bluuebunny/crossref_metadata_2025 huggingface dataset:
Combined carbon photon and hydrogel therapy mediates the synergistic repair of full-thickness skin wounds
Authors: Yang Fan , Zhou Xiuling , Chen Sitong , Li Qiuju , Li Ronghang , Li Chunying , Shi Chenyu , Zhu Lanyu
Published: August 2020

Objective

This study investigated the synergistic repair effects of Prontosan hydrogel and carbon photon therapy in a rat full-thickness wound model.

Methods

The wavelength distribution of the photon source was determined. Dehydration of the Prontosan hydrogel and fibroblast viability were analyzed following exposure to different durations of light exposure at different distances from the source. Indexes of wound healing in a full-thickness rat wound model were then determined in groups ( n = 8 each) subjected to either no treatment, Prontosan treatment only, carbon photon therapy only, or a combination of the two treatments (synergistic group).

Results

Carbon photon exposure for 15 minutes at a distance of 20 cm from the wound was found to be optimal. Wound healing occurred faster in the synergistic group compared with the control and single-treatment groups. Growth factor secretion, granulation tissue formation, inflammation regulation, collagen deposition, and neovascularization were all higher in the synergistic group.

Conclusions

Prontosan hydrogel combined with carbon photon therapy may provide an optimal environment for wound healing and serve as a novel physical approach to the treatment of wounds. However, the number of animals included in this study was relatively small and a larger study is required to confirm these findings.
Analysis of risk factors for perioperative hidden blood loss in patients undergoing transforaminal lumbar interbody fusion
Authors: Zhang Rui , Xing Fei , Yang Zhuqing , Lin Guoxiong , Chu Jianjun
Published: August 2020

Objective

This study was performed to analyze the correlation between perioperative hidden blood loss (HBL) and the general condition of patients undergoing transforaminal lumbar interbody fusion (TLIF).

Methods

We retrospectively analyzed patients who underwent TLIF from July 2017 to July 2019 in our hospital. Sex, age, body mass index, underlying diseases, American Society of Anesthesiologists classification, coagulation function, preoperative and postoperative hemoglobin level and hematocrit, surgery time, fusion level, intraoperative blood loss, and drainage volume were recorded. Postoperative complications were also recorded. The amount of HBL was calculated, and its correlation with related variables was analyzed.

Results

The mean surgery time was 153.32 ± 54.86 minutes. The total perioperative blood loss was 789.22 ± 499.68 mL, including HBL of 315.69 ± 199.87 mL. Pearson correlation analysis showed statistically significant differences in HBL according to the body mass index, hypertension, fibrinogen, surgery time, and fusion level. Multiple linear regression analysis indicated that the surgery time and fusion level were independent risk factors for HBL.

Conclusions

A certain amount of HBL occurs in TLIF surgery and cannot be ignored in daily clinical work. The operation time and surgery level are independent risk factors for HBL.
An Iliopsoas Impingement Lesion in the Absence of Painful Internal Snapping May Not Require Iliopsoas Fractional Lengthening
Authors: Meghpara Mitchell B. , Bheem Rishika , Diulus Samantha C. , Rosinsky Philip J. , Shapira Jacob , Maldonado David R. , Lall Ajay C. , Domb Benjamin G.
Published: August 2020

Background:

Iliopsoas impingement (IPI) has been associated with a distinct lesion on the anterior labrum. Iliopsoas fractional lengthening (IFL) can treat IPI in instances of painful internal snapping (PIS) and mechanical groin pain.

Purpose:

To report minimum 2-year outcomes of patients without PIS who had an IPI lesion diagnosed intraoperatively that did not undergo IFL (+IPI –PIS –IFL) as compared with a matched group of patients with PIS and an IPI lesion that was treated with IFL (+IPI +PIS +IFL).

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Data on all patients who underwent primary hip arthroscopy between May 2009 and June 2017 were retrospectively reviewed. Patients were included if they underwent hip arthroscopy for femoroacetabular impingement–related pathology, an IPI lesion was diagnosed intraoperatively, and they had minimum 2-year postoperative scores for the following: modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), iHOT-12 (International Hip Outcome Tool–12), patient satisfaction, and visual analog score (VAS) for pain. Patients were propensity score matched based on the following criteria: age, body mass index, follow-up time, sex, labral treatment, femoroplasty, and acetabuloplasty.

Results:

A total of 412 hips were eligible for the current study, of which 336 (81.6%) had 2-year follow-up. The matching process established 37 hips in the +IPI –PIS –IFL group and 87 hips in the +IPI +PIS +IFL group. Both groups experienced significant improvements from presurgery to latest follow-up for all recorded patient-reported outcomes (PROs). The +IPI –PIS –IFL group compared favorably with the +IPI +PIS +IFL group for mHHS (86.0 vs 86.1; P = .53), NAHS (83.0 vs 84.7; P = .40), and HOS-SSS (78.1 vs 76.5; P = .87). Additionally, iHOT-12, VAS, patient satisfaction, and rates of achieving the minimal clinically important difference for mHHS, NAHS, and HOS-SSS were similar between groups at the latest follow-up.

