bluuebunny/crossref_metadata_2025 huggingface dataset:
Overemphasis of USMLE and Its Potential Impact on Diversity in Otolaryngology
Authors: Quesada Pompeyo R. , Solis Roberto N. , Ojeaga Macaulay , Yang Nuen T. , Taylor Sandra L. , Diaz Rodney C.
Published: July 2021

Objective

Applicant demographics during the 2019‐2020 residency cycle were evaluated to determine if strict utilization of United States Medical Licensing Examination (USMLE) scores in applicant selection could lead to a restriction in diversity.

Study Design

Cross‐sectional study.

Setting

Otolaryngology residency applicants to a single institution.

Methods

A total of 381 applicants were analyzed by age, gender, applicant type, race/ethnicity, USMLE scores, permanent zip code, and graduating medical school.

Results

Among applicants, 37% were women; 9% were ≥30 years of age; 12% were underrepresented minorities (URMs); 71% to 81% had above‐average socioeconomic surrogate markers; 22% were from a top 25 US News & World Report–ranked institution; and 81% were from an institution with an otolaryngology residency program. There was no increase in applicants who identified as URM from the 2015‐2020 cycles. Multivariable regression analysis showed that applicants who were international medical graduates, URMs, and ≥30 years of age had lower Step 1 and Step 2 scores (P <. 05). Applicants who identified as women had a lower Step 1 score, and those from top 25 National Institutes of Health–funded institutions had a higher Step 1 score; however, there was no difference when Step 2 scores were compared (P >. 05).

Conclusion

Our data suggest that in the pre–USMLE Step 1 pass/fail setting, strict adherence to USMLE scores may lead to disproportionally low recruitment of applicants who are women, ≥30 years of age, URMs, and from institutions without an otolaryngology residency program. We must implement measures against overemphasizing the absolute values of USMLE scores for a true holistic review of applicants, specifically to prevent an overemphasis on the USMLE Step 2 score.
Challenges in the complex management of post-keratoplasty glaucoma
Authors: Anders Lisa-Marie , Gatzioufas Zisis , Grieshaber Matthias C.
Published: July 2021

Glaucoma is a serious complication after corneal transplantation and itself a common cause for graft failure and leading cause of vision loss post-keratoplasty due to corneal endothelial decompensation. Endothelial keratoplasty procedures like Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) may be superior to penetrating keratoplasty (PK) regarding the incidence of elevated intraocular pressure (IOP) and development of glaucoma. There are indications that regardless of the method of keratoplasty, some corneal diseases like pseudophakic bullous keratopathy, corneal perforation, and graft rejection have a higher risk for developing post-keratoplasty glaucoma than keratoconus and corneal dystrophies and likewise respond less to IOP lowering therapy. In this review, the pathophysiology of post-keratoplasty glaucoma, the diagnostic tools with focus on different devices, and their limitations with regard to measuring IOP and the treatment modalities are presented.
Retention of Sterile Compounding Knowledge Among Pharmacy Technicians
Authors: Davis Jameda , Ayars Candace
Published: July 2021

Background: Patient safety is in jeopardy due to a rise in the preparation of adulterated parenteral products with poor technique identified as a significant contributing factor. Pharmacy technicians perform an overwhelming majority of aseptic compounding practices; however, this group’s progressive loss of aseptic technique knowledge has not been documented. Objective: The purpose of this correlational research study was to investigate the association between sterile compounding knowledge and years in the field controlling for formal training in sterile compounding techniques. Methods: An assessment tool of fundamental sterile compounding content was electronically distributed to sterile compounding technician members of pharmacy organizations in the southeastern United States. A multiple regression was conducted to predict sterile compounding knowledge from number of years in the field and prior years of formal compounding training. Results: Sixty-eight assessments were returned complete. The overall model was significant ( P < .0005), explaining 22% of the variance in knowledge retention. Years in the field was the only significant predictor ( P < .001). Each additional year of work experience was associated with a 0.18 drop in the assessment score. Conclusions: The longer pharmacy technicians remain in the field, the more aseptic technique knowledge they will lose. Modeling of poor sterile compounding techniques in the workplace may promote loss of competency of the skill. As a result, a plan to address continuing education for pharmacy technician sterile compounders is necessary to ensure patient safety.
Cyclic evaluation of energy-dissipating hysteretic infilled reinforced concrete frame: A novel approach as low-cost passive energy–dissipating device
Authors: Pachappoyil Nidhin S , Agarwal Pankaj
Published: July 2021

