bluuebunny/crossref_metadata_2025 huggingface dataset:
Los espacios de prostitución en Madrid = Prostitution spaces in Madrid
Authors: Juste Hernández Andrés
Published: January 2021

ResumenLos datos sobre la prostitución en Madrid revelan su elevada presencia en el municipio. ¿Cómo se traducen estos datos en términos espaciales? El estudio de la prostitución en la ciudad contribuye a la comprensión de una realidad urbana extendida, normalmente oculta y ligada a multitud de procesos urbanos de interés. Asimismo, el análisis urbano permite ampliar el conocimiento sobre un fenómeno social que a menudo resulta controvertido e incierto. A través de entrevistas, trabajo de campo y el estudio de publicaciones, publicidad y foros de internet, en este artículo se analiza la espacialidad del negocio en Madrid en sus distintas vertientes, qué determina la ubicación de los espacios, cómo se hace uso de ellos y cuál es su influencia sobre el entorno. También se examinan las políticas urbanas recientes, centradas en el alejamiento de la prostitución de los espacios visibles y centrales, y estrechamente ligadas a la evolución del negocio en la ciudad. Además, se profundiza en los casos más relevantes y representativos con la finalidad de reunir experiencias o reflexiones que permitan mejorar la gestión futura tanto de la ciudad como del fenómeno de la prostitución.AbstractData on prostitution reveals its high presence in Madrid. How do these translate into spatial terms? The study of prostitution in the city contributes to the understanding of an extended urban reality, normally hidden, and linked to a multitude of urban processes of interest. Likewise, urban analysis allows us to broaden our knowledge of a social phenomenon that is often controversial and uncertain. Through interviews, field work and the study of advertising and internet forums, this article analyses the spatial nature of this business in Madrid in its different ways, the reasons that determine the location of spaces, how they are used and what influence they have on the environment. It also examines recent urban policies, which focus on moving prostitution away from visible and central spaces. In addition, the most representative cases are studied in depth with the aim of gathering experiences or reflections that will allow the future management of both the city and the phenomenon of prostitution to be improved.
Herramientas web y Sistemas de Información Geográfica participativos como métodos para introducir la participación en procesos de planeamiento: el caso del Master Plan de Helsinki = Web tools and PPGIS as methods for introducing public participation in urban planning processes: the case of Helsinki’s Master Plan
Authors: Santos Sánchez Beatriz
Published: January 2021

ResumenEl artículo explora nuevos métodos de participación que aprovechan las posibilidades de las herramientas web para implicar a la ciudadanía en los procesos de planificación urbana utilizando la metodología del estudio de caso a través de la revisión del Master Plan de Helsinki (Helsinki City Plan 2050). Las distintas herramientas utilizadas en cada fase, especialmente las basadas en Sistemas de Información Geográfica (PPGIS), han sido revisadas para evaluar su contribución al resultado del proceso e identificar las ventajas e inconvenientes que han planteado. Destaca el uso del cuestionario on-line con base cartográfica, una aplicación fácil de usar que presenta muchas posibilidades de análisis y visualización de datos y resultados, pero, sin embargo, los profesionales encuentran dificultades para incorporar los resultados en el documento final. Aspectos como la elección de la herramienta participativa, la preparación del cuestionario, la colaboración de los distintos agentes implicados y la devolución de resultados a la ciudadanía resultan claves para lograr el éxito del proceso.AbstractThe research explores new participation methods that use the potential of web tools to engage citizens in urban planning processes using the case study methodology through the Helsinki’s Master Plan Review (Helsinki City Plan 2050). Different participation tools used at every stage, particularly Public Participation Geographic Information System (PPGIS), have been analyzed in order to assess its contribution towards the outcome of the process and identify the advantages and disadvantages raised. The main tool is an on-line map-based survey, an easy-to-use application that offers many possibilities of data analysis and visualization but, however, planners find it difficult to incorporate the results into the final document. The choice of the participatory tool, the preparation of the survey, the collaboration of all stakeholders and reporting sessions to citizens are key issues to achieving the success of the process.
Análisis y caracterización geoespacial del modelo de cinturón verde en Vitoria-Gasteiz: Cambio, complejidad y oportunidad en el borde urbano (1993-2018) = Geospatial characterization and analysis of the green belt model in Vitoria-Gasteiz: Change, complexity and opportunity in the urban boundary (1993-2018)
Authors: Dios Lema Rebeca
Published: January 2021

