bluuebunny/crossref_metadata_2025 huggingface dataset:
HARNESSING HUMAN-CENTRED DESIGN APPROACHES TO BUILD A CHATBOT FOR PEOPLE LIVING WITH HYPERTENSION
Authors: Jacobs Mina , Ogboye Ayoposi , Mobisson Nneka
Published: June 2022

Objective:

To describe how human-centered design was used to create an artificial intelligence (AI) enabled chatbot for people living with hypertension.

Design and method:

The project focused on technology augmentation and testing to strengthen the mDoc’s CompleteHealthTM platform (an omnichannel platform that provides self-management techniques digitally to people with chronic diseases) to enable us to drive scale in providing self-care support. We leveraged Human-Centered Design principles to guide our pathway based on inspiration, ideation, and implementation to design a chatbot called “Kem’’, aimed to provide real-time response to members living with hypertension.

In the inspiration phase, our clinical and tech teams hypothesized that 80% of our growing members’ questions on hypertension could be answered by Kem at scale. In the ideation phase, we leveraged our members to understand and develop the conversation structure and conducted extensive research on how to provide real-time responses to as many members as possible. Kem’s prototype was developed on Botmock (a tool used for designing and fleshing out conversational design flow) with a persona designed to function as a health coach to help bridge the gap in knowledge of health topics, guide, and answer mDoc members.

After a series of iterations based on users’ feedback, during the implementation phase, Kem was integrated into a chat platform, Telegram, and was tested with a larger group of users.

Results:

By applying human-centered design and integrating user feedback into the design and creation of a chatbot to answer questions around hypertension, we were able to create a tool that will help members increase their knowledge of the prevention and management of hypertension.

Conclusions:

Co-creation should occur at every step of the journey when designing for members’ needs and behaviors. The users’ expressed excitement about Kem and the design process revealed that we needed to be more intentional about making the conversation with the bot interesting, user-friendly, and less technical. As the implementation phase continues and more members use Kem, we will be able to educate them about the prevention and management of hypertension.
Practical management of Raynaud's phenomenon – a primer for practicing physicians
Authors: Ramahi Ahmad , Hughes Michael , Khanna Dinesh
Published: June 2022

Purpose of review

Raynaud's phenomenon (RP) is a common vasospastic condition that results in digital hypoperfusion in response to cold and/or emotional stress and is associated with significant pain and disability. The aim of our review is to provide a practical approach for clinicians to inform assessment and management of patients with RP.

Recent findings

Autoantibodies and nailfold capillaroscopy are key investigations to stratify the risk of progression to systemic sclerosis (SSc) in patients RP, which was recently confirmed in the multicenter, very early diagnosis of systemic sclerosis (VEDOSS) project. Research has explored the complex lived-patient experience of RP including digital vasculopathy in SSc and has highlighted the need for outcome measure development to facilitate research in the field. Pharmacological treatment strategies vary significantly internationally and there is continued interest in developing surgical approaches.

We provide a practical and up-to-date approach to inform the assessment and management of patients with RP including guidance on drug initiation and escalation. Calcium channel blockers are first-line treatment and can be initiated by primary care physicians. We also highlight second-line drug therapies used for refractory RP and the potential role for surgical intervention.
Intramedullary Headless Screw Fixation for Phalanx Fractures: Technique and Review of Current Literature
Authors: Herekar Rajeev N. , John Mitchell P. , Doarn Michael C. , Nydick Jason A.
Published: June 2022

Fractures of the phalanges can often be managed nonoperatively, but displaced phalangeal fracture patterns, including malrotation, are more amenable to operative treatment. There are several described methods for surgical management of phalanx fractures, but there remains no consensus on a clearly superior method of fixation. Percutaneous Kirschner wires, interfragmentary screws, plate and screw constructs, intramedullary nails, and cannulated intramedullary headless screws are all utilized in the treatment of these fractures. Intramedullary headless screws for phalanx fractures may provide suitable fixation allowing early motion and recovery. Here, we describe a technique for antegrade and retrograde intramedullary headless screw fixation for phalanx fractures.
Denervation With Periosteal Resection of the First Carpometacarpal Joint
Authors: Arenas-Prat Joan
Published: June 2022

Osteoarthritis of the first carpometacarpal joint is a frequent condition that hand surgeons have to deal with. When conservative measures such as physiotherapy, steroid injections, or splinting fail to alleviate symptoms, trapeziectomy is considered the gold standard for surgical treatment. In the present article, a novel technique is presented to denervate the joint capsule together with the periosteum and the endosteum to address sensory receptors located in these 2 extracapsular structures in the proximity of the first carpometacarpal joint area. Denervation with periosteal resection, apart from being a relatively easy and less aggressive technique compared with trapeziectomy, offers satisfactory pain relief with a faster recovery time.
Surgical Management of Acute on Chronic Distal Radius Fractures: Correcting Malunion Deformities Through the Secondary Fracture Plane
Authors: Orbay Jorge L. , Wahood Menar , Vernon Lauren L. , Mercer Deana M.
Published: June 2022

