bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of siblings’ presence and oral health-related quality of life among children: a cross-sectional study
Authors: Liu Min , Yun Qingping , Zhao Mei , Chen Wei , Zhang Hui , Hou Wei , Chang Chun
Published: March 2021

Background

The quantity–quality trade-off theory indicates that an increase in siblings might decrease a child’s well-being, but little is known about the impacts of sibling number on children’s oral health-related quality of life (OHRQoL). This study aims to investigate the effects of presence of siblings on children’s OHRQoL, and to further test whether there is an interaction effect between siblings’ presence and locations on children’s OHRQoL.

Methods

Data were obtained from an oral-health survey of 12-year-old children in Beijing, China, which was a part of the 4th National Oral Health Survey in the Mainland of China (2015–2016). This study included 2158 children data for analysis. OHRQoL was assessed by the child’s Oral Impacts on Daily Performance (OIDP). OIDP prevalence served as an indicator of OHRQoL. Children with and without siblings were recorded as non-single and single children, respectively. Dental variables, including active caries, gingival bleeding, and calculus, were reported. A logistic regression model was applied to investigate the association of siblings’ presence and OIDP prevalence. A synergy index was used to assess the possible interaction effect between siblings’ presence and location on OIDP prevalence.

Results

Sixty percent of Chinese children reported suffering OIDP in the previous six months. OIDP prevalence for non-single and single children were 68.3% and 56.9%, respectively. The adjusted odds ratio (OR) of OIDP for non-single children was 1.31 (95% CI: 1.05, 1.63), and the adjusted OR of OIDP for non-single and rural children was 2.03 (95% CI: 1.47, 2.81). The synergy index between siblings’ presence and location on OIDP was 2.18 (85% CI: 1.30, 3.67), which indicates that an excessive risk increase for OIDP was observed among non-single and rural children.

Conclusions

Children with siblings are more likely to report OIDP and have lower OHRQoL, especially those from rural areas. These findings indicate that oral-health interventions should be given priority for non-single and rural children.
The use of personal health information outside the circle of care: consent preferences of patients from an academic health care institution
Authors: Tosoni Sarah , Voruganti Indu , Lajkosz Katherine , Habal Flavio , Murphy Patricia , Wong Rebecca K. S. , Willison Donald , Virtanen Carl , Heesters Ann , Liu Fei-Fei
Published: March 2021

Background

Immense volumes of personal health information (PHI) are required to realize the anticipated benefits of artificial intelligence in clinical medicine. To maintain public trust in medical research, consent policies must evolve to reflect contemporary patient preferences.

Methods

Patients were invited to complete a 27-item survey focusing on: (a) broad versus specific consent; (b) opt-in versus opt-out approaches; (c) comfort level sharing with different recipients; (d) attitudes towards commercialization; and (e) options to track PHI use and study results.

Results

222 participants were included in the analysis; 83% were comfortable sharing PHI with researchers at their own hospital, although younger patients (≤ 49 years) were more uncomfortable than older patients (50 + years; 13% versus 2% uncomfortable, p < 0.05). While 56% of patients preferred broad consent, 38% preferred specific consent; 6% preferred not sharing at all. The majority of patients (63%) preferred to be asked for permission before entry into a contact pool. Again, this trend was more pronounced for younger patients (≤ 49 years: 76%). Approximately half of patients were uncomfortable sharing PHI with commercial enterprises (51% uncomfortable, 27% comfortable, 22% neutral). Most patients preferred to track PHI usage (61%), with the highest proportion once again reported by the youngest patients (≤ 49 years: 71%). A majority of patients also wished to be notified regarding study results (70%).

Conclusions

While most patients were willing to share their PHI with researchers within their own institution, many preferred a transparent and reciprocal consent process. These data also suggest a generational shift, wherein younger patients preferred more specific consent options. Modernizing consent policies to reflect increased autonomy is crucial in fostering sustained public engagement with medical research.
“The staff are not motivated anymore”: Health care worker perspectives on the Integrated Management of Childhood Illness (IMCI) program in the Philippines
Authors:   on behalf of the National IMCI Evaluation Working Group, Reñosa Mark Donald C. , Bärnighausen Kate , Dalglish Sarah L. , Tallo Veronica L. , Landicho-Guevarra Jhoys , Demonteverde Maria Paz , Malacad Carol , Bravo Thea Andrea , Mationg Mary Lorraine , Lupisan Socorro , McMahon Shannon A.
Published: March 2021

Background

Studies focusing on the Integrated Management of Childhood Illness (IMCI) program in the Philippines are limited, and perspectives of frontline health care workers (HCWs) are largely absent in relation to the introduction and current implementation of the program. Here, we describe the operational challenges and opportunities described by HCWs implementing IMCI in five regions of the Philippines. These perspectives can provide insights into how IMCI can be strengthened as the program matures, in the Philippines and beyond.

Methods

In-depth interviews (IDIs) were conducted with HCWs (n = 46) in five provinces (Ilocos Sur, Quezon, National Capital Region, Bohol and Davao), with full transcription and translation as necessary. In parallel, data collectors observed the status (availability and placement) of IMCI-related materials in facilities. All data were coded using NVivo 12 software and arranged along a Social Ecological Model.

