bluuebunny/crossref_metadata_2025 huggingface dataset:
Review of the Afrotropical Thyatirinae (Lepidoptera, Drepanidae) with description of a new genus and a new species
Authors: LÁSZLÓ GYULA M.
Published: April 2022

A taxonomic review of the Afrotropical Thyatirinae is given and a new genus reminiscent of the Oriental Horipsestis Matsumura, 1933 is established for a new East African species: Watsonopsestis smithi gen. n., sp. n. Based on the analysis of the genital morphology, Aethiopsestis austrina nebulosa Watson, 1965, is raised to species rank: A. nebulosa Watson, 1965 stat. n., and the tribe Aethiopsestini is downgraded to subtribe rank: Aethiopsestina Watson, 1965 stat. n. The female adult and genitalia of Aethiopsestis mufindiae Watson, 1965 are illustrated and the latter is described for the first time. New locality records of Marplena designina Lane, 1973, Aethiopsestis nebulosa and A. mufindiae are reported. A distribution map of all known Afrotropical Thyatirinae is provided. The holotypes and additional specimens of all species together with their genitalia are illustrated in 18 colour and 16 black and white figures.
A review of the genus Maimuna Lehtinen, 1967 (Araneae, Agelenidae) in Turkey, with a description of a new species
Authors: DIMITROV DRAGOMIR
Published: April 2022

The records of the agelenid spider genus Maimuna Lehtinen, 1967 from Turkey are reviewed. A new species, Maimuna anatolica sp. n. is described from Muğla Province, Anatolia. The other two Turkish species of the genus are illustrated and re-diagnosed. Some discrepancies in the different diagnoses of the genus Maimuna are pointed out and discussed.
On the Bimodality of the Wind-Wave Spectrum: Mean Square Slopes and Azimuthal Overlap Integral
Authors: Romero Leonel , Lubana Kabir
Published: April 2022

We present an investigation of the azimuthal bimodality of the wind-wave spectrum for waves shorter than the dominant scale comparing numerical model solutions of developing waves from idealized experiments using WAVEWATCH III (WW3). The wave solutions were forced with the “exact” Webb–Resio–Tracy (WRT) nonlinear energy fluxes and the direct interaction approximation (DIA) with three different combinations of wind input and breaking dissipation parameterizations. The WRT gives larger azimuthal bimodal amplitudes compared to the DIA regardless of wind input/dissipation. The widely used wind input/dissipation parameterizations (i.e., ST4 and ST6) generally give narrow directional distributions with relatively small bimodal amplitudes and lobe separations compared to field measurements. These biases are significantly improved by the breaking dissipation of Romero (R2019). Moreover, the ratio of the resolved cross- to downwind mean square slope is significantly lower for ST4 and ST6 compared to R2019. The overlap integral relevant for the prediction of microseisms is several orders of magnitude smaller for ST4 and ST6 compared to R2019, which nearly agrees with a semiempirical model.

Significance Statement

Spectral gravity wave models generally cannot accurately predict the directional distribution which impacts their ability to predict the resolved down- and crosswind mean square slopes and the generation of microseisms. Our analysis shows that a directionally narrow spectral energy dissipation, accounting for long-wave–short-wave modulation, can significantly improve the directional distribution of the wind-wave spectrum by coupling to the nonlinear energy fluxes due to wave–wave interactions, which has important implications for improved predictions of the mean square slopes and the generation of microseisms.
Examining Terrain Effects on the Evolution of Precipitation and Vorticity of Typhoon Fanapi (2010) after Departing the Central Mountain Range on Taiwan
Authors: Wu Yao-Chu , Yang Ming-Jen , Rogers Robert F.
Published: April 2022

Typhoon Fanapi (2010) made landfall in Hualien in Taiwan on 0100 UTC 19 September 2010 and left Taiwan on 1200 UTC 19 September 2010, producing heavy rainfall and floods. Fanapi’s eyewall was disrupted by the Central Mountain Range (CMR) and reorganized after leaving the CMR. High-resolution simulations (nested down to 1-km horizontal grid size) using the Advanced Research Weather Research and Forecast (WRF) model, one simulation using the full terrain (CTL) and another set of simulations where the terrain on Taiwan was removed, were analyzed. Precipitation areas were classified into different sub-regions by a convective-stratiform separation algorithm to assess the impact of precipitation structure on Fanapi’s eyewall evolution. The percentage of deep convection increased from 9% to 20% when Fanapi underwent an eyewall reorganization process while departing the CMR. In the absence of terrain, moderate convection occupied most of the convective regions during the period when Fanapi moved across Taiwan Island. The low-level total vorticity stretching within the convective, stratiform and weak echo regions in the no-terrain experiment were of similar magnitudes, but the total vorticity stretching within the convective region at low levels was dominant in the CTL experiment. Total vorticity stretching in the region of deep convection increased after eyewall reorganization, and later became stronger than that in the moderate convection region. In the absence of the CMR, total vorticity stretching in moderate convection dominated. The total vorticity stretching within the deep convective region in the CTL experiment played an essential role in the reorganization of Fanapi’s eyewall through a bottom-up process.
Storm-Scale Predictability and Analysis of the 13 April 2020 Central Savannah River Area Tornado Outbreak
Authors: Kerr Christopher A. , Alsheimer Frank
Published: April 2022

