pilot protocol and acute improvements in affect
Authors: Shaw Michael T. , Palmeri Maria J. , Malik Martin , Dobbs Bryan , Charvet Leigh E.
Published: April 2021

Background

People living with multiple sclerosis (MS) experience a high symptom burden that interferes with daily functioning. Virtual reality (VR) is an emerging technology with a range of potential therapeutic applications that may include ameliorating the experience of some common MS symptoms.

Objective

We tested the feasibility and tolerability of a VR intervention and its preliminary effects on affect.

Methods

Participants with MS were recruited to complete a pilot study of eight sessions of VR over four weeks.

Results

A total of n = 16 participants with MS completed the study (age range: 28–63). Feasibility goals were met with 100% of the sample completing at least n = 4/8 of their intervention sessions, with a total of 119/128 (93%) completed sessions. Two of the n = 16 participants experienced brief adverse events (balance, vertigo) but these resolved with headset removal and were not otherwise treatment limiting. There was a preliminary indication of overall improved affect from baseline to intervention end, with significantly improved positive affect ( t(15) = −3.19, p = 0.006) and decreased negative affect ( t(15) = 2.25, p = 0.040).

Conclusion

VR interventions are feasible, safe, and tolerable for individuals living with MS and may improve affect.
Quantitative evidence for leapfrogging in urban growth
Authors: Glockmann Manon , Li Yunfei , Lakes Tobia , Kropp Jürgen P , Rybski Diego
Published: April 2021

Urban growth can take different forms, such as infill, expansion and leapfrog development. Here we focus on leapfrogging, which is characterised as new urban development bypassing vacant land. Analysing a sample of 100 global locations, we study the probability that land cover is converted from non-urban to urban as a function of the minimum distance to existing urban cells. The probability decreases with the distance but in many of the considered real-world samples it increases again just before the maximum possible distance. Comparing these empirical findings with numerical ones from a gravitational model, we discover that the characteristic increase can be found in both. Our results indicate that the conversion probability as a function of the distance to urban land cover includes three urban growth domains. (i) Expansion of existing settlements, (ii) discontinuous development of coincidental new settlements rather close to existing ones and (iii) leapfrogging of new settlements far away from existing ones. We conclude that gravitational effects can explain discontinuous development but leapfrogging can be attributed to a scarcity of developable land at long distances to settlements.
Effect of side-chain length in lignin model compound on MnO2 oxidation: comparison of oxidations between C6-C2- and C6-C1-type compounds
Authors: Sun Shirong , Yokoyama Tomoya
Published: April 2021

Monomeric C6-C2-type lignin model compounds with ap-hydroxyphenyl (H), guaiacyl (G), syringyl (S), orp-ethylphenyl (E) nucleus (1-phenylethanol derivatives) were individually oxidized by MnO2at a pH of 1.5 and room temperature. The results were compared with those of the corresponding C6-C1-type benzyl alcohol derivatives obtained in our recent report to examine the effect of the presence of theβ-methyl group on the oxidation. The presence decelerated the oxidation regardless of the type of aromatic nucleus, although it did not change the order of the oxidation rates:G > S >> H > E. This deceleration results from the steric factor of theβ-methyl group in the C6-C2-type compounds. The MnO2oxidations of the corresponding C6-C2-type compounds deuterated at theirα-(benzyl)positions showed that the magnitudes of the kinetic isotope effects are smaller than those observed in the oxidations of the corresponding C6-C1-type compounds, regardless of the type of aromatic nucleus. These smaller magnitudes suggest that the presence of theβ-methyl group shifts the initial oxidation mode of MnO2from direct oxidation of the benzyl position to one-electron oxidation of the aromatic nucleus. Only theS-type compounds afforded products via degradation of the aromatic nuclei.
Cyr61 promotes Schwann cell proliferation and migration via αvβ3 integrin
Authors: Cheng Zhenghui , Zhang Yawen , Tian Yinchao , Chen Yuhan , Ding Fei , Wu Han , Ji Yuhua , Shen Mi
Published: April 2021

Background

Schwann cells (SCs) play a crucial role in the repair of peripheral nerves. This is due to their ability to proliferate, migrate, and provide trophic support to axon regrowth. During peripheral nerve injury, SCs de-differentiate and reprogram to gain the ability to repair nerves. Cysteine-rich 61 (Cyr61/CCN1) is a member of the CCN family of matrix cell proteins and have been reported to be abundant in the secretome of repair mediating SCs. In this study we investigate the function of Cyr61 in SCs.

Results

We observed Cyr61 was expressed both in vivo and in vitro. The promoting effect of Cyr61 on SC proliferation and migration was through autocrine and paracrine mechanisms. SCs expressed αvβ3 integrin and the effect of Cyr61 on SC proliferation and migration could be blocked via αvβ3 integrin. Cyr61 could influence c-Jun protein expression in cultured SCs.

