bluuebunny/crossref_metadata_2025 huggingface dataset:
Perioperative continuation of aspirin, oral anticoagulants or bridging with therapeutic low‐molecular‐weight heparin does not increase intraoperative blood loss and blood transfusion rate in cystectomy patients: an observational cohort study
Authors: Furrer Marc A. , Abgottspon Janine , Huber Markus , Engel Dominique , Löffel Lukas M. , Beilstein Christian M. , Burkhard Fiona C. , Wuethrich Patrick Y.
Published: September 2021

Objective

To assess if uninterrupted anticoagulant agents’ administration affects blood loss and blood transfusion during open radical cystectomy (RC) and urinary diversion.

Patients and Methods

We conducted an observational single‐centre cohort study of a consecutive series of 1430 RC patients, between 2000 and 2020. Blood loss was depicted according to body weight and duration of surgery (mL/kg/h), and blood transfusion. The group ‘with anticoagulant agents’ was considered if surgery was performed with uninterrupted low‐dose aspirin (ASS), oral anticoagulants (OAC) with an international normalised ratio (INR) goal of 2–2.5 or bridging with therapeutic low‐molecular‐weight heparin (LMWH). Outcomes were intraoperative blood loss, blood transfusion rate (separately analysed if administered within 24 h perioperatively or >24 h after surgery) and the 90‐day major adverse cardiac events (MACE) rate. We used propensity score (PS)‐matching analysis to adjust for imbalances between groups with or without anticoagulant agents.

Results

The PS‐matched median (interquartile range [IQR]) blood loss was 2.10 (1.50–2.94) mL/kg/h in patients with anticoagulant agents vs 2.11 (1.47–2.94) mL/kg/h without anticoagulant agents (Padj > 0.99). The PS‐matched blood transfusion rates were 26.2% vs 35.1% (Padj = 0.875) within 24 h perioperatively and 57.0% vs 55.0% (Padj = 0.680) if administered >24 h postoperatively. A sub‐analysis of the three different anticoagulant agents could not detect any significance between ASS, OAC, or LMWH. The PS‐matched incidence of MACE was 9.1% in the group with anticoagulant agents and 8.1% in those without anticoagulant agents (Padj > 0.99). Limitations include selection bias and retrospective analysis from prospectively assessed data.

Conclusions

Perioperative continuation of ASS, uninterrupted OAC with low INR goal or bridging with LMWH had no impact on blood loss and transfusion rate in RC patients. Therefore, there might be no compulsory need for discontinuation of anticoagulant agents.
Circumcision devices versus standard surgical techniques in adolescent and adult male circumcisions: a Cochrane review
Authors: Hohlfeld Ameer Steven‐Jorg , Ebrahim Sumayyah , Zaki Shaik Muhammed , Kredo Tamara
Published: September 2021

Objectives

To assess the effects of device‐based circumcisions compared with standard surgical techniques in adolescent and adult males (10 years old and above).

Methods

We performed a comprehensive search with no restrictions to the language of publication or publication status. We included randomised controlled trials (RCTs) of device‐based circumcisions compared to standard surgical dissection‐based circumcision conducted by health professionals in a medical setting. We reported study results as risk ratios (RRs) or mean differences (MDs) using 95% confidence intervals (CIs) and a random‐effects model. We used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to evaluate the overall certainty of the evidence for each outcome.

Results

A total of 18 trials met the inclusion criteria. These trials did not report severe adverse events (AEs; 11 trials, 3472 participants). There may be a slight increase in moderate AEs for devices compared to surgical techniques (RR 1.31, 95% CI 0.55–3.10; I2 = 68%; 10 trials, 3370 participants; low‐certainty evidence); this corresponds to eight more (ranging from 15 fewer to 84 more) moderate AEs per 1000 participants. We are uncertain about the difference in mild AEs between groups when devices are used compared to surgical techniques (RR 1.09, 95% CI 0.44–2.72; I2 = 91%; 10 trials, 3370 participants; very low‐certainty evidence).

Conclusions

We found no serious AEs using a circumcision device compared to surgical techniques. Still, they may slightly increase moderate AEs, and it is unclear whether there is a difference in mild AEs. High‐quality trials evaluating this intervention are needed to provide further certainty regarding the rates of AEs. Clinicians, patients, and policymakers can use these results combined with their contextual factors to inform the best approach that suits their healthcare settings.
Uncovering the ‘sphinx’ of sphingosine 1‐phosphate signalling: from cellular events to organ morphogenesis
Authors: Cui Mengqiao , Göbel Verena , Zhang Hongjie
Published: September 2021

Sphingosine 1‐phosphate (S1P) is a bioactive sphingolipid metabolite, functioning as a signalling molecule in diverse cellular processes. Over the past few decades, studies of S1P signalling have revealed that the physiological activity of S1P largely depends on S1P metabolizing enzymes, transporters and receptors on the plasma membrane, as well as on the intracellular proteins that S1P binds directly to. In addition to its roles in cancer signalling, immunity and inflammation, a large body of evidence has identified a close link of S1P signalling with organ morphogenesis. Here we discuss the vital role of S1P signalling in orchestrating various cellular events during organ morphogenesis through analysing each component along the extracellular and intracellular S1P signalling axes. For each component, we review advances in our understanding of S1P signalling and function from the upstream regulators to the downstream effectors and from cellular behaviours to tissue organization, primarily in the context of morphogenetic mechanisms. S1P‐mediated vesicular trafficking is also discussed as a function independent of its signalling function. A picture emerges that reveals a multifaceted role of S1P‐dependent pathways in the development and maintenance of organ structure and function.
Residential care in California: Spatial and temporal trends in facility development and care capacity
Authors: Frochen Stephen , Ailshire Jennifer , Rodnyansky Seva , Sheehan Connor
Published: September 2021