An early morning tornado outbreak occurred on 13 April 2020 in the Central Savannah River Area. Multiple significant tornadoes were reported, resulting in fatalities and injuries. While the operational tornado warnings had positive lead times, the convective mode (quasi-linear convective system) increased the warning decision complexity. The timing of the event [0500–0600 local time (LT)] also made NWS-to-public communication difficult. The experimental NSSL Warn-on-Forecast System (WoFS) was run retrospectively for this case. The WoFS consists of 3–6-h ensemble forecasts initialized every 30 min, and the goals of the system are to bridge the gap between severe weather watches and warnings and to increase warning lead times. Multiple WoFS forecasts were initialized leading up to the first tornado report; those initialized prior to tornado warning issuance have high ensemble probabilities of low-level rotation in the appropriate areas based on subsequent tornado reports. This case highlights another example of the usefulness of WoFS before its eventual transition to operations. Using the WoFS forecasts, kinematic and thermodynamic storm–environment relationships are analyzed using ensemble sensitivity analysis (ESA). The analyses suggest variations in the mesoscale environmental vertical wind profile are not as influential on mesovortex intensity as variations in the thermodynamic environment. Surface observations recorded prior to the tornado outbreak reveal subtle temperature and moisture gradients that may be the impetus for mesovortex intensification and tornadogenesis.
Defining a sustainable French architecture: France's national pavilion at the 2004 Venice Biennale
Authors: Vincent Amanda Shoaf
Published: April 2022

The French pavilion at the 2004 Venice Biennale of Architecture took up the theme of sustainable design through a “prospective game” that challenged participating architects to imagine an urban neighborhood's transformation in response to economic, social, and environmental constraints over the following 30 years. The exhibition paradoxically appeared to proclaim French sustainable know-how at a time when French architects viewed the profession as lagging behind their European neighbors in terms of ecological approaches. By framing sustainability as avant-garde, experimental design, the pavilion reconciled “French” and “sustainable” architecture. Examining this exhibit and its impact contributes to an understanding of French self-fashioning of national identity around culture. Moreover, this case demonstrates how cultural elements of identity influence responses to global challenges such as climate change.
Probabilistic modeling methods for cell-free DNA methylation based cancer classification
Authors: Halla-aho Viivi , Lähdesmäki Harri
Published: April 2022

Background

cfMeDIP-seq is a low-cost method for determining the DNA methylation status of cell-free DNA and it has been successfully combined with statistical methods for accurate cancer diagnostics. We investigate the diagnostic classification aspect by applying statistical tests and dimension reduction techniques for feature selection and probabilistic modeling for the cancer type classification, and we also study the effect of sequencing depth.

Methods

We experiment with a variety of statistical methods that use different feature selection and feature extraction methods as well as probabilistic classifiers for diagnostic decision making. We test the (moderated) t-tests and the Fisher’s exact test for feature selection, principal component analysis (PCA) as well as iterative supervised PCA (ISPCA) for feature generation, and GLMnet and logistic regression methods with sparsity promoting priors for classification. Probabilistic programming language Stan is used to implement Bayesian inference for the probabilistic models.

Results and conclusions

We compare overlaps of differentially methylated genomic regions as chosen by different feature selection methods, and evaluate probabilistic classifiers by evaluating the area under the receiver operating characteristic scores on discovery and validation cohorts. While we observe that many methods perform equally well as, and occasionally considerably better than, GLMnet that was originally proposed for cfMeDIP-seq based cancer classification, we also observed that performance of different methods vary across sequencing depths, cancer types and study cohorts. Overall, methods that seem robust and promising include Fisher’s exact test and ISPCA for feature selection as well as a simple logistic regression model with the number of hyper and hypo-methylated regions as features.
Genomic epidemiology of the Los Angeles COVID-19 outbreak and the early history of the B.1.43 strain in the USA
Authors: Guo Longhua , Boocock James , Hilt Evann E. , Chandrasekaran Sukantha , Zhang Yi , Munugala Chetan , Sathe Laila , Alexander Noah , Arboleda Valerie A. , Flint Jonathan , Eskin Eleazar , Luo Chongyuan , Yang Shangxin , Garner Omai B. , Yin Yi , Bloom Joshua S. , Kruglyak Leonid
Published: April 2022

Background

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused global disruption of human health and activity. Being able to trace the early outbreak of SARS-CoV-2 within a locality can inform public health measures and provide insights to contain or prevent viral transmission. Investigation of the transmission history requires efficient sequencing methods and analytic strategies, which can be generally useful in the study of viral outbreaks.

Methods

The County of Los Angeles (hereafter, LA County) sustained a large outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). To learn about the transmission history, we carried out surveillance viral genome sequencing to determine 142 viral genomes from unique patients seeking care at the University of California, Los Angeles (UCLA) Health System. 86 of these genomes were from samples collected before April 19, 2020.