Results

HCWs spoke of the benefits of IMCI and discussed how they developed workarounds to ensure that integral components of the program could be delivered in frontline facilities. Five key challenges emerged in relation to IMCI implementation in primary health care (PHC) facilities: 1) insufficient financial resources to fund program activities, 2) inadequate training, mentoring and supervision among and for providers, 3) fragmented leadership and governance, 4) substandard access to IMCI relevant written documents, and 5) professional hierarchies that challenge fidelity to IMCI protocols.

Conclusion

Although the IMCI program was viewed by HCWs as holistic and as providing substantial benefits to the community, more viable implementation processes are needed to bolster acceptability in PHC facilities.
Adherence to standard treatment guidelines among prescribers in primary healthcare facilities in the Dodoma region of Tanzania
Authors: Wiedenmayer Karin , Ombaka Eva , Kabudi Baraka , Canavan Robert , Rajkumar Sarah , Chilunda Fiona , Sungi Selemani , Stoermer Manfred
Published: March 2021

Background

Tanzania’s primary healthcare system suffers from a scarcity of financial and human resources that impedes its effectiveness to deliver dependable and uniform quality healthcare. Adherence to standard treatment guidelines (STG) can help provide more consistent and correct diagnoses and treatments and limit the irrational use of medicines and the negative health consequences that can occur as a result. The purpose of this study was to investigate prescribers’ adherence of their diagnoses and respective treatments to national STG and to identify potential areas for planning interventions.

Methods

A cross-sectional study on prescribers’ adherence to diagnosis and treatment, according to national STG, was conducted in 2012 in public primary healthcare facilities (HCF) in the Dodoma region of Tanzania. Information on 2886 patients was collected, prospectively and retrospectively, from 120 HCF across the Dodoma region using a structured questionnaire. Twenty-five broadly defined main illness groups were recorded and the nine most prevalent and relevant conditions were statistically analysed in detail.

Results

Diagnoses and related treatments were recorded and analysed in 2872 cases. The nine most prevalent conditions were upper respiratory tract infections (25%), malaria (18%), diarrhoea (9.9%), pneumonia (6.1%), skin problems (5.8%), gastrointestinal diagnoses (5%), urinary tract infections (4%), worm infestations (3.6%) and eye problems (2.1%). Only 1.8% of all diagnoses were non-communicable diseases. The proportion of prescribers’ primary diagnoses that completely adhered to national STG was 599 (29.9%), those that partially adhered totalled 775 (38.7%), wrong medication was given in 621 cases (30.9%) and no diagnosis or medication was given in nine cases (0.5%). Sixty-one percent of all patients received an antibiotic regardless of the diagnoses. Complete adherence was highest when worms were diagnosed and lowest for diarrhoea. The proportion of cases that did not adhere to STG was highest with patients with skin problems and lowest for malaria.

Conclusion

Prescribers’ general adherence to national STG in primary HCF in the public sector in Dodoma region is sub-optimal. The reasons are multifaceted and focused attention, directed at improving prescribing and pharmacotherapy, is required with a view of improving patient care and health outcomes.
Health research knowledge translation into policy in Zambia: policy-maker and researcher perspectives
Authors: Malama Annie , Zulu Joseph Mumba , Nzala Selestine , Kombe Maureen Mupeta , Silumbwe Adam
Published: March 2021

Background

The translation of public health research evidence into policy is critical to strengthening the capacity of local health systems to respond to major health challenges. However, a limited amount of public health research evidence generated in developing countries is actually translated into policy because of various factors. This study sought to explore the process of health research knowledge translation into policy and to identify factors that facilitate or hinder the process in Zambia.

Methods

This work was an exploratory qualitative study comprising two phases. Firstly, a document review of health policies and strategic frameworks governing research was undertaken to understand the macro-environment for knowledge translation in Zambia. Secondly, key informant interviews were conducted with those responsible for health research and policy formulation. The study interviewed 15 key informants and a thematic analysis approach was used.

Results

The document review showed that there are policy efforts to promote knowledge translation through improvement of the research macro-environment. However, the interviews showed that coordination and linkage of the knowledge creation, translation and policy-making processes remains a challenge owing to lack of research knowledge translation capacity, limited resources and lack of knowledge hubs. Emerging local research leadership and the availability of existing stock of underutilized local health research data provide an opportunity to enhance knowledge translation to feed into policy processes in Zambia.

Conclusions

Public health research knowledge translation into policy remains a challenge in Zambia. To enhance the uptake of research evidence in policy-making, this study suggests the need for improved coordination, financing and capacity-building in knowledge translation processes for both health researchers and policy-makers.
A new type of flexible CP12 protein in the marine diatom Thalassiosira pseudonana
Authors: Shao Hui , Huang Wenmin , Avilan Luisana , Receveur-Bréchot Véronique , Puppo Carine , Puppo Rémy , Lebrun Régine , Gontero Brigitte , Launay Hélène
Published: March 2021

Background

CP12 is a small chloroplast protein that is widespread in various photosynthetic organisms and is an actor of the redox signaling pathway involved in the regulation of the Calvin Benson Bassham (CBB) cycle. The gene encoding this protein is conserved in many diatoms, but the protein has been overlooked in these organisms, despite their ecological importance and their complex and still enigmatic evolutionary background.

Methods

A combination of biochemical, bioinformatics and biophysical methods including electrospray ionization-mass spectrometry, circular dichroism, nuclear magnetic resonance spectroscopy and small X ray scattering, was used to characterize a diatom CP12.