Conclusion:

Patients without PIS who were diagnosed with an IPI lesion intraoperatively and did not undergo IFL had similar and favorable improvements in PROs, VAS, and satisfaction to a matched cohort with PIS who had IFL performed. Thus, an IPI lesion in the absence of PIS may not require IFL.
Allies, Antagonists, or Ambivalent? Exploring Latino Attitudes about the Black Lives Matter Movement
Authors: Corral Álvaro J.
Published: August 2020

While many Latinos suffer the injustices of racial profiling at the hands of law enforcement and immigration officials, differences in immigration status, racial identity, contact with the Black community, and the prevalence anti-Black sentiment pose challenges for coalition building with Blacks. This study explores the factors that lead to an avenue for allyship from the Latino community to the Black community. Using attitudes about the Black Lives Matter (BLM) movement, a series of hypotheses are tested to examine the structure of Latino-Black compared to white-Black coalitions. Two major findings emerge from the analysis; first, differences between whites and Latinos reveal that the effect of harboring anti-Black stereotypes are extraordinarily predictive of rejecting calls for racial social justice and combatting the scourge of police killings of unarmed Black men among whites but not among Latinos. Second, differences according to Latino racial identity and indicators of acculturation also impact support for the BLM movement in ways that both reaffirm but also challenge previous scholarship. These results suggest that while on the whole Latinos, and especially immigrants, are uninformed about BLM, once aware they exhibit a generally supportive stance toward the movement’s goals of criminal justice reform.
Synergistic effect of polyvinylpyrrolidone noncovalently modified graphene and epoxy resin in anticorrosion application
Authors: Wen Shifeng , Ma Jiacheng
Published: August 2020

In this article, polyvinylpyrrolidone (PVP) was used for the noncovalent modification on the surface of graphene. Compared with covalent modification, this method maintained the original structure of graphene layers, thereby maximizing the original properties of graphene. The π–π noncovalent bond was formed between PVP and graphene by X-ray photoelectron spectroscopy analysis, indicating that PVP successfully modified graphene. The thickness of graphene layer was measured by atomic force microscopy, which showed that the distance between graphene layers was increased by 5–6 nm, and the stability of the modified graphene in N, N-dimethylformamide was remarkably improved. The obtained composite coating by combination of the modified graphene and the epoxy resin was subjected to electrochemical impedance test to obtain the best anticorrosive effect of the coating with the graphene content of 0.3 wt%. The results showed that the addition of graphene to the epoxy resin could effectively improve the anticorrosive effect. Meanwhile, the good electrical conductivity allowed the electrons which lost from the substrate to led to air or saline rapidly, thereby reducing the combination of iron ions with oxygen and the generation of corrosion products (iron oxides).
HIV prevalence and associated risk factors among female sex workers in Dar es Salaam, Tanzania: tracking the epidemic
Authors: Mizinduko MM , Moen K , Likindikoki S , Mwijage A , Leyna GH , Makyao N , Leshabari MT , Ramadhan A , Kambi MB , Meyrowitsch D , Tersbøl B , Mmbaga EJ
Published: August 2020

Since 2014, HIV care and treatment services among key populations including female sex workers (FSWs) have intensified in Tanzania. We sought to track the epidemic among FSWs in Dar es Salaam, Tanzania. We conducted a cross-sectional integrated bio-behavioral survey using respondent-driven sampling and a structured questionnaire. Blood was drawn for HIV testing. Modified Poisson regression was used to determine factors associated with HIV infection. We recruited 958 FSWs (median age 26 years) of whom 952 consented to HIV testing. The HIV prevalence was 15.3% (95%CI: 12.5–18.6). Factors associated with higher HIV prevalence included old age (25–34 years: aPR 2.38; 95%CI: 1.23, 4.60 and over 35 years: aPR = 6.08; 95%CI: 3.19, 11.58) and having experienced sexual violence in the past year (aPR = 1.94; 95%CI: 1.34, 2.82). Attaining higher education level was associated with lower HIV prevalence (aPR = 0.51; 95%CI: 0.36, 0.73 for primary school level and aPR = 0.20; 95%CI: 0.08, 0.46 for secondary school level and/or above). The HIV prevalence among FSWs in Dar es Salaam has decreased by half since 2013. Prevention strategies should target older FSWs, aim to educate young girls, and institute approaches to mitigate violence among FSWs.
Random forests for high-dimensional longitudinal data
Authors: Capitaine Louis , Genuer Robin , Thiébaut Rodolphe
Published: August 2020

