bluuebunny/crossref_metadata_2025 huggingface dataset:
This Ain’t No Place for No Hero: Prevalence and Correlates of Representations of Victims, Helpers, and Perpetrators During the Time of National Socialism in German Families
Authors: Rees Jonas H. , Papendick Michael , Zick Andreas
Published: April 2021

The transmission of national history in general and family narratives in particular is prone to censorship and bias, protecting or enhancing social identities. The authors propose that, as has been shown for national groups, families also create and pass on representations about their roles and behaviors through history. In a representative survey, 1000 German respondents estimated the percentages of victims, perpetrators, and those who helped potential victims during the time of National Socialism to be 35%, 34%, and 16%, respectively. For family representations, the percentages shifted toward helping (29%) and away from complicity (20%), while representations of victimhood were as prevalent (36%) as estimates for the general population. Systematic differences suggested an alignment of general social representations of history with family representations. Participants reporting a perpetrator family representation held more positive attitudes toward refugees coming to Germany today than participants who did not report such a representation. This link was mediated through differences in societal representations. The authors discuss family representations as an intermediate, more proximate prescriptive background and points of reference, according to which more general historical representations on a national level may be aligned, and individual present-day political attitudes and behaviors oriented.
(Im)moral Symbols and (Im)moral Deeds: Defensive Strategies for Coping with Historical Transgressions of Group Heroes and Villains
Authors: Ivanović Jovan , Žeželj Iris , Psaltis Charis
Published: April 2021

In two post-conflict societies (Serbia and Cyprus), the authors investigated how people cope with in-group historical transgression when heroes and villains relevant for their collective identity are made salient in it. The authors set the events in foundational periods for Serbian (Experiment 1) and Greek Cypriot (Experiment 2) ethnic identity—that is, historical representations of the Battle of Kosovo (1389) and the Liberation Struggle (1955–1959), respectively. In both experiments, a between-subjects design was used to manipulate group membership (in-group or out-group) and representation of the salient character (hero, villain, or neutral) in fictitious but historically plausible accounts of transgressions. In Experiment 1 ( N = 225), the participants showed more moral disengagement in the case of in-group historical transgressions than in the case of identical transgressions by an out-group, while the in-group hero was rejected less than all the other historical characters. Social identification based on in-group superiority moderated both observed effects in such a manner that they were more pronounced for participants perceiving their ethnic group as superior. In Experiment 2 ( N = 136), historical transgression involving the in-group hero provoked the most moral disengagement and the least rejection of the group deviant. In-group superiority and in-group importance as distinct modes of social identification moderated these effects in such a way that they were more pronounced for high-identifying individuals. Taken together, the experiments show that the in-group hero, as a highly valued ethnic symbol, is exempt from the black sheep effect and the sanctions of critically attached group members. The authors discuss the implications of in-group heroes for political and educational communication.
Collective remembering of Confucianism in Chinese language textbooks
Authors: Xie Tian , Chen Shuang , Wang Dong , Liu James H.
Published: April 2021

This study focuses on the collective remembering of an ancient system of meaning, examining content and changes in the construction of Confucianism in Chinese textbooks. The data consists of 84 editions of Chinese language teaching textbooks published by the People’s Education Press from 1949 to 2019. Content analysis shows that Confucianism is and was barely represented in this corpus. Thematic analysis shows that: (i) Only Confucius and Mencius were recognized as Confucian masters. (ii) Representations of Confucianism in the textbooks come from The Analects, Mencius, The Book of Rites, and The Book of Poetry, all of which are more than 2000 years old. (iii) Except for the 1970s, Confucianism was represented in a positive or at least neutral way. (iv) Confucianism is represented in a distant, abstract, decontextualized, and apolitical way, disconnected from students’ daily life. This gives insight into how a core representation stripped of its peripheral elements can lose meaning, and lose its normative influence on behavior. Contributions to collective memory, and implications for how to edit Chinese language textbooks to be more engaging are discussed.
Treatment with eltrombopag of severe immune thrombocytopenia and hemolytic anemia associated with COVID-19 pneumonia: a case report
Authors: Gruden Gabriella , Beggiato Eloise , Camerino Enrica , Capriotti Serena , Canepa Silvia , Scandella Michela , Avolio Maria , Pittalunga Fabrizia , Barutta Federica , Durazzo Marilena
Published: April 2021

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of coronavirus disease 2019 (COVID-19). Whether SARS-CoV-2 can trigger an autoimmune reaction against platelets and red blood cells remains unclear. Herein, we report a case of COVID-19 pneumonia associated with severe immune thrombocytopenia and hemolytic anemia. An 83-year-old woman was admitted to the hospital because of both dyspnea and diffuse mucocutaneous bleeding. Exams revealed hemolytic anemia (HA), severe immune thrombocytopenia (ITP), and bilateral pneumonia. Molecular testing confirmed a diagnosis of COVID-19 pneumonia. Thrombocytopenia did not respond to first-line treatment with immunoglobulin, corticosteroids, and platelet transfusions. Addition to therapy of the thrombopoietin receptor agonist, eltrombopag, resulted in full recovery. COVID-19 can be associated with ITP and HA. There are neither guidelines nor clinical experience on the treatment of COVID-19-associated ITP and our case, showing complete response to eltrombopag, may help clinicians in their practice during the COVID-19 pandemic.