Results

We found that the early outbreak in LA County, as in other international air travel hubs, was seeded by multiple introductions of strains from Asia and Europe. We identified a USA-specific strain, B.1.43, which was found predominantly in California and Washington State. While samples from LA County carried the ancestral B.1.43 genome, viral genomes from neighboring counties in California and from counties in Washington State carried additional mutations, suggesting a potential origin of B.1.43 in Southern California. We quantified the transmission rate of SARS-CoV-2 over time, and found evidence that the public health measures put in place in LA County to control the virus were effective at preventing transmission, but might have been undermined by the many introductions of SARS-CoV-2 into the region.

Conclusion

Our work demonstrates that genome sequencing can be a powerful tool for investigating outbreaks and informing the public health response. Our results reinforce the critical need for the USA to have coordinated inter-state responses to the pandemic.
Weighted gene co-expression network indicates that the DYNLL2 is an important regulator of chicken breast muscle development and is regulated by miR-148a-3p
Authors: Li Yuanfang , Yuan Pengtao , Fan Shengxin , Zhai Bin , Jin Wenjiao , Li Donghua , Li Hong , Sun Guirong , Han Ruili , Liu Xiaojun , Tian Yadong , Li Guoxi , Kang Xiangtao
Published: April 2022

Background

The characteristics of muscle fibers determine the growth and meat quality of poultry. In this study, we performed a weighted gene co-expression network analysis (WGCNA) on the muscle fiber characteristics and transcriptome profile of the breast muscle tissue of Gushi chicken at 6, 14, 22, and 30 weeks.

Results

A total of 27 coexpressed biological functional modules were identified, of which the midnight blue module had the strongest correlation with muscle fiber and diameter. In addition, 7 hub genes were found from the midnight blue module, including LC8 dynein light chain 2 (DYNLL2). Combined with miRNA transcriptome data, miR-148a-3p was found to be a potential target miRNA of DYNLL2. Experiments on chicken primary myoblasts (CPMs) demonstrated that miR-148a-3p promotes the expression of myosin heavy chain (MYHC) protein by targeting DYNLL2, proving that it can promote differentiation of myoblasts.

Conclusions

This study proved that the hub gene DYNLL2 and its target miR-148-3p are important regulators in chicken myogenesis. These results provide novel insights for understanding the molecular regulation mechanisms related to the development of chicken breast muscle.
Physiological and multi-omics responses of Neoporphyra haitanensis to dehydration-rehydration cycles
Authors: Wang Zekai , Lu Caiping , Chen Juanjuan , Luo Qijun , Yang Rui , Gu Denghui , Wang Tiegan , Zhang Peng , Chen Haimin
Published: April 2022

Background

Seaweeds in the upper intertidal zone experience extreme desiccation during low tide, followed by rapid rehydration during high tide. Porphyra sensu lato are typical upper intertidal seaweeds. Therefore, it is valuable to investigate the adaptive mechanisms of seaweed in response to dehydration-rehydration stress.

Results

A reduction in photosynthetic capacity and cell shrinkage were observed when N. haitanensis was dehydrated, and such changes were ameliorated once rehydrated. And the rate and extent of rehydration were affected by the air flow speed, water content before rehydration, and storage temperature and time. Rapid dehydration at high air-flow speed and storage at − 20 °C with water content of 10% caused less damage to N. haitanensis and better-protected cell activity. Moreover, proteomic and metabolomic analyses revealed the abundance members of the differentially expressed proteins (DEPs) and differentially abundant metabolites (DAMs) mainly involved in antioxidant system and osmotic regulation. The ascorbic acid-glutathione coupled with polyamine antioxidant system was enhanced in the dehydration response of N. haitanensis. The increased soluble sugar content, the accumulated polyols, but hardly changed (iso)floridoside and insignificant amount of sucrose during dehydration indicated that polyols as energetically cheaper organic osmolytes might help resist desiccation. Interestingly, the recovery of DAMs and DEPs upon rehydration was fast.

Conclusions

Our research results revealed that rapid dehydration and storage at − 20 °C were beneficial for recovery of N. haitanensis. And the strategy to resist dehydration was strongly directed toward antioxidant activation and osmotic regulation. This work provided valuable insights into physiological changes and adaptative mechanism in desiccation, which can be applied for seaweed farming.
Regional opening strategies with commuter testing and containment of new SARS-CoV-2 variants in Germany
Authors: Kühn Martin J. , Abele Daniel , Binder Sebastian , Rack Kathrin , Klitz Margrit , Kleinert Jan , Gilg Jonas , Spataro Luca , Koslow Wadim , Siggel Martin , Meyer-Hermann Michael , Basermann Achim
Published: April 2022

Background

Despite the vaccination process in Germany, a large share of the population is still susceptible to SARS-CoV-2. In addition, we face the spread of novel variants. Until we overcome the pandemic, reasonable mitigation and opening strategies are crucial to balance public health and economic interests.

Methods

We model the spread of SARS-CoV-2 over the German counties by a graph-SIR-type, metapopulation model with particular focus on commuter testing. We account for political interventions by varying contact reduction values in private and public locations such as homes, schools, workplaces, and other. We consider different levels of lockdown strictness, commuter testing strategies, or the delay of intervention implementation. We conduct numerical simulations to assess the effectiveness of the different intervention strategies after one month. The virus dynamics in the regions (German counties) are initialized randomly with incidences between 75 and 150 weekly new cases per 100,000 inhabitants (red zones) or below (green zones) and consider 25 different initial scenarios of randomly distributed red zones (between 2 and 20% of all counties). To account for uncertainty, we consider an ensemble set of 500 Monte Carlo runs for each scenario.

