bluuebunny/crossref_metadata_2025 huggingface dataset:
Paternal childcare in early childhood and problematic behavior in children: a population-based prospective study in Japan
Authors: Ochi Manami , Fujiwara Takeo
Published: September 2021

Background

There have been numerous reports on the effects of paternal childcare on children’s behavioral development. However, little is known about these effects in Asian countries such as Japan, where fathers do not have sufficient time for childcare due to long working hours. This study explored the association between paternal childcare during toddlerhood in terms of childcare hours and the type of caregiving behavior and subsequent behavioral problems in children aged 5.5 years, stratified by sex.

Methods

We analyzed data from the Longitudinal Survey of Newborns in the twenty-first Century (2001–2006), a population-based cohort survey in Japan (N = 27,870). Paternal childcare was assessed at 18 months in terms of paternal childcare hours on weekdays or weekends and the frequency of each type of childcare (feeding, changing diapers, bathing, putting the child to sleep, playing with the child at home, and taking the child outside). Based on the frequency or lack of paternal involvement, six categories of child behavioral problems were assessed when the children were 5.5 years old. Logistic regression analysis was applied to account for the known confounding variables.

Results

Longer paternal childcare hours, on both weekdays and weekends in toddlerhood, had a protective effect on behavioral problems at 5.5 years of age. The dose-effect relationships were found between the frequency of fathers taking their children outside and behavioral problems in boys, and the frequency of fathers playing with their children at home and behavioral problems in both boys and girls.

Conclusions

Paternal childcare during toddlerhood could prevent subsequent behavioral problems in children. Several specific paternal caregiving behaviors, such as taking their children outside and playing with them at home, may play an important role in preventing subsequent behavioral problems.
Loneliness and problematic internet use: testing the role of interpersonal problems and motivation for internet use
Authors: Wongpakaran Nahathai , Wongpakaran Tinakon , Pinyopornpanish Manee , Simcharoen Sutapat , Kuntawong Pimolpun
Published: September 2021

Background

A number of factors have been demonstrated to be associated with Problematic Internet Use (PIU); otherwise known as Internet Addiction), which is mostly concerned with psychological problems such as loneliness. This study aimed to examine how and in what way loneliness influenced PIU.

Methods

A self-report measurement on loneliness, the Internet addiction test (IAT) and instruments on interpersonal problems were administered to 318 medical students (57% females); mean age totaled 20.88 years (SD = 1.8). We performed a mediation analysis to evaluate direct effects of loneliness on IAT, as well as indirect effects mediated by interpersonal problems. In addition, motivation for internet use was added to the mediation model and tested whether it acted as the second mediator (serial mediation model) or a moderator (moderated mediation model).

Results

After controlling for sex and age, socially inhibited problems exhibited full mediation whereas the remainder showed partial mediation effects, with the exception that intrusive and cold interpersonal problems indicated no mediating role. Negative motivation and motivation for being accepted had mediation effects for all types of interpersonal problems. Motivation for working was found to be a significant mediator and moderator of the most interpersonal problems. Intrusive and cold styles became a mediator only when some motivation variables were added to the model, implying that not only psychological problems should be included when analyzing PIU, but also other variables such motivation for internet use. The percent of variance explained, by IAT score, increased from 13% in the mediation model to 33% by the moderated mediation model, and 43% using the serial mediation model.

Conclusion

The study suggested the crucial role of loneliness and interpersonal problems on PIU, for which motivation for internet use explained how each interpersonal problem would be associated. This may provide some insight regarding the pathological characteristics of those using the internet as a coping strategy.
The role of ideation on the effect of an SBC intervention on consistent bed net use among caregivers of children under 5 years in Nigeria: a multilevel mediation analysis
Authors: Okoh Osabohien Mathew , Olapeju Bolanle , Oyedokun-Adebagbo Foyeke , Inyang Uwem , McCartney-Melstad Anna , Tweedie Ian , Babalola Stella , Storey Douglas
Published: September 2021

Background

Malaria remains a significant public health challenge in Nigeria. Consistent bed net use (sleeping under a treated net every night) has been identified as a key malaria prevention behavior. This paper explores the relationship between mass media social and behavior change interventions, psychosocial factors, and consistent bed net use.

Methods

Data is from the endline survey of a USAID-funded social and behavior change communication campaign conducted from 2012 to 2017 across five states in Nigeria. The outcome measure was consistent bed net use, and the mediator variable was a composite measure called ideation from a set of psychosocial factors believed to influence bed net use. The independent variable was recall of malaria specific media messages. Multilevel mediation analysis explored if recall of malaria specific media messages had any effect on bed net related ideation and if this ideation had any effect on consistent net use.