Conclusions

In this study, we found that Cyr61 promotes SC proliferation and migration via αvβ3 integrin and regulates c-Jun expression. Our study contributes to the understanding of cellular and molecular mechanisms underlying SC’s function during nerve injury, and thus, may facilitate the regeneration of peripheral nerves after injury.
Gene expression profiles underlying aggressive behavior in the prefrontal cortex of cattle
Authors: Eusebi Paulina G. , Sevane Natalia , O’Rourke Thomas , Pizarro Manuel , Boeckx Cedric , Dunner Susana
Published: April 2021

Background

Aggressive behavior is an ancient and conserved trait, habitual for most animals in order to eat, protect themselves, compete for mating and defend their territories. Genetic factors have been shown to play an important role in the development of aggression both in animals and humans, displaying moderate to high heritability estimates. Although such types of behaviors have been studied in different animal models, the molecular architecture of aggressiveness remains poorly understood. This study compared gene expression profiles of 16 prefrontal cortex (PFC) samples from aggressive and non-aggressive cattle breeds: Lidia, selected for agonistic responses, and Wagyu, selected for tameness.

Results

A total of 918 up-regulated and 278 down-regulated differentially expressed genes (DEG) were identified, representing above-chance overlap with genes previously identified in studies of aggression across species, as well as those implicated in recent human evolution. The functional interpretation of the up-regulated genes in the aggressive cohort revealed enrichment of pathways such as Alzheimer disease-presenilin, integrins and the ERK/MAPK signaling cascade, all implicated in the development of abnormal aggressive behaviors and neurophysiological disorders. Moreover, gonadotropins, are up-regulated as natural mechanisms enhancing aggression. Concomitantly, heterotrimeric G-protein pathways, associated with low reactivity mental states, and the GAD2 gene, a repressor of agonistic reactions associated with PFC activity, are down-regulated, promoting the development of the aggressive responses selected for in Lidia cattle. We also identified six upstream regulators, whose functional activity fits with the etiology of abnormal behavioral responses associated with aggression.

Conclusions

These transcriptional correlates of aggression, resulting, at least in part, from controlled artificial selection, can provide valuable insights into the complex architecture that underlies naturally developed agonistic behaviors.

This analysis constitutes a first important step towards the identification of the genes and metabolic pathways that promote aggression in cattle and, providing a novel model species to disentangle the mechanisms underlying variability in aggressive behavior.
Assessment of the mechanism of drug resistance in Trichophyton mentagrophytes in response to various substances
Authors: Xiao Chenwen , Wang Jiaoyu , Liao Zhenfeng , Huang Yee , Ji Quanan , Liu Yan , Su Fei , Xu Lijun , Wei Qiang , Pan Yao , Li Ke , Bao Guolian
Published: April 2021

Background

Trichophyton mentagrophyte (TM), a zoonotic pathogen, has been endangering public health due to emerging drug resistance. Although increased attention is paid to this issue, there is very limited research available on drug resistance in TM. In this study, we studied the gene and proteomic changes, morphological changes, cellular fat localization, fat content changes, and biofilm of TM treated with different substances.

Results

The TM growth curve showed a positive correlation with the concentration of Fenarimol (FE), genistein (GE), clotrimazole (KM), and Miconazole nitrate salt (MK). The morphology of TM cells changed in different degrees after treatment with different substances as observed by TEM and SEM. The results showed that under KM and berberine hydrochloride (BB) treatment, a total of 3305 differentially expressed genes were detected, with the highest number in the KM-treated group (578 up-regulated and 615 down-regulated). A total of 847 proteins and 1850 peptides were identified in TM proteomics. Nile red staining showed that the fat content of TM was significantly higher in the BB-, ethidium bromide- (EB), FE-, KM-, Adriamycin hydrochloride- (YA), and MK-treated group compared to the control group. Results of the biofilm thickness showed that it gradually increased under treatment with specific concentrations of KM or BB, which may be related to the up-regulation of ERG25 and CYP related gene proteins.

Conclusions

It is suggested that in order to effectively deal with dermatomycosis caused by TM, it is necessary to inhibit the expression of ERG25 and CYP related genes and fat metabolism, which can result in the inhibition of the production of biofilm by the fungus and solve the problem of fungal drug resistance in clinical settings.
Identifying and measuring the behavioural, dietary, and physical activity components of weight management consultations delivered by general practice nurses in routine care
Authors: Tong Heather , Morris Elizabeth , Jebb Susan A. , Koutoukidis Dimitrios A.
Published: April 2021

Background

Many people with obesity receive weight loss consultations by general practice nurses (GPNs) in routine primary care. This exploratory study aimed to characterise the components of these consultations, including behaviour change techniques (BCTs), and dietary and physical activity recommendations.