Random forests are one of the state-of-the-art supervised machine learning methods and achieve good performance in high-dimensional settings where p, the number of predictors, is much larger than n, the number of observations. Repeated measurements provide, in general, additional information, hence they are worth accounted especially when analyzing high-dimensional data. Tree-based methods have already been adapted to clustered and longitudinal data by using a semi-parametric mixed effects model, in which the non-parametric part is estimated using regression trees or random forests. We propose a general approach of random forests for high-dimensional longitudinal data. It includes a flexible stochastic model which allows the covariance structure to vary over time. Furthermore, we introduce a new method which takes intra-individual covariance into consideration to build random forests. Through simulation experiments, we then study the behavior of different estimation methods, especially in the context of high-dimensional data. Finally, the proposed method has been applied to an HIV vaccine trial including 17 HIV-infected patients with 10 repeated measurements of 20,000 gene transcripts and blood concentration of human immunodeficiency virus RNA. The approach selected 21 gene transcripts for which the association with HIV viral load was fully relevant and consistent with results observed during primary infection.
0.9% saline V/S Ringer’s lactate for fluid resuscitation in adult sepsis patients in emergency medical services: An open-label randomized controlled trial
Authors: Golla Rithvik , Kumar Susheel , Dhibhar Deba Prasad , Bhalla Ashish , Sharma Navneet
Published: August 2020

Background:

0.9% saline commonly used for resuscitation of septic patients might induce biochemical changes leading to detrimental effects. Ringer’s lactate being a balanced crystalloid might be beneficial in such a scenario.

Objectives:

We undertook this study to explore in detail the effect of these fluids in the resuscitation of septic patients, and risks and benefits these two fluids would have on the overall prognosis of patients.

Methods:

This was an open-label randomized controlled trial undertaken in emergency medical services attached to the department of medicine at a tertiary care teaching hospital. One hundred sixty adult (⩾18 years old) medical patients admitted with the diagnosis of sepsis fulfilling eligibility criteria were included. They were randomly assigned to receive 0.9% saline or ringer’s lactate. These fluids were given for the initial 24 h only, and after then, the type of fluid given was based on treating physician discretion. Various biochemical parameters were measured at baseline and various time points during the hospital stay. The primary outcome was to find out the incidence of hyperchloremia at 24 h from the time of randomization and during the hospital stay. The secondary outcomes were incidence of acute kidney injury, need for renal replacement therapy; differences in pH, bicarbonate, serum lactate, coagulation parameters, sequential organ failure assessment scores at various time points; and hospital/30-day mortality.

Results:

The baseline characteristics in both groups were comparable. At admission, each group had a serum chloride value which was comparable ( p value: 0.595); however, at 24 and 48 h, a statistically significant difference was noticed, with 0.9% saline group having a higher mean serum chloride value (113.66 ± 10.04 v/s 108.98 ± 8.04 mEq/L, p value: 0.001 at 24 h) and (114.75 ± 9.51 v/s 111.12 ± 7.84 mEq/L, p value: 0.022 at 48 h). At 24 and 48 h post-randomization, the incidence of hyperchloremia was significantly higher in the 0.9% saline group (at 24 h, 0.9% saline: 75.0% v/s Ringer’s lactate: 48.8%, p value: 0.001 and at 48 h, 0.9% saline: 77.2% v/s Ringer’s lactate: 60.3%, p value: 0.022), although there was no difference in the incidence of hyperchloremia recorded during the hospital stay. Acute kidney injury incidence at 24 and 48 h post-randomization was significantly higher in the 0.9% saline group (at 24 h, 0.9% saline: 23.8% v/s Ringer’s lactate: 10.0%, p value: 0.020 and at 48 h, 0.9% saline: 29.1% v/s Ringer’s lactate: 15.4%, p value: 0.039). No significant differences in other secondary outcomes were observed.

Conclusion:

Higher incidence of hyperchloremia and a higher rate of acute kidney injury at 24 and 48 h after randomization were noted in the 0.9% saline group.
The impact of transcranial magnetic stimulation (TMS) on irritability occurring with acute major depressive disorder (MDD)
Authors: Pridmore Saxby , Rybak Marzena , Morey Renée , May Tamara
Published: August 2020

Objective:

To examine the impact (if any) of a course of transcranial magnetic stimulation (TMS) on irritability occurring in association with acute major depressive disorder (MDD).

Method:

In a naturalistic study, patients with MDD according to DSM-5 criteria were given 20 daily TMS treatments. A visual analogue scale for irritability (VAS-I) was developed. Objective tools included the six-item Hamilton Depression Rating Scale (HAMDS6) and the Clinical Global Impression - Severity (CGI-S).

Results:

Fifty patients received 53 courses. Forty-seven courses achieved remission on both HAMD6 and CGI-S and six courses did not achieve remission with either. Irritability significantly reduced when MDD remission was achieved but was unchanged when remission was not achieved.