ResumenEste artículo toma el modelo de cinturón verde en Vitoria-Gasteiz (País Vasco, España) como un caso de estudio referente en planificación socio-ecológica. Más conocido como Anillo Verde, se analiza aquí con el objeto de contribuir a la revisión crítica de esta figura de planificación e informar su reinvención actual. El artículo presenta una síntesis de los trabajos de análisis y caracterización realizados a partir de la documentación vectorial y cartográfica generada en los primeros veinticinco años de este caso de estudio (1993-2018). Las distintas lecturas que se superponen en su evolución e implementación en el borde urbano, proporcionan los siguientes resultados: (i) muestran aspectos clave tanto en términos de proceso y estrategia, como de diseño y gestión; (ii) plantean la necesidad de una nueva mirada al proceso de planificación como un ensamblaje socio-ecológico complejo que trasciende la rigidez del planeamiento urbano convencional, y (iii) evidencian la necesidad de nuevos planteamientos, mecanismos y figuras que permitan avanzar hacia una integración sistémica entre ciudad y naturaleza.AbstractThis paper uses the green belt model in Vitoria-Gasteiz (Basque Country, Spain) as reference case study in socio-ecological planning. The analyses of this better known as “Anillo Verde”, aims to contribute to the critical review of this planning policy and to inform its reinvention. This paper presents a synthesis of the characterization and analysis based on the vector and cartographic documentation generated over the first twenty-five years of this case study (1993-2018). The various methods that overlap in its evolution and implementation on the urban boundary, deliver the following results: (i) They show key lessons in terms of process and strategy, and in terms of design and management; (ii) they uncover the need for a new approach towards the planning process, as a complex social-ecological assemblage that transcends the rigidity of conventional urban planning, and (iii) they demonstrate the need for new mechanisms and policies that allow progress towards a systemic integration between city and nature.
Controlling Nutritional Status (CONUT) Score is a Prognostic Indicator for Patients with Hemorrhagic Stroke: Results from a 3-month Follow-up Study
Authors: Zhu Bei-lei , Wu Yan-zhi , Cai Zhong-ming , Liao Cheng-wei , Sun Le-qiu , Liu Zhi-peng , Chen Hao-man , Huang Xue-rong , Feng Ren-qian , Ye Sheng-lie , Lin Qun-li , Zhou Xu-dong , Zhang Man-man , Yang Bo
Published: January 2021

Controlling Nutritional Status (CONUT) Score is useful for the nutritional screening. We aimed to explore whether the CONUT score may predict a 3-month functional outcome in hemorrhagic stroke (AHS). Totally, 349 patients with incident AHS were consecutively recruited, and their malnutrition risks were determined using a high CONUT score of ≥ 2. Poor functional outcomes were defined as the modified Rankin Scale (mRS) score of ≥ 3 at 3 months. A total of 328 patients (mean age, 60.4 ± 12.83 years; 66.8% male) were included, 172 (52.40%) patients at malnutrition risk and 104 (31.7%) patients with a poor prognosis. High-CONUT patients had lower total lymphocyte counts and total cholesterol levels than low-CONUT patients (p < 0.001 and p = 0.012). At 3-month post discharge, patients with malnutrition risk had higher hospitalization costs (p = 0.021), lower Barthel Index (p = 0.001), and more infectious complications (p = 0.002) than those without, and there was a greater risk for poor functional outcomes in the high-CONUT compared with the low-CONUT patients at admission (adjusted odds ratio: 2.32, 95% confidence interval: 1.28-4.17). High-CONUT scores predict a 3-month poor prognosis in AHS, which may help identify the AHS patients who need additional nutritional managements.
Determination of the Earthquake Epicenter from Line-of-Sight Displacement Images Obtained by Sentinel-1A/B Radar Data Using the GMTSAR Software Package
Authors: Akhmadiya Asset , Moldamurat Khuralay , Nabiyev Nabi , Kismanova Aigerim
Published: January 2021

This article described the technology of determining earthquake epicenter with radar remote sensing on the example of Sentinel-1A/B. To determine the epicenter of the earthquake, the Earth's crust displacements were analyzed using radar remote sensing data obtained for the ascending and descending flight orbits. Coordinates of Earthquake epicenters were found according to line-of-sight displacement images via its maximum value. Displacement of the Earth's crust was obtained by processing in the GMTSAR package in the VirtualBox virtual machine of the Linux Ubuntu 16.04 operation system. Two earthquakes that occurred in 2020 were studied to determine the accuracy of finding epicenters using the ascending and descending orbits Sentinel-1A/B. These earthquakes occurred in Western Xizang, China, and Doganyol, Turkey. The maximum deviation from the officially registered epicenter coordinates was 15.38 km for Doganyol and 3.2 km for the Western Xizang earthquake. The negative displacement was 90 mm for Doganyol and 50 mm for Western Xizang.
Blood Lead Level in a Paediatric Population of South-Eastern Spain: A Cross-Sectional Study
Authors: Ruiz Tudela Lucia , Vazquez Lopez Maria Angeles , Garcia Escobar Iciar , Cabrera Sevilla Jose Eugenio , Gomez Bueno Sara , Martin Gonzalez Manuel , Muñoz Vico Francisco Javier
Published: January 2021

Objective: To determine blood lead levels (BLL) in a healthy paediatric population and to analyse related sociodemographic, dietary and haematological factors. Methods: A cross-sectional study was made of 1,427 healthy subjects aged 1-16 years from the city of Almería (south-eastern Spain). BLL, iron parameters and erythropoietin were determined, and sociodemographic and dietary data obtained. The study data were analysed by multiple logistic regression. Results: The mean BLL was 1.98±1.1 µg/dl (95% CI:1.91–2.04). For 5.7% of the population, mean BLL was 2-5 µg/dl, for 2.1% it was >5 µg/dl and for 0.15% it was >10 µg/dl. Multivariate analysis showed that immigrant origin (OR:11.9; p<0.0001), low level of parental education (OR:4.6; p<0.02) and low dietary iron bioavailability (OR: 3.2; p<0.02) were all risk factors for toxic BLL. Subjects with toxic and non-toxic BLL presented similar iron and erythropoiesis-related parameters, except erythrocyte protoporphyrin, which was significantly higher in the BLL >5 µg/dl group. Conclusions: BLL and the prevalence of toxic BLL in healthy subjects aged 1-16 years living in south-eastern Spain are low and similar to those found in other developed countries. The factors associated with toxic BLL are immigrant origin, low level of parental education and dietary iron deficiency. The toxicity of BLL was not related to changes in the analytical parameters studied.
Nutritive and Bioactive Proteins in Breastmilk
Authors:   Department of Pediatrics, Paracelsus Medical University, Salzburg, Haschke Ferdinand , Haiden Nadja ,   Department of Pediatrics, Medical University Vienna, Vienna, Austria, Thakkar Sagar K. ,   Nestlé Research Center, Lausanne, Switzerland
Published: January 2021