Methods

We analysed audio recordings of weight management consultations conducted by 8 GPNs as part of the ‘usual care’ group in a randomised controlled trial (ISRCTN75092026). Consultations were coded against three taxonomies to classify BCTs, dietary recommendations, and physical activity recommendations. Associations between coded content and weight loss were assessed. Differences in the content of consultations where weight loss was < 5% or ≥ 5% from baseline weight at 6 months were explored.

Results

One hundred and fifty audio recordings were available from 53 out of 140 (38%) participants in the usual care group. Participants had on average 3 (SD = 1) recorded consultations over 3 months, lasting 14 (SD = 7) minutes each. Weight change at 3, 6, and 12 months was -3.6% (SD = 4.3), -5.5% (SD = 6.0) and -4.2% (SD = 6.5) for participants with audio recordings. GPNs used 3.9 (SD = 1.6) of 93 BCTs, 3.3 (SD = 2.7) of 30 dietary recommendations and 1.4 (SD = 1.2) of 10 physical activity recommendations per consultation. The most commonly employed BCTs were feedback on outcome of behaviour (80.0%), problem solving (38.0%), and social reward (34.3%). The most common dietary recommendations were about portion size (31.3%), nutrients (28.0%), and balanced diet (19.7%). The main physical activity recommendation was about walking (30.3%). There was no association between weight loss and the number of dietary recommendations, physical activity recommendations, or BCTs used per consultation, or per participant. Social reward was the only technique used significantly more in consultations of participants that lost ≥ 5% of their baseline weight at 6 months.

Conclusions

The study provides a new method that could be used to describe the content of weight management consultations. Specific dietary or physical activity recommendations and BCTs were used infrequently and inconsistently in this group of GPNs. Although replication is required in larger samples, this may point to a weakness in current practice.
Clinical features of parainfluenza infections among young children hospitalized for acute respiratory illness in Amman, Jordan
Authors: Howard Leigh M. , Rankin Danielle A. , Spieker Andrew J. , Gu Wenying , Haddadin Zaid , Probst Varvara , Rahman Herdi , McHenry Rendie , Pulido Claudia Guevara , Williams John V. , Faouri Samir , Shehabi Asem , Khuri-Bulos Najwa , Halasa Natasha B.
Published: April 2021

Background

Parainfluenza virus (PIV) is a leading cause of acute respiratory illness (ARI) in children. However, few studies have characterized the clinical features and outcomes associated with PIV infections among young children in the Middle East.

Methods

We conducted hospital-based surveillance for ARI among children < 2 years of age in a large referral hospital in Amman, Jordan. We systematically collected clinical data and respiratory specimens for pathogen detection using reverse transcription polymerase chain reaction. We compared clinical features of PIV-associated ARI among individual serotypes 1, 2, 3, and 4 and among PIV infections compared with other viral ARI and ARI with no virus detected. We also compared the odds of supplemental oxygen use using logistic regression.

Results

PIV was detected in 221/3168 (7.0%) children hospitalized with ARI. PIV-3 was the most commonly detected serotype (125/221; 57%). Individual clinical features of PIV infections varied little by individual serotype, although admission diagnosis of ‘croup’ was only associated with PIV-1 and PIV-2. Children with PIV-associated ARI had lower frequency of cough (71% vs 83%; p < 0.001) and wheezing (53% vs 60% p < 0.001) than children with ARI associated with other viruses. We did not find a significant difference in supplemental oxygen use between children with PIV-associated infections (adjusted odds ratio [aOR] 1.12, 95% CI 0.66–1.89, p = 0.68) and infections in which no virus was detected.

Conclusions

PIV is frequently associated with ARI requiring hospitalization in young Jordanian children. Substantial overlap in clinical features may preclude distinguishing PIV infections from other viral infections at presentation.
Parallel disease activity of Behçet’s disease with renal and entero involvements: a case report
Authors: Watanabe-Kusunoki Kanako , Kato Masaru , Oki Yotaro , Shimizu Tetsuo , Kusunoki Yoshihiro , Furukawa Shota , Furukawa Shin , Kitakawa Hirohiko , Sakai Kiyoshi
Published: April 2021

Background

Behçet’s disease (BD) is a systemic inflammatory vasculitis with both autoimmune and autoinflammatory properties. Renal involvement in BD and its spontaneous remission have been rare. We herein describe a case of parallel disease activity of BD with entero and renal involvements, followed by a spontaneous remission without corticosteroid treatment.