The development of residential care has not kept pace with the growth of the older population in many places. We merged the California Department of Social Services residential care for the elderly dataset with census place data to document the growth of facilities and beds per older adults in all of California and in its three largest cities. From 1996 to 2015, residential care steadily increased in California by the number of facilities and beds relative to older adults. However, due to a consistently increasing older adult population, the Cities of San Diego and San Jose experienced gradual and intermittent decline in capacity per older adults, respectively, even as they added many beds to their inventories from the sporadic development of large assisted living and continuing care retirement communities. Additionally, San Jose and Los Angeles exhibited the most overlap in densities of facility development and oldest old adults, with San Diego showing less intersection in cartographic analyses. Understanding facility development and care capacity trends can help local agencies and jurisdictions in the United States and other countries discern whether planning policies and other geographical and development factors appropriately encourage the development of residential care and other long‐term care facilities.
Therapeutic prognostic factors associated with retinal detachment and visual outcomes in acute retinal necrosis
Authors: Choi Eun Young , Lee Dong Hyun , Jun Jae Won , Byeon Suk Ho , Kim Sung Soo , Koh Hyoung Jun , Kim Min
Published: September 2021

Background

Acute retinal necrosis (ARN) is a fulminant necrotizing vaso‐occlusive retinitis associated with a high incidence of vision loss. Prognostic factors associated with the treatment of ARN have not been comprehensively identified. This study aimed to determine therapeutic prognostic factors associated with long‐term clinical outcomes in eyes with ARN.

Methods

This retrospective cohort study included patients with ARN who were treated between 2005 and 2019 in two tertiary ophthalmology departments in Seoul, Korea. Multiple logistic regression analysis was performed to investigate prognostic factors associated with late‐onset retinal detachment (RD) and vision loss (<20/200).

Results

Sixty‐one eyes with ARN with an average follow‐up of 63.5 months were included. Surgical intervention of vitrectomy (odds ratio [OR], 0.04; 95% confidence interval [CI], 0.004–0.47) and intraoperative prophylactic laser use (OR, 0.14; 95% CI, 0.02–0.81) were independently associated with a decreased risk of late RD. The factors independently associated with an increased risk of vision loss were worse initial visual acuity (OR, 3.28; 95% CI, 1.50–7.21), zone 1 involvement of necrotic retinitis (OR, 10.84; 95% CI, 1.62–72.41), and late‐onset RD (OR, 5.38; 95% CI, 1.92–31.54).

Conclusion

Vitrectomy and/or prophylactic intraoperative laser treatment may be effective treatment options in preventing delayed RD associated with an increased risk of vision loss in eyes with ARN.
Zonular defects in loxl1‐deficient zebrafish
Authors: Zhang Min , Sun Shaoyang , Wang Lei , Wang Xu , Chen Tianhui , Chen Zexu , Jiang Yongxiang
Published: September 2021

Background

To investigate the roles of the lysyl oxidase‐like 1 (loxl1) gene in zebrafish eye development and the potency of loxl1 deficiency in mimicking the ocular manifestations of exfoliation syndrome (XFS).

Methods

CRISPR/Cas9 technology was used to generate a frameshift coding deletion in zebrafish loxl1. Expression profiles and ocular manifestations of the wildtype, heterozygous mutant (loxl1+/−) and homozygous mutant (loxl1−/−) zebrafish were analysed in a range of developmental stages from zebrafish larvae to dissected adult zebrafish eyes.

Results

The loxl1 deficiency caused zonular bundling disorders in juvenile zebrafish and accumulation of pearl‐like particles adhering to the adult zebrafish zonule. The bundles appeared to lack form and were thinner in both loxl1+/− and loxl1−/− zebrafish compared with the wildtype (p < 0.01 for all Bonferroni post‐hoc analyses). The zonule of loxl1−/− zebrafish appeared stretched, ragged and torn, with isolated fibres also detected. The particles in loxl1−/− zebrafish were more numerous (counts: 92.33 ± 10.02/100 μm2 vs. 58.33 ± 5.03/100 μm2, p = 0.006), but smaller in size (diameter: 0.21 ± 0.03 μm vs. 0.43 ± 0.04 μm, p = 0.002) compared with those in loxl1+/−. Transmission electron microscopy revealed thinning or even loss of elastic lamina in loxl1+/− Bruch's membrane (BM) (thickness of elastic lamina: 92.94 ± 18.19 nm in the wildtype vs 35.65 ± 14.76 nm in loxl1+/−, p = 0.003). The breakage of BM was observed in loxl1−/−.