Results

Respondents included in this study were on average aged 31 years, mostly married or cohabiting (97.5%) and female 75%. Four in 10 (39.7%) respondents were able to recall malaria specific messages. Respondents with low, moderate and high recall were 23, 32 and 80% more likely to have a higher ideational score in the emotional domain compared to those not able to recall. Respondents were more likely to have higher ideational scores in the cognitive domain if they had low (AOR = 1.26, 95% CI 1.15–1.38), moderate (AOR = 1.16, 95% CI 1.00–1.34) or high recall (AOR = 1.55, 95% CI 1.16–2.06), respectively compared to those with no recall. Similarly, respondents with low (AOR = 1.03, 95% CI .99–1.08), moderate (AOR = 1.15, 95% CI 1.08–1.23) and high (AOR = 1.15, 95% CI 1.01–1.30) recall were more likely to have a higher ideational score in the social domain compared to those with no recall. After adjusting for recall of media messages and other potential covariates, all three ideational domains also had a significant positive effect on consistent bed net use. For every unit increase in ideational score, the likelihood of reporting consistent bed net use increased by 5 to 10%. There was a significant indirect effect of recalling malaria specific messages on consistent bed net use through each of the ideational domains.

Conclusion

Access to a bed net is a critical first step in the process of bed net utilization. However, psychosocial factors e.g., emotional, cognitive, and social domains of ideation also play a major role in bed net use. Mass media SBC interventions could potentially influence bed net related ideation and consequently improve net use behavior. Future Social and behavior change interventions should employ approaches that improve these domains of ideation within their audiences in order to increase bed net utilization.
Parental COVID-19 vaccine hesitancy for children: vulnerability in an urban hotspot
Authors: Alfieri Nina L. , Kusma Jennifer D. , Heard-Garris Nia , Davis Matthew M. , Golbeck Emily , Barrera Leonardo , Macy Michelle L.
Published: September 2021

Objective

To compare hesitancy toward a future COVID-19 vaccine for children of various sociodemographic groups in a major metropolitan area, and to understand how parents obtain information about COVID-19.

Methods

Cross-sectional online survey of parents with children < 18 years old in Chicago and Cook County, Illinois, in June 2020. We used logistic regression to determine the odds of parental COVID-19 vaccine hesitancy (VH) for racial/ethnic and socioeconomic groups, controlling for sociodemographic factors and the sources where parents obtain information regarding COVID-19.

Results

Surveys were received from 1702 parents and 1425 were included in analyses. Overall, 33% of parents reported VH for their child. COVID-19 VH was higher among non-Hispanic Black parents compared with non-Hispanic White parents (Odds Ratio (OR) 2.65, 95% Confidence Interval (CI): (1.99–3.53), parents of publicly insured children compared with privately insured (OR 1.93, (1.53–2.42)) and among lower income groups. Parents receive information about COVID-19 from a variety of sources, and those who report using family, internet and health care providers as information sources (compared to those who don’t use each respective source) had lower odds of COVID-19 VH for their children.

Conclusions

The highest rates of hesitancy toward a future COVID-19 vaccine were found in demographic groups that have been the most severely affected by the pandemic. These groups may require targeted outreach efforts from trusted sources of information in order to promote equitable uptake of a future COVID-19 vaccine.
Current status survey of the extramural hospital management of venous thromboembolism after total hip and knee arthroplasty in China
Authors: Tong Kai , Liu Hankun , Qin Jun , Pan Zhengqi , Shangguan Yangfan , Xiao Hao , Wang Hua , Chen Liaobin , Tan Yang
Published: September 2021

Background

Venous thromboembolism (VTE) is a potentially fatal complication after arthroplasty. Numerous prophylactic strategies and studies to reduce VTEs have focused on the duration of the hospital stay and on few extramural hospitals. This study aimed to investigate extramural hospital management of VTE after total hip/knee arthroplasty (THA/TKA) in China with a novel survey tool.

Methods

A total of 180 patients undergoing arthroplasty, including 68 THA patients and 112 TKA patients, were enrolled in this study. All patients received anticoagulant treatment management. A survey querying VTE management and adherence, such as therapy information, understanding of anticoagulation, satisfaction with the ability of medical staff, and satisfaction with health care costs, was administered by a questionnaire (TKA/THA Patients’ Experience with Anticoagulation in the Post-discharge Period) for quality improvement.

Results

The average age of the patients was 65.27 ± 13.62 years. All patients knew their follow-up times. 85 % of them were suggested that re-examine at the next 14 days, and the others at the next 28 days. All patients continued to visit the orthopaedic clinic after discharge without choosing other types of outpatient services, such as an anticoagulant clinic or home visit with a nurse/pharmacist or remote evaluation by telephone. A total of 96.6 % of all patients used new oral anticoagulants, and the most common treatment duration was 2–4 weeks (93.3 %). 48 % informed their physicians that they were taking anticoagulation medications when they visited ophthalmology, dentistry, dermatology, and other departments. The overall rate of satisfaction with anticoagulation management was 81.67 %, and 6.67 % of patients were not unsatisfied with their medical expenses. Patient compliance decreased with increasing follow-up time. Continuous follow-ups after discharge significantly improved patient compliance.

Conclusions

These results elucidate how we can improve the quality of anticoagulation. Continuous follow-up appointments for 30 days after discharge, especially for individuals over 65 years old, significantly improved patient satisfaction and reduced the incidence of VTE and medical costs.
Women’s self-care behavior and its relationship with social capital in Yazd, Iran
Authors: Shiri-Mohammadabad Hamideh , Afshani Seyed Alireza
Published: September 2021

Background

Research on factors affecting self-care is scarce. The social factors, in particular, have not been yet investigated in Iran. Therefore, the present study aimed to investigate the relationship between self-care and social capital among women.

