bluuebunny/crossref_metadata_2025 huggingface dataset:
Kinship Care and Child Protection in High-Income Countries: A Scoping Review
Authors: Hallett Nutmeg , Garstang Joanna , Taylor Julie
Published: August 2021

Kinship care is a global phenomenon with a long history, which in high-income countries (HICs) at least, is being increasingly formalized through legislation and policy. There are many benefits to kinship care, including improved child mental health and well-being when compared to other types of out-of-home care. Despite this, kinship care is not without its risks with a lack of support and training for kinship carers putting children at an increased risk of abuse and neglect. This scoping review was conducted across 11 databases to explore the breadth and depth of the literature about abuse and neglect within kinship care in HICs and to provide initial indications about the relationship between kinship care and abuse. Of the 2,308 studies initially identified, 26 met the inclusion criteria. A majority of studies were from the United States, and most used case review methods. From the included studies, rates of re-abuse, and particularly rates of physical and sexual abuse, appear to be lower in kinship care settings when compared to other out-of-home care settings, but rates of neglect are often higher. This review has demonstrated that a small but significant number of children living in kinship care experience neglect or abuse.
Maternal History of Childhood Adversities and Later Negative Parenting: A Systematic Review
Authors: Lotto Camila Regina , Altafim Elisa Rachel Pisani , Linhares Maria Beatriz Martins
Published: August 2021

Adverse childhood experiences negatively impact future violence, victimization, perpetration, health, and lifelong development. The aim of the present study was to systematically review the scientific evidence of empirical studies on the association between maternal childhood adversity in a familial context, including maltreatment, household challenges, and later maternal negative parenting. A search was performed in the PubMed, PsycINFO, Web of Science, SciELO, and LILACS databases, using the combination of the following keywords: (neglect OR abuse OR maltreatment OR harsh parenting OR punishment OR discipline OR negative parenting practices) AND (adverse childhood experiences OR early adversity OR cycle of violence OR cycle of maltreatment OR history of maltreatment) AND (mother OR maternal). The results of 29 studies showed predominantly significant direct associations between maternal childhood adversities and negative parenting with their children (83%). Parental stress was also significantly associated with a maternal history of childhood adversities. Focusing on the type of maltreatment practices, there were similar intergenerational transmission types: homotypic and heterotypic. Few studies have examined the protective factors that could buffer the negative impact of a maternal childhood history of adversities on later negative parenting.
Mechanical performance of 3D woven jute/green epoxy composites with novel weaving patterns
Authors: Umair Muhammad , Hamdani Syed Talha Ali , Hussain Muzzamal , Nawab Yasir
Published: August 2021

Green composites have ecofriendly features that are technically and economically feasible while minimizing the pollution. It refers to the combination of degradable fibers mostly cellulosic materials and natural resins to develop green composites. Since mechanical performance of such structures is a concern for industry, by playing with the position and pattern of yarns in woven fabric, these properties can be optimized. This research focuses on the development and characterization of novel 3D woven jute/green epoxy composites having hybrid interlocking patterns. Four conventional derivatives of 3D woven fabrics i.e. orthogonal layer to layer (OLL), orthogonal through thickness (OTT), angle interlock layer to layer (ALL), angle interlock through thickness (ATT) and three novel 3D woven fabrics i.e. H1 (combination of OTT and ATT binder yarns), H2 (combination of OTT and ALL binder yarns), H3 (combination of orthogonal layer to layer warp and weft interlock called as bi-directional interlock) were developed using different binding patterns on dobby loom. Tensile, flexural, and short beam shear tests were performed to check the mechanical performance of the developed composites. OTT composite structure showed the highest values of tensile strength, modulus, and maximum force both in warp and weft directions as compared to the other 3D interlock structures, due to least interlacement/crimp of binder yarn. While ATT composite exhibited the highest value of flexural strength and modulus both in warp and weft directions due to through thickness angle binder yarns. H3 composite showed the highest values of force and short beam shear strength in warp direction.
Predictive values of sST2 and IL-33 for heart failure in patients with acute myocardial infarction
Authors: Xing Jingxian , Liu Junyan , Geng Tao
Published: August 2021

