bluuebunny/crossref_metadata_2025 huggingface dataset:
Loss of Ambulatory Level and Activities of Daily Living at 1 Year Following Hip Fracture: Can We Identify Patients at Risk?
Authors: Konda Sanjit R. , Dedhia Nicket , Ranson Rachel A. , Tong Yixuan , Ganta Abhishek , Egol Kenneth A.
Published: April 2021

Introduction:

Operative hip fractures are known to cause a loss in functional status in the elderly. While several studies exist demonstrating the association between age, pre-injury functioning, and comorbidities related to this loss of function, no studies have predicted this using a validated risk stratification tool. We attempt to use the Score for Trauma Triage for Geriatric and Middle-Aged (STTGMA) tool to predict loss of ambulatory function and need for assistive device use.

Materials and Methods:

Five hundred and fifty-six patients ≥55 years of age who underwent operative hip fracture fixation were enrolled in a trauma registry. Demographics, functional status, injury severity, and hospital course were used to determine a STTGMA score and patients were stratified into risk quartiles. At least 1 year after hospitalization, patients completed the EQ-5D questionnaire for functional outcomes.

Results:

Two hundred and sixty-eight (48.2%) patients or their family members responded to the questionnaire. Of the 184 patients alive, 65 (35.3%) reported a return to baseline function. Eighty-nine (48.4%) patients reported a loss in ambulatory status. Patients with higher STTGMA scores were older, had more comorbidities, reported greater need for help with daily activities, increased difficulty with self-care, and a reduction in return to activities of daily living (all p ≤ 0.001). Patients with lower STTGMA scores were more likely to never require an assistive device while those with higher scores were more likely to continue needing one (p = 0.004 and p < 0.001). Patients in the highest STTGMA risk groups were 1.5x more likely to have an impairment in ambulatory status (need for ambulatory assistive device or decreased ambulatory capacity) (p = 0.004).

Discussion:

Patients in higher STTGMA risk quartiles were more likely to experience impairment after hip fracture surgery. The STTGMA tool can predict loss of ambulatory independence following hip fracture. At-risk populations can be targeted for enhanced physiotherapy and rehabilitation services for optimal return to prior functioning.
Design and Evaluation of a Hospital-Based Educational Event on Fracture Care for Older Adult
Authors: Gosch Markus , Kammerlander Christian , Fantin Emilio , Jensen Thomas Giver , Salazar Ana Milena López , Olarte Carlos , Bavatonavarech Suthorn , Medina Claudia , Link Bjoern-Christian , Cunningham Michael
Published: April 2021

Introduction:

Surgeons, internal medicine physicians, nurses, and other members of the healthcare team managing older adults with a fracture all have barriers to attending educational courses, including time away from practice and cost. Our planning group decided to create and evaluate a hospital-based educational event to address, meet, and improve the care of older adults with a fracture.

Materials and Methods:

A committee of surgeons and geriatricians defined 3 learning objectives to improve knowledge and attitudes in co-managed care. They designed a 1-day educational event consisting of a departmental visit, a review of cases, a planning session to identify gaps and plan changes, and presentations on selected topics. Thirteen hospitals worldwide completed an 8-question online application form, and 7 sites were selected for delivery over 3 years in Denmark, Colombia, Thailand, Paraguay, Switzerland, and the Dominican Republic.

Results:

Each event was conducted by 1 or more visiting surgeons and geriatricians, and the local team leaders. The most common challenges reported in the applications were preoperative assessment or optimization, delayed surgery, lack of protocols, access to a geriatrician, teamwork, and specific aspects of perioperative and postoperative care. In each department, 4 or 5 goals and targets for implementation were agreed. The presentations section was customized and attended by 20 to 50 team members.

Discussion:

Topics selected by a majority of departments were principles of co-managed care (7), preoperative optimization (7), and management of delirium (4). Follow up was conducted after 3 and 12 months to review the degree of achievement of each planned change and to identify any barriers to complete implementation.

Conclusions:

Hospital-based events with visiting and local faculty were effective to engage a broader audience that might not attend external courses. A performance improvement component with goal setting and follow up was acceptable to all host departments.
Outcomes of COVID-19 Negative Hip Fracture Patients During the Acute and Subacute Pandemic
Authors: Onizuka Naoko , Topor Lauren N. , Schroder Lisa K. , Switzer Julie A.
Published: April 2021

Objectives:

To better elucidate how the COVID-19 pandemic has affected the operatively treated geriatric hip fracture population and how the health care system adapted to pandemic dictated procedures.

Design:

Retrospective cohort study.

Setting:

A community hospital.

Participants:

Individuals ≥65 years of age presented with a proximal femoral fracture from a low-energy mechanism undergoing operative treatment from January 17, 2020 to July 2, 2020 (N = 125).

Measurements:

We defined 3 phases of healthcare system response: pre-COVID-19, acute phase, and subacute phase. Thirty-day mortality, time to operating room (OR), length of stay, time to start physical therapy, perioperative complications, delirium rate, hospice admission rate, discharge dispositions, readmission rate, and the reason of surgery delay were assessed.