Conclusions

The loxl1−/− zebrafish is a promising animal model of XFS zonular pathology.
Surf4 facilitates reprogramming by activating the cellular response to endoplasmic reticulum stress
Authors: Wu Li , He Shengxiang , Ye Wen , Shen Jiacheng , Zhao Kun , Zhang Yanping , Zhang Ran , Wei Junhao , Cao Shuyuan , Chen Kang , Le Rongrong , Xi Chenxiang , Kou Xiaochen , Zhao Yanhong , Wang Hong , Kang Lan , Gao Shaorong
Published: September 2021

Objectives

Maternal factors that are enriched in oocytes have attracted great interest as possible key factors in somatic cell reprogramming. We found that surfeit locus protein 4 (Surf4), a maternal factor, can facilitate the generation of induced pluripotent stem cells (iPSCs) previously, but the mechanism remains elusive.

Materials and Methods

In this study, we investigated the function and mechanism of Surf4 in somatic cell reprogramming using a secondary reprogramming system. Alkaline phosphatase (AP) staining, qPCR and immunofluorescence (IF) staining of expression of related markers were used to evaluate efficiency of iPSCs derived from mouse embryonic fibroblasts. Embryoid body and teratoma formation assays were performed to evaluate the differentiation ability of the iPSC lines. RNA‐seq, qPCR and western blot analysis were applied to validate the downstream targets of Surf4.

Results

Surf4 can significantly facilitate the generation of iPSCs in a proliferation‐independent manner. When co‐expressed with Oct4, Sox2, Klf4 and c‐Myc (OSKM), Surf4 can activate the response to endoplasmic reticulum (ER) stress at the early stage of reprogramming. We further demonstrated that Hspa5, a major ER chaperone, and the active spliced form of Xbp1 (sXbp1), a major mediator of ER stress, can mimic the effects of Surf4 on somatic cell reprogramming. Concordantly, blocking the unfolded protein response compromises the effect of Surf4 on reprogramming.

Conclusions

Surf4 promotes somatic cell reprogramming by activating the response to ER stress.
Challenges and opportunities with social inclusion and community‐based water management in Solomon Islands
Authors: Love Mark William , Beal Cara , Gonzalez Diana , Hagabore Joe , Benjamin Collin , Bugoro Hugo , Panda Nixon , O'oi Jael , Offer Carol , Souter Regina
Published: September 2021

Motivation

Rural water services are poor in Pacific Island countries (PICs); ineffective water management (WM) is one of the key reasons. Greater social inclusion in WM groups is a key goal of Sustainable Development Goal (SDG) 6, but there is a lack of data on the make‐up of WM groups and what appropriate and effective inclusivity in WM looks like in the region.

Purpose

This article contributes to filling these gaps by examining national community WM policy and the attributes and activities of rural WM groups, in practice, in villages across Solomon Islands. The purpose is to influence government policy and guidance relating to the structure and functionality of rural WM groups.

Methods and approach

Qualitative and quantitative data were gathered from eight rural communities in Solomon Islands between 2018 and 2020 by a team of international and local Solomon Islander researchers. Detailed data from six formalized WM groups along with an analysis of national policy and rural WM guidelines are used to identify strengths and weaknesses in current WM policy and approaches.

Findings

WM group inclusivity has improved with regard to women, but they still often remain excluded from decision‐making. Young people are essential to the ongoing operation of water systems yet were rarely formal members of water committees. Intra‐village levels of social cohesion were stronger than village‐wide levels. Most water committees had collapsed in the past, lacked institutional sustainability, and failed community expectations. Factors informing this included the high mean age of committee members, multiple obligations of executives, and often poor intra‐village social and geographical representation.

Policy implications

Villages are not homogenous communities, but include many smaller social units—tribes, extended families, different faith groups—that tend to have stronger social cohesion than “village‐wide” groups or committees. Moreover, many of these groupings are often socio‐spatially demarcated in formalized “zones/areas” of a village. This needs to be reflected in WM group membership and national policy guidelines. At these levels, social cohesion, collective action, and agency are greater than at the village‐wide level, offering opportunities for more inclusive and effective WM outcomes.
Pulmonary valve sarcoma in patient with coronavirus disease of 2019 (COVID‐19), mimicking pulmonary thromboembolism, a very rare case
Authors: Jalalian Rozita , Sadraee Javad , Azizi Soheil , Bagheri Babak , Iranian Mohammadreza
Published: September 2021

Pulmonary artery and pulmonary valve sarcoma are malignant and very rare vascular tumors with aggressive clinical course and very poor outcomes. Patients affected by coronavirus disease of 2019 (COVID‐19) are at a higher risk for thromboembolism complication. We describe a young woman with a history of coronavirus pneumonia and progressive dyspnea, hemodynamic disturbance, edema with initial evaluation, and clinical diagnosis of pulmonary thromboembolism. But further imaging study and pathology demonstrated giant sarcoma of pulmonary valve, obstructing pulmonary valve and extending to right ventricular outflow tract and main of pulmonary artery.
Pyridoxal‐5‐phosphate induced cardioprotection in aging associated with up‐expression of cystathionine‐γ‐lyase, 3‐mercaptopyruvate sulfurtransferase, and ATP‐sensitive potassium channels
Authors: Mys Lidiia , Goshovska Yulia , Strutynska Nataliia , Fedichkina Raisa , Korkach Yuliia , Strutynskyi Ruslan , Sagach Vadim
Published: September 2021

Background

In the present work, we investigated the cardioprotective potential of pyridoxal‐5‐phosphate (PLP) in old rats as a cofactor of enzymes that synthesize hydrogen sulphide (H2S).