Conclusion:

TMS reduces irritability occurring in association with MDD when this treatment affects MDD remission, but not when remission is not affected.
Democracy and Entrepreneurship
Authors: Audretsch David B. , Moog Petra
Published: August 2020

Entrepreneurship has been claimed to matter and deserve priority because it has been linked to some of the most compelling economic and social issues of our time. This paper suggests that entrepreneurship is also inextricably linked to a fundamental value common among the western developed economies, democracy. Three distinct contexts are examined to link democracy to entrepreneurship, two historical and one contemporary. The first is National Socialism in Germany, which emerged by suppressing both entrepreneurship and democracy. The second is the rise of the Trusts, or dominant large corporations and concomitant decline of small business in the United States at the end of the nineteenth century. Finally, both measurement and perception suggest a decline in democracy as well as entrepreneurship in the contemporary era. These concerns are only exacerbated in the current Covid-19 crisis. The paper concludes that an important policy mandate for entrepreneurship may be to ensure the independent, decentralized and autonomous decision-making serving as a cornerstone of democracy.
Understanding Hospice Patients’ Beliefs About Their Life Expectancy: A Qualitative Interview Study
Authors: Taber Jennifer M. , Stacey Clare L. , Sheehan Denice K.
Published: August 2020

Background:

Patients with advanced disease often overestimate their life expectancy, which potentially impacts decision making.

Objective:

To examine the nature and source of hospice patients’ life expectancy estimates, about which little is known.

Design:

Using semi-structured interviews, patients were asked to estimate their life expectancy and elaborate on their response.

Setting/Subjects:

Participants were hospice patients ( n = 20, 55% male; 60% cancer).

Measurement:

We conducted thematic analysis using open and focused coding.

Results:

Many participants had difficulty answering the life expectancy question and expressed uncertainty about when they would die. One-third overestimated their length of life relative to actual survival. The most common source of patients’ prognostic beliefs was knowledge about their body, including physical symptoms and change over time. Half of patients reported that a provider had given them a prognostic estimate, and one-third agreed with, or gave estimates consistent with, the provider’s estimate. Some patients said providers do not know prognosis or that time of death was unknowable.

Conclusions:

Key findings were that 1) many hospice patients had difficulty estimating life expectancy, and 2) hospice patients’ life expectancy estimates were frequently based on their body and not on information from medical providers. These findings have implications for measuring prognostic awareness, as valid assessment is a necessary component of determining whether prognostic awareness is beneficial for patients. Future research should examine how life expectancy estimates are associated with well-being and whether results extend to larger samples of patients with advanced disease not in hospice.
Dynamic solution for vehicle–track interaction considering the elastoplasticity of track slabs
Authors: Xu Lei , Yu Zhiwu
Published: August 2020

In this work, an entire multi-rigid-body system with two-stage suspension systems is assumed to run on a slab track system, where the elastoplasticity of the track slab is modeled by Mindlin plate theory considered in a framework of three-dimensional vehicle–track dynamic system. Considering the elastoplasticity of track slabs, the nonlinearity and time- and stress-dependent track slab stiffness matrices must be accounted for in the time-domain dynamic solutions; therefore, a two-step iterative algorithm separating the vehicle–track system into vehicle–rail subsystem and track slab system is developed to solve the dynamic equations of motion for vehicle–track interactions. The numerical studies have shown the accuracy and efficiency of this method in calibrating the vehicle–track dynamic behavior in conditions of track slab elastoplastic deformation. Besides, it has shown that the longitudinal unevenness of the track support stiffness has significant influence on the plasticity of track slabs.
Heading control of a novel finless high-speed supercavitating vehicle with an internal oscillating pendulum
Authors: Mirzaei Mojtaba , Taghvaei Hossein
Published: August 2020

High-speed supercavitating vehicles are surrounded by a huge cavity of gas and only a small portion of the nose and the tail of the vehicle are in contact with the water which leads to a considerable reduction in skin friction drag and reaching very high speeds. High-speed supercavitating vehicles are usually controlled by the cavitator at the nose which controls the pitch and depth of the vehicle and the control surfaces or fins which control the roll and heading angle of the vehicle using the bank-to-turn maneuvering method. However, control surfaces have disadvantages such as the high drag force and ineffectiveness due to the supercavity. Therefore, the purpose of the present study is to eliminate the fins from high-speed supercavitating vehicles and propose a new bank-to-turn heading control of this novel finless high-speed supercavitating vehicle which is composed of the cavitator at the nose and an oscillating pendulum as the internal actuator. Sliding mode control as a robust method is used for the six-degrees-of-freedom model of this finless high-speed vehicle against exposed disturbances. Some design criteria for the design of the internal pendulum in this finless supercavitating vehicle are presented for the damping coefficient, pendulum mass, and radius.
Planning School Transition Through Relational Influence in Chinese Families: Adolescents’ Perspectives
Authors: Wang Ziyu , Satka Mirja , Julkunen Ilse
Published: August 2020

Building on the relational approaches, particularly social relational theory, this study investigates how Chinese adolescents plan their transition to post-compulsory education through relational influences between themselves and their parents. By examining the family and school lives of 25 Chinese adolescents from a small Chinese town, it has been found that they exercise their agency when negotiating their educational future with their parents. Their mixed agentic strategies are embedded in multiple parenting styles and they result in differing levels of agreement. Despite such variation, the adolescent–parent relationship is interpreted as the reliable interdependence across the participants. The findings provide new insights into parental influence on young Chinese people’s educational future and stress the value of the relational approach in studying the family–education nexus.
Revived Originals – A proposal to deal with cultural overtourism
Authors: Frey Bruno S , Briviba Andre
Published: August 2020