Timely prediction of the risk of heart failure in acute myocardial infarction patients is critical for better prognosis. This article aims to evaluate the predictive value of serum soluble growth stimulation expressed gene 2 (sST2) and interleukin-33 in patients with acute myocardial infarction complicated by heart failure. A total of 42 healthy controls and 144 acute myocardial infarction patients were recruited in the study. According to Killip cardiac function classification as the basis for concurrent heart failure, they were distributed into non-heart failure group ( n = 76) and heart failure group ( n = 68). ELISA was utilized to determine the serum sST2 and interleukin-33 levels, and the diagnostic efficiency was evaluated by receiver operating characteristics curve. sST2 and interleukin-33 levels in patients with acute myocardial infarction were significantly increased when compared with normal healthy controls, and were further enhanced in the heart failure group. With the increased Killip cardiac function classification, interleukin-33 and sST2 levels were gradually elevated. Multivariate analysis indicated that interleukin-33 and sST2 could be used as independent predictors for heart failure combined with acute myocardial infarction.
Telmisartan ameliorates cardiac fibrosis and diastolic function in cardiorenal heart failure with preserved ejection fraction
Authors: Chang Di , Xu Ting-Ting , Zhang Shi-Jun , Cai Yu , Min Shu-Dan , Zhao Zhen , Lu Chun-Qiang , Wang Yuan-Cheng , Ju Shenghong
Published: August 2021

Chronic kidney disease (CKD) is a major contributor to the development of heart failure with preserved ejection fraction (HFpEF), whereas the underlying mechanism of cardiorenal HFpEF is still elusive. The aim of this study was to investigate the role of cardiac fibrosis in a rat model of cardiorenal HFpEF and explore whether treatment with Telmisartan, an inhibitor of renin-angiotensin-aldosterone system (RAAS), can ameliorate cardiac fibrosis and preserve diastolic function in cardiorenal HFpEF. Male rats were subjected to 5/6 subtotal nephrectomy (SNX) or sham operation (Sham), and rats were allowed four weeks to recover and form a stable condition of CKD. Telmisartan or vehicle was then administered p.o. (8 mg/kg/d) for 12 weeks. Blood pressure, brain natriuretic peptide (BNP), echocardiography, and cardiac magnetic resonance imaging were acquired to evaluate cardiac structural and functional alterations. Histopathological staining, real-time polymerase chain reaction (PCR) and western blot were performed to evaluate cardiac remodeling. SNX rats showed an HFpEF phenotype with increased BNP, decreased early to late diastolic transmitral flow velocity (E/A) ratio, increased left ventricular (LV) hypertrophy and preserved ejection fraction (EF). Pathology revealed increased cardiac fibrosis in cardiorenal HFpEF rats compared with the Sham group, while chronic treatment with Telmisartan significantly decreased cardiac fibrosis, accompanied by reduced markers of fibrosis (collagen I and collagen III) and profibrotic cytokines (α-smooth muscle actin, transforming growth factor-β1, and connective tissue growth factor). In addition, myocardial inflammation was decreased after Telmisartan treatment, which was in a linear correlation with cardiac fibrosis. Telmisartan also reversed LV hypertrophy and E/A ratio, indicating that Telmisartan can improve LV remodeling and diastolic function in cardiorenal HFpEF. In conclusion, cardiac fibrosis is central to the pathology of cardiorenal HFpEF, and RAAS modulation with Telmisartan is capable of alleviating cardiac fibrosis and preserving diastolic dysfunction in this rat model.
Reflexive ethnography of Poland’s non-memory about Jews and the Holocaust: Revisiting fieldwork, revising assumptions
Authors: Kapralski Slawomir , Niedźwiedzki Dariusz , Nowak Jacek
Published: August 2021

The authors present their experience of revisiting the in-depth interviews collected in 1988–1993 in the context of new research on Poland’s memories of Jews and the Holocaust conducted by them in 2013–2017. The revisit, carried out in a radically different intellectual and socio-political context, helped the authors: (1) to change their focus from the past to the present in which the interviews were conducted and in which the respondents constructed their remembrance; (2) to understand memory as a contingent and contextual image of the past, functional in relation to the identity-management of the remembering subjects; (3) to discover the previously neglected importance of the non-discursive attitudes to the past, located between amnesia and remembrance, which the authors have called non-memory.
Are Black Restaurant Servers Tipped Less Than White Servers? Three Experimental Tests of Server Race Effects on Customers’ Tipping Behaviors
Authors: Brewster Zachary W. , Gourlay Kenneth , Nowak Gerald Roman
Published: August 2021

A limited number of published studies have presented evidence indicating that restaurant customers discriminate against Black servers by tipping them less than their White coworkers. However, the cross-sectional, localized, and small samples that were analyzed in these extant studies do not support any unqualified claim that consumer racial discrimination in tipping practices is a widespread phenomenon. Thus, in an effort to further clarify the relationship between restaurant servers’ race and customers’ tipping practices, we present results from three survey experiments designed to assess the causal effect of servers’ race on customers’ tipping intentions. In three independent, demographically diverse, and relatively large samples of U.S. consumers, we found no evidence to conclude that all else being equal consumers discriminate against Black restaurant servers by tipping them less than comparable White servers. Furthermore, the null effects of servers’ race on customers’ tipping practices were not found to be sensitive to variation in service quality, dining satisfaction, servers’ sex, customers’ sex, or customers’ race. Our results challenge the generalizability of the previously observed server race effects on customers’ tipping practices and point toward the need for future research that aims to advance our understanding of the conditions under which customers’ tipping practices are sensitive to the perceived race of their server. The implications of our results for restaurant operations and directions for future research are also discussed.
Trigeminal Neuralgia Associated With a Solitary Pontine Lesion: A Case Report
Authors: Plantone Domenico , Distaso Eugenio , D’Onghia Mariangela , Dell’Aquila Claudia , Giannini Antonio , Rinaldi Giuseppe
Published: August 2021