Results

Here, we demonstrate that CP12 is expressed in the marine diatom Thalassiosira pseudonana constitutively in dark-treated and in continuous light-treated cells as well as in all growth phases. This CP12 similarly to its homologues in other species has some features of intrinsically disorder protein family: it behaves abnormally under gel electrophoresis and size exclusion chromatography, has a high net charge and a bias amino acid composition. By contrast, unlike other known CP12 proteins that are monomers, this protein is a dimer as suggested by native electrospray ionization-mass spectrometry and small angle X-ray scattering. In addition, small angle X-ray scattering revealed that this CP12 is an elongated cylinder with kinks. Circular dichroism spectra indicated that CP12 has a high content of α-helices, and nuclear magnetic resonance spectroscopy suggested that these helices are unstable and dynamic within a millisecond timescale. Together with in silico predictions, these results suggest that T. pseudonana CP12 has both coiled coil and disordered regions.

Conclusions

These findings bring new insights into the large family of dynamic proteins containing disordered regions, thus increasing the diversity of known CP12 proteins. As it is a protein that is more abundant in many stresses, it is not devoted to one metabolism and in particular, it is not specific to carbon metabolism. This raises questions about the role of this protein in addition to the well-established regulation of the CBB cycle.

Choregraphy of metabolism by CP12 proteins in Viridiplantae and Heterokonta.

While the monomeric CP12 in Viridiplantae is involved in carbon assimilation, regulating phosphoribulokinase (PRK) and glyceraldehyde-3-phosphate dehydrogenase (GAPDH) through the formation of a ternary complex, in Heterokonta studied so far, the dimeric CP12 is associated with Ferredoxin-NADP reductase (FNR) and GAPDH. The Viridiplantae CP12 can bind metal ions and can be a chaperone, the Heterokonta CP12 is more abundant in all stresses (C, N, Si, P limited conditions) and is not specific to a metabolism.
Categorisation of lumbar spine MRI referrals in Denmark as compliant or non-compliant to international imaging guidelines: an inter-rater reliability study
Authors: Krogh Susanne Brogaard , Jensen Tue Secher , Rolving Nanna , Laursen Malene , Thomsen Janus Nikolaj Laust , Hansen Casper Brink , Werenberg Christoffer Høj , Rasmussen Erik , Carlson Rune , Jensen Rikke Krüger
Published: March 2021

Background

Managing low back pain (LBP) often involves MRI despite the fact that international guidelines do not recommend routine imaging. To allow us to explore the topic and use this knowledge in further research, a reliable method to review the MRI referrals is needed. Consequently, this study aimed to assess the inter-rater reliability of a method evaluating lumbar spine MRI referrals’ appropriateness.

Methods

Four inexperienced students (chiropractic master’s students) and a senior clinician (chiropractor) were included as independent raters in this inter-rater reliability study. Lumbar spine MRI referrals from primary care on patients (> 18 years) with LBP with or without leg pain were included. The referrals were classified using a modified version of the American College of Radiology (ACR) imaging appropriateness criteria for LBP. Categories of appropriate referrals included; fractures, cancer, previous surgery, candidate for surgery or suspicion of cauda equina. Inappropriate referrals included lacking information on previous non-surgical treatment, no word on non-surgical treatment duration, or “other reasons” for inappropriate referrals.

After two rounds of training and consensus sessions, 50 lumbar spine MRI referrals were reviewed independently by the five raters. Inter-rater reliability was quantified using unweighted Kappa statistics, and the observed agreement was calculated with both a pairwise comparison and an overall five-rater comparison.

Results

Inter-rater reliability was substantial, with a Kappa value for appropriate vs. inappropriate referrals of 0.76 (95% CI: 0.55–0.89). When six and eight subcategories were evaluated, the Kappa values were 0.77 (95% CI: 0.58–0.91) and 0.82 (95% CI: 0.72–0.92), respectively.

The overall percentage of agreement for appropriate and inappropriate referrals was 92% and ranged from 88 to 98% for the pairwise comparisons of the five raters’ results. For the six and eight subcategories, the overall agreement was 92 and 88%, respectively, ranging from 88 to 98% and 84–92%, respectively, for the pairwise comparisons.

Conclusion

The inter-rater reliability of the evaluation of the appropriateness of lumbar spine MRI referrals, according to the modified ACR-appropriateness criteria, was found to range from substantial to almost perfect and can be used for research and quality assurance purposes.
All-arthroscopic repair of Atzei class II and III triangular fibrocartilage complex tears using the FasT-Fix suture device
Authors: Tsai Mengchun , Lin Yi-Hsuan , Chiu Chih-Hao , Cheng Chun-Ying , Chan Yi-Sheng , Chen Alvin Chao-Yu
Published: March 2021

Background

The study is aimed to propose an arthroscopic repair technique using a pre-tied suture device for peripheral TFCC (triangular fibrocartilage complex) tear with proximal component involvement.

Methods

Through a retrospective review in the medical records of patients who underwent unilateral arthroscopic repair for TFCC Palmer IB lesion between 2017 and 2019, 12 patients were arthroscopically diagnosed as proximal component tear and received more than 1 year follow-up postoperatively. The arthroscope was introduced from 6R portal to discriminate Atzei class II from III lesions by a “visualization test” and to supervise the repair procedure using pre-tied FasT-Fix suture device from 3-4 portal. Two poly-ether-ether-ketone (PEEK) blocks were further advanced along the device needle to finally seat outside the ulnar joint capsule, followed by gradually tightening the pre-tied suture loop until the TFCC periphery was securely repositioned and held stably.