Protein ingested with breast milk provides indispensable amino acids which are necessary for new protein synthesis for growth and replacement of losses via urine, feces, and the skin. Protein gain in the body of an infant is highest during the first months when protein concentrations in breast milk are higher than during later stages of lactation. Low-birth-weight infants have higher protein needs than term infants and need protein supplements during feeding with breastmilk. Based on our better understanding of protein evolution in breastmilk during the stages of lactation, new infant formulas with lower protein concentration but better protein quality have been created, successfully tested, and are now available in many countries. Besides providing indispensable amino acids, bioactive protein in breast milk can be broadly classified into 4 major functions, that is, providing protection from microbial insults and immune protection, aiding in digestive functions, gut development, and being carriers for other nutrients. Individual proteins and their proposed bioactivities are summarized in this paper in brief. Indeed, some proteins like lactoferrin and sIgA have been extensively studied for their biological functions, whereas others may require more data in support to further validate their proposed functions. Keywords: protein requirements for growth, nutritive proteins, bioactive proteins, bioactive peptides, infants, breastmilk, lactoferrin, immunoglobulins
Food labelling and food-induced anaphylaxis in children. Where are the intersection points?
Authors:   N.I.Pirogov Russian National Research Medical University, Moscow, Russian Federation, Pampura A.N. ,   Russian Medical Academy of Continuing Professional Education, Ministry of Health of the Russian Federation, Moscow, Russian Federation, Lepeshkova T.S. ,   Urals State Medical University, Ministry of Health of the Russian Federation, Yekaterinburg, Russian Federation, Andronova E.V. ,   «Semeyny Doctor» Medical Centre, Magnitogorsk, Russian Federation
Published: January 2021

Anaphylaxis is an acute life-threatening condition affecting several body systems. It might have a rapid onset and lead to a lethal outcome. The major provoking factors for the development of anaphylactic reactions in childhood are food allergens. High hypersensitivity to one food allergen can make it difficult for a family to find a substitution for an allergenic product. Food-induced anaphylactic reaction to quite a number of food allergens is a serious problem for both the physician and the family of an allergic child necessitating organization of appropriate and safe nutrition. In real life, the standard recommendation for the patient – to strictly follow the rules of the elimination diet with exclusion of the causative allergen and all cross-reactive allergens – often becomes unrealizable. There is a serious risk of developing new allergic reactions due to accidental intake of the triggering allergens because of incorrect food labelling by manufacturers. The objective of the work is to present a clinical case report that demonstrates the importance of performing allergy component testing (ImmunoCAP ISAC-112,) for identification of the full spectrum of allergens with subsequent assessment of allergenic molecules as triggering allergens and shows serious difficulties in the elaboration of recommendations on a personalised diet that should be adequate and safe for a child with a history of recurrent episodes of food-induced anaphylaxis. Key words: children, life-threatening reactions, allergy component testing, food labelling, food-induced anaphylaxis, food allergens
Comparative characteristics of the palatability of extensively hydrolyzed formulas: results of a questionnaire survey among medical doctors
Authors:   Russian Medical Academy of Continuing Professional Education, Ministry of Health of the Russian Federation, Moscow, Russian Federation, Gribakin S.G. , Stovolosov I.S. ,   OOO «Nutricia», Moscow region, Russian Federation, Lavrova T.Е. ,   OOO «Nutricia», Moscow region, Russian Federation
Published: January 2021

Objective. To compare the palatability of six extensively hydrolyzed formulas used in the Russian Federation for diet therapy in case of cow’s milk protein allergy. Materials and methods. А direct taste-testing of six specialized formulas with a subsequent questionnaire survey was performed among 336 paediatricians and paediatric allergologists. Results. A whey protein hydrolysate formula containing galacto- and fructooligosaccharides with lactose reduced contents scored higher (8.0 ± 1.8 out of 10, p < 0.01). On the whole, whey protein hydrolysates are more palatable compared to casein hydrolysates (5.7 ± 1.7 vs 3.5 ± 2.1, p < 0.01). Conclusion. Extensively hydrolyzed formulas differ significantly in their taste attributes. Whey protein hydrolysates containing prebiotic oligosaccharides and lactose have the best palatability among other extensively hydrolyzed formulas. Key words: cow’s milk protein allergy, extensively hydrolyzed formulas, hydrolysate taste, peptide size
Association between socioeconomic status and fertility among adolescents aged 15 to 19: An analysis of the 2013/2014 Zambia Demographic Health Survey (ZDHS)
Authors: Munakampe Margarate Nzala , Fwemba Isaac , Zulu Joseph Mumba , Michelo Charles
Published: January 2021