Results:

The number of hip fractures has remained constant during the pandemic. The 30-day mortality rate, time to OR, and length of stay were higher in the pandemic compared to the pre-pandemic. Those who had a longer wait time to OR (≥ 24 hours) had more complications and increased 30-day mortality rates. Some of the surgery delays were related to OR unavailability as a consequence of the COVID-19 pandemic. Surgery was delayed in 3 patients who were on direct oral anticoagulants (DOACs) in pandemic but none for pre-pandemic period.

Conclusion:

This is the first study to compare the effect of the acute and subacute phases of the pandemic on uninfected hip fracture patients. In the age of COVID-19, to provide the best care for the vulnerable geriatric orthopedic populations, the healthcare system must adopt new protocols. We should still aim to promote prompt surgical care when indicated. It is important to ensure adequate resource availability, such as OR time and staff so that hip fracture patients may continue to receive rapid access to surgery. A multidisciplinary approach remains the key to the management of fragility hip fracture patients during the pandemic.
Motives for Substance Use in Daily Life: A Systematic Review of Studies Using Ecological Momentary Assessment
Authors: Votaw Victoria R. , Witkiewitz Katie
Published: April 2021

The motivational model of substance use posits that four motive subtypes (coping, enhancement, social, conformity) dynamically interact with contextual factors to affect decisions about substance use. Yet prior studies assessing the motivational model have relied on between-persons, cross-sectional evaluations of trait motives. We systematically reviewed studies using ecological momentary assessment (EMA; N = 64) on motives for substance use to examine methodological features of EMA studies examining the motivational model, support for the motivational model between and within individuals, and associations between trait motives and daily processes. Results of the reviewed studies provide equivocal support for the motivational model and suggest that EMA measures and trait measures of motives might not reflect the same construct. The reviewed body of research indicates that most studies have not examined the momentary and dynamic nature of the motivational model, and more research is needed to inform interventions that address heterogeneous reasons for substance use in daily life.
Incentives, Status and Thereafter: A Critical Survey
Authors: Dey Oindrila , Banerjee Swapnendu
Published: April 2021

This article provides a critical discussion on the working of status as an instrument to elicit desirable effort within an organization. It postulates a comprehensive survey of the studies on incentive, especially non-monetary incentives like status. Different studies are summarized concisely and elaborate comments on the divergent views on valuation for status, the relationship between monetary and status incentives, the technique of modelling status and the cost of introducing status have been illustrated. The article underlines some probable adverse consequences associated with the use of the status incentive. Status works by creating inequality and has strong unwarranted influence even beyond organizational purview. It emphasizes the need for profound research to account for the optimal and prudent use of status as incentives.

JEL Classification: L2, D21, D86
Were Foreign Exchange Markets Reacting Negatively to Political Events? The Case of Malaysia
Authors: Hui Hon Chung
Published: April 2021

This article explores the effects of political events on foreign exchange returns in Malaysia. We identify five political events in recent history, namely the 13th General Election (GE13), the imprisonment of a key opposition politician, the scandal from the 1MDB exposé, the appointment of a new Central Bank Governor and the 14th General Election (GE14). Using event studies, our findings show that the imprisonment of the opposition party leader triggered a favourable response from the foreign exchange market. However, market reactions to the 1MDB scandal were largely unfavourable. The GE13 triggered unfavourable market response, while the reverse is true for market reactions to GE14. Market response to the appointment of the new Central Bank Governor was rather positive. The Event Study is the first of its kind that examines the foreign exchange market implications of key political events in Malaysia. There are practical considerations that emanate from these findings.

JEL Classification: F31, D72, D73, O38
Overcoming the “Trash Talk in Your Head”: Extending an Ethic of Care to Students Experiencing Intersectional Stigma in Community College
Authors: Brower Rebecca L. , Bertrand Jones Tamara , Hu Shouping
Published: April 2021

Intersectional stigma is experienced by individuals who share both a minoritized identity and a socially stigmatized identity. This study examines not only both types of intersectional stigma (e.g., homelessness, addiction, history of incarceration) that exist among students but also how campus personnel have extended an ethic of care to assist these students in changing their self-perceptions or “looking glass selves” to persist and succeed in community college. Recommendations for institutional improvement include flexibility in hiring staff with the expertise of lived experience, extending social support, improving access to campus and community resources, and horizontal peer mentoring for students with stigmatized identities.
Developing the Resilience Framework for Nursing and Healthcare
Authors: Morse Janice M. , Kent-Marvick Jacqueline , Barry Lisa A. , Harvey Jennifer , Okang Esther Narkie , Rudd Elizabeth A. , Wang Ching-Yu , Williams Marcia R.
Published: April 2021