Plain language summary

The case of an 83-year-old woman with COVID-19 pneumonia associated with two severe blood diseases that cause platelet and red cell destruction Coronavirus disease 2019 (COVID-19) is caused by a virus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We do not know exactly whether this virus can stimulate our immune system to react against platelets and red blood cells. Herein, we report a case of COVID-19 pneumonia associated with two severe blood diseases, immune thrombocytopenia, which causes platelet destruction, and hemolytic anemia, which causes red cell destruction. An 83-year-old woman was admitted to the hospital because of both difficulty in breathing and diffuse bleeding in mucosae and skin. Exams revealed hemolytic anemia, severe immune thrombocytopenia, and pneumonia in both lungs. Molecular testing confirmed a diagnosis of COVID-19 pneumonia. The first treatment with immunoglobulin, corticosteroids, and platelet transfusions was not enough to cure thrombocytopenia; the addition of eltrombopag which acts on the thrombopoietin receptor agonist resulted in full recovery. COVID-19 can be present together with immune thrombocytopenia and hemolytic anemia. As there are no guidelines on the treatment of immune thrombocytopenia in patients with COVID-19 and the clinical experience is limited, the complete response achieved with eltrombopag may help clinicians in their practice during the COVID-19 pandemic.
Spontaneous evisceration of small bowel through the rectum in the background of rectal prolapse
Authors: Basnayake Oshan , Jayarajah Umesh , Wijerathne AM Thilak
Published: April 2021

Small bowel evisceration secondary to rectal prolapse is an uncommon complication with significant morbidity and mortality if left untreated. We report a rare case of the spontaneous evisceration of the small bowel through the rectum in the background of rectal prolapse. A 73-year-old female presented to the emergency treatment unit with sudden worsening of her rectal procidentia (rectal prolapse) and pain for 3 h precipitated by straining at defecation. She had a history of complete rectal prolapse for 4 years and three uncomplicated vaginal deliveries. On examination, she was found to have evisceration of the small bowel through the anus without any evidence of strangulation. Emergency laparotomy was performed and small bowel was reduced into the abdomen with ease. She was found to have a linear tear on the anterior wall of the rectum. Primary repair of the rectal defect was carried out and a proximal defunctioning ileostomy was created. Histology was unremarkable and the recovery was uneventful. Old age, history of previous vaginal deliveries, and long-standing rectal prolapse were probable risk factors in this patient. Delay in treating this condition may result in significant morbidity and even mortality. Therefore, timely intervention is necessary.
Anti-neutrophil cytoplasmic antibody–associated vasculitis complicated with diffuse alveolar haemorrhage and central nervous system vasculitis
Authors: Nawata Takashi , Murakawa Kaori , Shiragami Kosaku , Shibuya Masaki , Kubo Makoto , Yano Masafumi
Published: April 2021

Diffuse alveolar haemorrhage and central nervous system vasculitis are life-threatening complications of anti-neutrophil cytoplasmic antibody-associated vasculitis. The simultaneous occurrence of diffuse alveolar haemorrhage and central nervous system vasculitis is a rare presentation of antibody-associated vasculitis. Its diagnosis by histopathology is difficult because biopsy is difficult to perform, and urgent treatment is needed. We report a case of a Japanese man with diffuse alveolar haemorrhage and central nervous system vasculitis associated with antibody-associated vasculitis. New classification criteria may be needed for diffuse alveolar haemorrhage and central nervous system vasculitis associated with systemic vasculitis. When antibiotic-resistant atypical bilateral pneumonia is noted in the acute phase of a cerebral stroke, with elements suggestive of vasculitis, clinicians should be aware that diffuse alveolar haemorrhage and central nervous system vasculitis may occur simultaneously.
The Effect of Brand Perceptions on Repurchase When Using the E-commerce Website for Shopping
Authors: Albarq Abbas N.
Published: April 2021

This study aims to investigate the influence of some critical factors (store/brand perceptions and trust in the web-store) on online repurchase intention. A pre-validated questionnaire was distributed to a convenience sample with response rate of 95.2% ( n = 684) web-store buyers that were examined for assessing the research model. Primary data were collected during the period between December 2019 and February 2020, from respondents in Amman the capital of Jordan. Using AMOS 22.0 software, the collected data were analyzed with structural equation modeling (SEM). Confirmatory factory analysis (CFA) was used to estimate the measurement model with respect to convergent and discriminant validities. This was followed by testing the structural model framework and research hypotheses. The results showed that retailers can not only enhance trust in this store through robust brands, but also reap several benefits such as better brand image and demand. Thus, it has been found that the store as a brand could turn out to be as important that make it easier for customers to build trust, constituting a strong antecedent of behavioral intentions where behavioral intentions can lead to repurchase patterns. Unlike extant research, this model proposes store brand perception and product brand perception as determinants of intentions and trust in a web-store.
Ulnar Collateral Ligament Reconstruction With the Modified Jobe Technique in Baseball Pitchers
Authors: Yoshida Masahito , Takenaga Tetsuya , Takeuchi Satoshi , Takaba Keishi , Tsuchiya Atsushi , Fukuyoshi Masaki , Nakagawa Hiroki , Matsumoto Yuji , Saito Masayoshi , Futamura Hidenori , Futamura Ryo , Murakami Hideki , Sugimoto Katsumasa
Published: April 2021

Background:

Tearing and insufficiency of the ulnar collateral ligament (UCL) of the elbow result in valgus instability, which can lead to pain while throwing and decline in performance in overhead athletes.