Methods

The participants were 737 women who were living in the marginal, middle and upper areas in the city of Yazd, Iran. Data were collected using a researcher-made self-care questionnaire and Harper’s (Off Natl Stat 11:2019, 2019) Social Capital Scale. The data were analyzed using structural equation modeling by SPSS and Amos v24.

Results

The results showed that the social capital had significant positive effects on the general self-care behavior of the participants (β = 0.56,p < 0.001). It also had significant positive effects on the self-care behavior of women living in the marginal (β = 0.58), middle (β = 0.49) and upper (β = 0.62) parts of the city (p < 0.001). Besides, the women living in the marginal parts had relatively lower levels of self-care compared to those living in the middle and upper parts of the city. The examination of the fit indices indicated that the model has a good fit (CMIN/DF = 2.087, NFI = 0.921, RMSEA = 0.027, CFI = 0.956, TLI = 0.940, GFI = 0.956, IFI = 0.957).

Conclusion

The findings of this study demonstrated that social capital has significant positive effects on the general self-care behavior of women. Therefore, improving their self-care can be achieved through promoting their social capital.
The use of health facility data to assess the effects of armed conflicts on maternal and child health: experience from the Kivu, DR Congo
Authors: Malembaka Espoir Bwenge , Altare Chiara , Bigirinama Rosine Nshobole , Bisimwa Ghislain , Banywesize Robert , Tabbal Nabil , Boerma Ties
Published: September 2021

Background

In conflict-affected settings, data on reproductive, maternal, newborn and child health (RMNCH) are often lacking for priority setting and timely decision-making. We aimed to describe the levels and trends in RMNCH indicators within Kivu provinces between 2015 and 2018, by linking conflict data with health facility (HF) data from the District Health Information System 2 (DHIS2).

Methods

We used data from the DHIS2 for the period 2015–2018, the 2014 Demographic and Health Survey, the 2018 Multiple Indicators Cluster Survey and the Uppsala Conflict Data Program. Health zones were categorised in low, moderate and high conflict intensity level, based on an annual conflict death rate. We additionally defined a monthly conflict death rate and a conflict event-days rate as measures of conflict intensity and insecurity. Outcomes were completion of four antenatal care visits, health facility deliveries, caesarean sections and pentavalent vaccine coverage. We assessed data quality and analyzed coverage and trends in RMNCH indicators graphically, by conflict categories and using HF data aggregated annually. We used a series of fixed-effect regression models to examine the potential dose-response effect of varying conflict intensity and insecurity on RMNCH.

Results

The overall HF reporting was good, ranging between 83.3 and 93.2% and tending to be lower in health zones with high conflict intensity in 2016 and 2017 before converging in 2018. Despite the increasing number of conflict-affected health zones over time, more in North-Kivu than in South-Kivu, we could not identify any clear pattern of variation in RMNCH coverage both by conflict intensity and insecurity. North-Kivu province had consistently reported better RMNCH indicators than South-Kivu, despite being more affected by conflict. The Kivu as a whole recorded higher coverage than the national level. Coverage of RMNCH services calculated from HF data was consistent with population-based surveys, despite year-to-year fluctuation among health zones and across conflict-intensity categories.

Conclusions

Although good in general, the HF reporting rate in the Kivu was negatively impacted by conflict intensity especially at the beginning of the DHIS2’s rolling-up. Routine HF data appeared useful for assessing and monitoring trends in RMNCH service coverage, including in areas with high-intensity conflict.
Can routine health facility data be used to monitor subnational coverage of maternal, newborn and child health services in Uganda?
Authors: Agiraembabazi Geraldine , Ogwal Jimmy , Tashobya Christine , Kananura Rornald Muhumuza , Boerma Ties , Waiswa Peter
Published: September 2021

Background

Routine health facility data are a critical source of local monitoring of progress and performance at the subnational level. Uganda has been using district health statistics from facility data for many years. We aimed to systematically assess data quality and examine different methods to obtain plausible subnational estimates of coverage for maternal, newborn and child health interventions.

Methods

Annual data from the Uganda routine health facility information system 2015–2019 for all 135 districts were used, as well as national surveys for external comparison and the identification of near-universal coverage interventions. The quality of reported data on antenatal and delivery care and child immunization was assessed through completeness of facility reporting, presence of extreme outliers and internal data consistencies. Adjustments were made when necessary. The denominators for the coverage indicators were derived from population projections and health facility data on near-universal coverage interventions. The coverage results with different denominators were compared with the results from household surveys.

Results

Uganda’s completeness of reporting by facilities was near 100% and extreme outliers were rare. Inconsistencies in reported events, measured by annual fluctuations and between intervention consistency, were common and more among the 135 districts than the 15 subregions. The reported numbers of vaccinations were improbably high compared to the projected population of births or first antenatal visits – and especially so in 2015–2016. There were also inconsistencies between the population projections and the expected target population based on reported numbers of antenatal visits or immunizations. An alternative approach with denominators derived from facility data gave results that were more plausible and more consistent with survey results than based on population projections, although inconsistent results remained for substantive number of subregions and districts.