Results

We find that the strength of the lockdown in regions with out of control virus dynamics is most important to avoid the spread into neighboring regions. With very strict lockdowns in red zones, commuter testing rates of twice a week can substantially contribute to the safety of adjacent regions. In contrast, the negative effect of less strict interventions can be overcome by high commuter testing rates. A further key contributor is the potential delay of the intervention implementation. In order to keep the spread of the virus under control, strict regional lockdowns with minimum delay and commuter testing of at least twice a week are advisable. If less strict interventions are in favor, substantially increased testing rates are needed to avoid overall higher infection dynamics.

Conclusions

Our results indicate that local containment of outbreaks and maintenance of low overall incidence is possible even in densely populated and highly connected regions such as Germany or Western Europe. While we demonstrate this on data from Germany, similar patterns of mobility likely exist in many countries and our results are, hence, generalizable to a certain extent.
X-linked hyper IgM syndrome with severe eosinophilia: a case report and review of the literature
Authors: Li He , Cao Yang , Ma Jijun , Li Chongwei
Published: April 2022

Background

Hyper IgM syndromes (HIGMS) are a group of rare primary immunodeficiency disorders. There are limited reports about HIGMS combined with severe eosinophilia.

Case presentation

In this report, we described a 2-year-old boy with chronic cough and symptoms of hypoxia. Lung computed tomography (CT) scan showed that diffuse ground-glass changes and eosinophils in peripheral blood increased significantly. Subsequent tests revealed a notable decrease in serum IgG and IgA. The lymphocyte subgroup classification was basically normal. Pneumocystis jirovecii were detected from the bronchoalveolar lavage fluid (BALF) of the patient by metagenomic next-generation sequencing (mNGS). After treatments of caspofungin combined with sulfamethoxazole, intravenous immunoglobulin (IVIG) replacement and anti-inflammatory steroid, the clinical symptoms and pulmonary imaging noticeably improved. The absolute eosinophil count (AEC) also returned to normal range. X-linked hyper IgM syndrome was confirmed by gene test. Two months after the diagnosis, the patient underwent allogeneic stem cell transplantation (HSCT) and has recovered well.

Conclusions

Children with HIGMS are prone to opportunistic infections such as Pneumocystis jirovecii pneumonia (PJP). Diffuse interstitial lung disease and hypoglobulinemia in a young child predict the diagnosis of a primary immunodeficiency (PID). mNGS has obvious advantages for obtaining etiological diagnosis of children with PIDs. Severe eosinophilia is rarely reported in this kind of PIDs. Considering literature review and the corresponding reaction to steroid, we proposed that eosinophilia in HIGMS might be related to infections. Steroid therapy can quickly relieve eosinophilia but is easy to rebound if the reduction is too fast. Once the diagnosis of HIGMS is confirmed, the earlier the HSCT, the better the prognosis.
Retention on antiretroviral therapy in person with HIV and viral hepatitis coinfection in Ethiopia: a retrospective cohort study
Authors: Seyoum Eleni , Demissie Meaza , Worku Alemayehu , Mihret Adane , Abdissa Alemseged , Berhane Yemane
Published: April 2022

Background

HIV coinfection with viral hepatitis B (HBV) or viral hepatitis C (HCV) is not uncommon in Ethiopia. Although the coinfections are presumed to interfere with antiretroviral treatment (ART), this is not widely studied in Sub-Saharan African settings. This study was conducted to determine ART retention in persons coinfected with HIV + HBV or HIV + HCV.

Methods

We reviewed the medical records of HIV-positive adults who initiated ART between 2011 to 2018 in four high-burden hospitals of Addis Ababa. Retention in care was the primary outcome of the study, which was compared between HIV and either HBV or HCV coinfected persons, and HIV-monoinfected persons. A parametric Gompertz regression model was used to compare retention between the coinfected and monoinfected groups.

Results

A total of 132 coinfected persons and 514 HIV-monoinfected individuals who initiated ART in 2011–2018 were compared. At 12-months of follow-up, 81.06% [95% CI: 73.3–86.9%] of the coinfected and 86.96% [95% CI: 83.7–89.6%] of the monoinfected were still on ART care. Cumulative retention in the coinfected group was 68.93% [60.4–76.3%] versus 80.35% [76.6–83.5%, p = 0.0048] in the monoinfected group. The cumulative retention was lower (61.25, 95% CI: 49.9–71.4%) in male coinfected patients than male monoinfected patients (77.77, 95% CI: 71.8–82.7%, p = 0.0041). In contrast, cumulative retention was similar in females in the coinfected group (80.76, 95% CI:67.3–89.5%) versus the monoinfected group (82.29, 95% CI:77.4–86.3%, p = 0.792). Overall, HIV-positive with viral hepatitis coinfection were 24 and 31% less likely to still be on ART care than the monoinfected group at 12 months and overall, with sub-distribution adjusted hazard ratio (AHR) of 0.76(95% CI:0.61–0.96, p = 0.021) and 0.69(95% CI:0.54–0.87, p = 0.002) respectively.