Results

Operation time averaged 87 min. Hook test and DRUJ arthroscopy confirmed proximal component tear in all 12 wrists. Four patients were diagnosed to be Atzei class II lesion as full thickness tear of distal component was arthroscopically identified from 6R portal while the other 8 exhibited partial thickness tear and were categorized as class III lesion. Follow-up averaged 15 months with a range of 12 to 24 months. Mayo modified wrist score improved from an average of 61.3 preoperatively to 90.4 at the latest visit.

Conclusions

A modified technique for diagnosis and all-arthroscopic repair in TFCC Atzei class II and III lesions using a pre-tied suture device is a feasible and safe option with promising results.
Circulating tumor cells and palbociclib treatment in patients with ER-positive, HER2-negative advanced breast cancer: results from a translational sub-study of the TREnd trial
Authors: Galardi Francesca , De Luca Francesca , Biagioni Chiara , Migliaccio Ilenia , Curigliano Giuseppe , Minisini Alessandro M. , Bonechi Martina , Moretti Erica , Risi Emanuela , McCartney Amelia , Benelli Matteo , Romagnoli Dario , Cappadona Silvia , Gabellini Stefano , Guarducci Cristina , Conti Valerio , Biganzoli Laura , Di Leo Angelo , Malorni Luca
Published: March 2021

Background

Circulating tumor cells (CTCs) are prognostic in patients with advanced breast cancer (ABC). However, no data exist about their use in patients treated with palbociclib. We analyzed the prognostic role of CTC counts in patients enrolled in the cTREnd study, a pre-planned translational sub-study of TREnd (NCT02549430), that randomized patients with ABC to palbociclib alone or palbociclib plus the endocrine therapy received in the prior line of treatment. Moreover, we evaluated RB1 gene expression on CTCs and explored its prognostic role within the cTREnd subpopulation.

Methods

Forty-six patients with ER-positive, HER2-negative ABC were analyzed. Blood samples were collected before starting palbociclib treatment (timepoint T0), after the first cycle of treatment (timepoint T1), and at disease progression (timepoint T2). CTCs were isolated and counted by CellSearch® System using the CellSearch™Epithelial Cell kit. Progression-free survival (PFS), clinical benefit (CB) during study treatment, and time to treatment failure (TTF) after study treatment were correlated with CTC counts. Samples with ≥ 5 CTCs were sorted by DEPArray system® (DA). RB1 and GAPDH gene expression levels were measured by ddPCR.

Results

All 46 patients were suitable for CTCs analysis. CTC count at T0 did not show significant prognostic value in terms of PFS and CB. Patients with at least one detectable CTC at T1 (n = 26) had a worse PFS than those with 0 CTCs (n = 16) (p = 0.02). At T1, patients with an increase of at least three CTCs showed reduced PFS compared to those with no increase (mPFS = 3 versus 9 months, (p = 0.004). Finally, patients with ≥ 5 CTCs at T2 (n = 6/23) who received chemotherapy as post-study treatment had a shorter TTF (p = 0.02). Gene expression data for RB1 were obtained from 19 patients. CTCs showed heterogeneous RB1 expression. Patients with detectable expression of RB1 at any timepoint showed better, but not statistically significant, outcomes than those with undetectable levels.

Conclusions

CTC count seems to be a promising modality in monitoring palbociclib response. Moreover, CTC count at the time of progression could predict clinical outcome post-palbociclib. RB1 expression analysis on CTCs is feasible and may provide additional prognostic information. Results should be interpreted with caution given the small studied sample size.
Occurrence of Phlebotomine sand flies (Diptera: Psychodidae) in the northeastern plain of Italy
Authors: Michelutti Alice , Toniolo Federica , Bertola Michela , Grillini Marika , Simonato Giulia , Ravagnan Silvia , Montarsi Fabrizio
Published: March 2021

Background

Recent climate and environmental changes have resulted in the geographical expansion of Mediterranean Leishmania infantum vectors towards northern latitudes and higher altitudes in different European countries, including Italy, where new foci of canine leishmaniasis have been observed in the northern part of the country. Northern Italy is also an endemic area for mosquito-borne diseases. During entomological surveillance for West Nile virus, mosquitoes and other hematophagous insects were collected, including Phlebotomine sand flies. In this study, we report the results of Phlebotomine sand fly identification during the entomological surveillance conducted from 2017 to 2019.

Methods

The northeastern plain of Italy was divided by a grid with a length of 15 km, and a CO2-CDC trap was placed in each geographical unit. The traps were placed ~ 15 km apart. For each sampling site, geographical coordinates were recorded. The traps were operated every two weeks, from May to November. Sand flies collected by CO2-CDC traps were identified by morphological and molecular analysis.

Results

From 2017 to 2019, a total of 303 sand flies belonging to the species Phlebotomus perniciosus (n = 273), Sergentomyia minuta (n = 5), P. mascittii (n = 2) and P. perfiliewi (n = 2) were collected, along with 21 unidentified specimens. The trend for P. perniciosus collected during the entomological surveillance showed two peaks, one in July and a smaller one in September. Sand flies were collected at different altitudes, from −2 m above sea level (a.s.l.) to 145 m a.s.l. No correlation was observed between altitude and sand fly abundance.

