bluuebunny/crossref_metadata_2025 huggingface dataset:
Female Managers and Corruption in SMEs: A Comparison Between Family and Nonfamily SMEs in Vietnam
Authors: Tran Nhat Minh , Nguyen Thu Thuy , Nguyen Thi Phuong Linh , Vu Anh Trong , Phan Thi Thanh Hoa , Nguyen Thi Hong Tham , Do Ngoc Diep , Phan Anh Tuan
Published: March 2022

Empirical evidence, regarding the impacts of female leadership on firm’s corrupt level, is lack of studies in various research context. The objective of this study is to assess whether female managers impact negatively or positively on the corrupt behavior of family SMEs (household business) and nonfamily SMEs (Small and Medium-sized Enterprises). To do that, this paper used regressions, taken from a sample of 1,720 Vietnamese SMEs (based on the survey data of UNU-WIDER), to compare the impact of female percentage in management board in family and nonfamily businesses in reducing the level of corruption of the firms for the period 2011 to 2015.The findings indicated that first, drawing on socioemotional wealth theory and Vietnam context, family SMEs (household businesses) are more likely to engage in corruption. Second, we also found that female participant in management team can promote firms to be less involved in unethical practices such as bribe. However, the positive role of female managers in reducing corruption engagement is moderated by family control. We used upper echelon theory to suggest that female managers tend to have less managerial discretion in family-controlled organizations. This study has practical contributions, especially for policymakers and owners of household businesses.
Political Discourse and Translation Studies. A Bibliometric Analysis in International Core Journals
Authors: Du Lijuan , Chen Wenliang
Published: March 2022

This study provides a bibliometric analysis of political discourse in translation studies based on the Web of Science (WoS) database from 1990 to 2020. It adopts a guiding procedure integrating the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines into the bibliometric standard workflow and using VOSviewer as the visualization tool. With the help of the built-in WoS analysis tools, the annual publication trends and the most influential productive countries are examined. VOSviewer is used to explore the influential sources in the field, research themes, cited references and their intersections with other references, cited sources and their links to other sources, and most frequently cited authors. The co-occurrence analysis of keywords distinguishes eight research themes, namely, linguistic analysis, ideology and manipulation, power embodied in political communication, interpreting and critical discourse analysis (CDA), the recontextualization of political discourse in media discourse, diplomatic translation, the representation of political speeches in news translation, and conflict and politics. The co-citation analysis of the cited references focuses on discourse analysis models, research approaches, and theoretical frameworks. The co-citation of sources suggests that interdisciplinary features characterize political discourse translation studies, interacting with other disciplines through fields such as pragmatics, discourse analysis, and communication research.
The Effect of Political Donation on Election Outcomes: Evidence from Taiwan Legislative Elections
Authors: Wang Ching-Hsing
Published: March 2022

While past studies have attempted to understand the factors influencing the donation amount received by candidates, little scholarly attention has been paid to the consequences of political donation. Using the candidate-level data from three legislative elections in Taiwan from 2008 to 2016, this study examines the relationship between political donation and candidates’ election outcomes. The empirical findings demonstrate that political donation exerts a significant positive effect on candidates’ election outcomes. Specifically, candidates who receive more campaign contributions are more likely to get a high vote share and elected. However, different sources of political donations have different effects on election outcomes and donation from individuals plays a more important role among four sources of political donations. Furthermore, this study also finds that political donation has a larger impact on non-incumbent candidates’ election outcomes than that of incumbent candidates. Overall, the findings suggest that money matters for candidates’ electoral fate, especially for challengers. Given the importance of political donation in election outcomes, the government should enhance transparency of campaign contributions to ensure fair electoral competition.
Leukocytoclastic Vasculitic Rash Following Second Dose of Moderna COVID-19 Vaccine
Authors: Ireifej Branden , Weingarten Mark , Dhamrah Umaima , Weingarten Michael , Hadi Suhail
Published: March 2022

The immunization against coronavirus disease (COVID-19) via vaccination serves as a significant milestone in the fight against the pandemic. Rapid introduction of various COVID-19 vaccines to stem the spread of virus has researchers scrambling to document the adverse effects left in its wake. Thus far, there have been singular examples of cutaneous vasculitis associated with COVID-19. A history of vasculitis leaves little error to miss its inclusion in diagnostic differentials. It also invokes the physiologic possibility that afflicted patients possess a more susceptible landscape for recurrence that was then triggered by the vaccine when compared with those who lack similar history. In our case report, we build on those findings with one of the first documented examples of vaccination-induced vasculitic rash in a previously asymptomatic patient.
Flexible Versus Rigid Reaming Systems for Independent Femoral Tunnel Reaming During ACL Reconstruction: Minimum 2-Year Clinical Outcomes
Authors: Moran Thomas E. , Ignozzi Anthony J. , Taleghani Eric R. , Bruce Amelia S. , Hart Joseph M. , Werner Brian C.
Published: March 2022

Background:

Radiographic and cadaveric studies have suggested that anatomic anterior cruciate ligament reconstruction (ACLR) femoral tunnel drilling with the use of a flexible reaming system through an anteromedial portal (AM-FR) may result in a different graft and femoral tunnel position compared with using a rigid reamer through an accessory anteromedial portal with hyperflexion (AAM-RR). No prior studies have directly compared clinical outcomes between the use of these 2 techniques for femoral tunnel creation during ACLR.