Purpose:

To assess the clinical results of a modified UCL reconstruction technique using 1 bone hole in the ulna and 1 bone tunnel in the humerus in baseball players.

Study Design:

Case series; Level of evidence, 4.

Methods:

The inclusion criteria were medial elbow pain preventing effective playing, clinically medial elbow laxity, and magnetic resonance imaging results consistent with UCL injury. Patients who were engaged in other sports and in other positions in baseball except pitchers were excluded from this study. Our modified Tommy John procedure was performed via a muscle-splitting approach and an original single-bone-tunnel technique, using a suture anchor. After a minimum of 24 months, patients were evaluated using the Conway scale and the Timmerman-Andrews score.

Results:

Of 31 patients, 20 baseball pitchers (20 male: 5 high school, 5 collegiate, 8 nonprofessional, and 2 professional pitchers) were reviewed. The mean patient age at the time of operation was 21.9 years, and the mean postoperative follow-up period was 35.1 months (range, 24-66 months). The mean Timmerman-Andrews subjective score improved significantly from pre- to postoperatively (from 68.3 to 98.3; P < .05); the objective score also improved significantly (from 81.1 to 96.4; P = .01). No complications were detected at the latest follow-up. Overall, 19 patients were able to return to their preinjury level of sports or higher.

Conclusion:

UCL reconstruction with 1 bone hole in the ulna and 1 bone tunnel in the humerus demonstrated satisfactory results in baseball pitchers. Our modified technique was safe and achieved satisfactory clinical results, with a 95% rate of return to sports.
A Sense of Humor is Especially Important During Difficult Times
Authors: Mandelbaum David E.
Published: April 2021

Artist-critic Clive James said: “Common sense and a sense of humor are the same thing, moving at different speeds. A sense of humor is just common sense, dancing. Those who lack humor are without judgment and should be trusted with nothing.”
Medical Student Leadership Development through a Business School Partnership Model: A Case Study and Implementation Strategy
Authors: Daaleman Timothy P , Storrie Mindy , Beck Dallaghan Gary , Smithson Sarah , Gilliland Kurt O , Byerley Julie S
Published: April 2021

Background:

There is an ongoing call for leadership development in academic health care and medical students desire more training in this area. Although many schools offer combined MD/MBA programs or leadership training in targeted areas, these programs do not often align with medical school leadership competencies and are limited in reaching a large number of students.

Methods:

The Leadership Initiative (LI) was a program created by a partnership between a School of Medicine (SOM) and Business School with a learning model that emphasized the progression from principles to practice, and the competencies of self-awareness, communication, and collaboration/teamwork. Through offerings across a medical school curriculum, the LI introduced leadership principles and provided an opportunity to apply them in an interactive activity or simulation. We utilized the existing SOM evaluation platform to collect data on program outcomes that included satisfaction, fidelity to the learning model, and impact.

Results:

From 2017 to 2020, over 70% of first-year medical students participated in LI course offerings while a smaller percentage of fourth-year students engaged in the curriculum. Most students had no prior awareness of LI course material and were equivocal about their ability to apply lessons learned to their medical school experience. Students reported that the LI offerings provided opportunities to practice the skills and competencies of self-awareness, communication, and collaboration/teamwork.

Discussion:

Adding new activities to an already crowded medical curriculum was the greatest logistical challenge. The LI was successful in introducing leadership principles but faced obstacles in having participants apply and practice these principles. Most students reported that the LI offerings were aligned with the foundational competencies.
Religion and Values in Contemporary Africa: Christian Interpretations of Vice/Virtue Discourses in Ghana
Authors: Asamoah-Gyadu J. Kwabena , Dzokoto Vivian , Tutu Annabella Osei , Kenin Abraham , Stahl Amanda
Published: April 2021

Despite the popularity of religion in African settings such as Ghana, reports of moral decline abound. This article reviews traditional, mission, and Christian theological perspectives of morality in Ghana. Using interviews, surveys, and content analysis of vehicle slogans, it examines what Ghanaians today consider to be values in terms of virtues and vices. It explores implications for Christian mission involvement in shaping morality in education and the public sphere.
Stemless Total Shoulder: A Review of Biomechanical Fixation and Recent Results
Authors: Wodarek Jeremy , Shields Edward
Published: April 2021