A novel energy-dissipating hysteretic infilled wall system comprising slotted concrete blocks with energy-dissipating links is designed and experimentally tested in a full-scale reinforced concrete frame. Its performance is compared with the conventional (brick) infilled frame as well as bare frame. This infill wall system helps to reduce the stiffening effect and also acts as a secondary load-resisting system that resists lateral loads even after the formation of plastic hinges in the frame. The post-yield response of the frame becomes stable and no collapse condition arises even at a large deformation. This is a kind of low-cost passive energy–dissipating method that may act as an efficient and versatile solution to minimize the damages in frame buildings. A systematic numerical model is developed on the basis of a series of experiments conducted on its constituent units that captures the elastic and post-yield load deformation behavior of the energy-dissipating hysteretic infilled frame under cyclic loading.
HIV-associated Burkitt lymphoma: outcomes from a US-UK collaborative analysis
Authors: Alderuccio Juan Pablo , Olszewski Adam J. , Evens Andrew M. , Collins Graham P. , Danilov Alexey V. , Bower Mark , Jagadeesh Deepa , Zhu Catherine , Sperling Amy , Kim Seo-Hyun , Vaca Ryan , Wei Catherine , Sundaram Suchitra , Reddy Nishitha , Dalla Pria Alessia , D’Angelo Christopher , Farooq Umar , Bond David A. , Berg Stephanie , Churnetski Michael C. , Godara Amandeep , Khan Nadia , Choi Yun Kyong , Kassam Shireen , Yazdy Maryam , Rabinovich Emma , Post Frank A. , Varma Gaurav , Karmali Reem , Burkart Madelyn , Martin Peter , Ren Albert , Chauhan Ayushi , Diefenbach Catherine , Straker-Edwards Allandria , Klein Andreas , Blum Kristie A. , Boughan Kirsten Marie , Mian Agrima , Haverkos Bradley M. , Orellana-Noia Victor M. , Kenkre Vaishalee P. , Zayac Adam , Maliske Seth M. , Epperla Narendranath , Caimi Paolo , Smith Scott E. , Kamdar Manali , Venugopal Parameswaran , Feldman Tatyana A. , Rector Daniel , Smith Stephen D. , Stadnik Andrzej , Portell Craig A. , Lin Yong , Naik Seema , Montoto Silvia , Lossos Izidore S. , Cwynarski Kate
Published: July 2021

Data addressing prognostication in patients with HIV related Burkitt lymphoma (HIV-BL) currently treated remain scarce. We present an international analysis of 249 (United States: 140; United Kingdom: 109) patients with HIV-BL treated from 2008 to 2019 aiming to identify prognostic factors and outcomes. With a median follow up of 4.5 years, the 3-year progression-free survival (PFS) and overall survival (OS) were 61% (95% confidence interval [CI] 55% to 67%) and 66% (95%CI 59% to 71%), respectively, with similar results in both countries. Patients with baseline central nervous system (CNS) involvement had shorter 3-year PFS (36%) compared to patients without CNS involvement (69%; P < .001) independent of frontline treatment. The incidence of CNS recurrence at 3 years across all treatments was 11% with a higher incidence observed after dose-adjusted infusional etoposide, doxorubicin, vincristine, prednisone, cyclophosphamide (DA-EPOCH) (subdistribution hazard ratio: 2.52; P = .03 vs other regimens) without difference by CD4 count 100/mm3. In multivariate models, factors independently associated with inferior PFS were Eastern Cooperative Oncology Group (ECOG) performance status 2-4 (hazard ratio [HR] 1.87; P = .007), baseline CNS involvement (HR 1.70; P = .023), lactate dehydrogenase >5 upper limit of normal (HR 2.09; P < .001); and >1 extranodal sites (HR 1.58; P = .043). The same variables were significant in multivariate models for OS. Adjusting for these prognostic factors, treatment with cyclophosphamide, vincristine, doxorubicin, and high-dose methotrexate, ifosfamide, etoposide, and high-dose cytarabine (CODOX-M/IVAC) was associated with longer PFS (adjusted HR [aHR] 0.45; P = .005) and OS (aHR 0.44; P = .007). Remarkably, HIV features no longer influence prognosis in contemporaneously treated HIV-BL.
Con: Access to advanced therapies for severe asthma should be restricted to patients with satisfactory adherence to maintenance treatment
Authors: Adejumo Ireti , Shaw Dominick E.
Published: July 2021

Current guidance states that advanced therapies should only be used when adherence to maintenance therapy (inhaled corticosteroid/long-acting β-agonist) has been proven. This is based on the costs of advanced therapies, the fact that they were generally trialled as add-ons to maintenance therapy, and the assumed efficacy of maintenance therapy in the majority of adherent patients.

In this pro/con debate, we argue that such a rigid view of access downplays the complex and multifactorial nature of poor adherence. Not only does the evidence indicate a role for psychosocial factors in both poor adherence and poor asthma outcomes, failure of maintenance therapy itself may be a driver of poor adherence behaviours. Some individuals at high risk of poor asthma outcomes will therefore also have poor adherence that is not rapidly amenable to intervention. Rather than punishing them for factors outside of their control, they should be allowed access to advanced therapies in order to reduce their adverse risk resulting from uncontrolled asthma.
Non-coding RNAs in the interaction between rice and Meloidogyne graminicola
Authors: Verstraeten Bruno , Atighi Mohammad Reza , Ruiz-Ferrer Virginia , Escobar Carolina , De Meyer Tim , Kyndt Tina
Published: July 2021

Background

Root knot nematodes (RKN) are plant parasitic nematodes causing major yield losses of widely consumed food crops such as rice (Oryza sativa). Because non-coding RNAs, including small interfering RNAs (siRNA), microRNAs (miRNAs) and long non-coding RNAs (lncRNAs), are key regulators of various plant processes, elucidating their regulation during this interaction may lead to new strategies to improve crop protection. In this study, we aimed to identify and characterize rice siRNAs, miRNAs and lncRNAs responsive to early infection with RKN Meloidogyne graminicola (Mg), based on sequencing of small RNA, degradome and total RNA libraries from rice gall tissues compared with uninfected root tissues.