Purpose:

To compare revision rates at a minimum of 2 years postoperatively for patients who underwent ACLR with AM-FR versus AAM-RR. The secondary objectives were to compare functional testing and patient-reported outcomes between the cohorts.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Included were consecutive patients at a single academic institution between 2013 and 2018 who underwent primary ACLR without additional ligamentous reconstruction. Patients were separated into 2 groups based on the type of anatomic femoral tunnel drilling: AM-FR or AAM-RR. Graft failure, determined by revision ACLR, was assessed with a minimum 2 years of postoperative follow-up. The authors also compared patient-reported outcome scores (International Knee Documentation Committee [IKDC] and Knee injury and Osteoarthritis Outcome Score [KOOS]) and functional performance testing performed at 6 months postoperatively.

Results:

A total of 284 (AAM-RR, 232; AM-FR, 52) patients were included. The mean follow-up time was 3.7 ± 1.5 years, with a minimum 2-year follow-up rate of 90%. There was no significant difference in the rate of revision ACLR between the AAM-RR and AM-FR groups (10.8% vs 9.6%, respectively; P = .806). At 6 months postoperatively, there were no significant between-group differences in peak knee extension strength, peak knee flexion strength, limb symmetry indices, or hop testing, as well as no significant differences in IKDC (AAM-RR, 81.1; AM-FR, 78.9; P = .269) or KOOS (AAM-RR, 89.0; AM-FR, 86.7; P = .104).

Conclusion:

In this limited study, independent femoral tunnel drilling for ACLR using rigid or flexible reaming systems resulted in comparable rates of revision ACLR at a minimum of 2 years postoperatively, with no significant differences in strength assessments or patient-reported outcomes at 6 months postoperatively.
Selections from the 2021 ABC Annual Conference, Answering Aretha’s Question: “Who’s Zooming Who?”
Authors: Whalen D. Joel
Published: March 2022

This article offers readers 12 teaching innovations introduced at the Association for Business Communication’s 86th annual meeting held online in October 2021. This My Favorite Assignment 22nd edition introduces readers to classroom-ready ideas in analysis, critical thinking, and business writing. Assignment support materials—instructions to students, stimulus materials, slides, grading rubrics, frequently asked questions, internet links, and sample student projects—are downloadable from the Association for Business Communication and DePaul University Center for Sales Leadership websites.
Still no bodies: Five years of “no body, no parole” in Queensland, Australia
Authors: Moffa Monique , Ruyters Michele , Stratton Greg
Published: March 2022

“No body, no parole” laws have been introduced in and expanded across Australia since 2015. These reforms were politically premised on the notion of providing closure to victims’ families by compelling prisoners convicted of homicide offences to disclose the location of their victims’ remains in order to be considered eligible to apply for parole. These laws are in operation in most states and territories across Australia despite low national numbers of reported no body homicides. Most Australian jurisdictions do not publish parole decisions, and Queensland is one of only two jurisdictions that require no body, no parole decisions to be made public. This article reviews the roll-out of the “no body” laws in Queensland and considers the potential to misuse the victims’ movement for political gain. We examine the ten published decisions made by the Parole Board Queensland under s193A of the Corrective Services Act 2006 (Qld) to date and discuss the extent to which the legislative aims of the reforms have been met. We argue that there is little evidence these reforms have achieved their aims, and there is a risk that the politicization of parole regimes exploits the victims’ rights movement by offering victims’ families false hope.
Effects of glutamate and aspartate on prostate cancer and breast cancer: a Mendelian randomization study
Authors: Lin Yindan , Yang Ze , Li Jingjia , Sun Yandi , Zhang Xueyun , Qu Zihao , Luo Yan , Zhang Lihong
Published: March 2022

Background

Respectively, prostate cancer (PCa) and breast cancer (BC) are the second most and most commonly diagnosed cancer in men and women, and they account for a majority of cancer-related deaths world-wide. Cancer cells typically exhibit much-facilitated growth that necessitates upregulated glycolysis and augmented amino acid metabolism, that of glutamine and aspartate in particular, which is tightly coupled with an increased flux of the tricarboxylic acid (TCA) cycle. Epidemiological studies have exploited metabolomics to explore the etiology and found potentially effective biomarkers for early detection or progression of prostate and breast cancers. However, large randomized controlled trials (RCTs) to establish causal associations between amino acid metabolism and prostate and breast cancers have not been reported.

Objective

Utilizing two-sample Mendelian randomization (MR), we aimed to estimate how genetically predicted glutamate and aspartate levels could impact upon prostate and breast cancers development.

Methods

Single nucleotide polymorphisms (SNPs) as instrumental variables (IVs), associated with the serum levels of glutamate and aspartate were extracted from the publicly available genome-wide association studies (GWASs), which were conducted to associate genetic variations with blood metabolite levels using comprehensive metabolite profiling in 1,960 adults; and the glutamate and aspartate we have chosen were two of 644 metabolites. The summary statistics for the largest and latest GWAS datasets for prostate cancer (61,106 controls and 79,148 cases) were from the Prostate Cancer Association Group to Investigate Cancer Associated Alterations in the Genome (PRACTICAL) consortium, and datasets for breast cancer (113,789 controls and 133,384 cases) were from Breast Cancer Association Consortium (BCAC). The study was performed through two-sample MR method.