Materials and methods

PLP was administered per os in a dose of 0.7 mg per kg daily for 2 weeks. Rats were divided into three groups (adult, old and old +PLP) of 20 animals. The cardiac mRNA levels of genes encoding H2S‐synthesizing enzymes cystathionine‐γ‐lyase (CSE) and 3‐mercaptopyruvate sulfurtransferase (3‐MST), uncoupling proteins (UCP3), subunits of ATP‐sensitive potassium (KATP) channels were determined using real‐time polymerase chain reaction analysis. We also studied the effect of PLP‐administration on the content of H2S, oxidative stress, the activities of inducible and constitutive NO‐synthase (iNOS, cNOS), arginase and nitrate reductase in the heart homogenates as well as cardiac resistance to ischemia‐reperfusion in Langendorff‐isolated heart model.

Results

It was shown that PLP restored mRNA levels of CSE, 3‐MST and UCP3 genes, and H2S content and also significantly increased the expression of SUR2 and Kir6.1 (2.2 and 3.3 times, respectively) in the heart of old rats. PLP significantly reduced the formation of superoxide, malondialdehyde, diene conjugates as well as the activity of iNOS and arginase. PLP significantly increased constitutive synthesis of NO and prevented reperfusion disturbances of the heart function after ischemia.

Conclusions

Thus, PLP‐administration in old rats was associated with up‐expression of CSE, 3‐MST, UCP3 and SUR2 and Kir6.1 subunits of KATP channels, and also increased cNOS activity and reduced oxidative stress and prevented reperfusion dysfunction of the heart in ischemia‐reperfusion.
Non‐aggression commitments and domestic violence margins
Authors: Benegas Maurício , Raimundo Carvalho José , Corrêa Márcio Veras
Published: September 2021

Domestic violence is a highly prevalent phenomenon around the world. The emotional behaviour of partners, which often culminates in verbal and physical violence, has emerged as one of the main explanations for its occurrence. The main objective of the present paper was to explain, through a dynamic general equilibrium model, the impact of non‐aggression commitments between intimate partners on reducing domestic violence incidents. More specifically, we theoretically evaluate the impact of a non‐aggression contract composed of sin taxes and participation in cognitive behavioural therapy sessions both in reducing incidents of intimate partner violence and in reducing the dynamics of divorce. We show that non‐aggression commitments lead to a reduction in domestic violence at its intensive margin, with no impact at the extensive margin of intimate partner violence. Therefore, this contractual mechanism needs to be combined with other policies to be effective.
Infant repetition effects and change detection: Are they related to adaptive skills?
Authors: López‐Arango Gabriela , Deguire Florence , Côté Valérie , Barlaam Fanny , Agbogba Kristian , Knoth Inga S. , Lippé Sarah
Published: September 2021

Repetition effects and change detection response have been proposed as neuro‐electrophysiological correlates of fundamental learning processes. As such, they could be a good predictor of brain maturation and cognitive development. We recorded high density EEG in 71 healthy infants (32 females) aged between 3 and 9 months, while they listened to vowel sequences (standard /a/a/a/i/ [80%] and deviant /a/a/a/a/ [20%]). Adaptive skills, a surrogate of cognitive development, were measured via the parent form of the Adaptive Behavior Assessment System Second Edition (ABAS‐II). Cortical auditory‐evoked potentials (CAEPs) analyses, time‐frequency analyses and a statistical approach using linear mixed models (LMMs) and linear regression models were performed. Age and adaptive skills were tested as predictors. Age modulation of repetition effects and change detection response was observed in theta (3–5 Hz), alpha (5–10 Hz) and high gamma (80–90 Hz) oscillations and in all CAEPs. Moreover, adaptive skills modulation of repetition effects was evidenced in theta (3–5 Hz), high gamma oscillations (80–90 Hz), N250/P350 peak‐to‐peak amplitude and P350 latency. Finally, adaptive skills modulation of change detection response was observed in the N250/P350 peak‐to‐peak amplitude. Our results confirm that repetition effects and change detection response evolve with age. Moreover, our results suggest that repetition effects and change detection response vary according to adaptive skills displayed by infants during the first year of life, demonstrating their predictive value for neurodevelopment.
Functional specificity and neural integration in the aesthetic appreciation of artworks with implied motion
Authors: Bara Ionela , Darda Kohinoor Monish , Kurz Andrew Solomon , Ramsey Richard
Published: September 2021

Although there is growing interest in the neural foundations of aesthetic experience, it remains unclear how particular mental subsystems (e.g. perceptual, affective and cognitive) are involved in different types of aesthetic judgements. Here, we use fMRI to investigate the involvement of different neural networks during aesthetic judgements of visual artworks with implied motion cues. First, a behavioural experiment (N = 45) confirmed a preference for paintings with implied motion over static cues. Subsequently, in a preregistered fMRI experiment (N = 27), participants made aesthetic and motion judgements towards paintings representing human bodies in dynamic and static postures. Using functional region‐of‐interest and Bayesian multilevel modelling approaches, we provide no compelling evidence for unique sensitivity within or between neural systems associated with body perception, motion and affective processing during the aesthetic evaluation of paintings with implied motion. However, we show suggestive evidence that motion and body‐selective systems may integrate signals via functional connections with a separate neural network in dorsal parietal cortex, which may act as a relay or integration site. Our findings clarify the roles of basic visual and affective brain circuitry in evaluating a central aesthetic feature—implied motion—while also pointing towards promising future research directions, which involve modelling aesthetic preferences as hierarchical interplay between visual and affective circuits and integration processes in frontoparietal cortex.
On the prediction of fatigue crack growth based on weight functions in residual stress fields induced by laser shock peening and laser heating
Authors: Kashaev Nikolai , Keller Sören , Staron Peter , Maawad Emad , Huber Norbert
Published: September 2021