The negative external effects from ‘overtourism’ have become a major subject of discussion. However, the shutdown of domestic and international tourism, which resulted in ‘undertourism’, gives us the chance to reconsider how visits to artistic sites should be organized in the future. It is safe to expect that the problem of cultural overtourism will occur again, further deteriorating the state of historic sites. Negative external effects burden the local population, manifesting themselves in overcrowding, vandalism, and pollution. To counter these developments, we propose ‘Revived Originals’, which is a new conceptual approach designed to identically replicate heavily visited historical sites in a suitable other location. With the support of the most advanced digital technology, such as holograms, ‘Revived Originals’ provide a more intense historical experience than provided by the ‘historical’ sites. Our proposal provides an alternative to overcrowded historical sites doomed to destruction by overtourism.
Implementation of a telehealth-enhanced home visiting programme for families of young children
Authors: Jetelina Katelyn K , Oke Oluwaseun , Rodriguez Patricia , Weerakoon Sitara M , Barlow Sarah E
Published: August 2020

Introduction

Health systems are applying innovative solutions, such as telehealth and home visiting, to reduce unnecessary healthcare utilization, including emergency department (ED) visits. A large paediatric healthcare system implemented a telehealth-enhanced home visiting programme as an extension of primary care services. The purpose of this paper is three-fold: (1) Examine the process of implementation and the intermediate clinical outcomes; (2) Evaluate patient experiences and acceptability of the programme post-implementation; (3) Identify system, clinic and patient factors influencing implementation of the home visiting programme.

Methods

Implementation of the telehealth-enhanced home visiting programme occurred from July 2018 to March 2019. Longitudinal electronic health records (EHR) and surveys were triangulated with qualitative data to evaluate the preliminary effectiveness, feasibility, and acceptability of the programme.

Results

Of the 948 eligible families, clinical care staff referred 38% of families to the home visiting programme and 49 families (5%) completed the 12-week home visiting programme. Necessary ED utilization significantly increased post-implementation compared with pre-implementation. Families were overall highly satisfied with the programme and its content. Several factors influenced implementation including outer setting (i.e. patient needs and external policy), inner setting (e.g. poor leadership engagement, fully integrated network, and high tension for change), and individual characteristics (e.g. high self-efficacy).

Conclusions

Once families were enrolled, the programme was fairly successful in addressing patient outcomes. The programme and visit process was highly regarded by families and the unlicensed healthcare professionals. Future programme recommendations, such as small programmatic changes and major improvements in the clinic, should be implemented before widespread dissemination.
Education and Cognitive Functioning Across the Life Span
Authors: Lövdén Martin , Fratiglioni Laura , Glymour M. Maria , Lindenberger Ulman , Tucker-Drob Elliot M.
Published: August 2020

Cognitive abilities are important predictors of educational and occupational performance, socioeconomic attainment, health, and longevity. Declines in cognitive abilities are linked to impairments in older adults’ everyday functions, but people differ from one another in their rates of cognitive decline over the course of adulthood and old age. Hence, identifying factors that protect against compromised late-life cognition is of great societal interest. The number of years of formal education completed by individuals is positively correlated with their cognitive function throughout adulthood and predicts lower risk of dementia late in life. These observations have led to the propositions that prolonging education might (a) affect cognitive ability and (b) attenuate aging-associated declines in cognition. We evaluate these propositions by reviewing the literature on educational attainment and cognitive aging, including recent analyses of data harmonized across multiple longitudinal cohort studies and related meta-analyses. In line with the first proposition, the evidence indicates that educational attainment has positive effects on cognitive function. We also find evidence that cognitive abilities are associated with selection into longer durations of education and that there are common factors (e.g., parental socioeconomic resources) that affect both educational attainment and cognitive development. There is likely reciprocal interplay among these factors, and among cognitive abilities, during development. Education–cognitive ability associations are apparent across the entire adult life span and across the full range of education levels, including (to some degree) tertiary education. However, contrary to the second proposition, we find that associations between education and aging-associated cognitive declines are negligible and that a threshold model of dementia can account for the association between educational attainment and late-life dementia risk. We conclude that educational attainment exerts its influences on late-life cognitive function primarily by contributing to individual differences in cognitive skills that emerge in early adulthood but persist into older age. We also note that the widespread absence of educational influences on rates of cognitive decline puts constraints on theoretical notions of cognitive aging, such as the concepts of cognitive reserve and brain maintenance. Improving the conditions that shape development during the first decades of life carries great potential for improving cognitive ability in early adulthood and for reducing public-health burdens related to cognitive aging and dementia.
Perspectives on the Process of Negative Pressure Wound Therapy at Home in Patients With Chronic Wound: A Qualitative Descriptive Study
Authors: Huang Yao , Hu Jiale , Mao Beiqian , Ni Pengwen , Shou Yuyan , Hou Lili , Xie Ting
Published: August 2020