It is challenging to restore the clinically acceptable alignment of the distal radius after an acute on chronic fracture or after a secondary fracture occurring after malunion of a primary distal radius fracture. In cases of insignificant primary deformity, restoration to the primary deformity may suffice to obtain a successful clinical result. A borderline acceptable primary radial deformity can be unacceptable after the second injury, resulting in functional disability. If surgery is indicated, the surgeon must contend with both primary and secondary deformities to restore proper distal radius anatomy. We present our technique to correct both primary and secondary distal radius deformities through the new or secondary fracture plane.
Dr. YouTube: A Snapshot of Credential Disclosure by Health Care Professionals
Authors: Carlson Kyle , Ejiofor Beverly , Dow Serena , Kind Terry , Chretien Katherine C.
Published: June 2022

Introduction:

YouTube is a popular source of health care information for consumers. The use of “Dr” or “Doctor” in a channel name is a way contributors establish expertise. The current study sought to understand the degree by which popular YouTube channels belonging to individuals who self-identify as doctors disclose their credentials and the nature of their disclosures.

Methods:

Two raters extracted descriptive characteristics from the most viewed public YouTube channel names meeting keyword search criteria of “Doctor” and “Dr”. Channel-level disclosure was captured by examining a channel's “About” section. Video-level disclosure was captured by watching the first 2 minutes of the five most viewed videos from each channel.

Results:

Forty-eight channels (45.7%; 48/105) disclosed degree, 60 channels (57.1%; 60/105) disclosed specialty, and 26 channels (24.8%; 26/105) disclosed the level of training. Two hundred thirty-six videos (46.6%; 236/506) disclosed degree, 201 videos (39.7%; 201/506) disclosed specialty, and 81 videos (16%; 81/506) disclosed the level of training.

Discussion:

Our findings suggest that the most viewed YouTube health channels and videos demonstrate inconsistent credential disclosure, occurring less than half of the time. Current professional guidance from licensing boards on social media encourages transparency around expertise and credential sharing. In addition, it remains unclear what guidance other health care professionals receive about disclosure practices online. Future recommendations and training to health care professionals should include explicit language for transparent disclosure of credentials.
A Novel Dual Incretin Agent, Tirzepatide (LY3298176), for the Treatment of Type 2 Diabetes Mellitus and Cardiometabolic Health
Authors: Bucheit John , Ayers Jessica , Pamulapati Lauren , Browning Audrieanna , Sisson Evan
Published: June 2022

The incretin hormone system is the target of multiple type 2 diabetes mellitus (T2DM) treatments because defects in this system play major roles in the pathogenesis of diabetes. Currently, the glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are recommended for patients with atherosclerotic cardiovascular (CV) disease and those at high risk for atherosclerotic CV disease. In addition to the favorable CV effects, GLP-1 RAs also provide robust lowering of hemoglobin A1c and weight. Although these factors make GLP-1 RAs attractive options for T2DM, the currently available agents have no effect on glucose-dependent insulinotropic polypeptide (GIP). Patients with T2DM are known to have GIP defect which is significant due to its profound insulinotropic effects. Tirzepatide is a novel incretin agent currently recently approved by the Food and Drug Administration for the treatment of T2DM. This first-in-class agent serves as a coagonist for both the GLP-1 and GIP receptors. In this review, we report on the pharmacologic mechanism of GLP-1, GIP, and coagonist effects on the cardiometabolic system. In addition, we review the glycemic lowering, weight loss effects, and other cardiometabolic outcomes of tirzepatide based on phase 2 and 3 data. The safety profile of tirzepatide is consistent across all phase 3 trials. The most common adverse effects are gastrointestinal symptoms, but they generally have a low risk for discontinuation. Overall, preliminary data suggest that tirzepatide is an efficacious and safe agent for the treatment of T2DM.
Incidence of difficult airway among adult patients of undiagnosed obstructive sleep apnea who are undergoing elective surgery: a prospective cohort study
Authors: Muzien Sulaiman J. , Gelgelo Kuchulo G. , Woldeyohans Misrak
Published: June 2022

Introduction:

Obstructive sleep apnea (OSA) is a dangerous medical disorder marked by obstruction of the upper airway during sleep that is frequently undiagnosed before surgery. Preoperative identification of suspected OSA patients necessitates appropriate preparation and prevents unfavorable outcomes. The incidence of difficult airway in adult patients with OSA who are undergoing elective surgery is significantly increased.

Materials and method:

The study population was separated into high and low-risk groups based on STOP-BANG scores of ≥3 and <3, respectively. The rate of occurrence was compared between the study groups. SPSS version 23 was used for statistical analysis. P-values <0.05 are considered significant. To find characteristics that predict problematic airway, researchers used logistic regression.

Result:

A total of 113 participants was enrolled. Based on STOP-BANG 77 patients and 36 patients were grouped in to low risk OSA and high risk OSA, respectively, the incidence of difficult intubation (DI) was significantly higher (22.2%) in high risk OSA group versus 5.2% in low risk OSA group, relative risk of 4.278 (95% confidence interval: 1.378–13.2). Mask ventilation was significantly more problematic for the high-risk group (P=0.011) (25% against 6.5%). Male sex, neck circumference >40 cm, Mallampati class 3, and 12.5 cm stern mental distance were all linked to DI. Age above 50 years, snoring history, and a neck circumference of >40 cm were all found to be predictors.