This study deals with fatigue crack growth prediction for thin sheet AA2024 specimens with residual stresses introduced through laser shock peening and laser heating treatments. Different weight functions are used to calculate the stress intensity factor due to the presence of residual stresses. A superposition principle is used by calculating the total stress intensity factor considering the applied loads and residual stresses. The fatigue crack growth is predicted using the Paris' law based on the effective stress intensity factor range, in that the effect of residual stresses is considered by changing the total stress intensity factor ratio. It is concluded, that weight functions are a powerful tool to predict fatigue crack growth in AA2024 containing residual stress fields, as long as the gradient in the loading direction, as induced by laser shock peening and laser heating, is moderate.
Examining community mental health providers' delivery of structured weight loss intervention to youth with serious emotional disturbance: An application of the theory of planned behaviour
Authors: Wykes Thomas L. , Worth Andrea S. , Richardson Kathryn A. , Woods Tonja , Longstreth Morgan , McKibbin Christine L.
Published: September 2021

Background

Rates of overweight and obesity are disproportionately high among youth with serious emotional disturbance (SED). Little is known about community mental health providers' delivery of weight loss interventions to this vulnerable population.

Objective

This study examined attitudinal predictors of their providers' intentions to deliver weight loss interventions to youth with SED using the theory of planned behaviour.

Design

This study used a cross‐sectional, single‐time‐point design to examine the relationship of the theory of planned behaviour constructs with behavioural intention.

Setting and Participants

Community mental health providers (n = 101) serving youth with SED in the United States completed online clinical practice and theory of planned behaviour surveys.

Main Variables Studied

We examined the relationship of direct attitude constructs (i.e., attitude towards the behaviour, social norms and perceived behavioural control), role beliefs and moral norms with behavioural intention. Analyses included a confirmatory factor analysis and two‐step linear regression.

Results

The structure of the model and the reliability of the questionnaire were supported. Direct attitude constructs, role beliefs and moral norms predicted behavioural intention to deliver weight loss interventions.

Discussion

While there is debate about the usefulness of the theory of planned behaviour, our results showed that traditional and newer attitudinal constructs appear to influence provider intentions to deliver weight loss interventions to youth with SED. Findings suggest preliminary strategies to increase provider intentions.

Public Contribution

This study was designed and the results were interpreted as part of a larger, community‐based participatory research effort that included input from youth, families, providers, administrators and researchers. Collaborative discussions with community mental health providers and administrators particularly contributed to the study question asked as well as interpretation of results.
Development and validation in Ecuador of the EPD Questionnaire, a diabetes‐specific patient‐reported experience and outcome measure: A mixed‐methods study
Authors: Martin‐Delgado Jimmy , Mula Aurora , Guilabert Mercedes , Solís Carlos , Gómez Lorena , Ramirez Amat Gustavo , Mira José Joaquin ,   EPD Research Group
Published: September 2021

Introduction

The global prevalence of diabetes in 2019 in adults was estimated to be 9.3%. This study developed in Ecuador, for the first time, instruments to assess patient‐reported outcomes and experiences.

Methods

The Experiences of the Person with Diabetes (EPD) Questionnaire is a diabetes‐specific instrument. A mixed‐methods study was conducted. First, a qualitative item development phase that included four focus groups and six semi‐structured interviews with patients was conducted in different rural and urban areas of Ecuador to obtain information on culture, beliefs, demographics, diet and social perspectives. A second quantitative phase for psychometric validation was carried out in primary care settings of rural and urban areas of Ecuador.

Results

Forty‐two and four hundred and eighty‐nine participants were included in each phase, respectively. The item development phase resulted in a questionnaire of 44 items (23 for perceived outcomes and 21 for experiences). In the validation study, most participants were women (58%) and from urban areas (57%). Exploratory factor analysis revealed three dimensions for each instrument. Outcomes instrument dimensions were symptoms and burnout, worries and fears and social limitations. Experiences instrument dimensions were information, patient‐centred care and care delivery. Cronbach's α values of the total score and dimensions were high, ranging between .81 and .93 in both instruments. Confirmatory factor analysis showed an acceptable fit of the data.

Conclusion

The EPD Questionnaire is probably the first instrument developed to assess patient‐reported experiences and perceived outcomes in a middle‐income country that included patients to capture all dimensions relevant for the intended population. Its psychometric properties are robust and could provide valuable information for clinicians and policymakers in the region.