Background: Adolescents face significant barriers to access and utilization of sexual and reproductive health services in many low-income settings which in turn may be associated with adverse consequences such as early pregnancy, sexually transmitted infections and unsafe abortion and mortality. There is evidence suggesting that limited access to sexual and reproductive health information and services among adolescents contribute to these outcomes. We aimed to find out the factors that affect the fertility of adolescents aged 15 to 19 years in Zambia and to identify possible drivers of adolescents’ fertility. Methods: Secondary analysis of the ZDHS 2013/14 data was carried out to find out the factors that affect the fertility rate of adolescents aged 15 to 19 years using multivariate logistic regression (n=3,666).Results: Overall, 23.1 % of adolescents had given birth at least once in the five years leading to the survey (n= 3,666, 99.4% response), and 49.8 % were rural-based while 50.2% were urban-based. The median number of schooling was 8 years (IQR= 6-10). About 52% of the adolescents were in the poorer, poor and medium wealth quintiles while the other 48% were in the rich and richer quintiles. Factors found to affect fertility include residence, wealth status, educational attainment, marriage and abortion. An urban-based adolescent with a lower socioeconomic status was 2.4 times more likely to give birth compared to rural-based poorer adolescents (95% CI 1.5, 3.7 p<0.001). Although odds of giving birth were much higher among rural married adolescents (aOR 8.0, 95% CI 5.4, 11.9 p<0.001) compared to urban married adolescents (aOR 5.5, 95%CI 8.3, 16.0, p<0.001), and these relationship both statistically significant, higher educational attainment (aOR 0.7 95% CI 0.6, 0.8 p<0.001) and abortion (aOR 0.3 95% CI 0.1, 0.8 p=0.020) reduced these odds, particularly for rural-based adolescents. Conclusion: Despite response aimed at reducing adolescent fertility, low wealth status, low educational attainment and early marriage remain significant drivers of adolescent fertility in Zambia. There is a need to address access to sexual and reproductive health needs of urban adolescents with a lower socioeconomic status.
Utilization of Maternity Services and Associated Factors among Women Living in Addis Ababa Ethiopia Nifas Silk Lafto Sub-city, Woreda 1
Authors: Woldemariam Finot , Desta Ayalew , Nadew Getachew
Published: January 2021

Background: Maternal service is the health service provided to mothers (women in their child bearing age). In Ethiopia mothers and children make up over 2/3rd of the whole population. Most pregnant women in developing world receive insufficient or no prenatal care and deliver without the help of appropriately trained health care provider. The situation in countries like Ethiopia is worsened by different factors such as poor infrastructure and lack of accessibility to health facilities. Taking this into account this study mainly focuses on the utilization of maternal service and associated factors among women living in selected villages in Nifas silk Lafto, Woreda 1. . Objective: This study assesses the utilization of maternity services and associated factors among women living in Nifas Silk lafto sub city, woredas 1. Method: A community based cross-sectional study design was used to assess the utilization of maternal service utilization and associated factors from January to March 2020. Mothers who gave birth in the past five years were included in the study. A pre tested Interview administered questionnaire was used for data collection; Data was coded and entered and analyzed using SPSS version 23. Result: The result showed that there is generally 38.6% maternal health service utilization practice. Availability of health facility ( OR:0.489, 95%CI(0.282,0.847),) and accessibility (OR:3.130, 95%CI (1.390,7.048) are found to have significant association with maternal health utilization practice. Conclusion: The finding revealed that the majority of the respondents have poor maternal health service utilization practice which might have an impact for the mother and the new born baby, it’s also indicated the majority of the respondents don’t have knowledge regarding danger signs of pregnancy and the risks associated with pregnancy and child birth, thus responsible authorities should establish a way to create awareness , and also government authorities should be involved in solving the problem of poor infrastructure and transportation.
Treatment of Post-Transplant Recurrent FSGS in Children Using Plasmapheresis and Augmentation of Immunosuppression
Authors: Restrepo-Tovar Jaime , Torres-Canchala Laura , Londoño Hernando , Somers Michael , Manzi Eliana , Restrepo-Restrepo Jaime
Published: January 2021

Background: Up to 60% of pediatric renal transplant recipients with end-stage renal disease due to primary focal and segmental glomerulosclerosis (FSGS) may develop recurrent disease. Such recurrence is associated with poor prognosis if no remission is achieved. We report a single center experience with a protocol based on plasmaphereis and increased immunosuppression that resulted in a high long-lived remission rates.Methods: This retrospective cohort study included consecutive pediatric renal transplant patients with recurrent FSGS treated with a standardized protocol using plasmapheresis and cyclophosphamide to supplement usual post-transplant immunosuppression with calcineurin inhibitors and steroids. Relapse was defined as urinary protein/creatinine ratio >1.0g/g and remission as <0.5g/g. Results: 15 patients with FSGS recurrence post-transplant were treated. All had therapy-resistant FSGS in native kidneys and had been on dialysis from 4-10 years. Of the 15, one died perioperatively from a pulmonary thromboembolism. 13 others achieved a complete remission within 3 months of treatment for FSGS recurrence. After a median follow-up period of 4 years, there were no recurrences of significant proteinuria. Conclusion: The addition of plasmapheresis and cyclophosphamide to a calcineurin- and steroid-based immunosuppression regime was highy successful in inducing high remission rates with recurrent FSGS. Prospective trials are needed to evaluate further the efficacy of increased immunosuppression along with plasmapheresis in this setting.
Femtosecond laser microdissection isolating regenerating C. elegans neurons for single cell RNA sequencing
Authors: Ben-Yakar Adela , Zhao Peisen , Martin Chris , Ma Ke-Yue , Jiang Ning
Published: January 2021