Despite four decades of resilience research, resilience remains a poor fit for practice as a scientific construct. Using the literature, we explored the concepts attributed to the development of resilience, identifying those that mitigate symptoms of distress caused by adversity and facilitate coping in seven classes of illness: transplants, cancer, mental illness, episodic illness, chronic and painful illness, unexpected events, and illness within a dyadic relationship. We identified protective, compensatory, and challenge-related coping-concept strategies that healthcare workers and patients use during the adversity experience. Healthcare-worker assessment and selection of appropriate coping concepts enable the individual to control their distress, resulting in attainment of equanimity and the state of resilience, permitting the resilient individual to work toward recovery, recalibration, and readjustment. We inductively developed and linked these conceptual components into a dynamic framework, The Resilience Framework for Nursing and Healthcare, making it widely applicable for healthcare across a variety of patients.
Where the System Failed: The COVID-19 Pandemic’s Impact on Pregnancy and Birth Care
Authors: Altman Molly R. , Gavin Amelia R. , Eagen-Torkko Meghan K. , Kantrowitz-Gordon Ira , Khosa Rue M. , Mohammed Selina A.
Published: April 2021

The COVID-19 pandemic created a massive shift in health care systems, including within pregnancy and birth care. To explore how experiences of pregnancy and birth were impacted, 15 patient participants and 14 nurse participants were interviewed and transcripts analyzed using critical thematic analysis. Patients highlighted how adaptations to care were inadequate to meet their needs, a desire for support in response to stress, and the impact of COVID on patients’ experiences. Nurses identified how inconsistencies in policies impacted nurses’ ability to care for patients, the impact on nurses from hospital actions, and the impact on patients from hospital actions. Both groups discussed how system changes had disparate impacts on marginalized communities, leading to racially-biased care. This pandemic will continue to have lasting impact on pregnant and birthing families, and the nurses who care for them, and it is imperative that hospitals examine their role and any potential impacts.
Agreement in Medications Reported in Medical and Dental Electronic Health Records
Authors: Tenuta L.M.A. , Canady C. , Eber R.M. , Johnson L.
Published: April 2021

Introduction:

The historical separation between medicine and dentistry has resulted in the creation of separate health records, which have the potential to negatively impact patient care and safety. Of particular importance, errors or omissions in medication lists in separate electronic health records (EHRs) may lead to medical errors and serious adverse outcomes.

Objective:

This study aimed to compare medication lists reported in the EHRs of active patients treated by both the University of Michigan School of Dentistry and Michigan Medicine to determine if differences exist.

Methods:

In this cohort study, EHRs of a population of 159,733 patients that the University of Michigan medical and dental clinics share in common were investigated for agreement in the reporting of 16 medications. After exclusion of minors and patients not seen in the last 5 y, records of 27,277 patients were examined.

Results:

The maximum percentage of agreement in medications reported in both records was 52% for levothyroxine, and the minimum was 7% for sildenafil. The medical record had a significantly higher number of unique medications than the dental record, suggesting higher underreporting in the dental setting.

Conclusion:

The lack of agreement in the report of medications with serious dental and medical implications argues in favor of unification of records and use of available technology to increase accurate medication reporting.

Knowledge Transfer Statement:

The results demonstrate a lack of agreement between medications reported in medical and dental records, which can have serious implications to patients’ health. A unified health record, employing available technology to increase accurate medication reporting, would mitigate this problem.
Social Exclusion Among Sexual Minorities: A Case of HIV-Positive Homosexuals
Authors: Kaushik Archana
Published: April 2021

Sexual minorities are one of the most vulnerable and marginalised groups in the society. Sero-positivity accentuates social exclusion among the sexual minorities. The article aims to appraise the factors that make Men who have Sex with Men (MSM) vulnerable to HIV infection and lead to their social exclusion. Qualitative in nature and based on fifteen in-depth case studies of HIV-infected MSM, the study is located in Delhi, India. Findings show that variables such as age, child sexual abuse, marital status and multiple sex partners, contribute to vulnerabilities of respondents. Sociocultural milieu puts structural barriers, restricting integration of MSM in the society. Culture of silence over sexual matters, notions of proving ‘manhood’ through aggression and sexual violence are some of the factors that hamper healthy behaviours and relationships among the MSM. At the interpersonal level, possessiveness, betrayal, infidelity, heartbreak, strong emotional whirlpool when love–relations go incongruent, all take a heavy toll of their mental and physical health. These variables socially exclude the sexual minorities from the mainstream life. Findings reflect both positive (disclosing to family, abstinence, spiritual growth) and negative (suicide attempts, drug use) ways of coping among the MSM respondents. Critical areas of concern for service providers while planning interventions for social inclusion and empowerment of people with sexual minority are delineated.
Speakable Selves and Unspeakable Identities
Authors: Bose Arunabha
Published: April 2021

Unlike the unitary subject of Western enlightenment, the Dalit non-subject has no single operational social self. Limbale’s subjecthood or Autos in The Outcaste is not a sedimented ontological position but rather a process of negotiation between material and social conditions that affect one’s embodied and situated self. Unlike the other Mahar boys, Parshya, Harya or Mallya; the social cartographies of Limbale’s identity positions are splintered. In place of a stable Mahar being, Limbale has multiple and differentiated becomings. These uneven and dissymmetrical genealogical relations are mimicked by the asymmetricality of the narrative which is structurally splintered; The Outcaste is simultaneously an autobiography, a counter-hegemonic historiography and an ethnobiography.
Affect as a multimodal practice
Authors: Westberg Gustav
Published: April 2021