Conclusion

Our systematic assessment of the quality of routine reports of key events and denominators shows that computation of district health statistics is possible with transparent adjustments and methods, providing a general idea of levels and trends for most districts and subregions, but that improvements in data quality are essential to obtain more accurate monitoring.
The burden of recording and reporting health data in primary health care facilities in five low- and lower-middle income countries
Authors: Siyam Amani , Ir Por , York Dararith , Antwi James , Amponsah Freddie , Rambique Ofelia , Funzamo Carlos , Azeez Aderemi , Mboera Leonard , Kumalija Claud John , Rumisha Susan Fred , Mremi Irene , Boerma Ties , O’Neill Kathryn
Published: September 2021

Background

Recording and reporting health data in facilities is the backbone of routine health information systems which provide data collected by health facility workers during service provision. Data is firstly collected in a register, to record patient health data and care process, and tallied into nationally designed reporting forms. While there is anecdotal evidence of large numbers of registers and reporting forms for primary health care (PHC) facilities, there are few systematic studies to document this potential burden on health workers. This multi-country study aimed to document the numbers of registers and reporting forms use at the PHC level and to estimate the time it requires for health workers to meet data demands.

Methods

In Cambodia, Ghana, Mozambique, Nigeria and Tanzania, a desk review was conducted to document registers and reporting forms mandated at the PHC level. In each country, visits to 16 randomly selected public PHC facilities followed to assess the time spent on paper-based recording and reporting. Information was collected through self-reports of estimated time use by health workers, and observation of 1360 provider-patient interactions. Data was primarily collected in outpatient care (OPD), antenatal care (ANC), immunization (EPI), family planning (FP), HIV and Tuberculosis (TB) services.

Result

Cross-countries, the average number of registers was 34 (ranging between 16 and 48). Of those, 77% were verified in use and each register line had at least 20 cells to be completed per patient. The mean time spent on recording was about one-third the total consultation time for OPD, FP, ANC and EPI services combined. Cross-countries, the average number of monthly reporting forms was 35 (ranging between 19 and 52) of which 78% were verified in use. The estimated time to complete monthly reporting forms was 9 h (ranging between 4 to 15 h) per month per health worker.

Conclusions

PHC facilities are mandated to use many registers and reporting forms pausing a considerable burden to health workers. Service delivery systems are expected to vary, however an imperative need remains to invest in international standards of facility-based registers and reporting forms, to ensure regular, comparable, quality-driven facility data collection and use.
Tumor-associated exosomes promote lung cancer metastasis through multiple mechanisms
Authors: Jiang Chunyang , Zhang Na , Hu Xiaoli , Wang Hongyan
Published: September 2021

As an important medium of intercellular communication, exosomes play an important role in information transmission between tumor cells and their microenvironment. Tumor metastasis is a serious influencing factor for poor treatment effect and shortened survival. Lung cancer is a major malignant tumor that seriously threatens human health. The study of the underlying mechanisms of exosomes in tumor genesis and development may provide new ideas for early and effective diagnosis and treatment of lung cancer metastasis. Many studies have shown that tumor-derived exosomes promote lung cancer development through a number of processes. By promoting epithelial–mesenchymal transition of tumor cells, they induce angiogenesis, establishment of the pretransfer microenvironment, and immune escape. This understanding enables researchers to better understand the mechanism of lung cancer metastasis and explore new treatments for clinical application. In this article, we systematically review current research progress of tumor-derived exosomes in metastasis of lung cancer. Although positive progress has been made toward understanding the mechanism of exosomes in lung cancer metastasis, systematic basic research and clinical translational research remains lacking and are needed to translate our scientific understanding toward applications in the clinical diagnosis and treatment of lung cancer metastasis in the near future.
DPYSL2 as potential diagnostic and prognostic biomarker linked to immune infiltration in lung adenocarcinoma
Authors: Wu Yang-Jie , Nai Ai-Tao , He Gui-Cheng , Xiao Fei , Li Zhi-Min , Tang San-Yuan , Liu Yan-Ping , Ai Xiao-Hong
Published: September 2021

Background

Dihydropyrimidinase like 2 (DPYSL2) has been linked to tumor metastasis. However, the function of DPSY2L in lung adenocarcinoma (LUAD) is yet to be explored.

Methods

Herein, we assessed DPYSL2 expression in various tumor types via online databases such as Oncomine and Tumor Immune Estimation Resource (TIMER). Further, we verified the low protein and mRNA expressions of DPYSL2 in LUAD via the ULCAN, The TCGA and GEPIA databases. We applied the ROC curve to examine the role of DPYSL2 in diagnosis. The prognostic significance of DPYSL2 was established through the Kaplan–Meier plotter and the Cox analyses (univariate and multivariate). TIMER was used to explore DPYSL2 expression and its connection to immune infiltrated cells. Through Gene Set Enrichment Analysis, the possible mechanism of DPYSL2 in LUAD was investigated.