Case presentation

A 54-year-old woman who had a 4-year history of BD, maintained with colchicine treatment, suffered abdominal pain, hemorrhagic stool and diarrhea. Physical examination revealed strong tenderness in the entire abdomen. Laboratory test results showed increased levels of inflammation, and a computed tomography scan revealed edematous intestinal wall thickening with ascites. Blood and stool cultures showed no specific findings. Since she was suspected to have developed panperitonitis with acute enterocolitis, she started treatment with an antibacterial agent under bowel rest. Her abdominal symptoms gradually improved, while diarrhea and high levels of inflammatory reaction persisted. Colonoscopy revealed discontinuous abnormal mucosal vascular patterns and ulcerations in the whole colon except for the rectum, and histological analyses of the intestine demonstrated transmural mucosal infiltration of inflammatory cells without epithelioid granuloma or amyloid deposition. Based on these findings, she was diagnosed with entero BD. Meanwhile, pedal edema appeared during her hospitalization. Urinalysis results were consistent with nephrotic syndrome, thus a renal biopsy was performed. Light microscopy showed no obvious glomerular and interstitial abnormalities, whereas electron microscopy revealed foot process effacement without immune complex deposition or fibrillary structure, compatible with minimal change disease (MCD). Only with conservative therapy, her proteinuria decreased, followed by a complete remission in 3 weeks from the onset of edema. The coincident episode of MCD was finally diagnosed as renal BD that paralleled disease activity to entero BD. She started adalimumab administration, resulting in the further improvement of diarrhea and inflammatory levels.

Conclusions

This is the first report to demonstrate MCD as renal involvement of BD along with the disease activity of entero BD.
Contribution of sleep quality to fatigue following a stroke: a cross-sectional study
Authors: Ho Lily Yuen Wah , Lai Claudia Kam Yuk , Ng Shamay Sheung Mei
Published: April 2021

Background

The prevalence of fatigue and sleep disturbances is high in stroke populations. Sleep quality can be targeted by interventions to alleviate fatigue following a stroke. This study aimed to determine the prevalence of fatigue and poor sleep quality, and to quantify the contribution of sleep quality to fatigue following a stroke, in chronic (≥1 year) stroke survivors.

Methods

A cross-sectional design was adopted. A total of 112 stroke survivors (mean age ± standard deviation [year], 64.18 ± 5.77) at 6.08 ± 4.80 years post-stroke completed this study. All participants were assessed using the Fatigue Assessment Scale, the Pittsburgh Sleep Quality Index, the Visual Analogue Scale-Pain, the Fugl-Meyer Assessment of the upper and lower extremities, the 5-Time Sit-To-Stand Test, the Epworth Sleepiness Scale, the Frenchay Activities Index, the Life-Space Assessment, the Community Integration Measure, and the Multidimensional Scale of Perceived Social Support. Pearson and partial correlation coefficients were used to examine the correlation between fatigue and other variables. A multiple linear regression (the forced entry method) was performed to quantify the independent contribution of sleep quality to prediction of fatigue.

Results

Of the 112 participants, 52.7% reported experiencing fatigue and 64.3% reported poor sleep quality. Sleep quality could independently account for 5.9% of the variance in fatigue scores after a stroke.

Conclusions

There is a high prevalence of fatigue and poor sleep quality in Chinese stroke survivors. Sleep quality is an independent predictor of fatigue in those living in the community who have survived a stroke for a year or longer.
Maternal and neonatal factors associated with child development in Ceará, Brazil: a population-based study
Authors: Rocha Hermano A. L. , Sudfeld Christopher R. , Leite Álvaro J. M. , Machado Márcia M. T. , Rocha Sabrina G. M. O. , Campos Jocileide S. , Silva Anamaria C. e , Correia Luciano L.
Published: April 2021

Background

The first 1000 days of life are a critical period when the foundations of child development and growth are established. Few studies in Latin America have examined the relationship of birth outcomes and neonatal care factors with development outcomes in young children. We aimed to assess the association between pregnancy and neonatal factors with children’s developmental scores in a cross-sectional, population-based study of children in Ceará, Brazil.

Methods

Population-based, cross-sectional study of children aged 0–66 months (0–5.5 years) living in Ceará, Brazil. We examined the relationship of pregnancy (iron and folic acid supplementation, smoking and alcohol consumption) and neonatal (low birth weight (LBW) gestational age, neonatal care interventions, and breastfeeding in the first hour) factors with child development. Children’s development was assessed with the Ages and Stages Questionnaire (ASQ-BR). We used multivariate generalized linear models that accounted for clustering sampling to evaluate the relationship of pregnancy and neonatal factors with development domain scores.