Conclusions

Four Phlebotomine sand fly species are reported for the first time from the northeastern plain of Italy. Except for S. minuta, the sand fly species are competent vectors of Leishmania parasites and other arboviruses in the Mediterranean Basin. These findings demonstrate the ability of sand flies to colonize new environments previously considered unsuitable for these insects. Even though the density of the Phlebotomine sand fly population in the plain areas is consistently lower than that observed in hilly and low mountainous areas, the presence of these vectors could herald the onset of epidemic outbreaks of leishmaniasis and other arthropod-borne diseases in areas previously considered non-endemic.

Graphical Abstract
A novel fungal metabolite inhibits Plasmodium falciparum transmission and infection
Authors: Niu Guodong , Wang Xiaohong , Hao Yue , Kandel Shambhu , Niu Guomin , Raptis Raphael G. , Li Jun
Published: March 2021

Background

Malaria transmission depends on infected mosquitoes and can be controlled by transmission-blocking drugs. The recently discovered FREP1-mediated malaria transmission pathway is an excellent target to screen drugs for limiting transmission.

Methods

To identify candidate small molecules, we used an ELISA-based approach to analyze extracts from a fungal library for inhibition of the FREP1–parasite interaction. We isolated and determined one active compound by chromatography and crystallography, respectively. We measured the effects of the bioactive compound on malaria transmission to mosquitoes through standard membrane-feeding assays (SMFA) and on parasite proliferation in blood by culturing.

Results

We discovered the ethyl acetate extract of the fungus Purpureocillium lilacinum that inhibited Plasmodium falciparum transmission to mosquitoes. Pre-exposure to the extract rendered Anopheles gambiae resistant to Plasmodium infection. Furthermore, we isolated one novel active compound from the extract and identified it as 3-amino-7,9-dihydroxy-1-methyl-6H-benzo[c]chromen-6-one, or “pulixin.” Pulixin prevented FREP1 from binding to P. falciparum-infected cell lysate. Pulixin blocked the transmission of the parasite to mosquitoes with an EC50 (the concentration that gave half-maximal response) of 11 µM based on SMFA. Notably, pulixin also inhibited the proliferation of asexual-stage P. falciparum with an EC50 of 47 nM. The compound did not show cytotoxic effects at a concentration of 116 µM or lower.

Conclusion

By targeting the FREP1–Plasmodium interaction, we discovered that Purpureocillium lilacinum extract blocked malaria transmission. We isolated and identified the bioactive agent pulixin as a new compound capable of stopping malaria transmission to mosquitoes and inhibiting parasite proliferation in blood culture.

Graphical Abstract
Lower extremity compression garments use by athletes: why, how often, and perceived benefit
Authors: Franke Thierry P. C. , Backx Frank J. G. , Huisstede Bionka M. A.
Published: March 2021

Background

Studies on the benefits of lower extremity compression garments (CGs) have focused on their effects on post-exercise recovery and performance improvement. Less is known about why athletes actually use CGs, the frequency with which they use them, and perceived benefits from using CGs. The purpose of this study was to investigate which athletes use CGs, why athletes use CGs, when CGs are worn by athletes, and, in case of an injury or injury prevention, for which injuries CGs are used.

Methods

This cross-sectional study involved 512 athletes who used lower extremity CGs. Athletes completed a questionnaire on the type of CGs they used, and when and why they used them. They also reported their sports participation, past and current sports injuries, and the perceived benefits of using CGs.

Results

88.1% (n=451) of the athletes were endurance athletes and 11.9% (n=61) were non-endurance athletes. Endurance and non-endurance athletes reported running (84.7%, n=382) and obstacle course racing (24.6%, n=15) the most frequently as primary sports, respectively. The most-used CG was the compression sock (59.2%, n=303). In total, 47.5% (n=246) of the athletes used a CG primarily to prevent re-injury and 14.5% (n=74) to reduce symptoms of a current sports injury. Other primary reported aims were primary prevention (13.6%), post-exercise recovery (14.3%), sports performance improvement (8.8%), and to look good (0.2%). The point prevalence of past and current sports injuries among all athletes was 84.2 and 20.2%, respectively. The most common current sports injuries were shin and calf injuries. Many athletes “always” or “often” used their CGs during training (56.8%, n=279) and competitions (72.9%, n=264). Furthermore, almost 90% of the athletes that aimed to prevent re-injury by using CGs reported that CGs contributed to secondary injury prevention.

Conclusion

88% of the CG-users were endurance athletes, of which 85% were runners. All athletes mainly used CGs to prevent injury recurrence, but also to reduce symptoms of a current sports injury. A majority of the athletes reported positive perceived effects from the CGs. CGs were used more during than after sports participation.
Exosomes from human umbilical cord mesenchymal stem cells attenuate the inflammation of severe steroid-resistant asthma by reshaping macrophage polarization
Authors: Dong Bing , Wang Chao , Zhang Jing , Zhang Jinrong , Gu Yinuo , Guo Xiaoping , Zuo Xu , Pan He , Hsu Alan Chen-Yu , Wang Guoqiang , Wang Fang
Published: March 2021

Background

Severe, steroid-resistant asthma (SSRA) is a serious clinical problem in asthma management. Affected patients have severe clinical symptoms, worsened quality of life, and do not respond to steroid, a mainstay steroid treatment of asthma. Thus, effective therapies are urgently needed. Exosomes derived from mesenchymal stem cell (MSC-Exo) has become attractive candidates for the lung inflammatory diseases through its immunomodulatory effects. In this study, we explored the therapeutic effects of MSC-Exo in SSRA and identified the therapeutic mechanism of MSC-Exo.