Results

In this study, database analysis revealed lower DPYSL2 expression in LUAD than in normal tissues. The ROC curve suggested that expression of DPYSL2 had high diagnostic efficiency in LUAD. The DPYSL2 expression had an association with the survival time of LUAD patients in the Kaplan–Meier plotter and the Cox analyses. The results from TIMER depicted a markedly positive correlation of DPYSL2 expression with immune cells infiltrated in LUAD, such as macrophages, dendritic cells, CD4+ T cells, and neutrophils. Additionally, many gene markers for the immune system had similar positive correlations in the TIMER analysis. In Gene Set Enrichment Analysis, six immune-related signaling pathways were associated with DPYSL2.

Conclusions

In summary, DPYSL2 is a novel biomarker with diagnostic and prognostic potential for LUAD as well as an immunotherapy target.

Highlights

Expression of DPYSL2 was considerably lower in LUAD than in normal tissues.

Investigation of multiple databases showed a high diagnostic value of DPYSL2 in LUAD.

DPYSL2 can independently predict the LUAD outcomes.

Immune-related mechanisms may be potential ways for DPYSL2 to play a role in LUAD.
Genome-wide mRNA profiling identifies the NRF2-regulated lymphocyte oxidative stress status in patients with silicosis
Authors: Zhao Yingzheng , Xu Guangcui , Li Haibin , Chang Meiyu , Xiong Cheng , Tao Yingjun , Guan Yi , Li Yuchun , Yao Sanqiao
Published: September 2021

Background

The immunomodulatory abnormalities of silicosis are related to the lymphocyte oxidative stress state. The potential effect of antioxidant therapy on silicosis may depend on the variation in nuclear factor erythroid 2-related factor 2 (NRF2)-regulated antioxidant genes in peripheral blood mononuclear cells (PBMCs). As NRF2 is a redox-sensitive transcription factor, its possible roles and underlying mechanism in the treatment of silicosis need to be clarified.

Methods

Ninety-two male patients with silicosis and 87 male healthy volunteers were randomly selected. PBMCs were isolated from fresh blood from patients with silicosis and healthy controls. The lymphocyte oxidative stress state was investigated by evaluating NRF2 expression and NRF2-dependent antioxidative genes in PBMCs from patients with silicosis. Key differentially expressed genes (DEGs) and signaling pathways were identified utilizing RNA sequencing (RNA-Seq) and bioinformatics technology. Gene set enrichment analysis was used to identify the differences in NRF2 signaling networks between patients with silicosis and healthy controls.

Results

The number of monocytes was significantly higher in patients with silicosis than that of healthy controls. Furthermore, RNA-Seq findings were confirmed using quantitative polymerase chain reaction and revealed that NRF2-regulated DEGs were associated with glutathione metabolism, transforming growth factor-β, and the extracellular matrix receptor interaction signaling pathway in PBMCs from patients with silicosis. The top 10 hub genes were identified by PPI analysis: SMAD2, MAPK3, THBS1, SMAD3, ITGB3, integrin alpha-V (ITGAV), von Willebrand factor (VWF), BMP4, CD44, and SMAD7.

Conclusions

These findings suggest that NRF2 signaling regulates the lymphocyte oxidative stress state and may contribute to fibrogenic responses in human PBMCs. Therefore, NRF2 might serve as a novel preventive and therapeutic candidate for silicosis.
PACS1-Neurodevelopmental disorder: clinical features and trial readiness
Authors: Van Nuland Abigail , Reddy Taruna , Quassem Farhad , Vassalli Jean-Dominique , Berg Anne T.
Published: September 2021

Background

PACS1-Neurodevelopmental Disorder (PACS1-NDD) is an ultra-rare condition due to a recurrent mutation in the PACS1 gene. Little systematically collected data exist about the functional abilities and neurodevelopmental morbidities in children with PACS1-NDD

Methods

Parents of individuals with PACS1-NDD completed an on-line survey designed collaboratively by researchers, parents, and clinicians. Analyses focused on those with a confirmed R203W variant.

Results

Of 35 individuals with confirmed variants, 18 (51%) were female. The median age was 8 years (interquartile range 4.5–15). Seventeen (49%) had a diagnosis of epilepsy. Twelve (40%, of 30 responding to the question) reported autism and (N = 11/30, 37%) reported features of autism. Most children walked independently (N = 29/32, 91%), had a pincer grasp (N = 23/32, 72%), could feed themselves independently (N = 15/32, 47%), and used speech (N = 23/32, 72%). Sixteen of twenty-nine (55%) had simple pre-academic skills. Neither epilepsy nor autism was associated with functional abilities or other clinical features (all P > 0.05).

Conclusions

PACS1-NDD is a moderately-severe intellectual disability syndrome in which seizures occur but are not a defining or primary feature. Successful precision medicine clinical trials for this ultra-rare disorder must target important core features of this disorder and utilize assessment tools commensurate with the level of function in this clinical population.
The management of multi-morbidity in elderly patients: Ready yet for precision medicine in intensive care?
Authors: Beil Michael , Flaatten Hans , Guidet Bertrand , Sviri Sigal , Jung Christian , de Lange Dylan , Leaver Susannah , Fjølner Jesper , Szczeklik Wojciech , van Heerden Peter Vernon
Published: September 2021