Results

We found 425 lncRNAs, 3739 siRNAs and 16 miRNAs to be differentially expressed between both tissues, of which a subset was independently validated with RT-qPCR. Functional prediction of the lncRNAs indicates that a large part of their potential target genes code for serine/threonine protein kinases and transcription factors. Differentially expressed siRNAs have a predominant size of 24 nts, suggesting a role in DNA methylation. Differentially expressed miRNAs are generally downregulated and target transcription factors, which show reduced degradation according to the degradome data.

Conclusions

To our knowledge, this work is the first to focus on small and long non-coding RNAs in the interaction between rice and Mg, and provides an overview of rice non-coding RNAs with the potential to be used as a resource for the development of new crop protection strategies.
Genome-wide association screening and verification of potential genes associated with root architectural traits in maize (Zea mays L.) at multiple seedling stages
Authors: Moussa Abdourazak Alio , Mandozai Ajmal , Jin Yukun , Qu Jing , Zhang Qi , Zhao He , Anwari Gulaqa , Khalifa Mohamed Abdelsamiaa Sayed , Lamboro Abraham , Noman Muhammad , Bakasso Yacoubou , Zhang Mo , Guan Shuyan , Wang Piwu
Published: July 2021

Background

Breeding for new maize varieties with propitious root systems has tremendous potential in improving water and nutrients use efficiency and plant adaptation under suboptimal conditions. To date, most of the previously detected root-related trait genes in maize were new without functional verification. In this study, seven seedling root architectural traits were examined at three developmental stages in a recombinant inbred line population (RIL) of 179 RILs and a genome-wide association study (GWAS) panel of 80 elite inbred maize lines through quantitative trait loci (QTL) mapping and genome-wide association study.

Results

Using inclusive composite interval mapping, 8 QTLs accounting for 6.44–8.83 % of the phenotypic variation in root traits, were detected on chromosomes 1 (qRDWv3-1-1 and qRDW/SDWv3-1-1), 2 (qRBNv1-2-1), 4 (qSUAv1-4-1, qSUAv2-4-1, and qROVv2-4-1), and 10 (qTRLv1-10-1, qRBNv1-10-1). GWAS analysis involved three models (EMMAX, FarmCPU, and MLM) for a set of 1,490,007 high-quality single nucleotide polymorphisms (SNPs) obtained via whole genome next-generation sequencing (NGS). Overall, 53 significant SNPs with a phenotypic contribution rate ranging from 5.10 to 30.2 % and spread all over the ten maize chromosomes exhibited associations with the seven root traits. 17 SNPs were repeatedly detected from at least two growth stages, with several SNPs associated with multiple traits stably identified at all evaluated stages. Within the average linkage disequilibrium (LD) distance of 5.2 kb for the significant SNPs, 46 candidate genes harboring substantial SNPs were identified. Five potential genes viz. Zm00001d038676, Zm00001d015379, Zm00001d018496, Zm00001d050783, and Zm00001d017751 were verified for expression levels using maize accessions with extreme root branching differences from the GWAS panel and the RIL population. The results showed significantly (P < 0.001) different expression levels between the outer materials in both panels and at all considered growth stages.

Conclusions

This study provides a key reference for uncovering the complex genetic mechanism of root development and genetic enhancement of maize root system architecture, thus supporting the breeding of high-yielding maize varieties with propitious root systems.
First Chinese case report of Helcococcus kunzii in a patient with diabetic foot
Authors: Li Ruiying , Xiang Lei , Lu Jinghui , Chen Linzhen , Cai Xiangsheng
Published: July 2021

Background

Infection of Helcococcus kunzii(H. kunzii) from diabetic foot wound is rarely reported. This case report describes the infection of H.kunzii and highlights the therapeutic effect on H.kunzii from a diabetic foot wound.

Case presentation

In this study, one H. kunzii strain was isolated from a patient with diabetic foot, which was confirmed by 16S rRNA gene analysis and MALDI-TOF-MS. It is the first Chinese case of H. kunzii in a patient with diabetic foot. As a result of the lack of antibiotic sensitivity data and multiple comorbidities, antibiotics were used cautiously, and those administered during the first 3 months were ineffective. Then, vacuum sealing drainage (VSD) was applied during hospitalization; no antibiotics were used and the wound healed well.

Conclusions

VSD alone may be more effective in treating diabetic feet infected with H. kunzii, which may provide reference for clinical treatment of H. kunzii infection from diabetic foot.
First report of Kingella kingae diagnosed in pediatric bone and joint infections in Morocco
Authors: Moutaouakkil Kaoutar , Oumokhtar Bouchra , Abdellaoui Hicham , El Fakir Samira , Arhoune Btissam , Mahmoud Mustapha , Atarraf Karima , Afifi Moulay Abderrahmane
Published: July 2021

Background

The progress of diagnostic strategies and molecular methods improved the detection ofKingella kingaein bone and joint infections, and now,Kingella kingaeis being increasingly recognized as the most frequent cause of bone and joint infection BJI in early childhood. The main objective of this prospective study is to report the frequency ofKingella Kingaein negative culture bone and joint pediatric infections, and to describe the clinical and biologic features of these children.