Conclusion:

Patients who scored ≥3 on the STOP-BANG had a significantly higher rate of DI and difficult mask ventilation. As a result, the STOP-BANG questionnaire should be used to screen every adult patient undergoing elective surgery for OSA.
Knowledge and practice of Nepalese doctors on reutilization of medical/surgical tools from developed nations: a national level online cross-sectional survey
Authors: Babel Shrinit , Baral Suman , Subedi Nuwadatta , Karn Mitesh , Poudel Shasi , Regmi Astha
Published: June 2022

Background:

A manifold cause of global disparity in medical and surgical care exists, among which lack of access to proper biomedical equipment including surgical tools are a recurrent theme. Use and reuse of such donated tools are common in low resource settings including countries like Nepal; however, there is a lack of adequate data and less has been explored. Through this nationwide study, we aimed to discover the knowledge of donated medical and surgical devices and the practice of reusing single-use equipment by Nepalese medical practitioners and surgeons.

Methods:

An online, questionnaire-based cross-sectional study was conducted using SurveyMonkey from October 2020 through January 2021. The link was sent to target respondents via email and social media and responses were recorded. Data processing and analysis were done using the same platform.

Results:

Among 466 respondents, 349 completed the survey. Around 81.5% recorded that their institute has never received medical devices or donations in the past, while 18.34% believed they had received such commodities. Most of the donations were received from countries like the United States, China, Japan, and India. Around 24% of the respondents reused the tools meant for single-use and only 5% communicated with the donors. Commodities like laparoscopic sets, sutures, dialysis machines, magnetic resonance imaging machines, surgical retractors, face masks, sanitizers, personal protective equipment, endoscopy apparatus, etc., were received. The majority of them were concerned about national guidelines regarding donating reusable tools which might not be acceptable through custom rules of the country, although the facilitation of functional yet unused tools is always welcome in the underserved regions of Nepal.

Conclusion:

Nepalese medical professionals had adequate knowledge about the donated medical devices and only a few of them had practiced reusing single-use equipment. Mutual cooperation between donors and recipients is one of the most important aspects of safe medical/surgical tools delivery.
Orbital Implants Receiving Food and Drug Administration Premarket Notification
Authors: Corcoran Ruiz Kiara M. , Vaishnav Yash J. , Desautels Jordan , Schaefer Jamie L. , Migliori Michael E. , Yilmaz Taygan
Published: June 2022

Purpose:

This perspective explores the Food and Drug Administration (FDA) 510(k) program, occasionally referred to as premarket notification, which facilitates faster marketing of Class II medical devices, such as orbital implants by demonstrating “substantial equivalence” to previously approved devices. This allows for FDA clearance, rather than FDA approval of orbital implants via comparison to currently marketed implants rather than clinically proven safety standards.

Methods:

Utilizing the FDA’s publicly available 510(k) Premarket Notification database, we conducted a thorough search of FDA-cleared orbital implants dating back to the inception of the 510(k) process in 1976.

Results:

We found that 29 orbital implants received 510(k) FDA clearance between 1987 and 2022. Four of the 29 implants were recalled. Only 9 of 29 implants had available data on their predicate or comparison devices; of these 9, 3 implants received clearance based on devices that were subsequently recalled.

Conclusions:

This investigation into premarket approval of orbital implants identifies a shortcoming in the FDA 510(k) approval process. Long-term implant-associated morbidity is difficult to predict during premarket analysis but is further complicated for 510(k) cleared implants since devices approved based on substantial equivalence to recalled devices may not be automatically recalled. Clinicians should be aware of the approval process for the devices they select, and review of the 510(k) process, especially as it applies to substantial equivalence to devices subsequently recalled is warranted.
Impact of COVID-19 Pandemic on Research Participation Among Older African Americans
Authors: Gwizdala Kathryn L. , Pugh Erika A. , Carter Leah , Carmichael Owen T. , Newton Robert L.
Published: June 2022

COVID-19 represents the newest health disparity faced by African Americans (AA). This study assessed the impact of COVID-19 on barriers and willingness to participate in research among older AAs. An online survey was sent to a nationwide sample of 65- to 85-year-old AAs between January and February 2021. Constant comparison analysis was used to extract themes. A total of 624 older AAs completed the survey. Approximately 40% of participants were willing to engage in virtual or in-person research. Of the individuals who were willing to participate in research, >50% were willing to engage in a spectrum of activities from group discussions to group exercise. Research participation themes related to logistics, technology, pandemic fears, and privacy or security. Older AAs face new research barriers that can be overcome through data use transparency and technology resources. This information can be used to encourage dementia research engagement among older AAs despite the pandemic.
Phase 1 Single Ascending and Multiple Ascending Dose Studies of Phosphodiesterase-9 Inhibitor E2027
Authors: Landry Ishani S. , Aluri Jagadeesh , Schuck Edgar , Ino Mitsuhiro , Horie Kanta , Boyd Peter , Reyderman Larisa , Lai Robert
Published: June 2022

Background:

E2027 is a novel, highly selective and potent inhibitor of phosphodiesterase9 (PDE9) being evaluated as a treatment for dementia with Lewy bodies.