This paper sets out a framework for analyzing affect as a multimodal practice. The overall objective is to contribute to the theoretical development of how affect can be approached as an object of semiotic enquiry. The framework is based on the assumption that affect is semiotically materialized through discourse, and with the ambition of taking multimodality seriously, subject formation, strategic perspectivation and affordance are proposed as conceptual starting points for the study of affective meaning-making. Examples are drawn from artifacts and images that represent the Sámi as desirable objects to consumers and tourists. Through a detailed semiotic analysis of a pair of jeans described as being Sámi inspired, and through an analysis of images that promote Sámi tourism experiences, the paper demonstrates how affective ways of being emerge in a relationship between the affordance of semiotic materials and different subjectivities. These insights point to the possibility of further investigating affective subject formation as materialized in diverse semiotic materials in relation to other social phenomena, political issues and ideological concerns.
Differentiation Between Phenotypes of Polycystic Ovarian Syndrome With Sonography
Authors: Abdel Khalek Abdel Razek Ahmed , Abou Elatta Heba
Published: April 2021

Objectives:

To differentiate between the classic (A/B) from the nonclassic (C/D) phenotypes of the polycystic ovarian syndrome (PCOS) with sonography.

Materials & Methods:

Retrospective analysis was performed upon 72 female patients with PCOS. All patients underwent transvaginal sonography. The patients were classified into classic and nonclassic phenotypes of PCOS. Image analysis was performed for the ovarian volume, follicle counts, follicle size, and endometrial plate thickness.

Results:

There were significant differences in the ovarian volume ( P = .001), follicle counts ( P = .001), follicle size ( P = .001), and endometrial plate thickness ( P = .001) between classic and nonclassic phenotypes of PCOS. The threshold value for ovarian volume, follicle count, follicle size, and endometrial plate thickness used to differentiate classic from nonclassic phenotypes were 12.5, 10.5, 5.25, and 5.75, respectively, with an area under the curve of 0.79, 0.82, 0.83, 0.77 and an accuracy of 75%, 73.6%, 79.2%, and 68.1%, respectively. The serum testosterone level and the body mass index were significantly higher in patients with classic than nonclassic phenotypes of PCOS ( P = .001, .04), respectively.

Conclusion:

Sonography findings can differentiate classic from nonclassic phenotypes of PCOS.
21st century headache: mapping new territory
Authors: Goadsby Peter J. , Lantéri-Minet Michel , Michel Martin C. , Peres Mario , Shibata Mamoru , Straube Andreas , Wijeratne Tissa , Ebel-Bitoun Caty , Constantin Luminita , Hitier Simon
Published: April 2021

Background

With headache experienced by up to 75% of adults worldwide in the last year, primary headache disorders constitute a major public health problem, yet they remain under-diagnosed and under-treated.

Headache prevalence and burden is changing as society evolves, with headache now occurring earlier in life. Contributing factors, mostly associated with changing life style, such as stress, bad posture, physical inactivity, sleep disturbance, poor diet and excess use of digital technology may be associated with the phenomenon that could be labelled as ‘21st century headache’. This is especially notable in workplace and learning environments where headache impacts mental clarity and therefore cognitive performance. The headache-related impact on productivity and absenteeism negatively influences an individual’s behaviour and quality of life, and is also associated with a high economic cost. Since the majority of sufferers opt to self-treat rather than seek medical advice, substantial knowledge on headache prevalence, causation and burden is unknown globally. Mapping the entire population of headache sufferers can close this knowledge gap, leading to better headache management. The broad use of digital technology to gather real world data on headache triggers, burden and management strategies, in self-treated population will allow these sufferers to access appropriate support and medication, and therefore improve quality of life.

Conclusion

These data can yield important insights into a substantial global healthcare issue and form the basis for improved patient awareness, professional education, clinical study design and drug development.
Total knee arthroplasty in femoral bowing: does patient specific instrumentation have something to add? A randomized controlled trial
Authors: ALShammari Sammy Abdullah , Choi Keun Young , Koh In Jun , Kim Man Soo , In Yong
Published: April 2021

Background

Patient-specific instrumentation (PSI) proponents have suggested the benefits of improved component alignment and reduced outliers. In this randomized controlled trial, we attempted to assess the advantage of using PSI over conventional intermedullary (IM) guides for primary total knee arthroplasty (TKA) with bilateral severe femoral bowing (> 5°). A parallel trial design was used with 1:1 allocation. We hypothesize that PSI would support more accurate alignment of components and the lower-limb axis during TKA with severe femoral bowing in comparison with conventional IM guides.