Methods

From December 2016 to June 2019, we selected all hospitalized patients with suspected BJI. When culture was negative on the fifth day, children under 10 years were subsequently included in the study, and PCR assay was performed systematically for researchingK. kingaespecific genecpn60. Microbial culture and identification were made using standard bacteriological methods. The demographics, clinical, laboratory, radiographic and clinical features were reviewed from medical records.

Results

We enrolled 65 children with culture negative BJI, 46 of them having under 10 years old have been screened for thecpn60gene. Thus, the gene encodingKingella kingaewas positive for 27 BJI cases (58.7%). The mean age of children was 3.02 years, 55.6% were aged 6 months-4 years and 29.6% of them were aged 5–10 years. The male to female ratio was 1.7 and 16 cases (59.26%) occurred during the fall-winter period. The most frequent BJI type was septic arthritis (77.8%) and the most affected sites were knee (51.9%) and hip (37.0%). We recorded a mild clinical picture with normal to mildly raised inflammatory markers. All patients had good clinical and functional outcomes, with no serious orthopedic sequelae..

Conclusion

K kingaeis an important pathogen of culture-negative BJI in Moroccan children. PCR testing should be performed in culture-negative cases of children not only in the typical age range of 6 months to 4 years. When implemented in the routine clinical microbiology laboratory, a specificK. kingaePCR assay can provide a better diagnostic performance of BJI.
COVID-19 social distancing: negative effects on people with Parkinson disease and their associations with confidence for self-management
Authors: Yogev-Seligmann Galit , Kafri Michal
Published: July 2021

Background

The purpose of this study was to describe the effects of COVID-19 social distancing on the function, health, and well-being of people with Parkinson disease (PD), and test the association of these effects with patients’ activation levels, i.e., their skills and confidence in managing their health.

Methods

Community-dwelling individuals with PD answered an anonymous web-based survey. Part 1 included 27 multiple-choice questions regarding changes in function, health, medical care, and well-being. Part 2 consisted of the Patient Activation Measure, which enquired about skills and confidence in managing one’s health.

Results

Respondents (N = 142) reported decreases in various function (24.8%–37.3%), health (33.8%–43%), and well-being (26.1%–47.1%) domains. Rehabilitation ceased for 61.2%. Among those reporting a worsening of health, 67.8% associated this with the cessation of rehabilitative treatments or decrease in physical activity.

Patients’ activation levels were inversely correlated with increased assistance for activities of daily living, increased tiredness, worsening symptoms, and lack of support from family and friends.

Conclusions

Social distancing had a major negative impact on the health and function of people with PD.

Practical implications

Supporting people with PD skills and confidence in managing health may preserve their physical and mental health during this period of dramatic changes in life’s circumstances.
Correlation between vascular endothelial growth factor pathway and immune microenvironment in head and neck squamous cell carcinoma
Authors: Zhu Chao , Gu Liqun , Liu Zelong , Li Jiang , Yao Mianfeng , Fang Changyun
Published: July 2021

Background

Immunotherapy is a crucial therapeutic approach in oncology. However, most patients with head and neck squamous cell carcinoma (HNSCC) do not derive benefit from immunotherapy. Vascular endothelial growth factor (VEGF)/VEGF Receptor 2 (VEGFR2) signaling pathway is one of the most important pathways regulating angiogenesis in tumor. The combination of immunotherapy and anti-angiogenic therapy is considered to improve efficacy of immunotherapy. The correlation between VEGF signaling pathway and tumor immune microenvironment in HNSCC patients is unclear.

Methods

We utilized RNA sequencing and clinical data of HNSCC patients from the TCGA database to study the correlation between VEGF signaling pathway and tumor immune microenvironment, on aspect of immune cell infiltration, immune-related gene expression profiling and immune-related biological pathways.

Results

We observed that VEGF signaling pathway is positively correlated with immune cell infiltration, immune-related gene expression profiles, and the prognosis of HNSCC patients. The functional enrichment analysis of differentially expressed genes between different VEGF score subtypes detected multiple immune-related biological processes.

Conclusion

Our findings suggested that combining anti-VEGF signaling pathway agents with immunotherapy, such as immune checkpoint inhibitors (ICI) therapy, may exhibit encouraging benefits in HNSCC.
Weight and waist-to-hip ratio change pattern during the first five years of survival: data from a longitudinal observational Chinese breast cancer cohort
Authors: Lei Yuan-Yuan , Ho Suzanne C. , Kwok Carol , Cheng Ashley , Cheung Ka Li , Lee Roselle , Mo Frankie , Yeo Winnie
Published: July 2021

Background

Body weight management was an important component in breast cancer survivorship care. The present study described the change patterns of body weight and waist-to-hip ratio (WHR) during the first 5 years of survival, and investigated potential factors associated with very substantial changes.

Patients and methods

Based on a longitudinal cohort with 1462 Chinese women with breast cancer, anthropometric measurements including body weight, height, waist and hip circumferences were measured by trained interviewers following standard protocol at four time-points: baseline at study entry, 18-, 36- and 60-months follow up assessments (termed as T0, T1, T2 and T3, respectively). Body height was measured at baseline and body weight at cancer diagnosis were retrieved from medical record.