Conclusions

We observed that coinfected individuals are less likely to stay on ART than HIV monoinfected individuals. The low retention in the coinfected group from this study may affect the success of survival gained in people living with HIV (PLHIV) in the long term. More concerted efforts need to be made to retain coinfected individuals at least at the level of monoinfected persons on long-term ART care. Future studies are needed to better understand the difference in retention, preferable in a prospective manner.
Lifetime impact of being underweight or overweight/obese during childhood in Vietnam
Authors: Baek Yeji , Owen Alice J. , Fisher Jane , Tran Thach , Ademi Zanfina
Published: April 2022

Background

There is limited evidence about lifetime burden of child malnutrition. This study aimed to estimate the lifetime impact of being underweight or overweight/obese during childhood in Vietnam.

Methods

We developed a life table model in combination with a Markov model for Vietnamese children aged 5–19 years and simulated until they reached 75 years of age or died using published data. The starting year was 2019 and the model estimated number of deaths, years of life lived and quality-adjusted life years (QALY) with an annual discount rate of 3%. We performed scenario, one-way, and probabilistic sensitivity analyses to assess the impact of uncertainties in input parameters.

Results

The model estimated 9.68 million deaths (6.44 million men and 3.24 million women), 622 million years of life lived (317 million men and 305 million women), and 601 million QALYs (308 million men and 293 million women). Scenario analyses showed that the reduction in either underweight or overweight/obesity alone, and reduction in both underweight and overweight/obesity resulted in fewer deaths, more years of life lived and more QALYs gained. In the scenario where everyone was a healthy weight, the model estimated 577,267 fewer deaths (6.0% less), 2 million more years of life lived (0.3% more), and 3 million QALYs gained (0.6% more) over base-case results which represents current situation in Vietnam.

Conclusions

Our results suggest that addressing underweight and overweight/obesity will contribute to reducing deaths and increasing years of life lived and QALYs. Policies and interventions in alignment with Sustainable Development Goals to address underweight and overweight/obesity are necessary to achieve health for all.
Identifying and articulating the student experience in the Intercalated Enrichment Year
Authors: Wan Eric Yuk Fai , Li Zhihao , Sun Kai Sing , Chan Karina Hiu Yen , Cheng Will Ho Gi , Chen Julie Yun , Chin Weng Yee , Lam Tai Pong , Tipoe George Lim , Wong Gordon Tin Chun , Chan Sarah So Ching , Lam Cindy Lo Kuen
Published: April 2022

Background

Benefits of intercalation during an undergraduate medical degree are well-recognized. The University of Hong Kong implemented a compulsory Enrichment Year (EY) in its Bachelor of Medicine and Bachelor of Surgery degree programme (MBBS) in 2016. In their third year of study, students could work on an area of interest in any of three programme categories (i) intercalation/ university exchange (IC); (ii) research (RA); (iii) service/ humanitarian work (SH). This study aimed to explore the barriers, enablers, and overall student learning experiences from the first cohort of EY students in order to inform future development of the EY.

Methods

An exploratory sequential mixed-method study in 2019-20. Twenty students were purposively selected to attend three semi-structured focus group interviews. Conventional thematic analysis was employed and results assisted the design of a cross-sectional questionnaire. Sixty-three students completed the questionnaire. ANOVA or chi-square test was used to compare the difference in student’s characteristics, barriers, enablers and perspectives on EY between programme categories. Adjusting student’s characteristics, logistic regressions were conducted to identify the effect of programme categories on the EY experience.

Results

Most students (95% in the questionnaire) agreed that EY was worthwhile and more rewarding than expected. EY was positively regarded for enhancing personal growth and interpersonal relationships. The main barriers were financial difficulties, scholarship issues and insufficient information beforehand. A few students had practical (i.e. accommodation, cultural adaptation) problems. Potential enablers included better financial support, more efficient information exchange and fewer assignments and preparation tasks. Similar barriers were encountered by students across all three categories of EY activities.

Conclusions

Personal growth was the most important benefit of the EY. Barriers were consistent with those identified in the literature except for cultural adaptation, which could be related to Hong Kong’s unique historical context. Financial limitation was the most concerning barrier, as it could result in unequal access to educational opportunities. Better and timely access to scholarships and other funding sources need to be considered.

Trial registration

Ethics approval was obtained from the local Institutional Review Board of The University of Hong Kong/Hospital Authority Hong Kong West Cluster (UW 19-585).
COVID-19 outbreak improves attractiveness of medical careers in Chinese senior high school students
Authors: Zhang Ruoxin , Pei Jianfeng , Wang Yanli , Wang Lei , Yeerjiang Yeerzhati , Gao Haifeng , Xu Wanghong
Published: April 2022

Background

The shortage of healthcare workers is becoming a serious global problem. The underlying reasons may be specific to the healthcare system in each country. Over the past decade, medicine has become an increasingly unpopular profession in China due to the heavy workload, long-term training, and inherent risks. The ongoing COVID-19 pandemic has placed the life-saving roles of healthcare professionals under the spotlight. This public health crisis may have a profound impact on career choices in Chinese population.