Results

Causal estimates were expressed as odds ratios (OR) and 95% confidence interval (CI) per standard deviation increment in serum level of aspartate or glutamate. Aspartate was positively associated with prostate cancer (Effect = 1.043; 95% confidence interval, 1.003 to 1.084; P = 0.034) and breast cancer (Effect = 1.033; 95% confidence interval, 1.004 to 1.063; P = 0.028); however, glutamate was neither associated with prostate cancer nor with breast cancer. The potential causal associations were robust to the sensitivity analysis.

Conclusions

Our study found that the level of serum aspartate could serve as a risk factor that contributed to the development of prostate and breast cancers. Efforts on a detailed description of the underlying biochemical mechanisms would be extremely valuable in early assessment and/or diagnosis, and strategizing clinical intervention, of both cancers.
Diversification of the aquaporin family in geographical isolated oyster species promote the adaptability to dynamic environments
Authors: Jia Yanglei , Liu Xiao
Published: March 2022

Background

The diversified aquaporin (AQP) family that was derived from gene duplication and subsequent functional differentiation play critical roles in multiple physiological processes and in adaptation to the dynamic environments during the evolutionary process. Oysters are a group of bivalve fauna in Mollusca that were widely distributed around the world and show extraordinary adaptation to harsh environments. However, knowledge is lacking with the diversity and evolution of the AQP family in oysters, even in molluscs.

Results

Here, we performed a comprehensive analysis of the AQP family in three geographical isolated oyster species that are native to different environments. Genome distribution and phylogenetic analysis revealed that the expansion of the AQP family in oysters were attributed to tandem duplication. Synteny analysis indicated that large-scale inversions lead to the independent duplication or deletion of the AQPs after speciation. As a consequence, these independent duplication events contributed to the diversification of the AQP family in different oysters. Pore pattern analysis suggested that the duplicated AQPs in oysters were highly diversified in inner surface profiles, implying the subsequent functional differentiation. The comparison conducted based on the transcriptome data demonstrated that the functional differentiated AQP family members in oysters may play critical roles in maintaining the balance between the stationary homeostasis and dynamic environments.

Conclusions

Our observation provides evidence for the correlation between the duplicated and functional differentiated AQP family and the adaptation to stationary life under dynamic environments in oysters. Additionally, it also broadens our knowledge of the evolution of AQP family in molluscs.
Efficacy and safety of rhomboid intercostal block for analgesia in breast surgery and thoracoscopic surgery: a meta-analysis
Authors: Chen Ruirong , Su Sheng , Shu Haihua
Published: March 2022

Background

Rhomboid intercostal block (RIB) is a new regional anesthesia technique that provides postoperative analgesia for breast surgery and thoracoscopic surgery. The published papers are not yet fully integrated and do not adequately address the impact and safety of the RIB on postoperative pain.

Methods

The PubMed, Web of Science and Embase were searched from 2016 to 2021 for all available randomized controlled trials (RCTs) that evaluated the analgesic efficacy and safety of RIB after thoracic surgery and breast surgery. Random and fixed-effects meta-analytical models were used where indicated, and between-study heterogeneity was assessed. The primary outcome was Postoperative Numerical Rating Scale (NRS) scores of patients at rest recorded 0–1, 6–8, 24 h after surgery. The secondary outcomes included rate of postoperative nausea and vomiting (PONV), postoperative fentanyl consumption and presence of complications of the block.

Results

From 81 records identified, four studies met our inclusion criteria, including 216 patients (RIB:108 patients; no block: 108 patients). In the primary outcome, RIB group showed significantly lower postoperative NRS at rest at first 0–1 h and 6–8 h (weighted mean difference [WMD] = -1.55; 95% confidence internal [CI] = -2.92 to -0.19;p < 0.05), (WMD = -0. 69; 95% CI = -1.29 to -0. 09; p < 0. 05). And there was no significant difference between groups in NRS at rest at 24 h (WMD = -0.78; 95% CI = -1.64 to -0.08;p = 0.77). Also, RIB group showed significantly lower postoperative NRS of breast surgery and thoracoscopic surgery at 0-1 h (WMD = -3.00; 95% CI = -3.13 to -2.87;p < 0.01), (WMD = -1.08; 95% CI = -1.98 to -0.18;p < 0.05). In the secondary outcome, the analysis also showed RIB group had significant lower of POVN rates (summary relative risk (RR) = 0.212;95%CI = 0.10 to 0.45;p < 0. 01) and the postoperative consumption of fentanyl (WMD = -57.52;95%CI = -106.03 to -9.02;p < 0. 05).

Conclusion

This review shows that RIB was more effective in controlling acute pain after breast surgery and thoracoscopic surgery than general analgesia. And it is a trend that RIB may be a kind of effective and safe nerve bock technology and it requires further studies.
Cognitive decline, sensory impairment, and the use of audio-visual aids by long-term care facility residents
Authors: Kwan Rick Yiu Cho , Kwan Chi Wai , Kor Patrick Pui Kin , Chi Iris
Published: March 2022

Background

Hearing and vision impairments and the use of audio-visual aids are associated with cognitive decline in community-dwelling older people, but effects in long-term care facilities (LFCF) are unclear. We hypothesize that visual and hearing impairment are associated with cognitive decline and these relationships are mediated by using visual and hearing aids.