Methods

Among 336 patients undergoing bilateral TKAs due to knee osteoarthritis, 29 patients with bilateral lateral femoral bowing of more than 5° were included in this study. Every patient was assigned randomly to PSI on one side and to conventional instrumentation lateralization of the entry point of the femoral IM guide was applied on the other with a goal of neutral mechanical alignment. The assessment of coronal alignment was completed by measuring the hip–knee–ankle (HKA) angle on preoperative and postoperative long film standing radiographs. Coronal and sagittal orientations of femoral and tibial components were assessed on weight-bearing radiographs. The rotational alignment of the femoral component was evaluated using computed tomography.

Results

The postoperative mean ± standard deviation (SD) HKA angle was varus 4.0° (± 2.7°) for conventional technique and varus 4.1° (± 3.1°) for PSI, with no differences between the two groups (p = 0.459). The component orientation showed no significant differences except with respect to the sagittal alignment of the femoral component (p = 0.001), with a PSI mean ± SD flexion of 5.8° (± 3.7°) and a conventional method mean ± SD flexion of 3.2° (± 2.5°), due to the intentional 3° flexion incorporated in the sagittal plane to prevent femoral notching in PSI planning. Computed tomography assessment for rotational alignment of the femoral components showed no difference between the two groups concerning the transepicondylar axis (p = 0.485) with a PSI mean ± SD external rotation of 1.5° (± 1.3°) and conventional mean ± SD external rotation of 1.5° (± 1.6°).

Conclusion

PSI showed no advantage over lateralization of the femoral entry for IM guidance.

Level of evidence

1

Trial registration

Registered on US national library of medicine ClinicalTrials.gov (NCT02993016) on December 12th 2016.
A scoping review of genetics and genomics research ethics policies and guidelines for Africa
Authors: Ali Joseph , Cohn Betty , Mwaka Erisa , Bollinger Juli M. , Kwagala Betty , Barugahare John , Sewankambo Nelson K. , Ochieng Joseph
Published: April 2021

Background

Genetics and genomics research (GGR) is increasingly being conducted around the world; yet, researchers and research oversight entities in many countries have struggled with ethical challenges. A range of ethics and regulatory issues need to be addressed through comprehensive policy frameworks that integrate with local environments. While important efforts have been made to enhance understanding and awareness of ethical dimensions of GGR in Africa, including through the H3Africa initiative, there remains a need for in-depth policy review, at a country-level, to inform and stimulate local policy development and revision on the continent.

Methods

To identify and characterize existing ethics-related guidelines and laws applicable to GGR across much of Africa, we conducted a scoping review of English language policy documents identified through databases, repositories, and web searches. Thirty-six documents were included and coded using a framework that contained a range of themes across five analytical categories: (1) respect, (2) beneficence, (3) justice, (4) independent oversight, and (5) bans and prohibitions. Data analysis software (NVivo 12) was used to organize, code, and tabulate information according to document characteristics and topics. Illustrative examples of policy requirements were selected for inclusion.

Results

Documents that met inclusion criteria spanned 20 years; published between 1996 and 2018, with the majority (58%) published after 2009. About two-thirds were denoted as “guidelines,” and slightly more than half were non-exclusive to GGR. Very few (six) country-level documents identified were specific to GGR. Requirements related to the principle of “respect” appeared most often across all documents, relative to other principles and processes. The most commonly stated ban was on reproductive cloning. Other prohibitions applied to germline editing, undue inducements in research, sample use for commercial purposes, employee mandatory DNA testing, fetal sex selection, stem cell use, eugenics, and research without public health benefits.

Conclusions

Enforceable policies that are indispensable to the ethical conduct and review of GGR are either deficient or missing in many African countries. Existing international, GGR-specific ethics guidelines can be used to inform GGR policy development at a country-level, in conjunction with insight from country specific ethics committees and other local stakeholders.
The impact of loss of PEPFAR support on HIV services at health facilities in low-burden districts in Uganda
Authors: Zakumumpa Henry , Paina Ligia , Wilhelm Jess , Ssengooba Freddie , Ssegujja Eric , Mukuru Moses , Bennett Sara
Published: April 2021

Background

Although donor transitions from HIV programs are more frequent, little research exists seeking to understand the perceptions of patients and providers on this process. Between 2015 and 2017, PEPFAR implemented the ´geographic prioritization´ (GP) policy in Uganda whereby it shifted support from 734 ‘low-volume’ facilities and 10 districts with low HIV burden and intensified support in select facilities in high-burden districts. Our analysis intends to explore patient and provider perspectives on the impact of loss of PEPFAR support on HIV services in transitioned health facilities in Uganda.

Methods

We report qualitative findings from a larger mixed-methods evaluation. Six facilities were purposefully selected as case studies seeking to ensure diversity in facility ownership, size, and geographic location. Five out of the six selected facilities had experienced transition. A total of 62 in-depth interviews were conducted in June 2017 (round 1) and November 2017 (round 2) with facility in-charges (n = 13), ART clinic managers (n = 12), representatives of PEPFAR implementing organizations (n = 14), district health managers (n = 23) and 12 patient focus group discussions (n = 72) to elicit perceived effects of transition on HIV service delivery. Data were analyzed using thematic analysis.