The purpose of this study was to explore the experience of negative pressure wound therapy (NPWT) at home among Chinese chronic wound patients. Qualitative descriptive study design was adopted, and qualitative data were collected through semistructured in-depth interviews. A purposive, sampling method was used. Informants were recruited from one single wound healing center of a teaching hospital and were interviewed following one course of NPWT at home. A thematic content analysis was undertaken in the framework of input-process-output theory to guide analysis. Of the 13 participants interviewed, 9 were female and 4 were male with an age ranging from 20 to 69 years. Two major categories with their corresponding codes were identified. The first, positive experience, had 6 codes: high-degree identity and feeling hope (input); easy operation and convenience (process); improvement of symptoms and effective treatment (output). The second category, negative experience, had 11 codes: high expenditure, defects of the NPWT device, health education deficiency, and lack of independence and rationales in making decision of NPWT (input); poor communication with wound professionals, unexpected circumstances, therapeutic side effects, and a change of self-image (process); impact on physical symptoms and daily life, impact on social activities, and impact on psychological well-being (output). Patients considered the NPWT at home as a promising regimen, but they also had a feeling of not being prepared and lack of health education to make medical decision independently. The participants’ perceptions and experiences would provide valuable information to promote the intervention program of health education and advance service process optimization.
Contribution of NK cells to HBsAg seroconversion in inactive HBsAg carriers following pegylated IFN therapy
Authors: Cao Zhenhuan , Meng Sha , Zheng Yanhong , Wang Junli , Wang Rui , Chen Xinyue
Published: August 2020

Our recent study showed a high rate of HBsAg seroconversion in inactive HBsAg carriers (IHCs) treated with pegylated IFN (PEG-IFN). To understand the immune-mediated component of the HBsAg seroconversion better, this study investigated the role of NK cells. A total of 44 IHCs were given 48 wk of PEG-IFN. Fifteen cases achieved HBsAg seroconversion (R group), whereas 29 failed (NR group). The proportion and activity (CD107α and IFN-γ production) of NK cells were measured before and during treatment. We found that the proportion of NK cells in the R group was higher than in the NR group at baseline and during PEG-IFN treatment, even when patients were matched for age, sex and treatment period. IFN- γ secretion and CD107α expression from NK cells in cases who achieved HBsAg seroconversion were significantly higher than patients matched for age, sex, HBsAg and treatment period in the NR group at baseline and during PEG-IFN treatment. We also found that in HBsAg seroconversion cases, NK cells activity increased after PEG-IFN treatment, especially before HBsAg seroconversion. These effects were not found in non-responders. In conclusion, we demonstrated that the increase of NK cells accompanied by enhanced activity during PEG-IFN treatment favoured HBsAg seroconversion for IHC, and that NK cells may play a role in HBV seroconversion.
Practice-Based Research Methods and Tools: Introducing the Design Diagnostic
Authors: Nanda Upali , Wingler Deborah
Published: August 2020

Objective:

To introduce a composite tool called Design Diagnostic that allows a rapid but triangulated insight into key areas of a facility combining the methods of shadowing, behavior mapping, surveys, interviews, photo-essays, and parametric analysis to determine key challenges and opportunities for improvement, identify future design drivers, and recommend simple “do-now” changes.

Background:

Research-based practice relies on agile and nimble methods to investigate, evaluate, and apply research in project work. This requires the ability to scale methodologies, so they can provide actionable insights in often constrained time lines. Surveys, observations, space analytics, and lit reviews often need to be done in extremely short periods of time. In this article, we share how these processes can be condensed to meet time constraints of project time lines, with the critical reminder not to generalize contextually derived insights.

Conclusion:

Combining field research (shadowing and behavior mapping) with user engagement (interviews), user feedback (surveys), and analytics of the plan itself allows designers and owners to understand the relationship between design intent and operational outcome and be resource effective in capital planning projects. Scaling these methods to fit the time and resource availability, and ensuring that results are always reviewed and applied in context, is critical.
The Facilitators Package, penal populism and the Rule of Law: Lessons from Italy
Authors: Minetti Marta
Published: August 2020

The past 20 years have witnessed an increase in the attention that the international, national and European policy responses have devoted to irregular immigration and transnational organised crime, with the Facilitators Package being among the protagonists of the criminalising approach adopted by the European legislator. More specifically, provision was drafted and ratified with the aim to tackle irregular migration by strengthening the penal framework on the facilitation of unauthorised entry within the European Union (EU) external borders in ‘the strict sense, and for the purpose of sustaining networks which exploit human beings’. Nevertheless, although its effectiveness in achieving the stated goals has been confirmed in the EU regulatory fitness performance programme (REFIT) assessment by the EU commission released in 2017, the academic judgment has taken a completely different direction, labelling the provision as exemplary of the preventive role taken by EU criminal law. The aim of the article is to analyse the transposition of the Facilitators Package by the Italian legislators and to examine its application within the national legal framework, in order to scrutinise the consequences that the symbolic application of the criminal law provision is having on the Italian jurisdiction in terms of Rule of Law (particularly on the principle of legal certainty).
Classifying Cam Morphology by the Alpha Angle: A Systematic Review on Threshold Values
Authors: van Klij Pim , Reiman Michael P. , Waarsing Jan H. , Reijman Max , Bramer Wichor M. , Verhaar Jan A.N. , Agricola Rintje
Published: August 2020

Background:

The alpha angle is the most often used measure to classify cam morphology. There is currently no agreement on which alpha angle threshold value to use.