Method

Exosomes from human umbilical cord mesenchymal stem cell (hUCMSC) were isolated and characterized by transmission electron microscopy, nanoparticle tracking analysis and flow cytometry analysis. Effects of MSC-Exo on airway hyper responsiveness (AHR), inflammation, histopathology, and macrophage polarization in SSRA in mice were evaluated. Systematic depletion of macrophages determined the role of macrophages in the therapeutic effect of SSRA in mice. LPS-stimulated RAW 264.7 cell model was constructed to determine the underlying mechanism of MSC-Exo on macrophage polarization. qRT-PCR, Western blotting, immunofluorescence, and flow cytometry were performed to evaluate the expression of M1 or M2 markers. Tandem mass tags (TMT)-labeled quantitative proteomics were applied to explore the central protein during the regulation effect of MSC-Exo on macrophage polarization. Knockdown and overexpression of TRAF1 were used to further clarify the role of the central protein on macrophage polarization.

Result

We successfully isolated and characterized exosomes from hUCMSCs. We verified that the intratracheal administration of MSC-Exo reversed AHR, histopathology changes, and inflammation in SSRA mice. Systematic depletion of macrophages weakened the therapeutic effect of MSC-Exo. We found that MSC-Exo treatment inhibited M1 polarization and promoted M2 polarization in LPS-stimulated RAW 264.7 cells. Subsequently, tumor necrosis factor receptor-associated factor 1 (TRAF1) was determined as the central protein which may be closely related to the regulation of macrophage polarization from TMT-labeled quantitative proteomics analysis. Knockdown and overexpression of TRAF1 demonstrated that the effect of MSC-Exo treatment on macrophage polarization, NF-κB and PI3K/AKT signaling was dependent on TRAF1.

Conclusion

MSC-Exo can ameliorate SSRA by moderating inflammation, which is achieved by reshaping macrophage polarization via inhibition of TRAF1.
CrfP, a fratricide protein, contributes to natural transformation in Streptococcus suis
Authors: Zhu Yinchu , Ma Jiale , Zhang Yue , Zhong Xiaojun , Bai Qiankun , Dong Wenyang , Pan Zihao , Liu Guangjin , Zhang Cun , Yao Huochun
Published: March 2021

Streptococcussuis (S.suis) is an important zoonotic pathogen that causes septicaemia, meningitis and streptococcal toxic shock-like syndrome in its host, and recent studies have shown that S.suis could be competent for natural genetic transformation. Transformation is an important mechanism for the horizontal transfer of DNA, but some elements that affect the transformation process need to be further explored. Upon entering the competent state, Streptococcus species stimulate the transcription of competence-related genes that are responsible for exogenous DNA binding, uptake and processing. In this study, we performed conserved promoter motif and qRT-PCR analyses and identified CrfP as a novel murein hydrolase that is widespread in S.suis and stimulated with a peptide pheromone in the competent state through a process controlled by ComX. A bioinformatics analysis revealed that CrfP consists of a CHAP hydrolase domain and two bacterial Src homology 3-binding (SH3b) domains. Further characterization showed that CrfP could be exported to extracellular bacterial cells and lytic S.suis strains of different serotypes, and this finding was verified by TEM and a turbidity assay. To investigate the potential effect of CrfP in vivo, a gene-deletion mutant (ΔcrfP) was constructed. Instead of stopping the natural transformation process, the inactivation of CrfP clearly reduced the effective transformation rate. Overall, these findings provide evidence showing that CrfP is important for S.suis serovar 2 competence.
Suspected cyanide toxicity in cattle associated with ingestion of laurel - a case report
Authors: Kennedy Aideen , Brennan Audrey , Mannion Celine , Sheehan Maresa
Published: March 2021

Background

Cyanide is one of the most rapidly acting toxins affecting cattle, with poisoning typically occurring following ingestion of cyanogenic plants. Laurel (Prunus laurocerasus), is one such potentially toxic cyanogenic plant. This case report details fatalities in an Irish herd following the ingestion of laurel and aims to raise awareness of the potential risk that access to laurel hedges poses to farm animals.

Case presentation

Over a twelve-day period, the death occurred of 36 dairy-cross weanlings; the majority (22 weanlings) died over a two-day period. Two days following entry to a field bounded by a laurel hedge, the weanlings displayed signs of lethargy and profuse green diarrhoea. In the majority of animals there was a limited response to treatment with antimicrobials, vitamin B complex and fluid therapy. Recumbency and death ensued. Cyanosis was noted terminally. Two weanlings were submitted for post mortem examination. Laurel leaves were identified in the rumen contents of one weanling. Post mortem findings and additional test results on cohort animals suggested a number of pathological processes may have been involved in the animals, possibly complicating/exacerbating the effects of laurel ingestion. However, cyanide was considered a factor in a least some of the casualties and arrangements were made to test for cyanide on blood samples from a random selection of seven cohort animals. Although collected one week after exposure to the laurel hedge, toxic cyanide levels were recorded in a sample from one animal, which subsequently died.