Methods

We conducted a questionnaire-based online survey among 21,085 senior high school students and 21,009 parents from 24 provinces (or municipalities) of China. We investigated the change of interest in medical study due to the outbreak of COVID-19 and the potential motivational factors based on the expectancy-value theory framework. Pearson correlation analysis was used to assess the correlation of static or dynamic interest in medical career pursuit with the reported number of COVID-19 cases. Logistic regression model was adopted to analyze the main factors associated with students’ choices.

Results

We observed an increased preference for medical study post the outbreak of COVID-19 in both students (17.5 to 29.6%) and parents (37.1 to 47.3%). Attainment value was found to be the main reason for the choice among students, with the contribution to society rated as the top motivation. On the other hand, the predominant demotivation in high school students was lack of interest, followed by concerns regarding violence against doctors, heavy workload, long-term training and heavy responsibility as a doctor. Additionally, students who were female, in the resit of final year, had highly educated parents and outside of Hubei province were significantly associated with a keen interest in pursuing medical study.

Conclusions

This is the first multi-center cross-sectional study exploring the positive change and motivations of students’ preferences in medical study due to the outbreak of COVID-19. Our results may help medical educators, researchers and policymakers to restructure medical education to make it more appealing to high school students, particularly, to develop a more supportive social and working environment for medical professionals to maintain the observed enhanced enthusiasm.
Using virtual reality in lumbar puncture training improves students learning experience
Authors: Vrillon Agathe , Gonzales-Marabal Laurent , Ceccaldi Pierre-François , Plaisance Patrick , Desrentes Eric , Paquet Claire , Dumurgier Julien
Published: April 2022

Background

Lumbar puncture (LP) is a commonly performed medical procedure in a wide range of indications. Virtual reality (VR) provides a stimulating, safe and efficient learning environment. We report the design and the evaluation of a three dimensions (3D) video for LP training.

Methods

We recorded a stereoscopic 180-degrees 3D video from two LPs performed in clinical settings in Fernand Widal Lariboisière University Hospital, Paris, France. The video was administered to third-year medical students as well as to a residents and attendings group during LP simulation-based training sessions.

Results

On 168 participants (108 novice third-year medical students, and 60 residents and attendings with prior LP experience), satisfaction after video exposure was high (rated 4.7 ± 0.6 on a 5-point scale). No significant discomfort was reported (comfort score graded 4.5 ± 0.8 on 5). LP-naive students displayed higher satisfaction and perceived benefit than users with prior LP experience (overall,P < 0.05). Trainees evaluated favorably the 3D feature and supported the development of similar tutorials for other medical procedures (respectively, 3.9 ± 1.1 and 4.4 ± 0.9 on 5).

Conclusion

We report our experience with a 3D video for LP training. VR support could increase knowledge retention and skill acquisition in association to LP simulation training.
Experiences using an instrument for non-technical skills in nurse anaesthesia education: a focus group study
Authors: Flynn Fiona M. , Valeberg Berit T. , Bing-Jonsson Pia C. , Lyberg Anne M. , Tønnessen Siri
Published: April 2022

Background

Although there is an increasing amount of research on the use of structured behavioural assessment instruments for non-technical skills in a simulation or clinical setting, there is currently little research into how healthcare professionals experience using these instruments. The structured behavioural assessment instrument, Nurse Anaesthetists’ Non-Technical Skills-Norway, has recently been introduced to nurse anaesthesia education as a means of developing and assessing non-technical skills in clinical practice. The aim of this study was therefore to explore the experiences of Norwegian student nurse anaesthetists, their mentors and clinical supervisors on using the instrument in clinical practice.

Methods

This study has a qualitative descriptive design. Data was collected through semi-structured interviews with four focus groups comprising twelve student nurse anaesthetists and thirteen mentors and clinical supervisors. The interviews were recorded and then transcribed verbatim. Data was analyzed using qualitative content analysis and an inductive approach.

Results

Six categories were identified that represented the manifest content. One main theme: Forging a path towards clinical excellence was identified representing the latent content, and three themes that described the participants’ experiences with using the instrument:

Promotion of excellent non-technical skills: Raising awareness of non-technical skills ensured professional suitability and shaping of a professional identity; internalizing the skills could lead to changes in behaviour.

Promotion of cooperative learning: Mentoring was more structured, based on a common language and understanding and clearly defined roles; measurable progress enabled a more reliable and objective evaluation.

Promotion of organizational acceptance: A lack of familiarity with the instrument, and challenges with scoring and the terminology impeded acceptance.

Conclusion

Increased awareness of non-technical skills when using Nurse Anaesthetists’ Non-Technical Skills-Norway contributes to a professionalization of the nurse anaesthetist role and mentoring/learning process in nurse anaesthesia education. Using Nurse Anaesthetists’ Non-Technical Skills-Norway promotes the ideal of clinical excellence, not only as an assessment instrument but also by guiding the student’s learning process. Despite a high level of commitment to using the instrument there is a need to promote further acceptance in the anaesthetic departments.
Examining the unit costs of COVID-19 vaccine delivery in Kenya
Authors: Orangi Stacey , Kairu Angela , Ngatia Anthony , Ojal John , Barasa Edwine
Published: April 2022

Background

Vaccines are considered the path out of the COVID-19 pandemic. The government of Kenya is implementing a phased strategy to vaccinate the Kenyan population, initially targeting populations at high risk of severe disease and infection. We estimated the financial and economic unit costs of procuring and delivering the COVID-19 vaccine in Kenya across various vaccination strategies.