Patient or Public Contribution

The development of these instruments has taken into consideration patients and the public since their conception. A qualitative approach gathered relevant information related to the cultural, social and economic burden of different populations in Ecuador. Before validation, a pilot test was carried out with users of the National Health Services to obtain their perspectives and insights of the developed instrument. Finally, during the data analysis, we have given special consideration to social variables such as rural and urban populations.
A comparative study of AJCC and the modified staging system in pT2/pT3 penile squamous cell carcinoma – a validation on an external data set
Authors: Sali Akash P , Prakash Gagan , de Cássio Zequi Stênio , da Costa Walter H. , Murthy Vedang , Soares Fernando A , Bakshi Ganesh , Guimarães Gustavo C , Joshi Amit , Pal Mahendra , Desai Sangeeta B , Cubilla Antonio L , Menon Santosh
Published: September 2021

Aims

The recent changes in the American Joint Commission on Cancer, 8th edition (AJCC‐8E) pT2 and pT3 tumour definitions for penile cancer need robust validation studies. A recent study redefined and modified the pT2 and pT3 stages incorporating the histopathological variables (tumour grade, lymphovascular invasion, perineural invasion) similar to that used in the current AJCC‐8E pT1 stage tumour subclassification. In this study, we validate and compare this proposed staging with the AJCC staging systems on an external data set.

Methods and results

The data set from a previously published study was obtained. pT2 and pT3 stages were reconstructed as per AJCC 7th edition (AJCC‐7E), AJCC‐8E and the proposed staging. The staging systems were correlated with nodal metastasis, disease‐free survival (DFS), cancer‐specific survival (CSS) and overall survival (OS). All systems were compared using receiver operating characteristic (ROC) curves. A total of 281 cases formed the study cohort. AJCC‐8E (P = 0.031) and the proposed staging (P = 0.003) correlated with nodal metastasis on adjusted analysis, the latter with a better strength of association (AJCC‐8E, γ = –0.471; proposed, γ = –0.625). On adjusted analysis, all the staging systems had a significant correlation with DFS, while only AJCC‐8E and the proposed staging correlated with CSS and OS. On ROC curve analysis, the proposed staging had the highest area under the curve and was the only staging system to statistically correlate with all the outcome variables.

Conclusions

The proposed staging for pT2/pT3 tumour stages in penile cancer may improve the prognostic and predictive ability.
Physical activity and adiposity in preschool children: The Barwon Infant Study
Authors: Bell Lisa A. , Vuillermin Peter , Timperio Anna , Ponsonby Anne‐Louise , Tang Mimi L. K. , Hesketh Kylie D. ,   the BIS Investigator Group
Published: September 2021

Background

The association between physical activity and adiposity in preschool‐aged children is unclear.

Objective

To assess the cross‐sectional association between objectively measured physical activity and body fat in preschool‐aged children.

Methods

In the preschool review in an Australian birth cohort study (n = 1074), mean duration and time accumulated in ≥1‐min bouts of physical activity at light‐intensity (LPA), moderate‐ to vigorous‐intensity (MVPA) and light‐ to vigorous‐intensity (LMVPA) were computed from accelerometer (ActiGraph GT3X+) data. Percent body fat was assessed by bioelectrical impedance. Associations between physical activity and percent body fat were examined by multiple regression, adjusted for accelerometer wear time, MVPA (in analyses of LPA), maternal body mass index (BMI) and maternal education.

Results

A total of 450 participants (n = 450) had valid data. There was evidence of associations between physical activity and adiposity: each additional hour of LVPA was associated with 0.6% (CI95 –0.2%, 1.3%) higher body fat; ≥1‐min bouts of LPA was associated with 1.0% (CI95 0.1%, 1.9%) higher body fat; each additional hour of MVPA was associated with −0.8% (CI95 −1.6%, −0.1%) less body fat; and ≥1‐min bouts of MVPA was associated with −1.3% (CI95 −2.5%, −0.1%) body fat.

Conclusions

Among a cohort of preschool‐aged children, there was evidence that more intensive physical activity assessed by an accelerometer is associated with reduced body fat.
In situ TEM observation on the ferroelectric‐antiferroelectric transition in Pb(Nb,Zr,Sn,Ti)O3/ZnO
Authors: Liu Binzhi , Li Ling , Zhang Shan‐Tao , Zhou Lin , Tan Xiaoli
Published: September 2021

Ceramic composites of (1‐x)Pb0.99{Nb0.02[(Zr0.57Sn0.43)0.937Ti0.063]0.98}O3 (PNZST)/xZnO were recently reported to exhibit exceptionally high pyroelectric coefficients near human body temperature due to the ferroelectric‐antiferroelectric transition of the matrix grains. In the present work, a comparative study is conducted on two composites of x = 0.1 and 0.4 with in situ heating transmission electron microscopy (TEM). The results verify the presence of strain field in the PNZST grain adjacent to a ZnO particle and the stabilized ferroelectric phase at room temperature in the composite of x = 0.1. During heating, the ferroelectric matrix grain transforms to the antiferroelectric phase, contributing to the pyroelectric effect. In the composite of x = 0.4, high‐angle annular dark‐field imaging combined with energy‐dispersive X‐ray spectroscopy reveal the existence of both ZnO and Zn2SnO4. The formation of Zn2SnO4 indicates that Sn in the PNZST matrix grain is selectively extracted, and decomposition of the perovskite phase has taken place. The decomposition products in the form of fine particles are observed to facilitate the nucleation of the antiferroelectric phase and restrict the motion of the phase boundary during heating. The larger amount of ZnO and Zn2SnO4 and the decomposition of the PNZST perovskite phase are suggested to be responsible for the much lower pyroelectric coefficient in the x = 0.4 composite.
Cardiac stereotactic body radiation therapy for ventricular tachycardia: Current experience and technical gaps
Authors: Wei Chen , Qian Pierre C. , Boeck Michelle , Bredfeldt Jeremy S. , Blankstein Ron , Tedrow Usha B. , Mak Raymond , Zei Paul C.
Published: September 2021