Purpose:

To systematically investigate the different alpha angle threshold values used for defining cam morphology in studies aiming to identify this threshold and to determine whether data are consistent enough to suggest an alpha angle threshold to classify cam morphology.

Study Design:

Systematic review; Level of evidence, 3.

Methods:

The Embase, Medline (Ovid), Web of Science, Cochrane Central, and Google Scholar databases were searched from database inception to February 28, 2019. Studies aiming at identifying an alpha angle threshold to classify cam morphology were eligible for inclusion.

Results:

We included 4 case-control studies, 10 cohort studies, and 1 finite-element study from 2437 identified publications. Studies (n = 3) using receiver operating characteristic (ROC) curve analysis to distinguish asymptomatic people from patients with femoroacetabular impingement syndrome consistently observed alpha angle thresholds between 57° and 60°. A 60° threshold was also found to best discriminate between hips with and without cam morphology in a large cohort study based on a bimodal distribution of the alpha angle. Studies (n = 8) using the upper limit of the 95% reference interval as threshold proposed a wide overall threshold range between 58° and 93°. When stratified by sex, thresholds between 63° and 93° in male patients and between 58° and 94° in female patients were reported.

Conclusion:

Based on the available evidence, mostly based on studies using ROC curve analysis, an alpha angle threshold of ≥60° is currently the most appropriate to classify cam morphology. Further research is required to fully validate this threshold.
Subgingival Microbiota during Healthy Pregnancy and Pregnancy Gingivitis
Authors: Balan P. , Brandt B.W. , Chong Y.S. , Crielaard W. , Wong M.L. , Lopez V. , He H.G. , Seneviratne C.J.
Published: August 2020

Introduction:

Previous studies have largely explored the microbial composition and pathogenesis of pregnancy gingivitis. However, the patterns of microbial colonization during pregnancy in the absence of pregnancy gingivitis have rarely been studied. Characterization of the oral microbiome in pregnant women with healthy gingiva is an important initial step in understanding the role of the microbiome in progression to pregnancy gingivitis.

Objectives:

In this study, we compared the oral microbiome of pregnant women without gingivitis (healthy pregnancy) with pregnant women having gingivitis and nonpregnant healthy women to understand how pregnancy modifies the oral microbiome and induces progression to pregnancy gingivitis.

Methods:

Subgingival plaque samples were collected from Chinese pregnant women with gingivitis ( n = 10), healthy pregnant women ( n = 10), and nonpregnant healthy women ( n = 10). The Illumina MiSeq platform was used to perform 16S rRNA gene sequencing targeting the V4 region.

Results:

The alpha and beta diversity was significantly different between pregnant and nonpregnant women, but minimal differences were observed between pregnant women with and without gingivitis. Interestingly, the oral bacterial community showed higher abundance of pathogenic taxa during healthy pregnancy as compared with nonpregnant women despite similar gingival and plaque index scores. However, when compared with overt pregnancy gingivitis, pathogenic taxa were less abundant during healthy pregnancy. PICRUSt analysis (phylogenetic investigation of communities by reconstruction of unobserved states) also suggested no difference in the functional capabilities of the microbiome during pregnancy, irrespective of gingival disease status. However, metabolic pathways related to amino acid metabolism were significantly increased in healthy pregnant women as compared with nonpregnant women.

Conclusion:

The presence of pathogenic taxa in healthy pregnancy and pregnancy gingivitis suggests that bacteria may be necessary for initiating disease development but progression to gingivitis may be influenced by the host environmental factors. More efforts are required to plan interventions aimed at sustaining health before the appearance of overt gingivitis.

Knowledge Transfer Statement:

The results of this study draw attention to the importance of oral health maintenance during pregnancy, as women without any prenatal oral conditions are predisposed to the risk of developing pregnancy gingivitis. Hence, it is important to incorporate comprehensive assessment of oral health in the prenatal health care schedules. Pregnant woman should be screened for oral risks, counseled on proper oral hygiene and expected oral changes, and referred for dental treatment, when necessary.
Contextual Analysis of Stakeholder Opinion on Management and Leadership Competencies for Undergraduate Medical Education: Informing Course Design
Authors: Rajeh Nisreen , Grant Janet , Farsi Jamila , Tekian Ara
Published: August 2020

Background:

The study aimed to conduct a contextual analysis of interviews intended to assist with the future design of a feasible and relevant leadership and management course for undergraduate medical students at King Abdulaziz University (KAU), Saudi Arabia.