Conclusions

The large fatality rate serves as a timely reminder to include plant poisoning as a differential diagnosis when dealing with large numbers of rapid fatalities. Failure to thoroughly examine rumen contents and collect a detailed history in this case, could easily have allowed death to be attributed to other causes and the involvement of cyanide toxicity to be missed. In cases of individual or group fatalities, history is invaluable and recent entry to new grazing areas or any potential diet change or access to garden plants should be thoroughly investigated.
Should the CIWA-Ar be the standard monitoring strategy for alcohol withdrawal syndrome in the intensive care unit?
Authors: Steel Tessa L. , Giovanni Shewit P. , Katsandres Sarah C. , Cohen Shawn M. , Stephenson Kevin B. , Murray Ben , Sobeck Hillary , Hough Catherine L. , Bradley Katharine A. , Williams Emily C.
Published: March 2021

Background

The Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar) is commonly used in hospitals to titrate medications for alcohol withdrawal syndrome (AWS), but may be difficult to apply to intensive care unit (ICU) patients who are too sick or otherwise unable to communicate.

Objectives

To evaluate the frequency of CIWA-Ar monitoring among ICU patients with AWS and variation in CIWA-Ar monitoring across patient demographic and clinical characteristics.

Methods

The study included all adults admitted to an ICU in 2017 after treatment for AWS in the Emergency Department of an academic hospital that standardly uses the CIWA-Ar to assess AWS severity and response to treatment. Demographic and clinical data, including Richmond Agitation-Sedation Scale (RASS) assessments (an alternative measure of agitation/sedation), were obtained via chart review. Associations between patient characteristics and CIWA-Ar monitoring were tested using logistic regression.

Results

After treatment for AWS, only 56% (n = 54/97) of ICU patients were evaluated using the CIWA-Ar; 94% of patients had a documented RASS assessment (n = 91/97). Patients were significantly less likely to receive CIWA-Ar monitoring if they were intubated or identified as Black.

Conclusions

CIWA-Ar monitoring was used inconsistently in ICU patients with AWS and completed less often in those who were intubated or identified as Black. These hypothesis-generating findings raise questions about the utility of the CIWA-Ar in ICU settings. Future studies should assess alternative measures for titrating AWS medications in the ICU that do not require verbal responses from patients and further explore the association of race with AWS monitoring.
Time for a renewed focus on the role of cleaners in achieving safe health care in low- and middle-income countries
Authors: Storr Julie , Kilpatrick Claire , Lee Karen
Published: March 2021

Water, sanitation and hygiene, collectively known as WASH, is an enabler of infection prevention and control (IPC), both of which contribute to safe, quality health care and the prevention of spread of antimicrobial resistance (AMR). This discussion paper considers the importance placed on the role of hygiene, including cleaning and those who clean, in health care facilities, within the context of existing data, guidelines and initiatives. Informed by this, the paper presents five areas for consideration that have the potential to strengthen and further demonstrate the value of this important cadre of staff and their role in clean, safe healthcare, particularly in low- and middle-income countries. The considerations centre around actions to overcome the current data gaps, including the paucity of national data on environmental cleaning and the training of cleaners; strengthening the implementation of norms and standards; combining global and national advocacy efforts; revisiting investment; and addressing research gaps on the issue. The need to act, in line with WHO and UNICEF recommendations to address this overlooked and undercompensated workforce and to elevate their status as important contributors to IPC, WASH and AMR is a pressing one.
A rapid multiclass method for antibiotic residues in goat dairy products by UPLC-quadrupole/electrostatic field orbitrap high-resolution mass spectrometry
Authors: Zhang Lu , Shi Liang , He Qiang , Li Ying
Published: March 2021

Background

Sulfanilamides, quinolones, nitroimidazoles, tetracyclines, cephalosporins, macrolides, and β-lactam are common tools in agriculture and can be found in animal-based foods such as goat milk and goat dried milk. To evaluate the risk of these species, reliable analytical methods are needed for accurate concentration determination, especially in goat milk and goat dried milk.

Method

We describe a method based on PRiME extraction coupled with UPLC-quadrupole/electrostatic field orbitrap high-resolution mass spectrometry to accomplish this task.

Result

Under optimal conditions, the limit of quantification for all antibiotics was 0.5–100 μg/L in goat milk and goat dried milk samples. The recoveries were 60.6–110.0% for goat milk and 60.1–109.6% for goat dried milk with a coefficient of variation less than 15%. The detection limits were 0.5–1.0 μg/kg. The limits of quantification for the analytes were 5.0–10.0 μg/kg. Finally, the method was used to screen veterinary antibiotics in 50 local goat milk and goat dried milk samples; metronidazole and enrofloxacin were detected in goat milk.

Conclusion

This method offers good reliability and the capacity for simultaneous detection can be used to detect residual contents and evaluate health risks in goat milk and goat dried milk.
Fire history and dendroecology of Catoctin Mountain, Maryland, USA, with newspaper corroboration
Authors: Howard Lauren F. , Cahalan Gabriel D. , Ehleben Kristyn , Muhammad El Baaqeyah Amala , Halza Hope , DeLeon Stephen
Published: March 2021

Background

Our study was designed to reveal a detailed forest fire history at Catoctin Mountain Park, Maryland, USA. We compared the ages of living trees to known fire dates in the dendrochronological record. Seasonality and years of fires in the dendrochronological record were juxtaposed with specific dates of fires recorded in newspapers.