Results

Compared to weight at breast cancer diagnosis, the median weight change was − 0.5 kg, 0 kg, + 0.5 kg, and + 1 kg at T0, T1, T2 and T3, respectively. During the first 5 years of survival, the proportion of women who were obese have slightly increased. At 60-months after diagnosis, only 14.3% of women had weight gain by > 5 kg; and the percentage of women who had weight gain by > 10% was 10.7%. Nearly half of patients had abdominal obesity at study entry, and this proportion were gradually increased to nearly 70% at 60-months follow-up. Multivariate analysis indicated that older age, and frequent sports participation during the first 5 years of survival were related to lower risk of very substantial weight gain (> 10%) at 60-month follow-up; patients aged 40–49 years, having ≥2 comorbidities and ER negative were associated with less likelihood of very substantial WHR substantial increase (> 10%) at 60-month follow-up.

Conclusion

Weight gain was modest in Chinese breast cancer survivors during the first 5 years of survival, while central adiposity has become a contemporary public health issue. The incorporation of healthy weight and abdominal circumference patient education and management has a potential to improve cancer survivorship.
Impact of surgical margin width on long-term outcomes for intrahepatic cholangiocarcinoma: a multicenter study
Authors: Liu Hongzhi , Lin Lianku , Lin Ziguo , Chen Yifan , Huang Qizhen , Ding Lei , Lou Jianying , Zheng Shuguo , Bi Xinyu , Wang Jianming , Guo Wei , Li Fuyu , Wang Jian , Zheng Yamin , Li Jingdong , Cheng Shi , Zhou Weiping , Cheng Zhangjun , Zeng Yongyi
Published: July 2021

Background

The objective of this study was to investigate the survival outcomes of surgical margin width in intrahepatic cholangiocarcinoma (ICC).

Methods

Between November 2011 and August 2017, patients who underwent hepatectomy for ICC were collected from 13 major hepatopancreatobiliary centers in China. The survival outcomes for patients who underwent wide margin hepatectomy (WMH) were compared with those who underwent narrow margin hepatectomy (NMH) using the 1:1 propensity score matching (PSM).

Results

Among 478 included patients, 195 (40.8%) underwent WMH whereas 283 (59.2%) underwent NMH. PSM yielded 79 matched patients with similar baseline characteristics. Patients underwent WMH had a significant better OS and DFS compared with those underwent NMH (before PSM: median OS 27 vs 17 months, P < 0.05; median DFS 15 vs 8 months, P = 0.001, after PSM: median OS 41 vs 22 months, p < 0.05; median DFS 16 vs 10 months, p < 0.05). However, subgroup analysis based on the AJCC staging system, WMH could only improve the survival outcomes in AJCC I ICC patients (Stage I: OS, DFS, P<0.05).

Conclusions

Surgeons should strive to achieve a wide surgical margin for patients with AJCC I ICC to optimize the long-term outcome.
A three-arm single blind randomised control trial of naïve medical students performing a shoulder joint clinical examination
Authors: Brewer P. E. , Racy M. , Hampton M. , Mushtaq F. , Tomlinson J. E. , Ali F. M.
Published: July 2021

Background

Technological advances have previously been hailed as a new dawn in Higher Education, with the advent of ‘massive open online courses’ (MOOCs) and online learning. Virtual platforms have potential advantages such as accessibility and availability but simply transferring educational material to the online environment may not ensure high quality learning. Clinical examination is a fundamental principle of medical assessment, and this study aimed to assess the role of technology in teaching these skills.

Aims/objectives

To determine whether three teaching modalities were of equal efficacy in teaching examination of the shoulder joint to naïve medical students.

Methods

Sixty-seven pre-clinical medical students naïve to large joint examination were recruited. Participants completed a learning style questionnaire and were then block randomised to three study: textbook study, face-to-face seminar, or video tutorial via online platform. The same examination technique was taught in all groups, with the intervention being the method of delivery All second year students were eligible for inclusion. The single exclusion criteria was previous exposure to clinical examination teaching. Students were assessed using a standardised scoring system at baseline (pre-intervention), and days 5 and 19 post-intervention (maximum score 30). Assessors were blinded to group allocation. The primary outcome was assessment score at day 5 post intervention.

Results

There was no difference between the three groups at baseline assessment (mean scores 2.4 for textbook, 2.8 for face-to-face, and 3.1 for video; p = 0.267). Mean post-intervention scores were 16.5 textbook, 25.5 face-to-face, and 22.4 video (p < 0.001, η2 = .449). There was no change between day 5 and day 19 post-intervention assessment scores in any group (p = 0.373), Preferred learning style did not affect scores (p = 0.543).

Conclusion

Face-to-face teaching was the most effective method for teaching clinical examination of the shoulder. Technology can potentially increase accessibility and remove geographic barriers, but is not as effective if teaching techniques are simply mirrored in an online format.

Online platforms allow in depth data analysis of how learners interact with educational material and this may have value in improving the design of online educational materials, and is a potential area for further research.
Scarcity of resources and inequity in access are frequently reported ethical issues for physiotherapists internationally: an observational study
Authors: Fryer Caroline , Sturm Andrea , Roth Roswith , Edwards Ian
Published: July 2021

Background

Little is known about the ethical situations which physiotherapists encounter internationally. This lack of knowledge impedes the ability of the profession to prepare and support physiotherapists in all world regions in their ethical practice. The purpose of the study was to answer the following research questions: What types of ethical issues are experienced by physiotherapists internationally? How frequently are ethical issues experienced by physiotherapists internationally? Can the frequency and type of ethical issue experienced by physiotherapists be predicted by sociodemographic, educational or vocational variables?