Methods:

Phase 1, randomized, double-blind, single ascending dose (SAD, n=96) and multiple ascending dose (MAD, n=68) studies evaluated E2027 doses (5 to 1200 mg) in healthy subjects. The impact of age, race (Japanese/non-Japanese), and food on pharmacokinetics (PK)/pharmacodynamics were evaluated. Serial cerebrospinal fluid (CSF) samples were collected to assess the target engagement.

Results:

E2027 PK profiles were biphasic (elimination half-life: ~30 hours. Approximately 3-fold accumulation was observed following multiple once-daily dosing. E2027 single doses of 50 to 400 mg resulted in mean maximum increases in CSF cyclic guanosine monophosphate ranging from 293% to 461% within 5.37 to 12.9 hours after dose administration to assess target engagement. Dose-response modelling of steady-state predose CSF cyclic guanosine monophosphate concentrations showed ≥200% increase from baseline is maintained with doses of ≥50 mg QD. The most common adverse events with E2027 were post-LP syndrome and back pain. PK profiles were similar between Japanese and non-Japanese. Higher exposure observed in fed versus fasted state was not considered clinically significant. PK exposure was higher in elderly subjects.

Conclusions:

S.E2027 was well-tolerated following single and multiple administration. E2027 achieved maximal and sustained target engagement at 50 mg QD, the dose selected for the phase 2 clinical trial.
Genetic characteristics of azithromycin-resistant Neisseria gonorrhoeae collected in Hyogo, Japan during 2015–2019
Authors: Miura Makiko , Shigemura Katsumi , Osawa Kayo , Nakanishi Noriko , Nomoto Ryohei , Onishi Reo , Yoshida Hiroyuki , Sawamura Toru , Fang Shiuh-Bin , Chiang Yi-Te , Sung Shian-ying , Chen Kuan-cho , Miyara Takayuki , Fujisawa Masato
Published: June 2022

Introduction. Azithromycin (AZM) is a therapeutic drug for sexually transmitted infections and is used for

Neisseria gonorrhoeae

when first- and second-line drugs are not available. Recently, the susceptibility of

N. gonorrhoeae

against AZM has been decreasing worldwide.

Hypothesis/Gap Statement. Azithromycin-resistance (AZM-R) rates among

N. gonorrhoeae

in Japan are increasing, and the gene mutations and epidemiological characteristics of AZM-R in

N. gonorrhoeae

have not been fully investigated.

Aim. We determined the susceptibility to AZM and its correlation with genetic characteristics of

N. gonorrhoeae

.

Methodology. We investigated the susceptibility to AZM and genetic characteristics of

N. gonorrhoeae

. Mutations in domain V of the 23S rRNA gene and mtrR were examined in 93 isolates, including 13 AZM-R isolates. Spread and clonality were examined using sequence types (STs) of multi-antigen sequence typing for

N. gonorrhoeae

(NG-MAST), and whole genome analysis (WGA) to identify single nucleotide polymorphisms.

Results. The number of AZM-R isolates increased gradually from 2015 to 2019 in Hyogo (P=0.008). C2599T mutations in 23S rRNA significantly increased in AZM-R isolates (P<0.001). NG-MAST ST4207 and ST6762 were frequently detected in AZM-R isolates, and they had higher MICs to AZM from 6 to 24 µg/ml. The phylogenic tree-based WGA showed that all isolates with ST4207 were contained in the same clade, and isolates with ST6762 were divided into two clades, AZM-S isolates and AZM-R isolates, which were different from the cluster containing ST1407.

Conclusion. Our study showed yearly increases in AZM-R rates in

N. gonorrhoeae

. NG-MAST ST4207 and ST6762 were not detected in our previous study in 2015 and were frequently identified in isolates with higher MICs to AZM. WGA confirmed that isolates with these STs are closely related to each other. Continued surveillance is needed to detect the emergence and confirm the spread of NG-MAST ST4207 and ST6762.
Clinical characteristics and antimicrobial susceptibility of Klebsiella pneumoniae, Klebsiella variicola and Klebsiella quasipneumoniae isolated from human urine in Japan
Authors: Watanabe Naoki , Watari Tomohisa , Otsuka Yoshihito , Yamagata Kazufumi , Fujioka Miyuki
Published: June 2022

Introduction. The three

Klebsiella

species

K. pneumoniae

,

K. variicola

and

K. quasipneumoniae

are difficult to distinguish, owing to their similar biochemical properties, and are often confused in medical practice.

Gap statement. There is a scarcity of data comparing the clinical characteristics and antimicrobial susceptibility of

K. pneumoniae

,

K. variicola

and

K. quasipneumoniae

. We believe that knowledge of the characteristics of each species will help in their better identification. Further, knowing the antimicrobial susceptibility of the species will help physicians in prescribing an effective treatment course for

Klebsiella

infections.

Aim. This study aimed to determine the clinical characteristics and antimicrobial resistance of

K. pneumoniae

,

K. variicola

and

K. quasipneumoniae

isolated from human urine samples.

Methodology. This study included 125

K

.

pneumoniae

strains isolated from human urine samples. Multiplex polymerase chain reaction was performed to identify

K. pneumoniae

,

K. variicola

and

K. quasipneumoniae

. We retrospectively investigated the patient background, complications of bacteraemia, antimicrobial susceptibility and extended-spectrum β-lactamase (ESBL).