Introduction: Anatomic total shoulder arthroplasty is the replacement of the humeral head and glenoid surfaces with the goal of replicating normal anatomy. It is commonly utilized for patients with osteoarthritis, rheumatoid arthritis, and osteonecrosis, who have decreased range of motion (ROM), persistent pain, and loss of strength. Total shoulder Arthroplasty (TSA) is the third most common joint replacement in the United States. The incidence of TSA has been increasing, some data suggest that by the year 2025, TSA incidence may rise to 439,206 operations per year. In recent years, stemless total shoulder implants have become available. Results: These implants preserve bone stock while decreasing complications such as osteolysis, stress shielding and periprosthetic fracture. Stemless implants improve anatomic reconstruction and biomechanical function of the shoulder joint. Conclusion: Increasing amounts of data suggest stemless TSA to be a safe and effective technology that will become more common in the coming year.
Postural changes in blood pressure among patients with diabetes attending a referral hospital in southwestern Uganda: a cross-sectional study
Authors: Migisha Richard , Agaba David Collins , Katamba Godfrey , Manne-Goehler Jennifer , Muyingo Anthony , Siedner Mark J.
Published: April 2021

Background

Orthostatic hypotension (OH) and orthostatic hypertension (OHT) are often unrecognized in clinical care for diabetic individuals, yet they are associated with increased risk for adverse cardiovascular outcomes. We aimed to determine the prevalence of the abnormal orthostatic blood pressure (BP) responses, and associated factors among diabetic individuals in ambulatory care for diabetes in southwestern Uganda.

Methods

We conducted a cross-sectional study among diabetic individuals aged 18–65 years at Mbarara Regional Referral Hospital, southwestern Uganda from November 2018 to April 2019. We obtained demographic and clinical data including a detailed medical history, and glycemic profile. BP measurements were taken in supine position and within 3 min of standing. We defined OH in participants with either ≥ 20 mmHg drop in systolic BP (SBP) or ≥ 10 mmHg drop in diastolic BP (DBP) after assuming an upright position. OHT was defined in participants with either a ≥ 20 mmHg rise in SBP, or ≥ 10 mmHg rise in DBP after assuming an upright position. Multivariate logistic regression was used to identify factors associated with OH and OHT.

Results

We enrolled 299 participants, with a mean age of 50 years (SD ± 9.8), and mean HbA1c of 9.7% (SD ± 2.6); 70% were female. Of the 299 participants, 52 (17.4%; 95% CI 13.3–22.2%) met the definition of OH and 43 (14.4%; 95% CI 10.6–18.9%) were classified as having OHT. In multivariable models, factors associated with diabetic OH were older age (OR = 2.40 for 51–65 years vs 18–50 years, 95% CI 1.02–5.67,P = 0.046), diabetic retinopathy (OR = 2.51; 95% CI 1.14–5.53,P = 0.022), higher resting SBP ≥ 140 mmHg (OR = 3.14; 95% CI 1.31–8.7.56,P = 0.011), and history of palpitations (OR = 2.31; 95% CI 1.08–4.92,P = 0.031). Self-report of palpitations (OR = 3.14; 95% CI 1.42–6.95,P = 0.005), and higher resting SBP ≥ 140 mmHg (OR = 22.01; 95% CI 1.10–4.42,P = 0.043) were associated with OHT.

Conclusion

OH and OHT are common among diabetic individuals in ambulatory diabetes care in southwestern Uganda. Orthostatic BP measurements should be considered as part of routine physical examination to improve detection of OH and OHT, especially among older diabetics with complications of the disease. Future studies to assess the health and prognostic implications of OH and OHT among diabetics in the region are warranted.
mRNA profiling of a well-differentiated G1 pancreatic NET correlates with immunohistochemistry profile: a case report
Authors: Venugopal Abhirami , Gillick-Walker Jessie , Michalczyk Agnes , Khasraw Mustafa , Ackland M. Leigh
Published: April 2021

Background

Neuroendocrine neoplasms (NENs) are a complex group of tumours that occur in many organs. Routinely used IHC markers for NEN diagnosis include CgA, synaptophysin, Ki67 and CD56. These have limitations including lack of correlation to clinical outcomes and their presence in non-tumour tissue. Identification of additional markers and more quantitative analyses of tumour tissue has the potential to contribute to improved clinical outcomes. We used qRT-PCR to profile the expression levels of a panel of markers in tumour and matched non-tumour tissue from a patient with a G1 pancreatic neuroendocrine tumour. Differences in mRNA levels between tumour and non-tumour tissue were compared with IHC analyses of the same sample.

Case presentation

An elderly man presented with lower abdominal pain for 6 months. Histological analysis identified a low grade, well differentiated pancreatic endocrine neoplasm. Twenty-seven tumour markers for neuroendocrine status, proliferation, stem cell phenotype, angiogenesis, epithelial to mesenchymal transition, cell adhesion, differentiation and tumour suppression were selected from previous studies and mRNA levels of these markers were measured in tumour and adjacent non-tumour tissue sample using qRT-PCR. IHC was carried out on the same tissue to detect the corresponding marker proteins. Of the markers analysed, seven showed higher mRNA levels in tumour relative to non-tumour tissue while thirteen had lower expression in tumour relative to non-tumour tissue. Substantial differences in mRNA levels were a gain of CgA, CD56, β-catenin, CK20, PDX1 and p53 and loss of Ki67, PCAD, CK7, CD31, MENA, ECAD, EPCAM, CDX2 and CK6. Comparison of qRT-PCR data with IHC showed correlation between fifteen markers.