Methods

An observational study was conducted in English using an online survey from October 2018 to May 2019. Participants were 1212 physiotherapists and physiotherapy students located internationally which represented less than 1% of estimated number of physiotherapists worldwide at that time. The survey questionnaire contained 13 items requesting demographic detail and knowledge of ethical codes and decision-making, and 46 items asking what frequency participants experienced specific ethical issues in four categories: (A) Physiotherapist and patient interaction (19 items), (B) Physiotherapist and other health professionals including other physiotherapists (10 items), (C) Physiotherapists and the system (5 items) and (D) Professional and economic ethical situations (12 items).

Results

The two most frequently experienced ethical issues were ‘Scarce resources and time affecting quality of physiotherapy treatment’ and ‘Physiotherapy not accessible to all people in society who need it’. These items were experienced, on average, more often than monthly. Interprofessional practice also presented frequent ethical issues for participants. Ethical issues related to the context of ‘Physiotherapists and the system’ were most frequently experienced for all world regions. Working longer years in physiotherapy and learning about ethics in basic physiotherapy education was associated with participants reporting lower frequencies of ethical issues across all contexts.

Conclusion

This study provides the first global profile of ethical issues experienced by physiotherapists. Societal and cultural systems are key influences on physiotherapists’ ethical practice. Physiotherapists globally need support from their work organisations, academic institutions and professional associations, and robust ethical training, to assist them to be active moral agents in their practice.
Exploring polypharmacy with artificial intelligence: data analysis protocol
Authors: Sirois Caroline , Khoury Richard , Durand Audrey , Deziel Pierre-Luc , Bukhtiyarova Olga , Chiu Yohann , Talbot Denis , Bureau Alexandre , Després Philippe , Gagné Christian , Laviolette François , Savard Anne-Marie , Corbeil Jacques , Badard Thierry , Jean Sonia , Simard Marc
Published: July 2021

Background

Polypharmacy is common among older adults and it represents a public health concern, due to the negative health impacts potentially associated with the use of several medications. However, the large number of medication combinations and sequences of use makes it complicated for traditional statistical methods to predict which therapy is genuinely associated with health outcomes. The project aims to use artificial intelligence (AI) to determine the quality of polypharmacy among older adults with chronic diseases in the province of Québec, Canada.

Methods

We will use data from the Quebec Integrated Chronic Disease Surveillance System (QICDSS). QICDSS contains information about prescribed medications in older adults in Quebec collected over 20 years. It also includes diagnostic codes and procedures, and sociodemographic data linked through a unique identification number for each individual. Our research will be structured around three interconnected research axes: AI, Health, and Law&Ethics. The AI research axis will develop algorithms for finding frequent patterns of medication use that correlate with health events, considering data locality and temporality (explainable AI or XAI). The Health research axis will translate these patterns into polypharmacy indicators relevant to public health surveillance and clinicians. The Law&Ethics axis will assess the social acceptability of the algorithms developed using AI tools and the indicators developed by the Heath axis and will ensure that the developed indicators neither discriminate against any population group nor increase the disparities already present in the use of medications.

Discussion

The multi-disciplinary research team consists of specialists in AI, health data, statistics, pharmacy, public health, law, and ethics, which will allow investigation of polypharmacy from different points of view and will contribute to a deeper understanding of the clinical, social, and ethical issues surrounding polypharmacy and its surveillance, as well as the use of AI for health record data. The project results will be disseminated to the scientific community, healthcare professionals, and public health decision-makers in peer-reviewed publications, scientific meetings, and reports. The diffusion of the results will ensure the confidentiality of individual data.
Using human centered design to identify opportunities for reducing inequities in perinatal care
Authors: Nijagal Malini A. , Patel Devika , Lyles Courtney , Liao Jennifer , Chehab Lara , Williams Schyneida , Sammann Amanda
Published: July 2021

Background

Extreme disparities in access, experience, and outcomes highlight the need to transform how pregnancy care is designed and delivered in the United States, especially for low-income individuals and people of color.

Methods

We used human-centered design (HCD) to understand the challenges facing Medicaid-insured pregnant people and design interventions to address these challenges. The HCD method has three phases: Inspiration, Ideation, and Implementation. This study focused on the first and second. In the Inspiration phase we conducted semi-structured interviews with a purposeful sample of stakeholders who had either received or participated in the care of Medicaid-insured pregnant people within our community, with a specific emphasis on representation from marginalized communities. Using a general inductive approach to thematic analysis, we identified themes, which were then framed into design opportunities. In the Ideation phase, we conducted structured brainstorming sessions to generate potential prototypes of solutions, which were tested and iterated upon through a series of community events and engagement with a diverse community advisory group.