Findings

A total of 3566 children were enrolled. Among pregnancy factors, children whose mothers did not receive folic acid supplementation during pregnancy had lower fine motor and problem-solving scores (p-values< 0.05). As for neonatal factors, LBW was associated with 0.14 standard deviations (SD) lower (CI 95% -0.26, − 0.02) communication, 0.24 SD lower (95% CI: − 0.44, − 0.04) fine motor and 0.31 SD lower (CI 95% -0.45, − 0.16) problem-solving domain scores as compared to non-LBW children (p values < 0.05). In terms of care, newborns that required resuscitation, antibiotics for infection, or extended in-patient stay after birth had lower development scores in selected domains. Further, not initiating breastfeeding within the first hour after birth was associated with lower gross motor and person-social development scores (p-values < 0.05).

Conclusion

Pregnancy and neonatal care factors were associated with later child development outcomes. Infants at increased risk of suboptimal development, like LBW or newborns requiring extended in-patient care, may represent groups to target for supplemental intervention. Further, early integrated interventions to prevent adverse pregnancy and newborn outcomes may improve child development outcomes.
Elderberry for prevention and treatment of viral respiratory illnesses: a systematic review
Authors: Wieland L. Susan , Piechotta Vanessa , Feinberg Termeh , Ludeman Emilie , Hutton Brian , Kanji Salmaan , Seely Dugald , Garritty Chantelle
Published: April 2021

Background

Elderberry has traditionally been used to prevent and treat respiratory problems. During the COVID-19 pandemic, there has been interest in elderberry supplements to treat or prevent illness, but also concern that elderberry might overstimulate the immune system and increase the risk of ‘cytokine storm’. We aimed to determine benefits and harms of elderberry for the prevention and treatment of viral respiratory infections, and to assess the relationship between elderberry supplements and negative health impacts associated with overproduction of pro-inflammatory cytokines.

Methods

We conducted a systematic review and searched six databases, four research registers, and two preprint sites for studies. Two reviewers independently assessed studies for inclusion, extracted data from studies, assessed risk of bias using Cochrane tools, and evaluated certainty of estimates using GRADE. Outcomes included new illnesses and the severity and duration of illness.

Results

We screened 1187 records and included five randomized trials on elderberry for the treatment or prevention of viral respiratory illness. We did not find any studies linking elderberry to clinical inflammatory outcomes. However, we found three studies measuring production of cytokines ex vivo after ingestion of elderberry. Elderberry may not reduce the risk of developing the common cold; it may reduce the duration and severity of colds, but the evidence is uncertain. Elderberry may reduce the duration of influenza but the evidence is uncertain. Compared to oseltamivir, an elderberry-containing product may be associated with a lower risk of influenza complications and adverse events. We did not find evidence on elderberry and clinical outcomes related to inflammation. However, we found evidence that elderberry has some effect on inflammatory markers, although this effect may decline with ongoing supplementation. One small study compared elderberry to diclofenac (a nonsteroidal anti-inflammatory drug) and provided some evidence that elderberry is as effective or less effective than diclofenac in cytokine reduction over time.

Conclusions

Elderberry may be a safe option for treating viral respiratory illness, and there is no evidence that it overstimulates the immune system. However, the evidence on both benefits and harms is uncertain and information from recent and ongoing studies is necessary to make firm conclusions.
Self-confidence in oral and maxillofacial surgery: a cross-sectional study of undergraduate dental students at Kuwait University
Authors: Kamal Mohammad , Abdulwahab Mohammad
Published: April 2021

Background

To evaluate the self-confidence of undergraduate dental students in relation to oral and maxillofacial surgery (OMFS) to assess the teaching curriculum at Kuwait University using a validated questionnaire originally developed by the Association of British Academic Oral Maxillofacial Surgeons (ABAOMS).

Methods

A cross-sectional survey of sixth year (n = 20) and seventh year (n = 19) dentistry students was conducted by Kuwait University Faculty of Dentistry between the 1st and 15th of May 2020. The ABAOMS questionnaire is composed of 17 questions assessing various areas of the undergraduate OMFS curriculum. The response options to the questionnaire utilised a Likert scale. Independent sample t-tests were performed to assess the difference in responses between the 2 year groups. Spearman’s rho correlations were calculated to measure the strength of association between confidence in all aspects of surgical and forceps exodontia.

Results

A total of 39 questionnaires were completed by the students. The majority of students expressed feelings of confidence that they have enough knowledge to undertake independent practice (61%). General aspects of the questionnaire were answered favourably except for surgical extraction of teeth, in which both classes reported a lower level of self-confidence.