Conclusion

Our study is unique as it included matched controls that provided a comparative assessment for tumour tissue analysis, whereas many previous studies report tumour data only. Additionally, we utilised qRT-PCR, a relatively quantitative diagnostic tool for differential marker profiling, having the advantage of being reproducible, fast, cheap and accurate. qRT-PCR has the potential to improve the defining of tumour phenotypes and, in combination with IHC may have clinical utility towards improving tumour stratification or distinguishing tumour grades. The results need to be validated with different grades of NENs and related to clinical outcomes.
Salvage liver transplantation after resection of colorectal cancer liver metastasis with favorable outcomes: a case report and review of the literature
Authors: Tabbal Mahmoud , Alkhalifa Abdullah Mahmoud , AlQattan Abdullah Saleh , AlJawad Mohammed , Tawfeeq Mansour Ahmed , Al Qahtani Mohammed Saad
Published: April 2021

Background

Approximately 50% of patients with colorectal cancer (CRC) develop metastases most commonly in the liver. Liver transplantation (LT) can be used in certain cases of primary liver malignancy or in metastatic diseases, such as Neuroendocrine tumors. However, there are controversies regarding LT as a treatment option for liver metastasis from CRC due to poor outcomes in previously reported cases.

Case presentation

We report a 37-year-old male who underwent resection of the left-sided colon due to cancer and was found to have synchronous liver metastasis for which he received chemotherapy. Later, he underwent a right hepatectomy, which was complicated by insufficient liver remnant function despite the preserved liver perfusion. Therefore, salvage liver transplantation was performed successfully with a good long-term outcome.

Conclusions

Many studies examined the survival and quality of life in patients undergoing liver transplantation for unresectable colorectal liver metastasis; these studies include the SECA Study (secondary cancer) and others with favorable outcomes. We reviewed the literature and compared the outcomes of some of these studies in this article. Our case emphasizes that liver transplantation could be an option for some colon cancer liver metastasis (CLM) patients, specifically, as a salvage procedure. Thus, more research is needed to develop selection criteria for patients who may benefit from liver transplantation.
Maternal depression, adverse childhood experiences, and social support in relation to gestational diabetes risk: results from the Albany Infant and Mother Study (AIMS)
Authors: Versteegen Margaret , Bozlak Christine T. , Larkin Heather , Appleton Allison A.
Published: April 2021

Background

Psychosocial factors are of increasing interest as potential influencers in disease development. This study explores associations between gestational diabetes mellitus (GDM) and maternal depression, adverse childhood experiences (ACEs), and social support, in response to emerging evidence in these areas.

Methods

An observational, prospective cohort study (AIMS) served as the source of secondary data for this study. Participants included 300 pregnant women aged 18–40 years at an upstate New York prenatal care clinic, who completed a set of self-report questionnaires assessing exposures and stressors both during and prior to their pregnancy. Data were also abstracted from infant and maternal medical records.

Results

Logistic regression modeling estimated the odds ratios (ORs) of developing GDM in relation to psychosocial factors. There was a significant association between depression and GDM (OR = 2.85, 95% CI: 1.15, 7.06), which persisted in the model adjusted for age and BMI (aOR = 3.19, 95% CI: 1.25, 8.10). No significant associations were found between ACEs or social support with GDM.

Conclusions

Study findings support an association between maternal depression and GDM development. This study underscores the need for additional research on psychosocial factors and connections to health risks.
Reducing dengue fever cases at the lowest budget: a constrained optimization approach applied to Thailand
Authors: Knerer Gerhart , Currie Christine S. M. , Brailsford Sally C.
Published: April 2021

Background

With the challenges that dengue fever (DF) presents to healthcare systems and societies, public health officials must determine where best to allocate scarce resources and restricted budgets. Constrained optimization (CO) helps to address some of the acknowledged limitations of conventional health economic analyses and has typically been used to identify the optimal allocation of resources across interventions subject to a variety of constraints.

Methods

A dynamic transmission model was developed to predict the number of dengue cases in Thailand at steady state. A CO was then applied to identify the optimal combination of interventions (release ofWolbachia-infected mosquitoes and paediatric vaccination) within the constraints of a fixed budget, set no higher than cost estimates of the current vector control programme, to minimize the number of dengue cases and disability-adjusted life years (DALYs) lost. Epidemiological, cost, and effectiveness data were informed by national data and the research literature. The time horizon was 10 years. Scenario analyses examined different disease management and intervention costs, budget constraints, vaccine efficacy, and optimization time horizon.

Results

Under base-case budget constraints, the optimal coverage of the two interventions to minimize dengue incidence was predicted to be nearly equal (Wolbachia50%; paediatric vaccination 49%) with corresponding coverages under lower bound (Wolbachia54%; paediatric vaccination 10%) and upper bound (Wolbachia67%; paediatric vaccination 100%) budget ceilings. Scenario analyses indicated that the most impactful situations related to the costs ofWolbachiaand paediatric vaccination with decreases/ increases in costs of interventions demonstrating a direct correlation with coverage (increases/ decreases) of the respective control strategies under examination.