Results

We engaged a total of 171 stakeholders across both phases of the HCD methodology. In the Inspiration phase, interviews with 23 community members and an eight-person focus group revealed seven insights centered around two main themes: (1) racism and discrimination create major barriers to access, experience, and the ability to deliver high-value pregnancy care; (2) pregnancy care is overmedicalized and does not treat the pregnant person as an equal and informed partner. In the Ideation phase, 162 ideas were produced and translated into eight solution prototypes. Community scoring and feedback events with 140 stakeholders led to the progressive refinement and selection of three final prototypes: (1) implementing telemedicine (video visits) within the safety-net system, (2) integrating community-based peer support workers into healthcare teams, and (3) delivering co-located pregnancy-related care and services into high-need neighborhoods as a one-stop shop.

Conclusions

Using HCD methodology and a collaborative community-health system approach, we identified gaps, opportunities, and solutions to address perinatal care inequities within our urban community. Given the urgent need for implementable and effective solutions, the design process was particularly well-suited because it focuses on understanding and centering the needs and values of stakeholders, is multi-disciplinary through all phases, and results in prototyping and iteration of real-world solutions.
The immune landscape of the microenvironment of thyroid cancer is closely related to differentiation status
Authors: Cunha Lucas Leite , Domingues Guilherme Augusto Barcelos , Morari Elaine Cristina , Soares Fernando Augusto , Vassallo José , Ward Laura Sterian
Published: July 2021

We have read with great interest the article entitled “Identification of an immune-related signature indicating the dedifferentiation of thyroid cells” by Wang et al. Their data reinforce our own previous results, here compiled. Anaplastic thyroid carcinoma had higher stromal scores, immune scores and enrichment of most immune cells than the control groups, suggesting that the immune microenvironment may correlate with differentiation status in thyroid cancer. We previously demonstrated that the differentiation status expressed by the pattern of protein expression may be related to the profile of immune cell infiltration of differentiated thyroid carcinoma. Wang et al. also explored the differences between the high-risk and low-risk score groups of samples. Among the distinct signaling pathways enriched in the high-risk score group, the epithelial to mesenchymal transition, TNFα signaling, and some common immune-related signaling pathways, including the IL-6/JAK/STAT3 pathway, interferon alpha response, interferon gamma response and inflammatory response were observed with high normalized enrichment score. We also investigated the IL-6 protein immune-histochemical expression in a retrospective study of 114 patients with papillary thyroid carcinoma and 39 patients with follicular thyroid carcinoma. We also obtained samples of 14 normal thyroid tissues from autopsies, 50 goiters and 43 follicular adenoma. We found IL-6 more frequently positive among malignant tumors than non-malignant samples. We demonstrated that IL-6 positivity was associated with infiltration of CD3 + cells, CD16 + cells and CD68 + macrophages. In addition, IL-6 expression was associated with infiltration of activated lymphocytes such as Granzyme B + cells and CD69 + cells. IL-6 positivity was not associated with infiltration of CD4+, CD8+, CD20+, FOXP3+, CD25 + cells but IL-6 was associated with tumor expression of PD-L1, FOXP3, IL-17, COX2, IL-1β, IL-10, CD134, IL-23. In summary, Wang et al. beautiful data reinforce the seminal idea that the immune landscape is closely related to the differentiation status of the tumor. This concept may help select individuals who deserve more careful attention, an essential point in the management of patients with mostly indolent tumors such as those of the thyroid. In fact, our results, here compiled, were obtained with immune-histochemistry, a routine laboratory technique that offers the possibility of simpler and practical execution.
Prognostic factors for ovarian metastases in colorectal cancer patients
Authors: Chen Chao , Wang Da , Ge Xiaoxu , Wang Jian , Huang Yuhuai , Ling Tianyi , Jin Tian , Yang Jinhua , Wang Fengping , Wu Weihong , Sun Lifeng
Published: July 2021

Purpose

The aim of this study was to analyze prognostic factors for ovarian metastases (OM) in colorectal cancer (CRC) using data from a Chinese center. In addition, the study aimed at developing a new clinical scoring system for prognosis of OM of CRC patients after surgery.

Patients and methods

Data of CRC patients with OM were collected from a single Chinese institution (n = 67). Kaplan-Meier analysis was used to evaluate cumulative survival of patients. Factors associated with prognosis of overall survival (OS) were explored using Cox’s proportional hazard regression models. A scoring system to determine effectiveness of prognosis was developed.

Results

Median OS values for patients with or without surgery were 22 and 7 months, respectively.

Size of OM, number of OM, peritoneal metastasis (PM), Peritoneal cancer index (PCI), and completeness of cytoreduction (CC) were associated with OS of patients through univariate analysis. Multivariate analysis using a Cox regression model showed that only CC was an independent predictor for OS. Three variables (the size of OM >15cm, PCI ≥ 10, and carcinoembryonic antigen (CEA) >30 ng/mL) assigned one point each were used to develop a risk score. The resulting score was used for prognosis of OS.

Conclusion

Surgical treatment of metastatic sites is effective and safe for CRC patients with OM. CC-0 is recommended for improved prognosis. The scoring system developed in this study is effective for prediction of OS of patients after surgery.
Effects of low intensity pulsed ultrasound on expression of B-cell lymphoma-2 and BCL2-Associated X in premature ovarian failure mice induced by 4-vinylcyclohexene diepoxide
Authors: Xu Haopeng , Xia Yi , Qin Juan , Xu Jie , Li Chongyan , Wang Yan
Published: July 2021

Background

Premature ovarian failure (POF) is a common disease in the field of Gynecology. Low intensity pulsed ultrasound (LIPUS) can promote tissue repair and improve function. This study was performed to determine the effects of LIPUS on granulosa cells (GCs) apoptosis and protein expression of B-cell lymphoma-2 (Bcl-2) and BCL2-Associated X (Bax) in 4-vinylcyclohexene diepoxide (VCD)-induced POF mice and investigate the mechanisms of LIPUS on ovarian function and reserve capacity.