Methods:

This was a cross-sectional study conducted at King Abdulaziz University (KAU), Saudi Arabia, during 2019. An exploratory qualitative approach, utilizing systematic content analysis, was used. Data were collected using semi-structured interviews that were conducted with 10 leaders who were stakeholders at KAU, health service providers at KAU hospital, and stakeholders in the Ministry of Health.

Results:

This study revealed critical findings that highlighted the areas in which KAU could instill better and adequate leadership and management skills in their undergraduate medical students. Multiple core categories for a leadership and management curriculum emerged with many interrelated themes. Most participants mentioned that leadership can be taught and that early exposure is beneficial for developing skills. Additionally, they stated that leaders should have a vision and the ability to articulate that vision.

Conclusions:

Different implementation challenges were described in relation to the availability of human resources, the current short supply of suitable teachers, and program design. Teaching methods recommended included simulations, lectures, and a project-based approach. Assessment methods that were recommended included objective structured clinical examination (OSCE), formative and summative assessments, self-assessments, and portfolios.
Imatinib-induced haematuria necessitating drug discontinuation
Authors: Hemakumar Anandu , Pavithran Keechilat
Published: August 2020

Gastrointestinal stromal tumours are rare neoplasms of the gastrointestinal tract that are mesenchymal in origin. The introduction of tyrosine kinase inhibitors resulted in significant improvement in survival of patients with gastrointestinal stromal tumour even in advanced disease conditions. A 43-year-old adult male who is a known case of gastrointestinal stromal tumour of the stomach, on adjuvant therapy with imatinib, presented with a history of gross haematuria of several episodes as well as persistent microhaematuria and was evaluated for the same. He was investigated for all possible causes, but all were negative. The patient was advised to withhold imatinib. Haematuria resolved 1 month after stopping imatinib. Then it was rechallenged. He had recurrence of symptoms, so it was discontinued. In view of the temporal relation of haematuria and administration of imatinib, a diagnosis of imatinib-induced haematuria was made.
Random walks in urban graphs: A minimal model of movement
Authors: Hanna Sean
Published: August 2020

A framework for calculating a weighted random walk on an urban street segment network is described, and tested as a predictor of pedestrian and vehicle movement in London and the wider region. This paper has three aims. First, it proposes the simplest possible model of agency in that individuals have neither memory, goals nor knowledge of the network beyond street segments immediately visible at an intersection. Second, it attempts to reconcile two divergent approaches to urban analysis, graph centrality measures and agent simulation, by demonstrating properties of topological graphs emerge from the lowest level agent behaviour. Third, it aims for far faster computation of relevant features such as the foreground street network and prediction of movement than currently exists. The results show that the idealised random walk predicts observed movement as well as the best existing centrality measures, is several orders of magnitude faster to calculate, and may help to explain movement without perfect knowledge of the map, by demonstrating the street network is structured such that long range information on optimal paths correlates with geometrical features locally visible at each intersection.
Red blood cell adhesion to ICAM-1 is mediated by fibrinogen and is associated with right-to-left shunts in sickle cell disease
Authors: Kucukal Erdem , Man Yuncheng , Quinn Erina , Tewari Neil , An Ran , Ilich Anton , Key Nigel S. , Little Jane A. , Gurkan Umut A.
Published: August 2020

Sickle cell disease (SCD), which afflicts 100 000 Americans, as well as millions worldwide, is associated with anemia, lifelong morbidity, and early mortality. Abnormal adhesion of sickle red blood cells (RBCs) to activated vascular endothelium may contribute acutely to the initiation of painful vaso-occlusive crises and chronically to endothelial damage in SCD. Sickle RBCs adhere to activated endothelium through several adhesion mechanisms. In this study, using whole blood from 17 people with heterozygous SCD (HbS variant) and 55 people with homozygous SCD (HbSS) analyzed in an in vitro microfluidic assay, we present evidence for the adhesion of sickle RBCs to immobilized recombinant intercellular adhesion molecule 1 (ICAM-1). We show that sickle RBC adhesion to ICAM-1 in vitro is associated with evidence of hemolysis in vivo, marked by elevated lactate dehydrogenase levels, reticulocytosis, and lower fetal hemoglobin levels. Further, RBC adhesion to ICAM-1 correlates with a history of intracardiac or intrapulmonary right-to-left shunts. Studies of potential ICAM-1 ligands on RBC membranes revealed that RBC–ICAM-1 interactions were mediated by fibrinogen bound to the RBC membrane. We describe, for the first time, RBC rolling behavior on ICAM-1 under high shear rates. Our results suggest that firm adhesion of sickle RBCs to ICAM-1 most likely occurs in postcapillary venules at low physiological shear rates, which is facilitated by initial rolling in high shear regions (eg, capillaries). Inhibition of RBC and ICAM-1 interactions may constitute a novel therapeutic target in SCD.