Conclusions

The ABAOMS survey revealed the students’ self-confidence in undertaking independent practice and preforming basic oral surgery procedures. Students felt comfortable with exodontia using forceps and elevators, root removal, managing acute pericoronitis, managing haemorrhage from a socket, assessing impacted teeth, and recognising the clinical features of potentially malignant and malignant lesions of the oral cavity. They reported a lower level of confidence in performing surgical procedures.
Comparison of medical student performance in summative undergraduate paediatric examinations and a clinician-designed minimum accepted competency (MAC) assessment
Authors: McCrossan Patrick , O’Donoghue Dara , Nicholson Alf , McCallion Naomi
Published: April 2021

Background

It is recognised that newly qualified doctors feel unprepared in many areas of their daily practice and that there is a gap between what students learn during medical school and their clinical responsibilities early in their postgraduate career. This study aimed to assess if undergraduate students and junior paediatric doctors met a Minimum Accepted Competency (MAC) of knowledge.

Methods

The knowledge of undergraduates and junior paediatric doctors was quantitatively assessed by their performance on a 30-item examination (the MAC examination). The items within this examination were designed by non-academic consultants to test ‘must-know’ knowledge for starting work in paediatrics. The performance of the students was compared with their official university examination results and with the performance of the junior doctors.

Results

For the undergraduate student cohort (n = 366) the mean examination score achieved was 45.9%. For the junior doctor cohort (n = 58) the mean examination score achieved was significantly higher, 64.2% (p < 0.01). 68% of undergraduate students attained the pass mark for the MAC examination whilst a significantly higher proportion, 97%, passed their official university examination (p < 0.01). A Spearman’s rank co-efficient showed a moderate but statistically significant positive correlation between students results in their official university examinations and their score in the MAC examination.

Conclusion

This work demonstrates a disparity between both student and junior doctor levels of knowledge with consultant expectations from an examination based on what front-line paediatricians determined as “must-know” standards. This study demonstrates the importance of involvement of end-users and future supervisors in undergraduate teaching.
Correction to: A qualitative study of barriers to employment experienced by people living with HIV in Toronto and Ottawa
Authors: Perri Melissa , Craig-Neil Amy , Gaspar Mark , Hunter Charlotte , Kendall Claire , Alexander Ower , Pinto Andrew D.
Published: April 2021

An amendment to this paper has been published and can be accessed via the original article.
Ruthenium-loaded mesoporous silica as tumor microenvironment-response nano-fenton reactors for precise cancer therapy
Authors: Sun Dongdong , Wang Zekun , Zhang Pu , Yin Chenyang , Wang Jingyuan , Sun Yu , Chen Ying , Wang Weiyun , Sun Baoliang , Fan Cundong
Published: April 2021

Background

Nano-Fenton reactors as novel strategy to selectively convert hydrogen peroxide (H2O2) into active hydroxyl radicals in tumor microenvironment for cancer therapy had attracted much attention. However, side effects and low efficiency remain the main drawbacks for cancer precise therapy.

Results

Here, ruthenium-loaded palmitoyl ascorbate (PA)-modified mesoporous silica (Ru@SiO2-PA) was successfully fabricated and characterized. The results indicated that Ru@SiO2-PA under pH6.0 environment displayed enhanced growth inhibition against human cancer cells than that of pH7.4, which indicated the super selectivity between cancer cells and normal cells. Ru@SiO2-PA also induced enhanced cancer cells apoptosis, followed by caspase-3 activation and cytochrome-c release. Mechanism investigation revealed that Ru@SiO2-PA caused enhanced generation of superoxide anion, which subsequently triggered DNA damage and dysfunction of MAPKs and PI3K/AKT pathways. Moreover, Ru@SiO2-PA effectively inhibited tumor spheroids and tumor xenografts growth in vivo by induction of apoptosis. The real-time imaging by monitoring Ru fluorescence in vitro and in vivo revealed that Ru@SiO2-PA mainly accumulated in cell nucleus and tumor xenografts. Importantly, Ru@SiO2-PA showed no side effects in vivo, predicting the safety and potential application in clinic.

Conclusions

Our findings validated the rational design that Ru@SiO2-PA can act as novel tumor microenvironment-response nano-Fenton reactors for cancer precise therapy.

Graphic Abstract
Laparoscopic gastrectomy plus D2 lymphadenectomy is as effective as open surgery in terms of long-term survival: a single-institution study on gastric cancer
Authors: Wang Yawei , Wang Yan , Wu Wang , Lu Xiaofang , An Tailai , Jiang Jiling
Published: April 2021

Background

Laparoscopic surgery has been widely accepted to treat early-stage gastric cancer. However, it is still controversial to perform laparoscopic gastrectomy plus D2 lymphadenectomy for locally advanced gastric cancer. We performed the present study to compare the long-term outcomes of patients after laparoscopic or open gastrectomy plus D2 lymphadenectomy.

Methods

The clinicopathological data of 182 gastric cancer patients receiving gastrectomy plus D2 lymphadenectomy between January 2011 and December 2015 at Shenzhen Traditional Chinese Medicine Hospital were retrospectively retrieved. The overall survival (OS) and disease-free survival (DFS) of these 182 patients were compared. Then, the prognostic significance of positive lymph node ratio (LNR) was assessed.