Methods

The current POF mice model was administrated with VCD (160 mg/kg) by intraperitoneal injection for 15 consecutive days. The mice were divided into the POF group, LIPUS group and control group. In the LIPUS group, the right ovary of mice was treated by LIPUS (acoustic intensity was 200 mW/cm2, frequency was 0.3 MHz, and duty cycle was 20%) for 20 min, 15 consecutive days from day 16. The mice of the POF group and control group were treated without ultrasonic output. The basic observation and body weight were recorded. Hematoxylin and eosin staining (H&E staining) and enzyme-linked immunosorbent assay (ELISA) were applied to detect ovarian follicle development, ovarian morphology and sex hormone secretion. Ovarian GCs apoptosis was detected by TUNEL assay and immunohistochemistry.

Results

The results showed that VCD can induce estrus cycle disorder, follicular atresia, sex hormone secretion decreased and GCs apoptosis in mice to establish POF model successfully. LIPUS significantly promoted follicular development, increased sex hormone secretion, inhibited excessive follicular atresia and GCs apoptosis. The mechanism might be achieved by increasing the protein expression of Bcl-2 and decreasing the expression of Bax in ovaries.

Conclusions

LIPUS can improve the POF induced by VCD. These findings have the potential to provide novel methodological foundation for the future research, which help treat POF patients in the clinic.
Updated research gaps on ending child marriage and supporting married girls for 2020–2030
Authors: Plesons Marina , Travers Ellen , Malhotra Anju , Finnie Arwyn , Maksud Nankali , Chalasani Satvika , Chandra-Mouli Venkatraman
Published: July 2021

Over the past 25 years, tremendous progress has been made in increasing the evidence on child marriage and putting it to good use to reduce the prevalence of child marriage and provide support to married girls. However, there is still much to be done to achieve the Sustainable Development Goal target 5.3 of ending child marriage by 2030, and to meet the needs of the 12 million girls who are still married before age 18 each year. To guide and stimulate future efforts, the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, the World Health Organization, the UNICEF-UNFPA Global Programme to End Child Marriage, and Girls Not Brides: The Global Partnership to End Child Marriage convened an expert group meeting in 2019 to: (1) review the progress made in building the evidence base on child marriage since the publication of research priorities in this area in 2015, (2) identify an updated set of research priorities for the next ten years, and (3) discuss how best to support research coordination, translation, and uptake.

This article provides a summary of the progress made in this area since 2015 and lists an updated set of research gaps and their rationale in four key areas: (1) prevalence, trends, determinants, and correlates of child marriage; (2) consequences of child marriage; (3) intervention effectiveness studies to prevent child marriage and support married girls; and (4) implementation research studies to prevent child marriage and support married girls. It also highlights a number of calls-to-action around research coordination and knowledge translation to support the emerging and evolving needs of the field.
Sexual wellbeing in early adolescence: a cross-sectional assessment among girls and boys in urban Indonesia
Authors: Kågesten Anna E. , Pinandari Anggriyani Wahyu , Page Anna , Wilopo Siswanto Agus , van Reeuwijk Miranda
Published: July 2021

Background

Early adolescence (ages 10–14) is a critical period of physical, cognitive, social and emotional development, which affect sexual and reproductive health and rights (SRHR). Yet, little is known about positive or healthy aspects of sexuality development during this period of life, especially in South East Asia where sexual norms remain restrictive. The objective of this study is to assess the prevalence and correlates of sexual wellbeing among early adolescent girls and boys ages 10–14 years in Indonesia.

Methods

Data for this cross-sectional study were collected as part of the Global Early Adolescent Study via a school-based survey in three Indonesian urban sites in 2018 (N = 4309). We assessed the prevalence of multiple indicators of sexual wellbeing (e.g. SRHR knowledge and communication, gender attitudes, body satisfaction, self-efficacy, freedom from violence) and tested for differences by sex using Chi-square, Student t-test, and Wilcoxon rank-sum test. Multivariable logistic regression models were used to assess the adjusted odds ratio of selected indicators in relation to sociodemographic factors, romantic relationship status, and sexual activities.

Results

The mean age of students was 12 years (53% girls); 90% had started puberty. SRHR knowledge and communication was low overall, but higher among boys than girls. Boys were more likely than girls to report high body satisfaction, less feelings of guilt in relation to sexuality, but also to have experienced physical peer violence. In contrast, girls were more likely to hold gender equal attitudes, greater perceived self-efficacy to say ‘no’, and to report being bullied by boys. In multivariable models, romantic relationship experiences, perceived voice (boys and girls) and decision-making (girls) were associated with three or more indicators of sexual wellbeing.

Conclusions

While young adolescents in Indonesia score high on some aspects of sexual wellbeing, misconceptions, feelings of guilt and uncertainties related to sexuality are common, with clear gender differences. These findings confirm the need for comprehensive sexuality education that begins early in adolescence.