Results. We identified 84 (67.2 %), 31 (24.8 %) and 10 strains (8 .0%) of

K. pneumoniae

,

K. variicola

and

K. quasipneumoniae

, respectively. There was no difference in patient background and frequency of bacteraemia complications among these species.

K. pneumoniae

was significantly less susceptible than

K. variicola

to ampicillin/sulbactam (P=0.03) and piperacillin (P<0.01). Furthermore,

K. pneumoniae

(79.8 %) was less susceptible to trimethoprim/sulfamethoxazole than

K. variicola

(96.8 %) and

K. quasipneumoniae

(100 %). There were nine ESBL-producing strains (7.2 %), all of which were

K. pneumoniae

.

Conclusion. There was no difference in patient background and frequency of bacteraemia complications between

K. pneumoniae

,

K. variicola

and

K. quasipneumoniae

isolated from urine. The three

Klebsiella

species showed a varying extent of antimicrobial susceptibility and ESBL production, and accurate identification is needed to understand the epidemiology of these species.
How Many Hours Do Internal Medicine Residents At University Of Toronto Spend Onboarding At Hospitals Each Year? A Cross-sectional Survey Study
Authors: Hodzic-Santor Benazir , Prakash Varuna , Raudanskis Ashley , Lorens Edmund , Detsky Allan S. , Fralick Michael
Published: June 2022

Background

Burnout among medical residents is common. One source of burnout is the need to complete redundant administrative tasks such as onboarding processes at various hospitals.

Objectives

To quantify the time residents at the University of Toronto spend onboarding at teaching hospitals, to identify areas of redundancy in onboarding processes, and to identify trainee perceptions of onboarding processes.

Methods

We conducted a quality improvement survey of core internal medicine residents at the University of Toronto where residents rotate through multiple different teaching hospitals. The primary outcome was time spent onboarding. Secondary outcomes included perceptions of the onboarding process, and impact on well-being.

Results

41% (N=93) of all Internal Medicine residents completed the survey. Most (n=81, 87%) rotated through at least four hospitals and 24 (26%) rotated through more than 5 in the preceding year. The median number of hours spent on the onboarding process was 5 hours per hospital (IQR 1-8) and these tasks were often completed when trainees were post-call (82%, n=76) or outside of work hours (97%, n= 90). The cumulative number of hours spent each year on onboarding tasks by the 93 trainees was 2325 hours (97 days) which extrapolates to 5625 hours (234 days) for all 225 trainees in the core internal medicine program. Most residents reported high levels of redundancy across hospital sites (n=79, 85%) and felt that their well-being was negatively affected (73%, n=68).

Conclusions

The median internal medicine resident at the University of Toronto spent 5 hours onboarding for each hospital. There is considerable redundancy and the process contributes to self-reported burnout.
Serotypes and Serogroups implicated in Bacterial meningitis across Ghana
Authors: Weyori Enoch Weikem , Abdul-Karim Abass , Eleeza John Bertson , Bernard Nkrumah , Abubakari Braimah Baba , Kosi Abiwu Hilarius Asiwome , Eugene Kuugbee Dogkotenge , Yidaana Adadow , Nuertey Benjamin , Kojo Adatsi Richard , Azure Stebleson , Mensah Sylvester , Yakubu Etowi Boye , Cheba Valentine Koyiri , Dombadoh Alentis Aba-ifaa
Published: June 2022

Background

Bacterial meningitis is a dangerous infection that can kill children and adults alike. An estimated 1.2 million instances of bacterial meningitis are anticipated to occur globally each year, despite the discovery of polysaccharide and conjugate vaccines in recent years [1]. The study aimed to find out which bacteria isolates are linked to meningitis and to compare the culture method to the rT-PCR method.

Method

This study examined data on bacterial meningitis from the Ghana Health Service’s Public Health Division from 2015 to 2019. Patients’ information was collected from case-based forms held at the Tamale Public Health and Reference Laboratory. The data from the case-based forms was transcribed into a pre-designed Microsoft Excel template. For analysis, the data was cleaned and loaded into Minitab version 18.

Results

There were 2,446 CSM cases documented in all, 34.4 percent were confirmed. Males (52.7%) were more suspected than females (47.3%). Age group 15-44 were affected most (37.5%). The predominant pathogens were Neisseria meningitidis (W135) and Streptococcus pneumoniae (St.1) with NMX, St.14, St.19, and St. 12F/12A/12b as new emerging strains.

Notwithstanding that, low NPV (72.6%), NLR (0.69), and sensitivity (31.8%) of culture method for detected pathogens of bacterial meningitis were found to produce a statistically significant false negatives compared to the gold standard (rT-PCR).

Conclusion

Emergence of new strains of bacterial meningitis and the false negative results chained out by the culture method is alarming.
School bullying and social adaptation in Chinese adolescents: A multiple mediation model of self-disclosure and school connectedness
Authors: Xiang Guo-Xing , Gan Xiong , Wang Pin-Yi , Zhang Rui-Jin , Jin Xin , Li Hao
Published: June 2022

Background

When it comes to the occurrence place of bullying behavior, school can never be ignored because adolescents spend a lot of time in school. School bullying has become a significant social issue among young generations, which influences their healthy growth. However, our understanding of the effects of school bullying is still limited. So, the present study aims to investigate how school bullying affects adolescent social adaptation.