Conclusions

Determining the best investment strategy for dengue control requires the identification of the optimal mix of interventions to implement in order to maximize public health outcomes, often under fixed budget constraints. A CO model was developed with the objective of minimizing dengue cases (and DALYs lost) over a 10-year time horizon, within the constraints of the estimated budgets for vector control in the absence of vaccination andWolbachia. The model provides a tool for developing estimates of optimal coverage of combined dengue control strategies that minimize dengue burden at the lowest budget.
Estimation of the serial interval and proportion of pre-symptomatic transmission events of COVID− 19 in Ireland using contact tracing data
Authors: McAloon Conor G. , Wall Patrick , Griffin John , Casey Miriam , Barber Ann , Codd Mary , Gormley Eamonn , Butler Francis , McV Messam Locksley L. , Walsh Cathal , Teljeur Conor , Smyth Breda , Nolan Philip , Green Martin J. , O’Grady Luke , Culhane Kieran , Buckley Claire , Carroll Ciara , Doyle Sarah , Martin Jennifer , More Simon J.
Published: April 2021

Background

The serial interval is the period of time between the onset of symptoms in an infector and an infectee and is an important parameter which can impact on the estimation of the reproduction number. Whilst several parameters influencing infection transmission are expected to be consistent across populations, the serial interval can vary across and within populations over time. Therefore, local estimates are preferable for use in epidemiological models developed at a regional level. We used data collected as part of the national contact tracing process in Ireland to estimate the serial interval of SARS-CoV-2 infection in the Irish population, and to estimate the proportion of transmission events that occurred prior to the onset of symptoms.

Results

After data cleaning, the final dataset consisted of 471 infected close contacts from 471 primary cases. The median serial interval was 4 days, mean serial interval was 4.0 (95% confidence intervals 3.7, 4.3) days, whilst the 25th and 75th percentiles were 2 and 6 days respectively. We found that intervals were lower when the primary or secondary case were in the older age cohort (greater than 64 years). Simulating from an incubation period distribution from international literature, we estimated that 67% of transmission events had greater than 50% probability of occurring prior to the onset of symptoms in the infector.

Conclusions

Whilst our analysis was based on a large sample size, data were collected for the primary purpose of interrupting transmission chains. Similar to other studies estimating the serial interval, our analysis is restricted to transmission pairs where the infector is known with some degree of certainty. Such pairs may represent more intense contacts with infected individuals than might occur in the overall population. It is therefore possible that our analysis is biased towards shorter serial intervals than the overall population.
Girl-only clubs’ influence on SRH knowledge, HIV risk reduction, and negative SRH outcomes among very young adolescent girls in rural Malawi
Authors: Manda Wanangwa Chimwaza , Pilgrim Nanlesta , Kamndaya Mphatso , Mathur Sanyukta , Sikweyiya Yandisa
Published: April 2021

Background

Early adolescence is an important period to lay the foundation for positive sexual health development that can overcome sexual and reproductive health (SRH) challenges faced by very young adolescents (VYAs) as they reach puberty and sexual debut. In this study, we explored the following questions: first, what are the experiences of VYA girls on DREAMS’ Go Girl club participation? Second, how does club participation influence the VYAs SRH knowledge to reduce their risk for HIV and negative sexual health outcomes?

Methods

This was a qualitative study in which twenty-three in-depth interviews were conducted with VYA girls aged 12–14 years. These girls were enrolled in girl-only clubs in two rural southern districts in Malawi. The clubs were a part of larger comprehensive HIV prevention project called DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) which provided an evidence-based core package of interventions to VYAs to prevent HIV. Interventions included improved access to key health services, education support, social skills, asset building, and economic strengthening. Narrative inquiry was used to generate first-hand accounts of the girls’ experiences with club participation. Thematic analysis was used to generate themes from the transcribed stories.

Results

Six main themes were generated: 1) reasons for joining the clubs with desire to learn about SRH as a motivation for joining the clubs.; 2) influence on gender norms and roles whereby participants described a change of gender roles and norms at home; 3) influence on child abuse practices whereby participants reported a decline in child abusive practices at home;4) influence on life skills and social networks whereby participants described learning about networking; 5) support to go back to school whereby out-of-school girls described how economic empowerment of their guardians facilitated their return to school; and 6) influence of clubs on SRH knowledge acquisition and behaviours whereby participants described acquiring knowledge on sexual health issues.

Conclusion

Girls-only HIV and SRH programs coupled with economic empowerment for their families can be effective in keeping VYA girls in school and improving SRH knowledge and health seeking behavior.
Severe infection including disseminated herpes zoster triggered by subclinical Cushing’s disease: a case report
Authors: Yamauchi Yuki , Kameda Hiraku , Omori Kazuno , Tani Michio , Cho Kyu Yong , Nakamura Akinobu , Miyoshi Hideaki , Tanaka Shinya , Atsumi Tatsuya
Published: April 2021

Background

Subclinical Cushing’s disease (SCD) is defined by corticotroph adenoma-induced mild hypercortisolism without typical physical features of Cushing’s disease. Infection is an important complication associated with mortality in Cushing’s disease, while no reports on infection in SCD are available. To make clinicians aware of the risk of infection in SCD, we report a case of SCD with disseminated herpes zoster (DHZ) with the mortal outcome.