There is ongoing demographic ageing and increasing longevity of the population, with previously devastating and often-fatal diseases now transformed into chronic conditions. This is turning multi-morbidity into a major challenge in the world of critical care. After many years of research and innovation, mainly in geriatric care, the concept of multi-morbidity now requires fine-tuning to support decision-making for patients along their whole trajectory in healthcare, including in the intensive care unit (ICU). This article will discuss current challenges and present approaches to adapt critical care services to the needs of these patients.
A novel Penicillium sumatraense isolate reveals an arsenal of degrading enzymes exploitable in algal bio-refinery processes
Authors: Giovannoni M. , Larini I. , Scafati V. , Scortica A. , Compri M. , Pontiggia D. , Zapparoli G. , Vitulo N. , Benedetti M. , Mattei B.
Published: September 2021

Background

Microalgae are coming to the spotlight due to their potential applications in a wide number of fields ranging from the biofuel to the pharmaceutical sector. However, several factors such as low productivity, expensive harvesting procedures and difficult metabolite extractability limit their full utilization at industrial scale. Similarly to the successful employment of enzymatic arsenals from lignocellulolytic fungi to convert lignocellulose into fermentable sugars for bioethanol production, specific algalytic formulations could be used to improve the extractability of lipids from microalgae to produce biodiesel. Currently, the research areas related to algivorous organisms, algal saprophytes and the enzymes responsible for the hydrolysis of algal cell wall are still little explored.

Results

Here, an algal trap method for capturing actively growing microorganisms was successfully used to isolate a filamentous fungus, that was identified by whole-genome sequencing, assembly and annotation as a novelPenicilliumsumatraenseisolate. The fungus, classified asP.sumatraenseAQ67100, was able to assimilate heat-killedChlorellavulgariscells by an enzymatic arsenal composed of proteases such as dipeptidyl- and amino-peptidases, β-1,3-glucanases and glycosidases including α- and β-glucosidases, β-glucuronidase, α-mannosidases and β-galactosidases. The treatment ofC.vulgariswith the filtrate fromP.sumatraenseAQ67100 increased the release of chlorophylls and lipids from the algal cells by 42.6 and 48.9%, respectively.

Conclusions

The improved lipid extractability fromC.vulgarisbiomass treated with the fungal filtrate highlighted the potential of algal saprophytes in the bioprocessing of microalgae, posing the basis for the sustainable transformation of algal metabolites into biofuel-related compounds.
Is comprehensiveness critical? Comparing short and long format cognitive assessments in preclinical Alzheimer disease
Authors: Hassenstab Jason , Nicosia Jessica , LaRose Megan , Aschenbrenner Andrew J. , Gordon Brian A. , Benzinger Tammie L. S. , Xiong Chengjie , Morris John C.
Published: September 2021

Background

Comprehensive testing of cognitive functioning is standard practice in studies of Alzheimer disease (AD). Short-form tests like the Montreal Cognitive Assessment (MoCA) use a “sampling” of measures, administering key items in a shortened format to efficiently assess cognition while reducing time requirements, participant burden, and administrative costs. We compared the MoCA to a commonly used long-form cognitive battery in predicting AD symptom onset and sensitivity to AD neuroimaging biomarkers.

Methods

Survival, area under the receiver operating characteristic (ROC) curve (AUC), and multiple regression analyses compared the MoCA and long-form measures in predicting time to symptom onset in cognitively normal older adults (n = 6230) from the National Alzheimer’s Coordinating Center (NACC) cohort who had, on average, 2.3 ± 1.2 annual assessments. Multiple regression models in a separate sample (n = 416) from the Charles F. and Joanne Knight Alzheimer Disease Research Center (Knight ADRC) compared the sensitivity of the MoCA and long-form measures to neuroimaging biomarkers including amyloid PET, tau PET, and cortical thickness.

Results

Hazard ratios suggested that both the MoCA and the long-form measures are similarly and modestly efficacious in predicting symptomatic conversion, although model comparison analyses indicated that the long-form measures slightly outperformed the MoCA (HRs > 1.57). AUC analyses indicated no difference between the measures in predicting conversion (DeLong’s test, Z = 1.48, p = 0.13). Sensitivity to AD neuroimaging biomarkers was similar for the two measures though there were only modest associations with tau PET (rs = − 0.13, ps < 0.02) and cortical thickness in cognitively normal participants (rs = 0.15–0.16, ps < 0.007).

Conclusions

Both test formats showed weak associations with symptom onset, AUC analyses indicated low diagnostic accuracy, and biomarker correlations were modest in cognitively normal participants. Alternative assessment approaches are needed to improve how clinicians and researchers monitor cognitive changes and disease progression prior to symptom onset.
Late presentation of a cauda equina lesion with a vulval abscess: a case report
Authors: Ekanayake Chanil Deshan , Weerasekera Deepal , Dissanayake Dilini , Wickramarachchi Ranga , Pushpakumara Saman , Govindapala Dumitha
Published: September 2021

Background

Cauda equina syndrome is a rare clinical condition that requires prompt diagnosis and timely surgical decompression with postoperative rehabilitation to prevent devastating complications.