Methods

A sample of 434 Chinese adolescents (56.9% females; Mage=13.07 years, SD=0.93) participated in the survey. Structural equation modeling was adopted to assess the hypothesized model.

Results

The results indicated that school bullying had a direct effect on negative social adaptation rather than positive social adaptation. Moreover, self-disclosure and school connectedness mediated the relationship between school bullying and social adaptation, separately and sequentially.

Conclusions

The present study combines self-disclosure and school connectedness into a multiple mediation model, highlighting the importance of individual and environmental factors in the effects of school bullying on adolescents’ social adaptation. Practically, the current findings may provide some guidance for the prevention and intervention of school bullying and the promotion of social adaptation in adolescents.
Baseline Peripheral Blood Counts and Outcomes in Patients Presenting with COVID-19
Authors: Jeyaraman Preethi , Borah Pronamee , Singh Omender , Dewan Arun , Dayal Nitin , Naithani Rahul
Published: June 2022

Background

SARS-CoV-2 pandemic has significant impact on hematopoietic system.

Objective

To report the incidence and pattern of baseline hematological parameters in patients with COVID-19 and their association with severity of disease and outcome.

Methods

Retrospective observational study.

Results

A total of 440 patients were included in the study. The mean age of the study cohort was 47.5 ±15.8 years. Fifty percent of patients had at least 1 comorbidity. ICU stay was required in 125 (39.6%) patients. Overall mortality in the study cohort was 3.52%. The average age of patients who died was significantly higher than that of patients who were alive (65.1 years vs 46.5 years; p= 0.000). DM, HTN, CAD and CKD were all associated with higher incidence of ICU stay and mortality. Lymphopenia < 1×109/μl was observed in 24.3% and eosinopenia was noted in 44.3% patients. Leukocytosis>11×109/μl was seen in 8.2 % of patients. The median neutrophil lymphocyte ratio (NLR) of whole cohort was 2.63. NLR, Lymphopenia, eosinopenia, leucocytosis, D dimer, lactate dehydrogenase (LDH), ferritin and IL6 levels all were associated with need for ICU transfer and mortality. Hemoglobin, red cell distribution width (RDW), PT and aPTT correlated with need for ICU transfer but not with mortality. Ferritin cutoff ≥751 ng/ml and IL6 levels ≥64pg/ml was able to identify all deaths. Ferritin (0.989) and IL-6 (0.985) had very high negative predictive value.

Conclusions

Peripheral blood counts at time of hospitalization is a simple tool to predict outcomes in patients admitted with Covid-19.
Do children evaluated for maltreatment have higher subsequent emergency department and inpatient care utilization compared to a general pediatric sample?
Authors: Liu Yuerong , Shepherd-Banigan Megan , Evans Kelly , Stilwell Laura , Terrell Lindsay , Hurst Jillian , Gifford Elizabeth J.
Published: June 2022

Background

Child maltreatment leads to substantial adverse health outcomes, but little is known about acute health care utilization patterns after children are evaluated for a concern of maltreatment at a child abuse and neglect medical evaluation clinic.

Objective

To quantify the association of having a child maltreatment evaluation with subsequent acute health care utilization among children from birth to age three.

Participants and Setting

Children who received a maltreatment evaluation (N = 367) at a child abuse and neglect subspecialty clinic in an academic health system in the United States and the general pediatric population (N = 21,231).

Methods

We conducted a retrospective cohort study that compared acute health care utilization over 18 months between the two samples using data from electronic health records. Outcomes were time to first emergency department (ED) visit or inpatient hospitalization, maltreatment-related ED use or inpatient hospitalization, and ED use or inpatient hospitalization for ambulatory care sensitive conditions (ACSCs). Multilevel survival analyses were performed.

Results

Children who received a maltreatment evaluation had an increased hazard for a subsequent ED visit or inpatient hospitalization (hazard ratio [HR]: 1.3, 95% confidence interval [CI]: 1.1, 1.5) and a maltreatment-related visit (HR: 4.4, 95% CI: 2.3, 8.2) relative to the general pediatric population. A maltreatment evaluation was not associated with a higher hazard of health care use for ACSCs (HR: 1.0, 95% CI: 0.7, 1.3).

Conclusion

This work can inform targeted anticipatory guidance to aid high-risk families in preventing future harm or minimizing complications from previous maltreatment.
A systems approach to enhance Lynch syndrome diagnosis through tumor testing
Authors: Singh Vinit , Mezzacappa Catherine , Gershkovich Peter , Di Giovanna Jessica , Ganzak Amanda , Gibson Joanna , Sinard John , Xicola Rosa M. , Llor Xavier
Published: June 2022

Background

Guidelines recommend universal mismatch repair tumor (MMR) testing of colorectal adenocarcinomas (CRC) to screen for Lynch syndrome (LS). However, its implementation remains disjointed and referral for genetic testing dismal, particularly among minorities. We aimed to increase referral, cancer genetic testing, and eventually LS diagnosis by developing a systems approach which, in the second phase was automated.