Our understanding of nerve regeneration can be enhanced by delineating its underlying molecular activities at single neuron resolution in small model organisms such as Caenorhabditis elegans. Existing cell isolation techniques cannot isolate regenerating neurons from the nematode. We present femtosecond laser microdissection (fs-LM), a new single cell isolation method that dissects intact cells directly from living tissue by leveraging the micron-scale precision of fs-laser ablation. We show that fs-LM facilitated sensitive and specific gene expression profiling by single cell RNA-sequencing, while mitigating the stress related transcriptional artifacts induced by tissue dissociation. Single cell RNA-sequencing of fs-LM isolated regenerating C. elegans neurons revealed transcriptional program leading to successful regeneration in wild-type animals or regeneration failure in animals lacking DLK-1/p38 kinase. The ability of fs-LM to isolate specific neurons based on phenotype of interest allowed us to study the molecular basis of regeneration heterogeneity displayed by neurons of the same type. We identified gene modules whose expression patterns were correlated with axon regrowth rate at a single neuron level. Our results establish fs-LM as a highly specific single cell isolation method ideal for precision and phenotype-driven studies.
Biocidal Potential of Plants Extracts Against Wood-Degrading Microbes and Their In-Vitro Application on Wood: As Promising Wood Natural Preservatives
Authors: Ifthkar Amina , Jabeen Faiza , Mirza Saima , Abbas Afshan , Younis Tahira , Waseem Muhammad , Abdallah Mohnad
Published: January 2021

Background: Besides the increasing demand of wooden articles, there is a burning issue of microbial attack which affects the aesthetics of wood. Thus it is a current concern to protect the wooden articles from both fungal and bacterial attack by using toxin free preservatives. Results: Powder of Calotropis procera (leaves), Curcuma zedoaria (rhizome) and Swertia chirata (whole plant) was extracted with solvents like methanol, ethanol and chloroform and then the qualitative phytochemical screening was carried out, which exhibited the presence of different secondary metabolites. These extracts were also evaluated against wood degrading microbes (Bacillus cereus, Escherichia coli, Pseudomonas aeruginosa, Aspergillus flavus and Aspergillus niger) isolated from decaying wood. Our study demonstrated that the ethanol extract of S. chairata showed highest bactericidal potential against E.coli (19.0mm) and A. flavus (19.33mm). This study also revealed that S. chirata exhibited strongest biocidal spectrum of action followed by C. procera and C. zedaira. It was observed that laminated veneer treated with ethanol extract of S. chirata showed strong bactericidal potential against E.coli (82.67mm). On the other hand Syzygium cumini wood treated with ethanol extract of C. zedoaria exhibited high antibacterial potential against P. aeruginosa (58.0mm). The active plant extracts showed MIC's ranged from 3.6 to 6.0 mg/ml and MBC/MFC of 4.8 and 8.4 mg/ml. Conclusion: The results demonstrated the potential effects of selected plant extracts as a natural preservative that can protect wood from bacterial and fungal deterioration. The extracts can be applied to prevent furniture deterioration and raw wood protection.
The Flipped Classroom Is Effective for Medical Students to Improve Deep Tendon Reflex Examination Skills: A Mixed-Method Study
Authors: Uchida Shun , Shikino Kiyoshi , Ishizuka Kosuke , Yamauchi Yosuke , Yanagita Yasutaka , Yokokawa Daiki , Tsukamoto Tomoko , Noda Kazutaka , Uehara Takanori , Ikusaka Masatomi
Published: January 2021

Background: Deep tendon reflexes (DTR) are a prerequisite skill in clinical clerkships. However, many medical students are not confident in their technique and need to be effectively trained. We evaluated the effectiveness of a flipped classroom for teaching DTR skills. Methods: We recruited 83 fifth-year medical students who participated in a clinical clerkship at the Department of General Medicine, Chiba University Hospital, from November 2018 to July 2019. They were allocated to the flipped classroom technique (intervention group, n=39) or the traditional technique instruction group (control group, n=44). Before procedural teaching, while the intervention group learned about DTR by e-learning, the control group did so face-to-face. A 5-point Likert scale was used to evaluate self-confidence in DTR examination before and after the procedural teaching (1=no confidence, 5=confidence). We evaluated the mastery of techniques after procedural teaching using the Direct Observation of Procedural Skills (DOPS). Unpaired t-test was used to analyze the results of the 5-point Likert scale and DOPS. We assessed self-confidence in DTR examination before and after procedural teaching using a free description questionnaire in the two groups. Additionally, in the intervention group, focus group interviews (FGI) (7 groups, n=39) were conducted to assess the effectiveness of the flipped classroom after procedural teaching.Results: Pre-test self-confidence in the DTR examination was significantly higher in the intervention group than in the control group (2.8 vs. 2.3, P=0.005). Post-test self-confidence in the DTR examination was not significantly different between the two groups (3.9 vs. 4.1, P=0.31), and so was mastery (4.3 vs. 4.1, P=0.68). The questionnaires before the procedural teaching revealed themes common to the two groups, including “lack of knowledge” and “lack of self-confidence.” Themes about prior learning, including “acquisition of knowledge” and “promoting understanding,” were specific in the intervention group. The FGI revealed themes including “application of knowledge,” “improvement in DTR technique,” and “increased self-confidence.” Conclusions: Teaching DTR skills to medical students in flipped classrooms improves readiness for learning and increases self-confidence in performing the procedure at a point before procedural teaching.
The Spectrum of Children's Kidney Diseases—2403 Renal Biopsy-proven Cases from a Single Centre in China between 1999 and 2019
Authors: Jiang Li-Jun , Zhao Xue , Dou Zhi-Yan , Rong Zan-Hua , Yang Lin
Published: January 2021