Methods

We used an activity-based costing approach to estimate the incremental costs of COVID-19 vaccine delivery, from a health systems perspective. Document reviews and key informant interviews(n = 12) were done to inform the activities, assumptions and the resources required. Unit prices were derived from document reviews or from market prices. Both financial and economic vaccine procurement costs per person vaccinated with 2-doses, and the vaccine delivery costs per person vaccinated with 2-doses were estimated and reported in 2021USD.

Results

The financial costs of vaccine procurement per person vaccinated with 2-doses ranged from $2.89-$13.09 in the 30% and 100% coverage levels respectively, however, the economic cost was $17.34 across all strategies. Financial vaccine delivery costs per person vaccinated with 2-doses, ranged from $4.28-$3.29 in the 30% and 100% coverage strategies: While the economic delivery costs were two to three times higher than the financial costs. The total procurement and delivery costs per person vaccinated with 2-doses ranged from $7.34-$16.47 for the financial costs and $29.7-$24.68 for the economic costs for the 30% and 100% coverage respectively. With the exception of procurement costs, the main cost driver of financial and economic delivery costs was supply chain costs (47–59%) and advocacy, communication and social mobilization (29–35%) respectively.

Conclusion

This analysis presents cost estimates that can be used to inform local policy and may further inform parameters used in cost-effectiveness models. The results could potentially be adapted and adjusted to country-specific assumptions to enhance applicability in similar low-and middle-income settings.
Cardiac microstructural alterations in immune-inflammatory myocardial disease: a retrospective case-control study
Authors: Kwan Alan C. , Salto Gerran , Nguyen Trevor-Trung , Kim Elizabeth H. , Luong Eric , Hiremath Pranoti , Ouyang David , Ebinger Joseph E. , Li Debiao , Berman Daniel S. , Kittleson Michelle M. , Kobashigawa Jon A. , Patel Jignesh K. , Cheng Susan
Published: April 2022

Background

Immune-inflammatory myocardial disease contributes to multiple chronic cardiac processes, but access to non-invasive screening is limited. We have previously developed a method of echocardiographic texture analysis, called the high-spectrum signal intensity coefficient (HS-SIC) which assesses myocardial microstructure and previously associated with myocardial fibrosis. We aimed to determine whether this echocardiographic texture analysis of cardiac microstructure can identify inflammatory cardiac disease in the clinical setting.

Methods

We conducted a retrospective case-control study of 318 patients with distinct clinical myocardial pathologies and 20 healthy controls. Populations included myocarditis, atypical chest pain/palpitations, STEMI, severe aortic stenosis, acute COVID infection, amyloidosis, and cardiac transplantation with acute rejection, without current rejection but with prior rejection, and with no history of rejection. We assessed the HS-SIC’s ability to differentiate between a broader diversity of clinical groups and healthy controls. We used Kruskal-Wallis tests to compare HS-SIC values measured in each of the clinical populations with those in the healthy control group and compared HS-SIC values between the subgroups of cardiac transplantation rejection status.

Results

For the total sample of N = 338, the mean age was 49.6 ± 20.9 years and 50% were women. The mean ± standard error of the mean of HS-SIC were: 0.668 ± 0.074 for controls, 0.552 ± 0.049 for atypical chest pain/palpitations, 0.425 ± 0.058 for myocarditis, 0.881 ± 0.129 for STEMI, 1.116 ± 0.196 for severe aortic stenosis, 0.904 ± 0.116 for acute COVID, and 0.698 ± 0.103 for amyloidosis. Among cardiac transplant recipients, HS-SIC values were 0.478 ± 0.999 for active rejection, 0.594 ± 0.091 for prior rejection, and 1.191 ± 0.442 for never rejection. We observed significant differences in HS-SIC between controls and myocarditis (P = 0.0014), active rejection (P = 0.0076), and atypical chest pain or palpitations (P = 0.0014); as well as between transplant patients with active rejection and those without current or prior rejection (P = 0.031).

Conclusions

An echocardiographic method can be used to characterize tissue signatures of microstructural changes across a spectrum of cardiac disease including immune-inflammatory conditions.
Prevalence and risk factor of post-operative lower extremities deep vein thrombosis in patients undergoing gynecologic surgery: a single-institute cross-sectional study
Authors: Lorchaivej Supakorn , Suprasert Prapaporn , Srisuwan Tanop , Rujiwetpongstorn Jintana
Published: April 2022

Background and aim

The study of prevalence and risk factors of postoperative lower limb deep vein thrombosis (DVT) in Thai gynecologic patients was limited. The present study was conducted to evaluate this issue.

Methods

The patients were age > 15 years old without a history of DVT or pulmonary emboli (PE) scheduled for laparotomy or vaginal gynecologic surgery between May and November 2020 were invited to participate. All of these patients were scheduled for a complete duplex ultrasound to detect lower limb DVT 72 h before and within 14 days after the operation. The patients without DVT were scheduled for an interview by telephone about DVT symptoms 30 days after the operation. The clinical variables were compared using univariate and multivariate analysis to identify the independent factors related to the development of DVT.