Methods

This is a cohort study of all patients diagnosed with CRC at an academic center between 1/1/2012 and 1/31/2021. Tumor testing included MMR immunohistochemistry, followed by BRAF V600E/MLH1 promoter methylation testing when indicated. The intervention included a manual phase, which systematized Pathology screening and cancer genetics (CG) referral mechanisms, and an automated phase utilizing computer programming.

Results

A total of 249/1,541 CRC (17.38%) had MMR loss of expression and 129 (8.37%) qualified for CG evaluation. Referral was 27.58% in the original cohort and 92.1% in the intervention (p<0.001). Patients seen by CG among referred were 27.58% in the original cohort and 74.3 % in the intervention (P two-sided <0.001). The distribution of race/ethnicity among patients qualifying and referred for CG evaluation was not significantly different across cohorts. LS diagnosis increased from 0.56% (original cohort) to 1.43% (intervention). Cost per new diagnosis of LS decreased from $173,675 to $87,960 from original cohort to intervention.

Conclusion

Implementation of systematic case identification and referral support mechanisms significantly increased the proportion of patients undergoing genetic testing and doubled the percentage of patients diagnosed with Lynch syndrome with no referral differences across racial/ethnic groups.
Surface anchoring of the Kingella kingae galactan is dependent on the lipopolysaccharide O-antigen
Authors: Montoya Nina R. , Porsch Eric A. , Muñoz Vanessa L. , Muszyński Artur , Vlach Jiri , Hahn David K. , Azadi Parastoo , Sherman Matthew , Yang Hyojik , Chandler Courtney E. , Ernst Robert K. , St. Geme Joseph W.
Published: June 2022

Kingella kingae is a leading cause of bone and joint infections and other invasive diseases in young children. A key K. kingae virulence determinant is a secreted exopolysaccharide that mediates resistance to serum complement and neutrophils and is required for full pathogenicity. The K. kingae exopolysaccharide is a galactofuranose homopolymer called galactan and is encoded by the pamABC genes in the pamABCDE locus. In this study, we sought to define the mechanism by which galactan is tethered on the bacterial surface, a prerequisite for mediating evasion of host immune mechanisms. We found that the pamD and pamE genes are glycosyltransferases and are required for synthesis of an atypical lipopolysaccharide (LPS) O-antigen. The LPS O-antigen in turn is required for anchoring of galactan, a novel mechanism for association of an exopolysaccharide with the bacterial surface.

Significance

Kingella kingae is an emerging pediatric pathogen and produces invasive disease by colonizing the oropharynx, invading the bloodstream, and disseminating to distant sites. This organism produces a uniquely multifunctional exopolysaccharide called galactan that is critical for virulence and promotes intravascular survival by mediating resistance to serum and neutrophils. In this study, we established that at least some galactan is anchored to the bacterial surface via a novel structural interaction with an atypical lipopolysaccharide O-antigen. Additionally, we demonstrated that the atypical O-antigen is synthesized by the pamD and pamE genes, located downstream of the gene cluster responsible for galactan biosynthesis. This work addresses how the K. kingae exopolysaccharide can mediate innate immune resistance and advances understanding of bacterial exopolysaccharides and lipopolysaccharides.
Native RNA sequencing in fission yeast reveals frequent alternative splicing isoforms
Authors: Montañés José Carlos , Huertas Marta , Moro Simone G. , Blevins William R. , Carmona Mercè , Ayté José , Hidalgo Elena , Albà M. Mar
Published: June 2022

The unicellular yeast Schizosaccharomyces pombe (fission yeast) retains many of the splicing features observed in humans and is thus an excellent model to study the basic mechanisms of splicing. Nearly half the genes contain introns, but the impact of alternative splicing in gene regulation and proteome diversification remains largely unexplored. Here we leverage Oxford Nanopore Technologies native RNA sequencing (dRNA), as well as ribosome profiling data, to uncover the full range of polyadenylated transcripts and translated open reading frames. We identify 332 alternative isoforms affecting the coding sequences of 262 different genes, 97 of which occur at frequencies >20%, indicating that functional alternative splicing in S. pombe is more prevalent than previously suspected. Intron retention events make ∼80% of the cases; these events may be involved in the regulation of gene expression and, in some cases, generate novel protein isoforms, as supported by ribosome profiling data in 18 of the intron retention isoforms. One example is the rpl22 gene, in which intron retention is associated with the translation of a protein of only 13 amino acids. We also find that lowly expressed transcripts tend to have longer poly(A) tails than highly expressed transcripts, highlighting an interdependence between poly(A) tail length and transcript expression level. Finally, we discover 214 novel transcripts that are not annotated, including 158 antisense transcripts, some of which also show translation evidence. The methodologies described in this work open new opportunities to study the regulation of splicing in a simple eukaryotic model.
Evolution of transcription factor binding through sequence variations and turnover of binding sites
Authors: Krieger Gat , Lupo Offir , Wittkopp Patricia , Barkai Naama
Published: June 2022