Background: This study aimed to investigate the clinical and pathological characteristics and the profile of and temporal changes in glomerular diseases in 2403 paediatric renal biopsies from 1999 to 2019.Methods: Renal biopsies performed on children aged ≤18 years between 1999 and 2019 were analysed at our centre. We analysed the clinical and histological characteristics, distribution of paediatric renal diseases with various clinical presentations, and changes in the pattern of kidney disease during the study period.Results: The most common primary glomerular disease was IgA nephropathy (IgAN) (24.3%), followed by minimal change disease (MCD) (15.3%) and membranous glomerulonephritis (MN) (13.1%). Henoch-Schonlein purpura nephritis (HSPN) (18.1%) and lupus nephritis (LN) (7.2%) were the most frequently recorded secondary glomerular diseases. Alport syndrome and thin basement membrane nephropathy (TBMN) were the most common inherited glomerular diseases, accounting for 1.2% and 0.6% of the total glomerular diseases in children, respectively. The number of boys with IgAN, MCD and IgM nephropathy (IgMN) was significantly higher than that of girls, while the number of girls with MN and LN was significantly higher than that of boys. The frequencies of MCD, MN, IgMN and endocapillary proliferative glomerulonephritis (EnPGN) in the 13-18-year-old group were significantly higher than those in the 0-12-year-old group, while the frequencies of IgAN, mesangial proliferative glomerulonephritis (MsPGN) and focal proliferative glomerulonephritis (FPGN) were lower than those in the 0-12-year-old group. The ratio of Alport syndrome and TBMN in the 0-12-year-old group was significantly higher than that in the 13-18-year-old group. The proportion of patients with MCD and MN in 2010-2019 was significantly higher than that in 1999-2009, while the ratio of IgAN, MsPGN, IgMN, EnPGN, membranoproliferative glomerulonephritis (MPGN), HSPN and HBV-associated glomerulonephritis (HBV-GN) decreased. MCD (28.5%) was the most common cause of nephrotic syndrome (NS). In children with haematuria and proteinuria, HSPN (38.8%) and IgAN (36.9%) were more common than other glomerular diseases. IgAN (39.4%) was the most common cause of AKI. Sclerosing glomerulonephritis (SGN) (21.1%) was the main cause of progressive chronic kidney disease (CKD).Conclusions: Glomerular diseases in children were related to sex and age. From 1999 to 2019, the spectrum of children's kidney disease in our centre changed significantly.
Clinician Acceptance of Complex Clinical Decision Support Systems for Treatment Allocation of Patients with Chronic Low Back Pain.
Authors: Jansen-Kosterink Stephanie , Velsen Lex van , Cabrita Miriam
Published: January 2021

Background: The uptake of complex clinical decision support systems (CDSS) in daily practice remains low, despite the proven potential to reduce medical errors and to improve the quality of care. To improve successful implementation of a complex CDSS service, the aim of this study is to identify the factors that hinder or alleviate the acceptance of clinicians toward the use of a complex CDSS for treatment allocation of patients with chronic low back pain. Methods: We tested a research model in which the intention to use a CDSS by clinicians is influenced by the perceived usefulness; this usefulness, on its turn is influenced by the perceived service benefits and perceived service risks. An online survey was created to test our research model and the data was analysed using Partial Least Squares Structural Equation Modelling (PLS-SEM). The study population consisted of clinicians. The online questionnaire started with demographic questions and continued with an animation of the CDSS followed by the set of measurement items. The online questionnaire ended with two open questions enquiring the reasons to use, and not to use, a complex CDSS.Results: Ninety-eight participants (46% general practitioners, 25% primary care physical therapists, and 29% clinicians at a rehabilitation centre) fully completed the questionnaire. Fifty-two percent of the respondents were male. The average age was 48 years (SD±12.2). The causal model suggests that perceived usefulness is the main factor contributing to the intention to use a complex CDSS. Perceived service benefits and risks are both significant antecedents of perceived usefulness and Perceived service risks are affected by the perceived threat to autonomy and trusting beliefs, particularly benevolence and competence.Conclusions: To improve the acceptance of complex CDSSs it is important to address the risks, but the main focus during the implementation phase should be on the expected improvements in patient outcomes and the overall gain for clinicians. Our results will help the developers of complex CDSSs to develop a CDSS that fits more into the daily clinical practice of clinicians.
Serum lipidomics as diagnostic potential for metabolic-associated hepatocellular carcinoma
Authors: Lewinska Monika , Santos-Laso Alvaro , Arrretxe Enara , Alonso Cristina , Jimenez-Aguero Raul , Eizaguirre Emma , Pareja María , Romero-Gomez Manuel , Arrese Marco , Suppli Malte , Knop Filip , Oversoe Stine , Villadsen Gerda , Decaens Thomas , Carrilho Flair , Oliveira Claudia , Sangro Bruno , Macias Rocio , Banales Jesus , Andersen Jesper
Published: January 2021