Methods

Secondary data analysis of a longitudinal study was conducted in the 7 government-subsidized LTCF operated by one of the largest non-governmental organizations in Hong Kong using data between 2005 and 2016. Eligible residents were ≥ 60 years of age without severe cognitive impairment at baseline who had stayed in the facilities for more than 3 years. All variables were measured by using the Minimum Data Set-Resident Assessment Instrument Version 2.0, Hong Kong version. The outcome was cognitive decline. Predictors were visual and hearing impairments. Mediators were the use of visual and hearing aids. General linear models were employed to test the hypotheses.

Results

Results for 2,233 residents were analyzed, with a mean age of 82.1 ± 8.2 years and a mean follow-up period of 4.4 ± 0.8 years. Results showed that those who had visual impairment (p = 0.004) and hearing impairments (p = 0.022) had a higher risk of cognitive decline. Using hearing aids (coefficient = 0.0186, p < 0.05) positively mediates the effect of hearing impairment on cognitive decline. Using visual aids (coefficient = -0.0881, p < 0.05) negatively mediates the effects of visual impairment on cognitive decline.

Conclusion

In LTCF, hearing and visual impairments are associated with a higher risk of cognitive decline. Hearing aids often-users were associated with a higher risk of cognitive decline. LTCF residents with visual impairment did not use visual aids. Use of visual aids demonstrated potential effects in slowing cognitive decline. A future study with a larger and more diverse sample with attention to quality of devices is proposed to confirm its effects.
Seroprevalence of SARS-CoV-2 antibodies, associated factors, experiences and attitudes of nursing home and home healthcare employees in Switzerland
Authors: West Erin A. , Kotoun Olivia J. , Schori Larissa J. , Kopp Julia , Kaufmann Marco , Rasi Manuela , Fehr Jan , Puhan Milo A. , Frei Anja ,   the Corona Immunitas Research Group
Published: March 2022

Background

Many studies in hospital settings exist and have shown healthcare employees to be particularly exposed to SARS-CoV-2. While research focused on hospital staff, little evidence exists for employees in nursing homes and home care. The aims of this study were to assess the seroprevalence in nursing homes and home care employees in the Canton of Zurich, compare it to the general population, assess factors associated with seropositivity and explore the perspective of the employees regarding how the pandemic changed their daily work.

Methods

This cross-sectional study is part of the national Corona Immunitas research program of coordinated, seroprevalence studies in Switzerland. Six nursing homes and six home healthcare organizations providing at home care services in Zurich were selected and 296 and 131 employees were recruited, respectively. Assessments included standardized questionnaires, blood sampling for antibodies, and additional work-specific questions. All participants were recruited between 21st September and 23rd October 2020, before the second wave of the pandemic hit Switzerland, and were possibly exposed to SARS-CoV-2 at their work during the first wave in spring 2020.

Results

Seroprevalence of SARS-CoV-2 was 14.9% (95% CI 11.1%-19.6%; range 3.8% to 24.4%) for nursing home employees and 3.8% (95% CI 1.4–9.1%; range 0% to 10%) for home healthcare employees, compared to the general population of Zurich at 3.5% in September 2020 for those aged 20–64. Nurses were 2.6 times more likely to have SARS-CoV-2 antibodies than those employees who were not nurses (95% CI 1.1–6.2). The employees (nursing homes vs. home healthcare) perceived the implementation of general safety measures (44.9% vs. 57.3%) and wearing masks during work (36.8% vs. 43.5%), especially due to the limited communication with residents/clients, as the most crucial changes.

Conclusions

Nursing home employees who worked through SARS-CoV-2 outbreaks at their work were substantially more affected by SARS-CoV-2 infection compared to the general population and to home healthcare employees who similarly worked through outbreaks in their communities. Employees reported that important resources to cope with the burdensome changes they perceived in their daily work were personal resources and team support.

Trial registration

Current Controlled Trials ISRCTN18181860 dated 09/07/2020.
Retrospectively registered.
Clinical-demographic markers for improving diabetes mellitus diagnosis in people with tuberculosis in Tanzania
Authors: Byashalira Kenneth Cleophace , Chamba Nyasatu Godfrey , Alkabab Yosra , Mbelele Peter Masunga , Ntinginya Nyanda Elias , Ramaiya Kaushik Laxmidas , Alimohamed Mohamed Zahir , Heysell Scott Kirkland , Mmbaga Blandina Theophil , Bygbjerg Ib Christian , Christensen Dirk Lund , Mpagama Stellah George , Lillebaek Troels ,   ADEPT Consortium, Byashalira Kenneth Cleophace , Chamba Nyasatu Godfrey , Alkabab Yosra , Mbelele Peter Masunga , Ntinginya Nyanda Elias , Ramaiya Kaushik Laxmidas , Alimohamed Mohamed Zahir , Heysell Scott Kirkland , Mmbaga Blandina Theophil , Bygbjerg Ib Christian , Christensen Dirk Lund , Mpagama Stellah George , Lillebaek Troels , Affenaar Jan-Willem
Published: March 2022

Background

Tuberculosis (TB) control is threatened by an increasing prevalence of diabetes mellitus (DM), particularly in endemic countries. Screening for DM is not routinely implemented in Tanzania; therefore, we aimed to screen for DM at TB diagnosis using clinical-demographic markers.