Case presentation

An 83-year-old Japanese woman was diagnosed with SCD, treated with cabergoline in the outpatient. She was hospitalized for acute pyelonephritis, and her fever gradually resolved with antibiotics. However, herpes zoster appeared on her chest, and the eruptions rapidly spread over the body. She suddenly went into cardiopulmonary arrest and died. Autopsy demonstrated adrenocorticotropic hormone-positive pituitary adenoma, renal abscess, and DHZ.

Conclusions

As immunosuppression caused by SCD may be one of the triggers of severe infection, the patients with SCD should be assessed not only for the metabolic but also for the immunodeficient status.
Clinician acceptance of complex clinical decision support systems for treatment allocation of patients with chronic low back pain
Authors: Jansen-Kosterink Stephanie , van Velsen Lex , Cabrita Miriam
Published: April 2021

Background

The uptake of complex clinical decision support systems (CDSS) in daily practice remains low, despite the proven potential to reduce medical errors and to improve the quality of care. To improve successful implementation of a complex CDSS this study aims to identify the factors that hinder, or alleviate the acceptance of, clinicians toward the use of a complex CDSS for treatment allocation of patients with chronic low back pain.

Methods

We tested a research model in which the intention to use a CDSS by clinicians is influenced by the perceived usefulness; this usefulness, in turn is influenced by the perceived service benefits and perceived service risks. An online survey was created to test our research model and the data was analysed using Partial Least Squares Structural Equation Modelling. The study population consisted of clinicians. The online questionnaire started with demographic questions and continued with a video animation of the complex CDSS followed by the set of measurement items. The online questionnaire ended with two open questions enquiring the reasons to use and not use, a complex CDSS.

Results

Ninety-eight participants (46% general practitioners, 25% primary care physical therapists, and 29% clinicians at a rehabilitation centre) fully completed the questionnaire. Fifty-two percent of the respondents were male. The average age was 48 years (SD ± 12.2). The causal model suggests that perceived usefulness is the main factor contributing to the intention to use a complex CDSS. Perceived service benefits and risks are both significant antecedents of perceived usefulness and perceived service risks are affected by the perceived threat to autonomy and trusting beliefs, particularly benevolence and competence.

Conclusions

To improve the acceptance of complex CDSSs it is important to address the risks, but the main focus during the implementation phase should be on the expected improvements in patient outcomes and the overall gain for clinicians. Our results will help the development of complex CDSSs that fit more into the daily clinical practice of clinicians.
The impacts of caregiving intensity on informal caregivers in Malaysia: findings from a national survey
Authors: Jawahir Suhana , Tan Ee Hong , Tan Yeung R’ong , Mohd Noh Sarah Nurain , Ab Rahim Iqbal
Published: April 2021

Background

Provision of informal care may adversely affect health, daily and social activities of the informal caregivers, but few studies have examined these effects in relation to caregiving intensity. This study examined the predictive factors associated with the effects of caregiving roles on health, daily and social activities of informal caregivers, accounting for caregiving intensity.

Methods

Data of adults aged 18 years and over from the National Health and Morbidity Survey 2019 were used. Respondent’s demographic, socioeconomic, health, and caregiving-related characteristics were described using complex samples analysis. Logistic regression analysis was performed to examine the factors affecting health, daily and social activities of caregivers, accounting for caregiving intensity.

Results

Five point one percent of adults in Malaysia provided informal care. High intensity caregivers were more likely to be actively employed and provided longer duration of care compared with low intensity caregivers. For low intensity caregiving, females, those aged 35–59 years, and those with long-term condition were more likely to have negative effects on health. Daily activities of non-Malays were more likely to be affected, while no factor was found significantly associated with effect on social activities. For high intensity caregiving, caregivers aged 60 and over, those received training and those without assistance were more likely to have negative effects on health. Daily activities of those without assistance were more likely to be affected. Social activities of non-Malays, those received training and those providing care for 2 years or more were more likely to be affected.

Conclusions

Our study indicates that both low- and high-intensity caregivers have common features, with the exception of employment status and care duration. Caregiving, regardless of intensity, has a significant impact on caregivers. In order to reduce the negative consequences of caregiving responsibilities, all caregivers need assistance from the community and government, that is customised to their needs. By addressing the factors contributing to the negative effects of caregiving, a continuation of informal caregiving can be sustained through policies supporting the growing demand for informal care necessitated by an ageing population and higher life expectancy in Malaysia.
Mental health professionals’ experiences of working with parents with psychosis and their families: a qualitative study
Authors: Radley Jessica , Barlow Jane , Johns Louise
Published: April 2021

Background

Healthcare service users who are parents with psychosis form part of the caseload of most community mental health teams. Mental health professionals can experience uncertainty about how to work with and ask about the children of these parents, and often report difficulties when collaborating with other agencies. This study focused on professionals’ experiences of working with parents with psychosis and their families to gain an understanding of these parents’ needs from a service-level perspective, and to identify barriers that professionals may experience in meeting those needs.