Results

As a whole, OS (P = 0.789) and DFS (P = 0.672) of patients receiving laparoscopic gastrectomy plus D2 lymphadenectomy were not significantly different from those of patients receiving open surgery. For stage I patients, laparoscopic gastrectomy plus D2 lymphadenectomy was not significantly different from open surgery in terms of OS (P = 0.573) and DFS (P = 0.157). Similarly, for stage II patients, laparoscopic gastrectomy plus D2 lymphadenectomy was not significantly different from open surgery in terms of OS (P = 0.567) and DFS (P = 0.830). For stage III patients, laparoscopic gastrectomy plus D2 lymphadenectomy was not significantly different from open surgery in terms of OS (P = 0.773) and DFS (P = 0.404). Laparoscopic or open gastrectomy plus D2 lymphadenectomy was not proven by Cox regression analysis to be an independent prognostic factor for OS and DFS. High LNR was significantly associated with worse OS (P < 0.001) and DFS (P < 0.001). Surgical type did not significantly affect prognosis of patients with low LNR or survival of patients with high LNR.

Conclusions

For patients with gastric cancer, laparoscopic gastrectomy plus D2 lymphadenectomy was not inferior to open surgery in terms of long-term outcomes. LNR is a useful prognostic marker for GC patients.
The “Great Debate” at Melanoma Bridge 2020: December, 5th, 2020
Authors: Ascierto Paolo A. , Atkins Michael B. , Eggermont Alexander M. , Gershenwald Jeffrey E. , Grob Jean-Jacques , Hamid Omid , Sondak Vernon K. , Sosman Jeffrey A. , Tawbi Hussein A. , Weber Jeffrey S. , Caracò Corrado , Osman Iman , Puzanov Igor
Published: April 2021

The Great Debate session at the 2020 Melanoma Bridge virtual congress (December 3rd–5th, Italy) featured counterpoint views from experts on five specific controversial issues in melanoma. The debates considered whether or not innate immunity is important in the response to cancer and immunotherapy, how useful are the revised American Joint Committee on Cancer (AJCC) classification for the staging of patients, the use of sentinel node biopsy for staging patients, the use of triplet combination of targeted therapy plus immunotherapy versus combined immunotherapy, and the respective benefits of neoadjuvant versus adjuvant therapy. As is usual with Bridge congresses, the debates were assigned by meeting Chairs and positions taken by experts during the debates may not have necessarily reflected their own personal opinion.
Effects of implementing a postabortion care strategy in Kinshasa referral hospitals, Democratic Republic of the Congo
Authors: Ishoso Daniel Katuashi , Tshefu Antoinette , Delvaux Thérèse , Dramaix Michèle , Mukumpuri Guy , Coppieters Yves
Published: April 2021

Objectives

To evaluate the effects of the implementation of a postabortion care (PAC) strategy in Kinshasa referral hospitals, this study analyzed the quality of postabortion care services, including postabortion contraception, and the duration of hospitalization.

Methodology

We estimated the effects of the PAC strategy using a quasi-experimental study by evaluating the outcomes of 334 patients with the diagnosis of a complication of induced abortion admitted to 10 hospitals in which the PAC strategy was implemented compared to the same outcomes in 314 patients with the same diagnosis admitted to 10 control facilities from 01/01/2016 to 12/31/2018. In response to government policy, the PAC strategy included the treatment of abortion complications with recommended uterine evacuation technology, the family planning counseling and service provision, linkages with other reproductive health services, including STI evaluation and HIV counseling and/or referral for testing, and partnerships between providers and communities. The information was collected using a questionnaire and stored using open data kit software. We supplemented this information with data abstracted from patient records, facility registries of gynecological obstetrical emergencies, and family planning registries. We analyzed data and developed regression models using STATA15. Thus, we compared changes in use of specific treatments and duration of hospitalization using a "difference-in-differences" analysis.

Results

The implementation of PAC strategy in Kinshasa referral hospitals has resulted in the utilization of WHO recommended uterine evacuation method MVA (29.3% more in the experimental structures, p = 0.025), a non-significant decline in sharp-curettage (19.3% less, p = 0.132), and a decline in the duration of hospitalization of patients admitted for PAC (1 day less, p = 0.020). We did not observe any change in the use of PAC services, mortality, and the provision of post abortion contraception.