Results

One hundred and twelve patients met the inclusion criteria. Of these patients, 44 cases (39.3%) were diagnosed as malignancy and 102 patients underwent a hysterectomy. Post-operative DVTs were detected in six patients (5.4%) and all except one had a malignancy. Thus, the prevalence of DVT in malignancy cases was five in 44 patients (11.4%). The independent risk factors for postoperative DVT were age > 60-year-old and receiving a perioperative blood transfusion. Five of six DVT patients received low molecular-weight heparin for treatment of DVT and none developed PE. The rest of the participants reported no symptom-related DVTs from the interview 30 days after the operation.

Conclusion

The prevalence of postoperative DVT in gynecologic patients was 5%, and the independent risk factors were elderly patients and receiving a perioperative blood transfusion.
Transformative effect of a Humanitarian Program for individuals affected by rare diseases: building support systems and creating local expertise
Authors: Verma I. C. , El-Beshlawy A. , Tylki-Szymańska A. , Martins A. , Duan Y.-L. , Collin-Histed T. , van der Linde M. Schoneveld , Mansour R. , Dũng V. C. , Mistry Pramod K.
Published: April 2022

Rare diseases affect > 400 million people globally with a disproportionate burden falling on children, resulting in high morbidity and mortality rates. Affected individuals in some under-resourced countries have limited access to expert care or treatments; moreover, they suffer long diagnostic journeys during which debilitating and life-threatening complications occur. Lysosomal storage disorders (LSD) are prototype rare diseases due, in the main, to inherited deficiencies of lysosomal enzymes/transporters that affect up to 1 in 5000 newborns. Recognizing the need to provide treatment access to people with LSDs everywhere, a collaborative partnership was pioneered and set up 30 years ago. Partnering with local authorities, non-government organizations across six continents, local as well as international experts, a robust, sustainable Humanitarian Program emerged that now represents the most enduring charitable access program for LSD treatment. Here we present the history, process, lasting beneficial effect of the program to develop healthcare systems and infrastructures, and the lessons learned from addressing major unmet needs for LSDs.
Health-related quality of life, direct medical and societal costs among children with moderate or severe haemophilia in Europe: multivariable models of the CHESS-PAEDs study
Authors: Rodriguez-Santana Idaira , DasMahapatra Pronabesh , Burke Tom , Hakimi Zalmai , Bartelt-Hofer José , Nazir Jameel , O’Hara Jamie
Published: April 2022

Background

Haemophilia bears substantial humanistic and economic burden on children and their caregivers. Characterising the differential impact of severe versus moderate paediatric haemophilia is important for clinical and health policy decisions. We analysed health-related quality of life (HRQoL), annual direct medical (excluding factor treatment costs), non-medical and societal costs among children and adolescents with moderate and severe haemophilia A or B without inhibitors from the European CHESS-PAEDs study. Information was reported by physicians and caregivers; patients aged ≥ 8 years self-reported their HRQoL. Descriptive statistics summarised demographic and clinical characteristics, costs, and HRQoL scores (EQ-5D-Y). Regression models estimated differences in HRQoL and costs for moderate versus severe haemophilia adjusting for age, body mass index z-score, country, number of comorbidities, and weight-adjusted annual clotting factor consumption.

Results

The analytic sample comprised 794 patients with a mean age of 10.5 years; most had haemophilia A (79%) and 58% had severe haemophilia. Mean predicted direct medical costs in moderate patients were two-thirds of the predicted costs for severe disease (€3065 vs. €2047; p < 0.001; N = 794), while societal costs were more than half of the predicted costs for children with severe haemophilia (€6950 vs. €3666; p < 0.001; N = 220). Mean predicted HRQoL scores were 0.74 and 0.69 for moderate and severe disease, respectively (p < 0.05; N = 185).

Conclusion

Children with haemophilia and their caregivers displayed a significant economic and humanistic burden. While severe patients showed the highest direct medical and societal costs, and worse HRQoL, the burden of moderate haemophilia on its own was substantial and far from negligible.
Overview of the practices of on-farm emergency slaughter of cattle in the Nordic countries
Authors: Skúladóttir Gíslína , Phythian Clare Joan , Holmøy Ingrid Hunter , Myhrene Guro , Alvåsen Karin , Martin Adam Dunstan
Published: April 2022

On farm mortality is an increasing problem in cattle production systems in the Nordic countries. It represents an economic loss to the farmer and raises questions of sustainability, food waste and animal welfare. On-farm emergency slaughter (OFES) represents, in some situations, an opportunity for a farmer to salvage some of the economic value from an animal that cannot be transported to a slaughterhouse. The basis of the regulation of OFES in the Nordic countries originates largely from legislation from the European Union. However, this review has found that the availability and practice of OFES in the Nordic countries differs considerably. For example, in Norway 4.2% of all cattle slaughter is OFES, whilst in Iceland OFES has never been recorded. National food safety authorities have issued differing regulations and guidelines regarding the suitability of sick and injured animals for OFES. This review shows there is a paucity of data regarding the incidence and reasons for the use of OFES of cattle in the Nordic countries and points out the need for more investigation into this area to improve veterinary education, consumer protection and animal welfare.