Methods

Qualitative focus groups were conducted with four to eight mental health professionals per group. Data were analysed using reflexive thematic analysis. JR familiarised herself with the transcripts and then coded each salient unit within the text. Themes were then identified and discussed amongst all authors until there was agreement.

Results

We developed two overarching themes: 1) Diversity of need in parents with psychosis and 2) Role boundaries. The first explored mental health professionals’ perceived range of experiences that parents with psychosis and their families have, and the range of potential effects of parental psychosis on a child. The second theme described how some mental health professionals emphasised the importance of supporting service users in terms of their parenting status and others felt it was more critical to treat the person’s symptomatic expression. This theme also included issues with communication both with their service users and with other agencies.

Conclusions

Mental health professionals identified that the needs of parents with psychosis were diverse and reflected significant variation in the experiences of service users. Mental health professionals across different types of team (early intervention and community mental health) expressed contrasting viewpoints about how achievable it was to respond to a service user’s parenting status in an adult mental health setting. Future research should aim to determine where training is needed to enhance mental health professionals’ ability to work holistically with families in an adult mental health setting, and how to enhance collaboration with other agencies.
Leveraging phone-based mobile technology to improve data quality at health facilities in rural Malawi: a best practice project
Authors: Tizifa Tinashe A. , Nkhono William , Mtengula Spencer , van Vugt Michele , Munn Zachary , Kabaghe Alinune N.
Published: April 2021

Background

To further reduce malaria burden, identification of areas with highest burden for targeted interventions needs to occur. Routine health information has the potential to indicate where and when clinical malaria occurs the most. Developing countries mostly use paper-based data systems however they are error-prone as they require manual aggregation, tallying and transferring of data. Piloting was done using electronic data capture (EDC) with a cheap and user friendly software in rural Malawian primary healthcare setting to improve the quality of health records.

Methods

Audit and feedback tools from the Joanna Briggs Institute (Practical Application of Clinical Evidence System and Getting Research into Practice) were used in four primary healthcare facilities. Using this approach, the best available evidence for a malaria information system (MIS) was identified. Baseline audit of the existing MIS was conducted in the facilities based on available best practice for MIS; this included ensuring data consistency and completeness in MIS by sampling 25 random records of malaria positive cases. Implementation of an adapted evidence-based EDC system using tablets on an OpenDataKit platform was done. An end line audit following implementation was then conducted. Users had interviews on experiences and challenges concerning EDC at the beginning and end of the survey.

Results

The existing MIS was paper-based, occupied huge storage space, had some data losses due to torn out papers and were illegible in some facilities. The existing MIS did not have documentation of necessary parameters, such as malaria deaths and treatment within 14 days. Training manuals and modules were absent. One health centre solely had data completeness and consistency at 100% of the malaria-positive sampled records. Data completeness and consistency rose to 100% with readily available records containing information on recent malaria treatment. Interview findings at the end of the survey showed that EDC was acceptable among users and they agreed that the tablets and the OpenDataKit were easy to use, improved productivity and quality of care.

Conclusions

Improvement of data quality and use in the Malawian rural facilities was achieved through the introduction of EDC using OpenDataKit. Health workers in the facilities showed satisfaction with the use of EDC.
Accuracy of conventional and novel scoring systems in predicting severity and outcomes of acute pancreatitis: a retrospective study
Authors: Wu Qing , Wang Jie , Qin Mengbin , Yang Huiying , Liang Zhihai , Tang Guodu
Published: April 2021

Background

Recently, several novel scoring systems have been developed to evaluate the severity and outcomes of acute pancreatitis. This study aimed to compare the effectiveness of novel and conventional scoring systems in predicting the severity and outcomes of acute pancreatitis.

Methods

Patients treated between January 2003 and August 2020 were reviewed. The Ranson score (RS), Glasgow score (GS), bedside index of severity in acute pancreatitis (BISAP), pancreatic activity scoring system (PASS), and Chinese simple scoring system (CSSS) were determined within 48 h after admission. Multivariate logistic regression was used for severity, mortality, and organ failure prediction. Optimum cutoffs were identified using receiver operating characteristic curve analysis.

Results

A total of 1848 patients were included. The areas under the curve (AUCs) of RS, GS, BISAP, PASS, and CSSS for severity prediction were 0.861, 0.865, 0.829, 0.778, and 0.816, respectively. The corresponding AUCs for mortality prediction were 0.693, 0.736, 0.789, 0.858, and 0.759. The corresponding AUCs for acute respiratory distress syndrome prediction were 0.745, 0.784, 0.834, 0.936, and 0.820. Finally, the corresponding AUCs for acute renal failure prediction were 0.707, 0.734, 0.781, 0.868, and 0.816.

Conclusions

RS and GS predicted severity better than they predicted mortality and organ failure, while PASS predicted mortality and organ failure better. BISAP and CSSS performed equally well in severity and outcome predictions.