Introduction

Despite advances in drug and catheter ablation therapy, long‐term recurrence rates for ventricular tachycardia remain suboptimal. Cardiac stereotactic body radiotherapy (SBRT) is a novel treatment that has demonstrated reduction of arrhythmia episodes and favorable short‐term safety profile in treatment‐refractory patients. Nevertheless, the current clinical experience is early and limited. Recent studies have highlighted variable duration of treatment effect and substantial recurrence rates several months postradiation. Contributing to these differential outcomes are disparate approaches groups have taken in planning and delivering radiation, owing to both technical and knowledge gaps limiting optimization and standardization of cardiac SBRT.

Methods and Findings

In this report, we review the historical basis for cardiac SBRT and existing clinical data. We then elucidate the current technical gaps in cardiac radioablation, incorporating the current clinical experience, and summarize the ongoing and needed efforts to resolve them.

Conclusion

Cardiac SBRT is an emerging therapy that holds promise for the treatment of ventricular tachycardia. Technical gaps remain, to be addressed by ongoing research and growing clincial experience.
Examining quality time as a mediator of dyadic change in a randomized controlled trial of relationship education for low‐income couples
Authors: Carlson Ryan G. , Barden Sejal M. , Locklear Lauren , Dillman Taylor Dalena , Carroll Nakita
Published: September 2021

Research identifying specific mechanisms of positive change for couples participating in relationship education is scant. Recent studies have identified the potential of communication skills as a likely mechanism, yet more information is needed about the contribution of process factors. Thus, we examined the influence that quality time spent together had on positive post‐intervention outcomes based on couples’ reports of dyadic coping and dyadic adjustment for 1,367 low‐income couples randomly assigned to receive relationship education. Results indicated that treatment couples reported significant gains in quality time spent together, and that those gains fully mediated positive changes in dyadic coping and adjustment. Additionally, actor and partner effects existed such that men's and women's reports of improved quality time influenced their own and their partners dyadic coping and dyadic adjustment. We discuss study implications for practice and future research.
Dyadic parent–adolescent relationship quality as pathways from maternal childhood abuse to adolescent psychopathology
Authors: Fitzgerald Michael , Esplin Jacob , Wright Lindsay , Hardy Nathan , Gallus Kami
Published: September 2021

Children of maternal caregivers abused in childhood are at increased risk for mental health problems including anxiety and depression. To date, most studies exploring the intergenerational transmission of trauma have focused on younger children, with far fewer studies investigating adolescent mental health. Previous research suggests that maternal childhood abuse negatively impacts the parent–adolescent relationship, which may contribute to the development and maintenance of adolescent mental health problems. The current study examined dyadic reports of maternal–adolescent relationship quality as mediators linking maternal reports of childhood abuse to adolescent depression and anxiety. The bootstrapped indirect effects from maternal childhood abuse to adolescent symptoms of anxiety and depression were significant through adolescent reports of relationship quality, but not through maternal reports of relationship quality. Findings suggest that an adolescent's perception of their maternal–adolescent relationship may mediate the relationship between their maternal caregiver's childhood abuse and their own symptoms of anxiety and depression.
Glucose availability limits microglial nitric oxide production
Authors: Castillo Erika , Mocanu Ebony , Uruk Gӧkhan , Swanson Raymond A.
Published: September 2021

Metabolic intermediates influence inflammation not only through signaling effects, but also by fueling the production of pro‐inflammatory molecules. Microglial production of nitric oxide (NO) requires the consumption of NADPH. NADPH consumed in this process is regenerated from NADP+ primarily through the hexose monophosphate shunt, which can utilize only glucose as a substrate. These factors predict that glucose availability can be rate‐limiting for glial NO production. To test this prediction, cultured astrocytes and microglia were incubated with lipopolysaccharide and interferon‐γ to promote expression of inducible nitric oxide synthase, and the rate of NO production was assessed at defined glucose concentrations. Increased NO production was detected only in cultures containing microglia. The NO production was markedly slowed at glucose concentrations below 0.5 mM, and comparably reduced by inhibition of the hexose monophosphate shunt with 6‐aminonicotinamide. Reduced NO production caused by glucose deprivation was partly reversed by malate, which fuels NADPH production by malate dehydrogenase, and by NADPH itself. These findings highlight the role of the hexose monophosphate shunt in fueling NO synthesis and suggest that microglial NO production in the brain may be limited at sites of low glucose availability, such as abscesses or other compartmentalized infections.

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Description of a safe doppler ultrasound‐guided technique for hyaluronic acid filler in the face—A method to avoid adverse vascular events
Authors: Rocha Paula Stéfany , Guerra Thais Almeida , Teixeira Danilo Augusto
Published: September 2021

Background

Knowledge of facial anatomy is essential for professionals intending to inject hyaluronic acid (HA) into that region, but due to the considerable anatomical variations in region, it does not guarantee the complete safety of the procedure. Similarly, procedures widely disseminated among professionals, such as aspiration and the use of cannulas, do not ensure total safety against vascular occlusion events caused by the filler.