Conclusion

Despite significant improvement in the management of PAC, the uptake in WHO approved technology—namely MVA, and the duration of hospitalization, these outcomes while a significant improvement for DRC, indicate that additional quality improvement strategies for management of PAC and risk-mitigating strategies to reduce barriers to care are required.
Local immune responses to tuberculin skin challenge in Mycobacterium bovis BCG-vaccinated baboons: a pilot study of younger and older animals
Authors: Scordo Julia M. , Piergallini Tucker J. , Reuter Nicole , Headley Colwyn A. , Hodara Vida L. , Gonzalez Olga , Giavedoni Luis D. , Papin James F. , Turner Joanne
Published: April 2021

Individuals over the age of 65 are highly susceptible to infectious diseases, which account for one-third of deaths in this age group. Vaccines are a primary tool to combat infection, yet they are less effective in the elderly population. While many groups have aimed to address this problem by studying vaccine-induced peripheral blood responses in the elderly, work from our lab and others demonstrate that immune responses to vaccination and infectious challenge may differ between tissue sites and the periphery. In this pilot study, we established an in vivo delayed-type hypersensitivity model of Mycobacterium bovis BCG vaccination and tuberculin skin test in two adult and two aged baboons. Vaccination generates BCG-specific immune cells that are recruited to the skin upon tuberculin challenge. We tested short term recall responses (8 weeks post-vaccination) and long term recall responses (25 weeks post-vaccination) by performing skin punch biopsies around the site of tuberculin injection. In short term recall responses, we found increased oxidation and decreased production of immune proteins in aged baboon skin at the site of TST challenge, in comparison to adult skin. Differences between adult and aged animals normalized in the long term response to tuberculin. In vitro, aged peripheral blood mononuclear cells had increased migration and functional responses to antigen-specific stimulation, suggesting that age-related changes in the tissue in vivo impairs aged immune recall responses to antigenic challenge. These findings highlight the impact of age-associated changes in the local tissue environment in memory recall responses, which may be more broadly applied to the study of other tissues. Moreover, these findings should be considered in future studies aimed at understanding and improving aging immune responses to vaccination and tissue challenge.
Our child’s TBI: a rehabilitation engineer’s personal experience, technological approach, and lessons learned
Authors: Sulzer James , Karfeld-Sulzer Lindsay S.
Published: April 2021

I (JS) am currently a faculty member at The University of Texas at Austin in Mechanical Engineering. My primary research focus is rehabilitation engineering. In May 2020, a week before her fourth birthday, our daughter suffered a severe traumatic brain injury in the early days of the coronavirus pandemic. The purpose of this article is to describe the current state of pediatric neurorehabilitation from technologically-adept parents’ first-person perspectives in order to inform and motivate rehabilitation engineering researchers. We describe the medical and personal challenges faced during the aftermath of the accident, the technological approaches to her recovery that my wife (LKS) and I have examined, some of which may be considered beyond standard practice, and the lessons we have absorbed during this period regarding both the state of rehabilitation research and the clinical uptake of rehabilitation technologies. We introduce a set of questions for designers to consider as they create and evaluate new technologies for pediatric rehabilitation.
Evaluating the cerebrospinal fluid tap test with the Hellström iNPH scale for patients with idiopathic normal pressure hydrocephalus
Authors: Rydja Johanna , Eleftheriou Andreas , Lundin Fredrik
Published: April 2021

Background

The cerebrospinal fluid tap test (CSF TT) is used for selecting shunt surgery candidates among patients with idiopathic normal pressure hydrocephalus (iNPH). We aimed to evaluate the predictive value of the CSF TT, by using the Hellström iNPH scale for shunted iNPH patients with a standardized method.

Methods

One hundred and sixteen shunt-operated iNPH patients were retrospectively included in this study. The gait and balance domains in the iNPH scale were used as outcome measures for the CSF TT and the total iNPH scale score as the postoperative outcome. A positive response to CSF TT was defined as a change of ≥ 5 points in the gait domain and ≥ 16 points in the balance domain. Differences between CSF TT responders and non-responders, sensitivity, specificity, positive and negative predictive values, accuracy, and correlations between changes from baseline to post CSF TT and from baseline to the postoperative follow-up, were calculated.

Results

In the CSF TT there were 63.8% responders in the gait domain and correspondingly 44.3% in the balance domain. CSF TT responders had a significantly better postoperative outcome in the total scale score (gait P ≤ 0.001, balance P ≤ 0.012) and gait CSF TT responders improved more in gait (P ≤ 0.001) and balance CSF TT responders in balance (P ≤ 0.001). No differences between CSF TT gait or balance responders could be found in neuropsychological or urinary continence assessments postoperatively. The sensitivity and specificity of the CSF TT and the outcome of the total iNPH scale score postoperatively were 68.1% and 52.0% for gait and 47.8% and 68.0% for balance, respectively.

Conclusions

The CSF TT, with the Hellström iNPH scale as the outcome measure, has clear limitations in predicting postoperative results. The gait domain may be used to predict outcomes for gait, but the balance domain is too insensitive.