Methods

Our cross-sectional study recruited TB patients who received anti-TB treatment between October 2019 and September 2020 at health care facilities in three regions from Tanzania. Patients were screened for DM using DM symptoms (polydipsia, polyphagia and polyuria) and random blood glucose (RBG) testing. Patients with a history of DM and those with no history of DM but an RBG ≥ 7.8 mmol/L had point-of-care glycated haemoglobin (HbA1c) testing, and were considered to have DM if HbA1c was ≥ 48 mmol/mol.

Results

Of 1344 TB patients, the mean age was 41.0 (± 17.0) years, and 64.7% were male. A total of 1011 (75.2%) had pulmonary TB, and 133 (10.4%) had at least one DM symptom. Overall, the prevalence of DM was 7.8%, of which 36 (2.8%) TB patients with no history of DM were newly diagnosed with DM by RBG testing. TB/DM patients were older than those with only TB (50.0 ± 14.0 years vs 40.0 ± 17.0 years, p < 0.001). Patients with RBG ≥ 7.8 mmol/L were more likely to have pulmonary TB (p = 0.003), age ≥ 35 years (p = 0.018), and have at least one DM symptom (p < 0.001). There was a substantial agreement (Kappa = 0.74) between the on-site glucometer and point-of-care HbA1c tests in detecting DM range of hyperglycemia.

Conclusion

The implementation of clinical-demographic markers and blood glucose screening identified the overall prevalence of DM and those at risk of DM in TB patients. Clinical-demographic markers are independent predictors for DM range hyperglycemia and highlight the importance of further diagnostic testing and early co-management of TB and DM.
Correction to: Do the implementation processes of a school-based daily physical activity (DPA) program vary according to the socioeconomic context of the schools? A realist evaluation of the active at school program
Authors: Gosselin Véronique , Laberge Suzanne
Published: March 2022

An amendment to this paper has been published and can be accessed via the original article.
Evaluating the variety of GNAS inactivation disorders and their clinical manifestations in 11 Chinese children
Authors: Chang Guoying , Li Qun , Li Niu , Li Guoqiang , Li Juan , Ding Yu , Huang Xiaodong , Shen Yongnian , Wang Jian , Wang Xiumin
Published: March 2022

Background

The GNAS gene on chromosome 20q13.3, encodes the alpha-subunit of the stimulatory G protein, which is expressed in most tissues and regulated through reciprocal genomic imprinting. Disorders of GNAS inactivation produce several different clinical phenotypes including pseudohypoparathyroidism (PHP), pseudopseudohypoparathyroidism (PPHP), progressive osseous heteroplasia (POH), and osteoma cutis (OC). The clinical and biochemical characteristics overlap of PHP subtypes and other related disorders presents challenges for differential diagnosis.

Methods

We enrolled a total of 11 Chinese children with PHP in our study and analyzed their clinical characteristics, laboratory results, and genetic mutations.

Results

Among these 11 patients, nine of them (9/11) presented with resistance to parathyroid hormone (PTH); and nine (9/11) presented with an Albright′s hereditary osteodystrophy (AHO) phenotype. GNAS abnormalities were detected in all 11 patients, including nine cases with GNAS gene variations and two cases with GNAS methylation defects. These GNAS variations included an intronic mutation (c.212 + 3_212 + 6delAAGT), three missense mutations (c.314C > T, c.308 T > C, c.1123G > T), two deletion mutations (c.565_568delGACT*2, c.74delA), and two splicing mutations (c.721 + 1G > A, c.432 + 1G > A). Three of these mutations, namely, c.314C > T, c.1123G > T, and c.721 + 1G > A, were found to be novel. This data was then used to assign a GNAS subtype to each of these patients with six cases diagnosed as PHP1a, two cases as PHP1b, one as PPHP, and two as POH.

Conclusions

Evaluating patients with PTH resistance and AHO phenotype improved the genetic diagnosis of GNAS mutations significantly. In addition, our results suggest that when GNAS gene sequencing is negative, GNAS methylation study should be performed. Early genetic detection is required for the differential diagnosis of GNAS disorders and is critical to the clinician’s ability to distinguish between heterotopic ossification in the POH and AHO phenotype.
Failure to demonstrate effects of interruptions on diagnostic reasoning: three experiments
Authors: Alajaji Mai , Saleh Nada , AlKhulaif Ali Hassan , Mamede Silvia , Rotgans Jerome I. , Sukkarieh Hatouf , AlHarbi Nouf , Magzoub Mohi Eldin , Schmidt Henk G.
Published: March 2022

Background

Diagnostic error is a major source of patient suffering. Researchshows that physicians experience frequent interruptions while being engaged with patients and indicate that diagnostic accuracy may be impaired as a result. Since most studies in the field are observational, there is as yet no evidence suggesting a direct causal link between being interrupted and diagnostic error. Theexperiments reported in this article were intended to assess this hypothesis.

Methods

Three experiments were conducted to test the hypothesis that interruptions hurt diagnostic reasoning and increase time on task. In the first experiment (N = 42), internal medicine residents, while diagnosing vignettes of actual clinical cases were interrupted halfway with a task unrelated to medicine, solving word-spotting puzzles and anagrams. In the second experiment (N = 78), the interruptions were medically relevant ones. In the third experiment (N = 30), we put additional time pressure on the participants. In all these experiments, a control group diagnosed the cases without interruption. Dependent variables were diagnostic accuracy and amount of time spent on the vignettes.