Results

While core HIV services, such as testing and treatment, offered by case-study facilities prior to transition were sustained, patients and providers reported changes in the range of HIV services offered and a decline in the quality of HIV services offered post-transition. Specifically, in some facilities we found that specialized pediatric HIV services ceased, free HIV testing services stopped, nutrition support to HIV clients ended and the ‘mentor mother’ ART adherence support mechanism was discontinued. Patients at three ART-providing facilities reported that HIV service provision had become less patient-centred compared to the pre-transition period. Patients at some facilities perceived waiting times at clinics to have become longer, stock-outs of anti-retroviral medicines to have been more frequent and out-of-pocket expenditure to have increased post-transition.

Conclusions

Participants perceived transition to have had the effect of narrowing the scope and quality of HIV services offered by case-study facilities due to a reduction in HIV funding as well as the loss of the additional personnel previously hired by the PEPFAR implementing organizations for HIV programming. Replacing the HIV programming gap left by PEPFAR in transition districts with Uganda government services is critical to the attainment of 90–90-90 targets in Uganda.
Microfluidic guillotine reveals multiple timescales and mechanical modes of wound response in Stentor coeruleus
Authors: Zhang Kevin S. , Blauch Lucas R. , Huang Wesley , Marshall Wallace F. , Tang Sindy K. Y.
Published: April 2021

Background

Wound healing is one of the defining features of life and is seen not only in tissues but also within individual cells. Understanding wound response at the single-cell level is critical for determining fundamental cellular functions needed for cell repair and survival. This understanding could also enable the engineering of single-cell wound repair strategies in emerging synthetic cell research. One approach is to examine and adapt self-repair mechanisms from a living system that already demonstrates robust capacity to heal from large wounds. Towards this end,Stentor coeruleus, a single-celled free-living ciliate protozoan, is a unique model because of its robust wound healing capacity. This capacity allows one to perturb the wounding conditions and measure their effect on the repair process without immediately causing cell death, thereby providing a robust platform for probing the self-repair mechanism.

Results

Here we used a microfluidic guillotine and a fluorescence-based assay to probe the timescales of wound repair and of mechanical modes of wound response inStentor. We found thatStentorrequires ~ 100–1000 s to close bisection wounds, depending on the severity of the wound. This corresponds to a healing rate of ~ 8–80 μm2/s, faster than most other single cells reported in the literature. Further, we characterized three distinct mechanical modes of wound response inStentor: contraction, cytoplasm retrieval, and twisting/pulling. Using chemical perturbations, active cilia were found to be important for only the twisting/pulling mode. Contraction of myonemes, a major contractile fiber inStentor, was surprisingly not important for the contraction mode and was of low importance for the others.

Conclusions

While events local to the wound site have been the focus of many single-cell wound repair studies, our results suggest that large-scale mechanical behaviors may be of greater importance to single-cell wound repair than previously thought. The work here advances our understanding of the wound response inStentorand will lay the foundation for further investigations into the underlying components and molecular mechanisms involved.
Label-free quantitative proteomics of Sorghum bicolor reveals the proteins strengthening plant defense against insect pest Chilo partellus
Authors: Tamhane Vaijayanti A. , Sant Surhud S. , Jadhav Abhilash R. , War Abdul R. , Sharma Hari C. , Jaleel Abdul , Kashikar Akanksha S.
Published: April 2021

Background

Spotted stem borer- Chilo partellus - a Lepidopteran insect pest of Sorghum bicolor is responsible for major economic losses. It is an oligophagous pest, which bores through the plant stem, causing ‘deadheart’ and hampering the development of the main cob. We applied a label-free quantitative proteomics approach on three genotypes of S. bicolor with differential resistance/ susceptibility to insect pests, intending to identify the S. bicolor’s systemic protein complement contributing to C. partellus tolerance.

Methods

The proteomes of S. bicolor with variable resistance to insect pests, ICSV700, IS2205 (resistant) and Swarna (susceptible) were investigated and compared using label-free quantitative proteomics to identify putative leaf proteins contributing to resistance to C. partellus.

Results

The multivariate analysis on a total of 967 proteins led to the identification of proteins correlating with insect resistance/susceptibility of S. bicolor. Upon C. partellus infestation S. bicolor responded by suppression of protein and amino acid biosynthesis, and induction of proteins involved in maintaining photosynthesis and responding to stresses. The gene ontology analysis revealed that C. partellus-responsive proteins in resistant S. bicolor genotypes were mainly involved in stress and defense, small molecule biosynthesis, amino acid metabolism, catalytic and translation regulation activities. At steady-state, the resistant S. bicolor genotypes displayed at least two-fold higher numbers of unique proteins than the susceptible genotype Swarna, mostly involved in catalytic activities. Gene expression analysis of selected candidates was performed on S. bicolor by artificial induction to mimic C. partellus infestation.