Results

Twenty-seven pines (Pinus L.) captured 122 fire scars representing 58 distinct fire years between 1702 and 1951. Climate was significantly hotter and drier in the years of burns that affected at least two trees and was wetter two years prior. Thirty-three fires described in local newspapers were reported largely in the spring and fall months (68% between March and June, 32% between September and December). Ninety-one percent of fire scars in our tree-ring chronology had dormant seasonality. The mean fire interval was 5.47 ± 10.14 (SD; standard deviation) yr, and the Weibull median fire interval was 3.22 yr during the entire chronology. The longest fire-free interval was from 1952 to 2018.

The size structure of living trees was biased toward smaller black gums (Nyssa sylvatica Marshall) and oaks (Quercus L.) that recruited in the 1930s and 1940s. Most living pitch pines (Pinus rigida Mill) recruited between 1890 and 1910, but a few individuals recruited before the 1850s. Diversity of tree stems smaller than 10 cm diameter at breast height (DBH) was generally lacking; the youngest tree >10 cm DBH in our study area had recruited by 1967.

Conclusions

The Catoctin Mountains experienced frequent fire during the 1800s and early 1900s. The causes of fires were diverse, including accidental ignitions and purposeful cultural burning for berry (Vaccinium L.) production. The current forest developed during a period of low deer density and after the demise of the charcoal iron industry ended an era of logging. The lack of fire since the 1950s has encouraged the development of a black gum dominated mid- and understory. Management with frequent fire would facilitate pine and oak regeneration.
Comparison of Internal Patient Satisfaction Scores at a Cancer Center With Star Ratings on Online Physician-Rating Websites
Authors: Kim Catherine , Chisholm Gary , Bevolo Abby , Shelton Beverly , Kian Leslie , Lewis Carol M. , Garcia Elizabeth A. , Weber Randal S. , Frumovitz Michael
Published: March 2021

PURPOSE:

Patients have been increasingly using physician-rating websites (PRWs); however, few studies have analyzed the validity of star ratings on PRWs. We aimed to compare PRW patient satisfaction scores with internally generated patient satisfaction scores (internal scores) of physicians at a large quaternary cancer center.

METHODS:

We collected internal scores and PRW scores for physicians at MD Anderson Cancer Center. Internal scores were based on patient responses to the Clinician and Group Consumer Assessment of Healthcare Providers and Systems patient experience (CG-CAHPS) survey. Only physicians with an internal score on the basis of ≥ 30 patient reviews were included. The median numbers of reviews and median scores were compared between internal data and four PRWs (Google, HealthGrades, Vitals, and WebMD). Both internally and on PRWs, possible scores ranged from 1 (least satisfied) to 5 (most satisfied).

RESULTS:

Of 640 physicians with an internal score, 510 (79.7%) met the inclusion criteria. For these 510 physicians, the median (IQR) number of internal reviews was 49.5 (30-93) and the median (IQR) internal score was 4.89 (4.81-4.93); the median number of reviews on PRWs ranged from 2 to 7, and the median score on PRWs ranged from 4.40 to 5.00. No physician had an internal score < 4, but the proportions with score < 4 on PRWs ranged from 16% to 30%.

CONCLUSION:

Internal patient satisfaction scores were higher and calculated from more reviews than PRW patient satisfaction scores and correlated weakly with PRW scores. Given that patients rely on PRWs when evaluating potential physicians, we recommend publishing internal scores online to give patients more complete information regarding physician performance.
Predictors and Acceptability of Shared Physical Activity Participation in Parent–Child Dyads
Authors: Filanowski Patrick M. , Camhi Sarah M. , Whiteley Jessica A. , Iannotti Ronald J. , Milliken Laurie A.
Published: March 2021

Shared physical activity (PA) in children and their parents is an approach to increase PA participation for both children and adults. Understanding variables associated with shared PA is essential to inform effective, tailored PA interventions for families. The purpose of this study was to identify predictors and to assess the acceptability of shared PA in parent–child dyads. Each parent–child dyad (n = 31; mean ± SD age, parents: 38.0 ± 6.6 yr, children: 5.9 ± 1.7 yr) was guided through five standardized PAs (brisk walking, jumping games, body-weight exercises, dancing, and tag games) at a research fitness center. Parents reported demographic characteristics and PA-related variables (i.e., PA self-efficacy, family chaos, and annual household income). One week later, parents (n = 28) reported their dyad’s weekly minutes spent in shared PA. A forward selection procedure was used to determine the optimal regression model for predicting minutes of shared PA. McNemar’s tests were used to determine the dyad’s acceptability of each shared PA. Lower family chaos (β = −19.41, P = 0.034), higher parent body mass index (β = 7.65, P = 0.003), and higher annual household income (β = 11.85, P = 0.023) predicted minutes of shared PA. Jumping games, body-weight exercises, dancing, and tag games were not acceptable for parent–child dyads to participate in together (P < 0.05). Brisk walking was an acceptable shared PA (P = 0.125). Lower family chaos, higher parent body mass index, and higher annual household income predicted shared PA. Brisk walking was an acceptable PA for parent–child dyads to participate outside of a research laboratory setting. These results can aid future PA programs that include children and parents together.