Results

In none of the experiments interruptions were demonstrated to influence diagnostic accuracy. In Experiment 1: Mean of interrupted group was 0.88 (SD = 0.37) versus non- interrupted group 0.91 (SD = 0.32). In Experiment 2: Mean of interrupted group was 0.95 (SD = 0.32) versus non-interrupted group 0.94 (SD = 0.38). In Experiment 3: Mean of interrupted group was 0.42 (SD = 0.12) versus non-interrupted group 0.37 (SD = 0.08). Although interrupted residents in all experiments needed more time to complete the diagnostic task, only in Experiment 2, this effect was statistically significant.

Conclusions

These three experiments, taken together, failed to demonstrate negative effects of interruptions on diagnostic reasoning. Perhaps physicians who are interrupted may still have sufficient cognitive resources available to recover from it most of the time.
Relationship between spiritual health, resilience, and happiness among a group of dental students: a cross-sectional study with structural equation modeling method
Authors: Hatami Saeed , Shekarchizadeh Hajar
Published: March 2022

Background

Given the importance of spiritual health, resilience and happiness to encounter challenges facing dental students, we aimed to examine these variables, their relationship and the mediating role of resilience between spiritual health and happiness among a group of Iranian dental students in Islamic Azad University of Isfahan.

Methods

In this cross-sectional study, utilizing a stratified sampling method, 150 volunteer dental students in different academic years filled in the Persian version of Spiritual Well-Being scale, the Persian version of Connor-Davidson Resilience Scale, and Isfahan-Fordyce Happiness Inventory. Independent t-test, Kruskal–Wallis test, and Pearson correlation coefficient served for statistical analysis. In addition, we conducted a Structural Equation Modeling analysis.

Results

The mean age of the students was 23.43 ± 3.11, and 56% were women. The mean score of spiritual health, resilience, and happiness was 89.27 ± 16.69, 90.19 ± 15.03, and 295.17 ± 65.82, respectively. Spiritual health of a great majority of dental students was upper medium or high (87.3%), most of them had high level of resilience (69.3%), and 55.3% reported medium level of happiness. Spiritual health was directly associated with both happiness and resilience (p <  0.001). Resilience acted as an intermediary variable between spiritual health and happiness (p <  0.001).

Conclusions

Spiritual health was associated with increased happiness, and this relationship was mediated by resilience. Thus, it is recommended to address the issue of spiritual health to those students with lower scores in order to increase their resilience and their level of happiness.
Audit of documentation accompanying referred maternity cases to a referral hospital in northern Ghana: a mixed-methods study
Authors: Ameyaw Edward Kwabena , Amoah Roberta Mensima , Njue Carolyne , Tran Nguyen Toan , Dawson Angela
Published: March 2022

Background

Effective referral of maternity cases, which cannot be managed at the primary healthcare level, with detailed referral forms is important for reducing possible delays in the provision of higher-level healthcare. This is the first study to audit documentation or referral forms that accompany referred maternity cases to a referral hospital in the northern region of Ghana.

Materials and methods

This study employed an explanatory sequential mixed-method design, starting with a quantitative review of referral forms that accompanied all patients referred to four units (antenatal, antenatal emergency, labour and neonatal intensive care) of a referral hospital in northern Ghana. In-depth interviews were held with the heads of the four units afterwards. Descriptive statistics were computed for the quantitative data. The qualitative data was subjected to content analysis. Integration of the data occurred at the data interpretation/discussion level.

Results

A total of 217 referral forms were analysed. Nearly half of the cases were referred from the Tamale Metropolis (46.5%) and 83.9% were referred for advanced care, whilst 8.3% were referred due to a lack of medical logistics and equipment such as oxygen and skilled personnel (6%). Completion rates of the referral forms were as follows: < 50% completion (n = 81; 37.3%), 50–75% completion (n = 112; 51.6%) above 75% completion (n = 24; 11.1%). Some of the handwriting were not legible and were quite difficult to read. The key informants stated that incomplete forms sometimes delay treatment. The head of the antenatal care unit at the referral hospital suggested professional development sessions as a strategy for supporting clinicians to fill the forms as expected.

Conclusion

The Ghana Health Service should conduct regular audits, develop job aides and provide incentives for health professionals who accurately complete referral forms. Completing forms and digitizing health records can help ensure further efficiencies in the health information system and sustain good maternity referral documentation practices.
Nasal carriage of Methicillin-Resistant Staphylococcus aureus among sympatric free-ranging domestic pigs and wild Chlorocebus pygerythrus in a rural African setting
Authors: Kalule John Bosco , Nakintu Valeria Zalwango , SSendawula Simon Peter
Published: March 2022

Background

Methicillin Resistant Staphylococcus aureus (MRSA) nasal carriage in domestic pigs and vervet monkeys is a risk factor for subsequent severe infections in domestic pigs and for dissemination to the human population. This study assessed nasal carriage of MRSA in domestic pigs and sympatric vervet monkeys in a rural African village during an outbreak of a virus hemorrhagic fever suspected to be contracted from wild primates.

This study was conducted during the 2012 Ebola outbreak to determine nasal carriage of MRSA in free-ranging domestic pigs and sympatric freely roaming vervet monkeys using conventional methods. Staphylococcus aureus (S. aureus) isolated from the anterior nares were tested for susceptibility to commonly used antibiotics and conventional PCR was used to confirm methicillin resistance. The MRSA strains were then genotyped using SCCmec typing.