Conclusion

The collection of identified proteins differentially expressed in resistant S. bicolor, are interesting candidates for further elucidation of their role in defense against insect pests.
Spatial learning and memory deficits induced by prenatal glucocorticoid exposure depend on hippocampal CRHR1 and CXCL5 signaling in rats
Authors: Zheng You , Zhang Yan-Min , Tang Zheng-Shan , Du Jian-Kui , Guo De-Wei , Xu Yong-Jun , Sheng Hui , Lu Jian-Qiang , Ni Xin
Published: April 2021

Background

Prenatal synthetic glucocorticoid (sGC) exposure increases the susceptibility to cognitive and affective disorders in postnatal life. We previously demonstrated that prenatal sGC exposure results in an increase in corticotropin-releasing hormone (CRH) receptor type 1 (CRHR1) expression in the hippocampus of rats, and CRHR1 is involved in synapse formation via regulation of C-X-C chemokine ligand 5 (CXCL5) in hippocampus. We sought to investigate that the roles of CRHR1 and CXCL5 in learning and memory impairment caused by prenatal sGC exposure.

Methods

Pregnant rats were administered with saline or dexamethasone (DEX) from gestational day (GD) 14 to GD21. DEX offspring at 2-day old were treated with saline and CRHR1 antagonists (antalarmin and CP154526) for 7 days. Some DEX offspring received intra-hippocampal injection of AAV9 carrying CXCL5 gene. Spatial learning and memory was assessed by Morris water maze test. Immunofluorescence analysis was applied to show synapsin I and PSD95 signals in hippocampus. Synapsin I and PSD95 protein level and CXCL5 concentration were determined by western blotting and ELISA, respectively. Organotypic hippocampal slice cultures were used to investigate the effect of DEX on CXCL5 production in vitro.

Results

Both male and female DEX offspring displayed impairment of spatial learning and memory in adulthood. Synapsin I and PSD95 signals and CXCL5 levels were decreased in DEX offspring. DEX offspring with antalarmin and CP154526 treatment showed improved spatial learning and memory. Antalarmin and CP154526 treatment increased synapsin I and PSD95 signals and CXCL5 concentration in hippocampus. Bilaterally hippocampal injection of AAV9 carrying CXCL5 gene improved the spatial learning and memory and increased CXCL5 concentration and synapsin I and PSD95 levels in hippocampus. DEX dose-dependently suppressed CXCL5 production in cultured hippocammpal slices, which was prevented by antalarmin treatment.

Conclusion

CRHR1 and CXCL5 signaling in the hippocampus are involved in spatial learning and memory deficits caused by prenatal DEX exposure. CRHR1 activation contributes to decreased CXCL5 production in hippocampus induced by prenatal DEX treatment. Our study provides a molecular basis of prenatal GC exposure programming spatial learning and memory.
Exploring the historical distribution of Dracaena cinnabari using ethnobotanical knowledge on Socotra Island, Yemen
Authors: Al-Okaishi Abdulraqeb
Published: April 2021

Background

In this study, we present and analyze toponyms referring to Socotra Island’s endemic dragon’s blood tree (Dracaena cinnabari) in four areas on the Socotra Archipelago UNESCO World Heritage site (Republic of Yemen). The motivation is the understanding of the past distribution ofD. cinnabaritrees which is an important part of conservation efforts by using ethnobotanical data. We assumed that dragon’s blood trees had a wider distribution on Socotra Island in the past.

Methods

This research was based on field surveys and interviews with the indigenous people. The place names (toponyms) were recorded in both Arabic and the indigenous Socotri language. We grouped all toponyms into five different categories according to the main descriptor: terrain, human, plant, water, and NA (unknown). Also, this study identified current and historical Arabic names of dragon’s blood trees of the genusDracaenathrough literature review.

Results

A total of 301 toponyms were recorded from the four study areas in Socotra Island. Among names related to plants, we could attribute toponyms to nine different plants species, of which six toponyms referred to theD. cinnabaritree, representing 14.63% of the total phytotoponyms in the category. Three historical naming periods prior to 2000 could be identified. The most commonly used name for dragon’s blood trees (D. cinnabari,D. serrulata,D. ombet) appears to be “ahrieb” “إعريهب” and its resin “dum al-akhawin” “دم الأخوين,” while derived (mixed-cooked) products are called “eda’a” “إيدع,” while regionally different names can be found.

Conclusion

The place names that refer toD. cinnabariare herein suggested to represent remnant areas of once large populations. Therefore, the toponyms may support known hypotheses based on climate models thatD. cinnabarihad a wider distribution on Socotra Island in the past. This study also confirmed the historical importance of dragon’s blood.
Detection of cytogenomic abnormalities by OncoScan microarray assay for products of conception from formalin-fixed paraffin-embedded and fresh fetal tissues
Authors: Wen Jiadi , Grommisch Brittany , DiAdamo Autumn , Chai Hongyan , Ng Sok Meng Evelyn , Hui Pei , Bale Allen , Mak Winifred , Wang Guilin , Li Peining
Published: April 2021

Background

The OncoScan microarray assay (OMA) using highly multiplexed molecular inversion probes for single nucleotide polymorphism (SNP) loci enabled the detection of cytogenomic abnormalities of chromosomal imbalances and pathogenic copy number variants (pCNV). The small size of molecular inversion probes is optimal for SNP genotyping of fragmented DNA from fixed tissues. This retrospective study evaluated the clinical utility of OMA as a uniform platform to detect cytogenomic abnormalities for pregnancy loss from fresh and fixed tissues of products of conception (POC).