Case presentation

A 55-year-old Sinhalese woman presented with a vulval abscess, with a history of involuntary leakage of urine for the last 7 years. Her sexual activity has been compromised due to coital incontinence, and she had also been treated for recurrent urinary tract infections during the last 7 years. On examination, a distended bladder was found. Neurological examination revealed a saddle sensory loss of S2–S4 dermatomes. There was no sensory loss over the lower limbs. Bladder sensation was absent, but there was some degree of anal sphincter tone. Motor functions and reflexes were normal in the limbs. Magnetic resonance imaging revealed L5–S1 spondylolisthesis. Ultrasound imaging confirmed the finding of a distended bladder, in addition to bilateral hydroureters with hydronephrosis. An incision and drainage with concomitant intravenous antibiotics were started for the vulval abscess. An indwelling catheter was placed to decompress the bladder and to reduce vulval excoriations due to urine. Bilateral ureteric stenting was performed later for persistent hydronephrosis and hydroureter despite an empty bladder.

Conclusion

This is a tragic case that illustrates the devastating long-term sequelae that ensues if cauda equina syndrome is left undiagnosed. It reiterates the importance of prompt referral and surgical decompression.
Critical iron deficiency anemia with record low hemoglobin: a case report
Authors: Chai Audrey L. , Huang Owen Y. , Rakočević Rastko , Chung Peter
Published: September 2021

Background

Anemia is a serious global health problem that affects individuals of all ages but particularly women of reproductive age. Iron deficiency anemia is one of the most common causes of anemia seen in women, with menstruation being one of the leading causes. Excessive, prolonged, and irregular uterine bleeding, also known as menometrorrhagia, can lead to severe anemia. In this case report, we present a case of a premenopausal woman with menometrorrhagia leading to severe iron deficiency anemia with record low hemoglobin.

Case presentation

A 42-year-old Hispanic woman with no known past medical history presented with a chief complaint of increasing fatigue and dizziness for 2 weeks. Initial vitals revealed temperature of 36.1 °C, blood pressure 107/47 mmHg, heart rate 87 beats/minute, respiratory rate 17 breaths/minute, and oxygen saturation 100% on room air. She was fully alert and oriented without any neurological deficits. Physical examination was otherwise notable for findings typical of anemia, including: marked pallor with pale mucous membranes and conjunctiva, a systolic flow murmur, and koilonychia of her fingernails. Her initial laboratory results showed a critically low hemoglobin of 1.4 g/dL and severe iron deficiency. After further diagnostic workup, her profound anemia was likely attributed to a long history of menometrorrhagia, and her remarkably stable presentation was due to impressive, years-long compensation. Over the course of her hospital stay, she received blood transfusions and intravenous iron repletion. Her symptoms of fatigue and dizziness resolved by the end of her hospital course, and she returned to her baseline ambulatory and activity level upon discharge.

Conclusions

Critically low hemoglobin levels are typically associated with significant symptoms, physical examination findings, and hemodynamic instability. To our knowledge, this is the lowest recorded hemoglobin in a hemodynamically stable patient not requiring cardiac or supplemental oxygen support.
Managing the economic sustainability of the Belt and Road Initiative by applying Pragmatic Identity Matching PrIM
Authors: Erbach Markus
Published: September 2021

Achieving and managing economic sustainability is one of the crucial tasks for our globalized world. One of the most ambitious economic projects known to humankind claims to stand for long-term global economic sustainability including ecological, social, and cultural aspects: the Belt and Road Initiative (BRI), in which China invites the world to join its vision of a “peaceful cooperation for the wealth and cultural exchange of all nations” (Xi Jinping 2013 in his famous speech Promote People-to-People Friendship an Create a Better Future). This invitation led to a wide range of responses, from fundamental rejection to supportive participation. Matching the participants in this megaproject—their contributions, particular prerequisites, and development interests—requires a holistic participative planning approach with solutions tailored specifically to the participating partners. This article shows how Pragmatic Identity Matching (PrIM), a scalable integration framework, can be used to meet this requirement. PrIM provides an identity-oriented infrastructure for aligned planning, implementation and communications, acknowledging, and embracing participants from different cultural backgrounds such as Asian, Arabian, African, Russian, and European cultures. As a structural-scientific approach that synthesizes elemental semiotic thinking and research in psychology and the neurosciences, PrIM provides a meta-planning structure beyond any value-driven positions and perspectives, one that imparts equivalence to information. PrIM can help the BRI avoid a spiral of non-coordinated activities, thereby preventing loss of investment. The formation of a transdisciplinary BRI Management Academy that uses PrIM would help create the necessary infrastructure for a successful and transparent implementation of the BRI.
Simulation-based validation of activity logger data for animal behavior studies
Authors: Chen Jiawei , Brown Geoffrey , Fudickar Adam
Published: September 2021

Bio-loggers are widely used for studying the movement and behavior of animals. However, some sensors provide more data than is practical to store given experiment or bio-logger design constraints. One approach for overcoming this limitation is to utilize data collection strategies, such as non-continuous recording or data summarization that may record data more efficiently, but need to be validated for correctness. In this paper we address two fundamental questions—how can researchers determine suitable parameters and behaviors for bio-logger sensors, and how do they validate their choices? We present a methodology that uses software-based simulation of bio-loggers to validate various data collection strategies using recorded data and synchronized, annotated video. The use of simulation allows for fast and repeatable tests, which facilitates the validation of data collection methods as well as the configuration of bio-loggers in preparation for experiments. We demonstrate this methodology using accelerometer loggers for recording the activity of the small songbird Junco hyemalis hyemalis.
Regularity in distribution, and control, of pests in the hall of mental cultivation, the Forbidden City, Beijing, China
Authors: Zhang Guoqing , Gu An , Wei Le
Published: September 2021