Variations in noncoding regulatory sequences play a central role in evolution. Interpreting such variations, however, remains difficult even in the context of defined attributes such as transcription factor (TF) binding sites. Here, we systematically link variations in cis-regulatory sequences to TF binding by profiling the allele-specific binding of 27 TFs expressed in a yeast hybrid, in which two related genomes are present within the same nucleus. TFs localize preferentially to sites containing their known consensus motifs but occupy only a small fraction of the motif-containing sites available within the genomes. Differential binding of TFs to the orthologous alleles was well explained by variations that alter motif sequence, whereas differences in chromatin accessibility between alleles were of little apparent effect. Motif variations that abolished binding when present in only one allele were still bound when present in both alleles, suggesting evolutionary compensation, with a potential role for sequence conservation at the motif's vicinity. At the level of the full promoter, we identify cases of binding-site turnover, in which binding sites are reciprocally gained and lost, yet most interspecific differences remained uncompensated. Our results show the flexibility of TFs to bind imprecise motifs and the fast evolution of TF binding sites between related species.
Human resource development and turnover intention: organizational commitment's role as a mediating variable
Authors: Rawashdeh Adnan M. , Elayan Malek Bakheet , Shamout Mohamed Dawood , Hamouche Salima
Published: June 2022

Purpose

The purpose of this paper is to examine the effect of human resource development on turnover intention through the mediating role of organizational commitment.

Design/methodology/approach

This paper used a quantitative research design. Data were collected from 204 flight attendants employees working at Royal Jordanian Airlines Company using an email survey questionnaire. Structural equation modeling (SEM) was adopted to test the hypothesized model.

Findings

The results assure positive effect of human resource development (HRD) on organizational commitment. Negative effect of both HRD and organizational commitment to turnover intention is observed. The results also confirm that the effect of HRD on turnover intention is negatively mediated by organizational commitment.

Originality/value

This research paper extends the literature by empirically adducing evidence that organizational commitment negatively mediated the effect of human resource development on turnover intention of the airlines in Jordan.
Introduction: innovation in qualitative research in HRD
Authors: Cho Yonjoo , Grenier Robin , Williams Peter
Published: June 2022

Purpose

The purpose of this paper is to offer a collection of articles that explore some of the many innovative approaches to qualitative inquiry and to challenge HRD scholars and practitioners to consider using innovative approaches in their work. In doing so, qualitative research in HRD can better capture and honour voices, experiences and meaning making of individuals, teams, organizations and communities.

Design/methodology/approach

Using Lê and Schmid’s (2022) definition of innovation in qualitative research, the authors selected four innovative approaches to qualitative research that have the potential to enhance HRD research and practice: use of multiple-case study designs in case study research in HRD, a new take on critical incident technique, a narrative approach of testimonio and a visual approach of participant photography.

Findings

Innovative approaches to qualitative research in this special issue include a review of case study research in HRD by Tkachenkoet al., a new take on the familiar critical incident technique of Watkinset al., a narrative approach to testimonio by Salcedoet al.and a visual approach to participant photography by Hurtienneet al.The last article, by Grenieret al., addresses the implications of these articles to the field of HRD and points to additional directions for innovative qualitative approaches that can help to understand and create more inclusive, democratic and just organizations.

Research limitations/implications

The articles in this special issue are intended to spark a dialogue about the meaning of innovation in qualitative research in HRD. It also can serve as an impetus for considering how innovative approaches to qualitative research can better tackle questions that come from the new normal of the workplace, society and diverse contexts.

Practical implications

This special issue will give HRD scholars and practitioners a realistic, practical view on how innovation in qualitative research can help in exploring specific problems in the workplace. The articles will offer a glimpse into how specific social complex issues can be explored and addressed through innovative approaches, new and tried/modified, to qualitative inquiry.

Originality/value

Four articles introduce new and tried/modified qualitative methods, and their value is in prompting HRD scholars and practitioners to consider some of the innovative approaches in exploring, understanding and transforming the workplace. The final article is a review of more innovative qualitative approaches for HRD scholars and practitioners to understand complex organizational phenomena and promote positive and inclusive change accordingly.
Asymmetric effects of global uncertainty: the socioeconomic and environmental vulnerability of developing countries
Authors: Nguyen Canh Phuc , Schinckus Christophe , Su Thanh Dinh
Published: June 2022

Purpose

This study aims to investigate the influences of global uncertainty indicators volatility on the domestic socioeconomic and environmental vulnerability in a sample of 54 developing countries.

Design/methodology/approach

The two-step system generalized method of moments estimator is recruited to deal with autoregression and endogeneity matter in our dynamic panel data. Seven different global uncertainty indicators (US trade uncertainty; world trade uncertainty; economic policy uncertainty; world commodities and oil prices; the geopolitical risk index and the world uncertainty index) have been mobilized and compared for their empirical impact on the economic (growth and GDP), social (the misery index and income inequality) and environmental (CO2 emissions) vulnerabilities of nations.

Findings

Our empirical estimations suggest that the socioeconomic and environmental vulnerability cannot be solved through the same pattern: all decrease of a particular aspect will necessarily have a cost and an opposite influence on at least one of the other aspects of the nations' vulnerability.

Originality/value

The originality of this article is to combine these three dimensions of vulnerability in the same investigation. To our knowledge, our research is one of the few providing a joint analysis of the influence of global uncertainty on the economic and socioenvironmental countries' vulnerabilities – given the fact social, economic and environmental aspects are at the heart of the UN sustainable goals, our study can be seen as an investigation of the nations' capabilities to work proactively on meaningful sustainable goals in an increasingly uncertain world.