Metabolic-associated fatty liver disease (MAFLD) is affecting more people globally. Indeed, MAFLD is associated with a spectrum of metabolic dysfunctions that can progress to hepatocellular carcinoma (MAFLD-HCC). This development can occur in a non-cirrhotic liver and thus, often lack clinical surveillance. Using comprehensive ultra-high-performance liquid chromatography mass-spectrometry, we investigated 1,295 metabolites in serum from 249 Caucasian liver patients. Here we show that MAFLD-HCC is characterized by a complete rearrangement of the serum lipidome which distinguishes MAFLD-HCC from other HCC patients. We used machine learning to build a diagnostic model for MAFLD to MAFLD-HCC. We quantified predictive metabolites and adjusted the model into the MAFLD-HCC Diagnostic Score, presenting superior diagnostic potential compared to current alpha-fetoprotein (AFP). The metabolic landscape shows a progressive depletion in unsaturated fatty acids and acylcarnitines during transformation. Therefore, serum metabolomics may provide valuable insight to monitor patients at risk, including morbidly obese, diabetics, and MAFLD patients.
Impact of Second Forward-view Examination of the Right side of the Colon on Polyp and Adenoma Detection during Colonoscopy: A Randomized Controlled Trial
Authors: Shan Keshu , Lu Hongpeng , Zhang Zhixin , Xie Jiarong , Xu Lu , Wang Weihong , Xu Lei
Published: January 2021

Objectives: Colorectal cancer in the right side of the colon is supposed to harder to detect by colonoscopy. The aim of this study was to evaluate whether a second forward-view examination of the right side of the colon could increase adenoma detection rate (ADR) and polyp detection rate (PDR).Methods: This was a single-centre randomized controlled trial. Patients undergoing colonoscopy were recruited and randomly assigned to the second forward-view examination (SFE) group, in which the right side of the colon was examined twice and a traditional colonoscopy (TC) group in which the colonoscopy was performed in a standard manner. The primary outcomes were the proximal PDR and ADR. The overall PDR and ADR, and advanced lesion detection rate were also recorded and compared..Results: A total of 392 patients were included in the study (SFE group 197 vs. TC group 195). The proximal PDR and ADR in the SFE group were significantly higher than those in the TC group (PDR 17.8% vs. 9.7%, P =0.021; ADR 14.2% vs.7.2%, P =0.024). No significant difference was found for overall PDR/ADR, or advanced lesion detection rate between the two groups. Conclusions: This prospective study revealed that a second forward-view examination of the right side of the colon could result in a modest improvement in proximal ADR and PDR. This simple and time-effective technique might be recommended for routine colonoscopy. Trial registration: Clinical Trials.gov, NCT03619122. Registered on 7/8/2018.
De Novo Design of a Nanopore for DNA Detection that Incorporates a β-Hairpin Peptide
Authors: Shimizu Keisuke , Mijiddorj Batsaikhan , Usami Masataka , Yoshida Shuhei , Akayama Shiori , Hamada Yoshio , Ohyama Akifumi , Usui Kenji , Kawamura Izuru , Kawano Ryuji
Published: January 2021

The amino acid sequence of a protein encodes information on its three-dimensional structure and specific functionality. De novo protein design has emerged as a method to manipulate the primary structure for the development of artificial proteins and peptides with desired functionality. This paper describes the de novo design of a pore-forming peptide that has a β-hairpin structure and assembles to form a stable nanopore in a bilayer lipid membrane. This large synthetic nanopore is an entirely artificial device with practical applications. This peptide, named SV28, forms nanopore structures ranging from 1.6 to 6.2 nm in diameter assembled from 7 to 18 monomers. The nanopore formed with a diameter of 5 nm is able to detect long double-stranded DNA (dsDNA) with 1 kbp length. Moreover, the larger sized nanopore can discriminate and human telomeric DNA (G-quadruplex, G4). The blocking current signals allowed us to investigate the translocation behavior of dsDNA or G4 structure at the single molecule level. Such de novo design of peptide sequences has the potential to create novel nanopores, which would be applicable in molecular transporter between across lipid membrane.
Divergent Patterns of Confrontation With Death Using the Anticipated Farewell to Existence Questionnaire (AFEQT): Cross-Sectional Comparative Study of Four Samples With Increasing Proximity to Death.
Authors: Valdés-Stauber Juan , Stabenow Ursula , Böttinger Jakob , Kramer Sarah , Kilian Reinhold
Published: January 2021

Background: Based on the concept of “Daseinsverabschiedung”, an anthropological theory of “Anticipated Farewell to Existence” (AFE) was suggested on the basis of six grounding dimensions (“derived in AFE”): selfhood (“expiration of the time of existence”), interpersonality (“altruistic preoccupation”), temporality (“struggle for acceptance”), corporeality (“wounded physical integrity”), worldliness (“reconciliation with own existence”), and transcendence (“self-transcendence”). The purpose of the study is to investigate the extent to which the relevance of these anthropological dimensions differs between people in different stages of life, especially those facing their own death.Methods: The sample (N=485) consists of dying individuals in palliative wards and hospices (n=121); old people living in nursing homes not suffering from a mortal disease (n=62); young adults (n=152), and middle-aged adults (n=150). The relevance of anticipated farewell to existence was measured by means of the “Anticipated Farewell to Existence Questionnaire” (AFEQT). Further assessment tools: Big Five Inventory (BFI-10), Life Attitude Profile (LAP-R), Eastern Cooperative Oncology Group (ECOG), and Basic Documentation for Psycho-Oncology (PO-Bado). The internal consistency of the AFEQT was assessed using Cronbach’s alpha and convergent validity by means of dimensions of LAP-R. Differences in the relevance of the AFEQT dimensions among stages of life were estimated by means of multiple regression models.Results: According to Cronbach’s alpha, the internal consistency of the AFEQT subscales was sufficient for the whole sample. Convergent validity with dimensions of LAP-R was found for young and middle-aged participants. Dying people scored significantly higher for most of the dimensions than young and middle-aged as well as elderly people. Personality traits of “oenness” and “agreeableness” are positively associated with the extent of assessed dimensions of AFEQT.Conclusions: Anthropological reflections on the structure of human beings, which is activated or actualized in a special way in the face of death, can provide a framework for practice facing a humanization of medicine at the end of life, considering real experiences, possible needs, and underlying human conditions when facing end of life. The dimensions proposed can be taken into account in a sensitive way by supporting dialogues with dying people and their relatives.Trial registration: observational study.
An exploration of the association between fuel subsidies and
fuel riots
Authors: McCulloch Neil , Natalini Davide , Hossain Naomi , Justino Patricia
Published: January 2021