Results

Overall, there was a high level of resistance to tetracycline [90% (63/70) in pigs and 67% (10/15) in vervet monkeys], trimethoprim/sulphamethoxazole [90% (63/70) in pigs and 67% (10/15) in vervet monkeys], and penicillin [83% (58/70) in pigs and 67% (10/15) in vervet monkeys]. Most of the MRSA strains (91.6%, 11/12) were of the SCCmec type I [1B] genotype.

Conclusion

The nasal carriage of drug resistant S. aureus in freely roaming domestic and wild animals presents a risk for widespread environmental spread of antimicrobial resistance thus presenting a risk for treatment failure in domestic animals, wild animals, and humans.
Remnant lipoprotein cholesterol is associated with incident new onset diabetes after transplantation (NODAT) in renal transplant recipients: results of the TransplantLines Biobank and cohort Studies
Authors: Szili-Torok Tamas , Sokooti Sara , Osté Maryse C. J. , Gomes-Neto Antonio W. , Dullaart Robin P. F. , Bakker Stephan J. L. , Tietge Uwe J. F.
Published: March 2022

Background

New onset diabetes after transplantation (NODAT) is a frequent and serious complication of renal transplantation resulting in worse graft and patient outcomes. The pathophysiology of NODAT is incompletely understood, and no prospective biomarkers have been established to predict NODAT risk in renal transplant recipients (RTR). The present work aimed to determine whether remnant lipoprotein (RLP) cholesterol could serve as such a biomarker that would also provide a novel target for therapeutic intervention.

Methods

This longitudinal cohort study included 480 RTR free of diabetes at baseline. 53 patients (11%) were diagnosed with NODAT during a median [interquartile range, IQR] follow-up of 5.2 [4.1–5.8] years. RLP cholesterol was calculated by subtracting HDL and LDL cholesterol from total cholesterol values (all directly measured).

Results

Baseline remnant cholesterol values were significantly higher in RTR who subsequently developed NODAT (0.9 [0.5–1.2] mmol/L vs. 0.6 [0.4–0.9] mmol/L, p = 0.001). Kaplan-Meier analysis showed that higher RLP cholesterol values were associated with an increased risk of incident NODAT (log rank test, p < 0.001). Cox regression demonstrated a significant longitudinal association between baseline RLP cholesterol levels and NODAT (HR, 2.27 [1.64–3.14] per 1 SD increase, p < 0.001) that remained after adjusting for plasma glucose and HbA1c (p = 0.002), HDL and LDL cholesterol (p = 0.008) and use of immunosuppressive medication (p < 0.001), among others. Adding baseline remnant cholesterol to the Framingham Diabetes Risk Score significantly improved NODAT prediction (change in C-statistic, p = 0.01).

Conclusions

This study demonstrates that baseline RLP cholesterol levels strongly associate with incident NODAT independent of several other recognized risk factors.
Operation of a triage committee for advanced life support during the COVID-19 pandemic
Authors: Herreros Benjamín , Ruiz de Luna Rafael , de la Calle Natalia , Gayoso Diego , Martínez Paula , Olaciregui Dague Karmele , Palacios Gregorio
Published: March 2022

Background

During the first weeks of March 2020 in Spain, the cases of severe respiratory failure progressively increased, generating an imbalance between the clinical needs for advanced life support (ALS) measures and the effective availability of ALS resources. To address this problem, the creation of triage committees (TC) was proposed, whose main function is to select the best candidates to receive ALS. The main objective of our study is to describe the clinical characteristics of the patients evaluated by the TC of the Alcorcón Foundation University Hospital (AFUH) during the first wave of SARS CoV-2. Other objectives are to determine if there are differences between the patients considered candidates / not candidates for ALS and to analyze the functioning of the TC.

Methods

Retrospective observational study of all patients assessed by the AFUH TC.

Results

There were 19 meetings, in which 181 patients were evaluated, 65.4% male and with a mean age of 70.1 years. 31% had some degree of functional dependence, the Barthel median was 100 and Charlson 4. 58.5% were not considered a candidate for ALS at that time. The patients considered candidates to receive ALS were younger (72 vs 66; p < 0.001), had less comorbidity (Charlson 4 vs 3; p < 0.001) and had a better previous functional situation. A median of 5 physicians participated in each meeting and, after being assessed by the TC, 13.6% received ALS: 29.3% of those considered candidates for ALS and 2% of the non-candidates.

Conclusions

The patients evaluated by the TC had a mean age of 70 years, high comorbidity and almost a third had some degree of functional dependence. More than half were not considered candidates for ALS at that time, these patients being older, with more comorbidity and a worse previous functional situation. TC decisions, based on objective clinical criteria, were almost always respected. Public institutions must get involved in triage procedures, which should and in our opinion must include the creation of TC in health centers. The implementation of Anticipated Decision programs (ADP) would help enable patients affected by triage decisions to participate in them.
Development and psychometric properties of COVID-19 related Healthcare Student stress scale (CHSSS)
Authors: Baghcheghi Nayereh , Mesri Mehdi , Karimi Mahmood , Bigdeli Shoaleh , Koohestani Hamid Reza
Published: March 2022

Background

There is no valid and reliable tool to measure COVID-19 healthcare stress felt by healthcare students. A scale was developed to assess COVID-19 stress in healthcare students and its psychometrics was examined.