Pests can seriously threaten the safety of organic relics and historic buildings. Every year, the Palace Museum spends a large of money and time preventing and controlling pests, but there is still no a better systematic and targeted method. The Hall of Mental Cultivation is a representative and essential building in the Forbidden City. Through three years of pest monitoring, the species, quantity, and occurrence regularity of the major pests were investigated. During this time, more than ten species of insects were trapped. These included carpet beetles (Anthrenus picturatus hintoni Mroczkowski, 1952 and Thylodrias contractus Motschulsky, 1839), silverfish (Ctenolepisma longicaudata Escherich, 1905), powder-post beetles (Lyctus brunneus Stephens, 1830), booklice (Liposcelis bostrychophila Badonnel, 1931), spider beetles (Ptinus japonicus Reitter, 1877 and Gibbium aequinoctiale Boieldieu, 1865) and the case bearing clothes moths (Tinea pellionella Linnaeus, 1758), among which the Anthrenus picturatus was the primary pests. Abundant resources of organic relics, suitable temperature, humidity, and light environment, and cypress existence are favorable factors for the occurrence of pests, and analysis of these factors is helpful for further integrated pest management (IPM). The period with the most significant number of active pests in the Hall of Mental Cultivation is July and August, and April and May are the rapid growth period. Carpet beetles are the key pests that can affect the overall change trend significantly. It should combine with their living habits, the ideal treatment time and methods, to give them a better control. Fumigation should be done in July and August, while chemical spray should be done referring to the florescence of outdoor trees (March to June), and used of pheromone is reasonable preventative measures.
Measuring the effectiveness of a car seat program in an urban, level one pediatric trauma center
Authors: Budziszewski Ross , Thompson Rochelle , Lucido Thomas , Walker Janelle , Meyer Loreen K. , Arthur L. Grier , Grewal Harsh
Published: September 2021

Background

Motor vehicle collisions (MVCs) are a significant safety issue in the United States. Young children are disproportionally impacted by car accidents and suffer high rates of injuries and mortality. When used properly, car seats have been found to reduce the severity of injuries. However, individuals from low-income areas often do not have access to education or car seats compared to those in suburban or higher income areas. Therefore, the goal of the present study was to measure the effectiveness of a car seat program in an urban, Level I Pediatric Trauma Center on caregiver car seat knowledge.

Methods

Caregivers (N = 200) attended a single, one-hour car seat educational program with a Child Passenger Safety Technician (CPST). The sessions included educational and hands-on components, where caregivers were asked to complete a seven-item pre-post knowledge assessment. For completion of the course, caregivers received a car seat for their child.

Results

A paired t-test revealed that the workshop significantly increased caregiver knowledge from pre-post: t (199) = − 12.56, p < .001; d = 1.27. McNemar’s Chi-Square analyses displayed that caregivers increased in all knowledge categories (p < .001).

Conclusions

While caregivers in urban areas or in low-income areas may have less access to resources, hospital-led car seat courses can increase knowledge of proper car seat usage in these communities. These findings should be used to establish programs in hospitals in areas where these resources are not readily available to caregivers.
Protect Our Kids: a novel program bringing hemorrhage control to schools
Authors: Tobias Joseph , Cunningham Aaron , Krakauer Kelsi , Nacharaju Deepthi , Moss Lori , Galindo Carlos , Roberts Michael , Hamilton Nicholas A. , Olsen Kyle , Emmons Molly , Quackenbush Jim , Schreiber Martin A. , Burns Beech S. , Sheridan David , Hoffman Benjamin , Gallardo Adrienne , Jafri Mubeen A.
Published: September 2021

Background

Following the shooting at Sandy Hook Elementary School, the Hartford Consensus produced the Stop the Bleed program to train bystanders in hemorrhage control. In our region, the police bureau delivers critical incident training to public schools, offering instruction in responding to violent or dangerous situations. Until now, widespread training in hemorrhage control has been lacking. Our group developed, implemented and evaluated a novel program integrating hemorrhage control into critical incident training for school staff in order to blunt the impact of mass casualty events on children.

Methods

The staff of 25 elementary and middle schools attended a 90-minute course incorporating Stop the Bleed into the critical incident training curriculum, delivered on-site by police officers, nurses and doctors over a three-day period. The joint program was named Protect Our Kids. At the conclusion of the course, hemorrhage control kits and educational materials were provided and a four-question survey to assess the quality of training using a ten-point Likert scale was completed by participants and trainers.

Results

One thousand eighteen educators underwent training. A majority were teachers (78.2%), followed by para-educators (5.8%), counselors (4.4%) and principals (2%). Widely covered by local and state media, the Protect Our Kids program was rated as excellent and effective by a majority of trainees and all trainers rated the program as excellent.

Conclusions

Through collaboration between trauma centers, police and school systems, a large-scale training program for hemorrhage control and critical incident response can be effectively delivered to schools.