Fuel riots are common around the world. Between 2005 and 2018, 41 countries had at least one riot directly associated with popular demand for fuel. We make use of a new international dataset on fuel riots to explore the effects of fuel prices and price regimes on fuel riots. In line with prior expectations, we find that large
domestic fuel price shocks are a key driver of riots - as these are often linked to international price shocks. In addition, we report a novel result: fuel riots are closely associated with domestic price regimes. Countries that maintain fixed price regimes - notably net energy exporters - tend to have large fuel subsidies. When such subsidies become unsustainable, domestic price adjustments are large, often leading to riots.
A Qualitative Study on Experiences of HIV Vaccine Trial Participants in a Phase I/II Double Blinded, Randomized Placebo Controlled Clinical Trial in Tanzania: Lessons for COVID-19 Vaccine Testing
Authors: Sanga Erica , Wyk Brian Van , Maboko Leonard , Shamu Simukai
Published: January 2021

Background: HIV remains a major public health problem in Sub-Saharan Africa. More than half (54.5%) of all people living with HIV live in Eastern and Southern Africa where 700,000 new infections were reported in 2019. There is no HIV vaccine or cure available yet despite ongoing research to develop one. Uptake of vaccines, when these become available, is critical for its successful introduction in the global society. It is imperative to describe the knowledge, expectations, perceptions and experiences of the vaccines trial participants, as these may be indicative of future vaccine uptake, and may give lessons for COVID-19 vaccine development. Methods: A phenomenological qualitative study was conducted to describe the experiences of volunteers who participated in the first HIV vaccine trial in Mbeya, Tanzania. A purposive sample of 20 of the 60 trial participants was interviewed. Interviews were audio-recorded, transcribed, translated, and subjected to thematic-content analysis.Results: The study showed that trial participation was driven by positive expectations related to health and the realization of the need for an effective vaccine to combat HIV. However fear, concerns and worries about the safety of the trial vaccine were the frequently reported challenges to participation. Not only participants but also the significant others and community play an important role in the trial participation.Conclusions: The success of a trial depends on direct and indirect participation in trials. Future trials, COVID-19 vaccine trials included, must promote positive expectations for trial participation and address fears and concerns related to vaccine safety.
Incidence and Risk Factors for Symptomatic Myocardial Ischemia After Posterior Decompressive Surgery for Degenerative Lumbar Disorders
Authors: Liu Wenjun , Zhang Sisheng , Liu Yang , Hu Haiyan
Published: January 2021

Background: This study aimed to determine the incidence of symptomatic myocardial ischemia (PSMI) after posterior decompressive surgery for degenerative lumbar disorders and identify its risk factors. Methods: 256 patients who underwent the posterior decompressive surgery and were discharged from the hospital between January 2011 and December 2016 were enrolled in this study, according to the inclusion and exclusion criteria. Subjects were divided into two groups by the occurrence of PSMI: the PSMI group and the N-PSMI group. Three sets of factors were analyzed to investigate potential risk factors for PSMI. Patient characteristics included age, gender, body mass index, smoking, drinking, venous thrombosis of lower extremities, comorbidities, visual analog scale, hemoglobin, electrolytes. Preoperative cardiac functional variables included electrocardiogram, ventricular ejection fraction, history of ischemic attack, previous cardiac surgery. Perioperative variables included surgical strategy, surgery time, blood loss, intraoperative aortic injury, intraoperative maximum heart rate, arterial blood pressure, postoperative temperature, daily liquid intake and output volume, electrolytes glucose, drug allergy, and postoperative visual analog scale. Univariate analyses followed by the multivariate logistic regression model were employed to identify the risk factors for PSMI. Results: PSMI was developed in 23 of 256 patients (8.9%) before discharge. Univariate analyses revealed that patients with onset of PSMI were older, more likely to have undergone cardiac surgery, with less daily liquid intake volume, and less intravenous infusion (p < 0.05). Logistic regression analysis revealed that age > 52 years, heart rate > 81 Bpm, daily liquid intake < 2140 mL, and cardiac surgery history were independently associated with PSMI after posterior decompressive surgery for degenerative lumbar disorders.Conclusions: The incidence of PSMI after posterior decompressive surgery for degenerative lumbar disorders was 8.9%; senior, fast heart rate, insufficient daily liquid intake, and cardiac surgery history are potential risk factors and should be carefully evaluated before an operation.