Methods

This is a two phases mixed-method study including a qualitative stage consisting of student interview and literature review to develop content of the tool. In the quantitative stage, the psychometrics of the scale was examined in 2020–2021.

Results

The COVID-19 related healthcare student stress scale (CHSSS) featured five factors including fear of catching coronavirus, social constraints, changes in education, non-compliance of health protocols and worrying news and overload information, which totally explained 51.75% of the total variance.

Conclusion

Validity and reliability of CHSSS with 17 items were supported to measure COVID-19 stress in healthcare students as a self-assessment tool. Researchers can utilize this tool to assess COVID-19 stress in healthcare students and introduce policies and intervention especially designed for healthcare students.
Brain death: a clinical overview
Authors: Spears William , Mian Asim , Greer David
Published: March 2022

Brain death, also commonly referred to as death by neurologic criteria, has been considered a legal definition of death for decades. Its determination involves many considerations and subtleties. In this review, we discuss the philosophy and history of brain death, its clinical determination, and special considerations. We discuss performance of the main clinical components of the brain death exam: assessment of coma, cranial nerves, motor testing, and apnea testing. We also discuss common ancillary tests, including advantages and pitfalls. Special discussion is given to extracorporeal membrane oxygenation, target temperature management, and determination of brain death in pediatric populations. Lastly, we discuss existing controversies and future directions in the field.
Successful separation of male pygopagus with anal canal and urethral reconstruction: a case report
Authors: Toyama Chiyoshi , Nomura Motonari , Tazuke Yuko , Yokota Chisato , Kagawa Naoki , Kishima Haruhiko , Yoshimura Akihiro , Ujike Takeshi , Nagahara Akira , Nonomura Norio , Kubo Tateki , Matsui Futoshi , Matsumoto Fumi , Okuyama Hiroomi
Published: March 2022

Background

Pygopagus is a type of conjoined twin binding at the buttocks. Some cases of pygopagus involve the fusion of the gastrointestinal tract, urinary tract, and spinal cord. Few cases of male pygopagus have been reported; however, the prognosis after separation is unclear. Herein, we report a case of male pygopagus in which successful separation was performed with the reconstruction of the anal canal.

Case presentation

Twins with male pygopagus were born at 35 weeks by cesarean section. They shared a common anus, penis, and scrotum with four testes. The infants had normal defecation and urination after birth. The separation surgery was scheduled when they were 5 months. Two distinct anesthesia teams and four surgical teams (neurosurgery, pediatric urology, plastic surgery, and pediatric surgery) were involved in the multidisciplinary approach. After separating the spinal cord, we found that the anal canal and sphincter muscle complex were fused near the anal aperture, and we separated them. The fused penis and testis were separated and reconstructed using the same incisional line as the other separation, and the reconstructions of the anal canals with the sphincter muscle complex were completed. Both patients had an uneventful postoperative course. At 2 years of age, they could walk and defecate independently. In addition, they voided spontaneously without urinary incontinence at the time of 3 years and 11 months.

Conclusions

Separation of the spinal cord with anal canal and urethral reconstruction is important for male pygopagus patients as it allows them to preserve their independent function.
Ecology of sand flies (Diptera: Psychodidae, Phlebotominae) in Jajarm County, an area with high risk of cutaneous leishmaniasis, in North Khorasan, Iran
Authors: Jalali Hasan , Nikookar Seyed Hassan , Hosseini-Vasoukolaei Nasibeh , Jahanifard Elham , Enayati Ahmad Ali , Motevalli-Haghi Farzad , Yazdani-Charati Jamshid
Published: March 2022

The present study was conducted to investigate the ecological aspects of sand flies in southwestern North Khorasan, in which cutaneous leishmaniasis caused byLeishmania majorhas been reported with the highest annual incidence in Iran. Sampling was carried out in four localities including: Khorasha (natural), Ghamiteh (natural), Jorbat (semi urban) and Brick kilns (urban), twice a month using 105 sticky paper traps from indoors and outdoors dwellings during May-December 2017. Specimens were removed from sticky papers, washed in acetone, preserved in 80% ethanol, mounted on microscopic slides by Puri’s medium, and identified using valid morphological keys. Simpson (D), richness (S), Menhinick (DMg), Margalef (DMn), Shannon-Weiner (H′), evenness (J’) were calculated for species diversity. The synanthropic index was determined for the first time in the area. Totally 517 specimens were collected, 47% in outdoors and 30.4% in human indoor dwellings and 22.6% in animal. Eight species of sand flies including 5 species of the genusPhlebotomusand 3 species of the genusSergentomyiawere identified.Phlebotomus papatasiandSergentomyia sintoniwere the most common and Eudominant species, active in all months, collected in the maximum number and percentage in September and August, respectively, and showed the highest abundance in outdoors. The synanthropic index ranged from 6.25 to 38.9 in the study area. The Shannon-Wiener index was estimated to be up to 1.4 and 1.37 in Khorasha and November, respectively, which showed the highest diversity due to maximal richness and evenness compared to other areas. High abundance ofPh. papatasi, as the main vector of cutaneous leishmaniasis, can enhance the potential risk of emerging CL in new areas, the data can be equally important when vector control measures are considered.