Objectives

This article describes a technique for injecting hyaluronic acid into the face guided by Doppler ultrasonography (DUS) in order to ensure greater safety against vascular occlusion events secondary to the procedure.

Methods

We describe a Doppler ultrasound‐guided filling technique, with an 18 MHZ transducer, consisting of three steps: arterial mapping, real‐time ultrasound‐guided filling, and assessing the perfusion.

Results

The described technique was performed in 480 patients and can be adopted in the routine of professionals who inject hyaluronic acid, especially in areas at high risk for vascular events. Its use results in greater safety against vascular occlusion events secondary to the procedure, without the need for prior aspiration. We conclude that there is a local vasodilation right after the filling that makes it difficult the possibility of extrinsic compression exerted by the filler on the vessel. Furthermore, the product moves to deep planes even with the bevel facing up (toward the epidermis).

Conclusions

We believe that in the future the use of Doppler ultrasound‐guided filling technique will be mandatory for professionals who intend to perform HA injection, to both ensure patient safety and provide legal protection for the professional.
An integrative review of fatigue in adults with type 2 diabetes mellitus: Implications for self‐management and quality of life
Authors: Kuo Hsuan‐Ju , Huang Ya‐Ching , García Alexandra A.
Published: September 2021

Aims and objectives

To synthesise empirical studies on factors related to fatigue and its impact on diabetes self‐management (DSM) and quality of life (QOL) in adults with type 2 diabetes mellitus (T2DM).

Background

Fatigue is commonly reported in people with T2DM, a chronic condition that is highly prevalent worldwide. However, a holistic understanding of the consequences and factors related to fatigue in adults with T2DM is not well synthesised.

Design

This integrative review used Whittemore and Knafl's methodology and was reported according to the Preferred Reporting for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines and checklist.

Methods

The theory of unpleasant symptoms (TOUS) was used as a conceptual model to guide the review. The PubMed, PsychINFO and CINAHL databases were searched to identify studies that recruited adults with T2DM, were peer‐reviewed, written in English and investigated fatigue as a primary or secondary outcome. Two investigators independently appraised the quality of the studies and extracted the data.

Results

Twenty‐nine articles met the inclusion criteria: 23 observational studies, two randomised controlled trials, one quasi‐experimental study and three qualitative studies. All articles were of high quality. Physiological (e.g. T2DM duration, complications and inflammatory biomarkers), psychological (e.g. diabetes distress, depression and sleep quality) and situational factors (e.g. race/ethnicity, education and social support) were related to fatigue. Studies reported fatigue as a barrier to physical activity, healthy eating behaviours and the physical aspect of QOL.

Conclusions

Multiple factors are related to fatigue in adults with T2DM. Gaps in the literature include the multiple dimensions of fatigue, the effectiveness of interventions to alleviate fatigue and fatigue experiences in under‐represented populations.

Relevance to clinical practice

This integrative review supports the complex origin of fatigue and its impact on adults with T2DM. Nurses should evaluate modifiable factors related to fatigue and provide support to help improve DSM and QOL in this population.
A NEW REGIONAL PETROLEUM SYSTEMS MODEL FOR CENTRAL ITALY AND THE CENTRAL ADRIATIC SEA SUPPORTED BY BASIN MODELLING AND AN ANALYSIS OF HYDROCARBON OCCURRENCES
Authors: Lipparini Lorenzo , D'Ambrosio Andrea , Trippetta Fabio , Bigi Sabina , Derks Jan Federik , Bambridge Victoire Roblet , Cassola Teodoro
Published: September 2021

The petroleum system in Central Italy and the Adriatic Sea is of great interest for future hydrocarbon exploration. However, major uncertainties remain about key risk elements such as source rock spatial distribution and maturation history, the timing of hydrocarbon migration, and the nature of migration pathways. This paper presents a new regional‐scale petroleum systems model based on an integrated inter‐disciplinary study which includes public‐domain subsurface data on key petroleum systems elements, heat‐flow and petroleum geochemical data, and an extensive set of 1D basin models.

Results show the importance of the Mesozoic palaeogeographic and stratigraphic setting which was characterized by the presence of platform and basinal domains. Thermal data highlight an overall higher basal heat flow in platform domains which persist at the present‐day. Considering the geochemical and thermal characteristics of possible source rocks in the study area, the Upper Triassic Burano Formation appears to be the most likely active source rock but only in those geological domains where it has been deeply buried. In particular, source rocks reached maturity only during the most recent Apennine deformation phase in the late Pliocene/early Pleistocene, i.e. after the deposition of regional seals such as the Messinian Gessoso‐Solfifera Formation. Lateral migration is suggested to have occurred to explain most of the known oil accumulations. The margin of the Apulia Platform could have acted as a migration pathway for hydrocarbons, connecting basinal kitchens to the carbonate reservoir units at the top of the platform succession within which oil and gas accumulations have been proven. Heavy oils could represent early expulsion products from the source rock, but may also locally be a result of biodegradation due to recent partial exhumation of the traps and the loss of lighter components.

The results of this study may support ongoing and future exploration efforts over other carbonate platforms in the study area, and more widely on carbonate targets elsewhere in the Mediterranean region.