Results

Fresh specimens of POC were routinely subjected to cell culture and then analyzed by karyotyping. POC specimens with a normal karyotype (NK) or culture failure (CF) and from formalin-fixed paraffin-embedded (FFPE) tissues were subjected to DNA extraction for OMA. The abnormality detection rate (ADR) by OMA on 94 cases of POC-NK, 38 cases of POC-CF, and 35 cases of POC-FFPE tissues were 2% (2/94), 26% (10/38), and 57% (20/35), respectively. The detected cytogenomic abnormalities of aneuploidies, triploidies and pCNV accounted for 50%, 40% and 10% in POC-CF and 85%, 10% and 5% in POC-FFPE, respectively. False negative result from cultured maternal cells and maternal cell contamination were each detected in one case. OMA on two cases with unbalanced structural chromosome abnormalities further defined genomic imbalances and breakpoints.

Conclusion

OMA on POC-CF and POC-FFPE showed a high diagnostic yield of cytogenomic abnormalities. This approach circumvented the obstacles of CF from fresh specimens and fragmented DNA from fixed tissues and provided a reliable and effective platform for detecting cytogenomic abnormalities and monitoring true fetal result from maternal cell contamination.
Family Talk versus usual services in improving child and family psychosocial functioning in families with parental mental illness (PRIMERA—Promoting Research and Innovation in Mental hEalth seRvices for fAmilies and children): study protocol for a randomised controlled trial
Authors: Furlong Mairead , McGilloway Sinead , Mulligan Christine , McGuinness Colm , Whelan Nuala
Published: April 2021

Background

Parental mental illness is common and can lead to dependent children incurring a high risk of developing mental disorders, physical illness, and impaired educational and occupational outcomes. Family Talk is one of the better known interventions designed to prevent the intergenerational transmission of mental illness. However, its evidence base is small, with few robust independent randomised controlled trials, and no associated process or cost evaluations. The PRIMERA (Promoting Research and Innovation in Mental hEalth seRvices for fAmilies and children) research programme involves a mixed method evaluation of Family Talk which is being delivered in mental health settings in Ireland to improve child and family psychosocial functioning in families with parental mental illness.

Methods

The study comprises a multi-centre, randomised controlled trial (RCT), with nested economic and process evaluations, to assess the clinical and cost-effectiveness and implementation mechanisms of Family Talk compared to usual services. The study is being conducted in 15 adult and child mental health settings in Ireland. Families with a parent with mental illness, and children aged 5–18 years (n = 144 families) will be randomised to either the 7-session Family Talk programme (n = 96) or to standard care (n = 48) using a 2:1 allocation ratio. The primary outcomes are child psychosocial functioning and family functioning. Secondary outcomes are as follows: understanding and experience of parental mental illness, parental mental health, child and parental resilience, partner wellbeing and service utilisation. Blind assessments will take place at pre-intervention and at 6- and 12-month follow-up.

Discussion

Given the prevalence and burden of intergenerational mental illness, it is imperative that prevention through evidence-based interventions becomes a public health priority. The current study will provide an important contribution to the international evidence base for Family Talk whilst also helping to identify key implementation lessons in the scaling up of Family Talk, and other similar interventions, within routine mental health settings.

Trial registration

ISRCTN Registry, ISRCTN13365858. Registered 5th February 2019.
The development of an effective synthetic route of rilpivirine
Authors: Zhang Tao , Yang Jiapei , Zhou Zhongxia , Fu Zhipeng , Cherukupalli Srinivasulu , Kang Dongwei , Zhan Peng , Liu Xinyong
Published: April 2021

Background

Rilpivirine (RPV) was approved by the U.S. FDA (Food and Drug Administration) in 2011 to treat individuals infected with human immunodeficiency virus 1 (HIV-1). Significantly, rilpivirine is three fold more potent than etravirine. Once-daily, it is used with a low oral dose (25 mg/tablet), decreasing the drug administration and bringing a better choice to the patients. However, there are many shortcomings in the existing synthesis route of RPV, such as the high cost, prolonged reaction time and low yield (18.5%).

Results

This article describes our efforts to develop an efficient and practical microwave-promoted method to synthesize rilpivirine using less toxic organic reagents and low boiling solvents. The last step's reaction time decreased from 69 h to 90 min through this optimized synthetic procedure, and the overall yield improved from 18.5 to 21%. In addition, the yield of intermediate 3 increased from 52 to 62% compared to the original patent.

Conclusion

Overall, through a series of process optimization, we have developed a practical synthesis method of rilpivirine, which is easy to scale with higher yield and shorter reaction time.