Trigeminal neuralgia associated with brainstem lesions is currently considered as a rare condition and only few patients have been reported so far in literature. Tohyama and colleagues recently proposed the nosological entity of trigeminal neuralgia associated with solitary pontine lesion, trying to categorize it as a new clinical syndrome on its own. Based on this description, trigeminal neuralgia associated with solitary pontine lesion patients have an identical clinical presentation compared to other patients with trigeminal neuralgia but have a solitary pontine lesion. The nature of the pontine lesion has been attributed to several etiologies, including ischemia, demyelination or previous pontine viral neuritis. In those patients with a putative demyelinating lesion, a definite diagnosis of multiple sclerosis cannot be made due to the lack of dissemination in space. Very little is known in relation to the cerebrospinal fluid characteristics of this population of patients.

We present a case of a 42-year-old man suffering of trigeminal neuralgia associated with solitary pontine lesion with a possible demyelinating etiology. The patient herein described had an atypical trigeminal neuralgia associated with a single pontine lesion. The MRI characteristics of the lesion, along with the presence of oligoclonal bands in the cerebrospinal fluid, suggested a demyelinating etiology. Trigeminal neuralgia associated with a solitary pontine lesion may be categorized as a possible manifestation of solitary sclerosis. Future research need to reveal which features can predict the risk of conversion to clinically defined multiple sclerosis and which treatments modify this risk.
A non-injected opioid analgesia protocol for acute pain crisis in adolescents and adults with sickle cell disease
Authors: Telfer Paul , Bestwick Jonathan , Elander James , Osias Arlene , Khalid Nosheen , Skene Imogen , Nzouakou Ruben , Challands Joanne , Barroso Filipa , Kaya Banu
Published: August 2021

Initial management of the acute pain crisis (APC) of sickle cell disease (SCD) is often unsatisfactory, and might be improved by developing a standardised analgesia protocol. Here, we report the first stages in developing a standard oral protocol for adolescents and adults. Initially, we performed a dose finding study to determine the maximal tolerated dose of sublingual fentanyl (MTD SLF) given on arrival in the acute care facility, when combined with repeated doses of oral oxycodone. We used a dose escalation algorithm with two dosing ranges based on patient’s weight (<50 kg or >50 kg). We also made a preliminary evaluation of the safety and efficacy of the protocol. The study took place in a large tertiary centre in London, UK. Ninety patients in the age range 14–60 years were pre-consented and 31 treatment episodes were evaluated. The first 21 episodes constituted the dose escalation study, establishing the MTD SLF at 600 mcg (>50 kg) or 400 mcg (<50 kg). Further evaluation of the protocol indicated no evidence of severe opioid toxicity, nor increased incidence of acute chest syndrome (ACS). Between 0 and 6 hours, the overall gradient of reduction of visual analogue pain score (visual analogue scale (VAS)) was 0.32 centimetres (cm) per hour (95% confidence interval (CI) = 0.20 to 0.44, p < 0.001). For episodes on MTD SLF, there was median (interquartile range (IQR)) reduction in VAS score of 2.8 cm (0–4.2) and 59% had at least a 2.6-cm reduction. These results are supportive of further evaluation of this protocol for acute analgesia of APC in a hospital setting and potentially for supervised home management.
From “Oh, you’re Chinese . . . ” to “No bats, thx!”: Racialized Experiences of Australian-Based Chinese Queer Women in the Mobile Dating Context
Authors: Li Haili , Chen Xu
Published: August 2021

This article explores racial exclusion, bias, and prejudice in the context of same-sex mobile dating, focusing on the experiences of a group of Australian-based Chinese queer women. Semi-structured in-depth interviews and participant observation were used to examine participants’ racialized experiences. The findings indicate that Western dating apps, such as Tinder, Bumble, and HER, served as crucial channels of these women’s interracial and intercultural encounters while living in Australia. However, they largely perceived these apps, and HER in particular, as White-dominated and ill-suited to their dating practices, thus reinforcing their sense of exclusion and ostracism. Although the participants frequently encountered subtle prejudice on dating apps, they experienced more blatant and aggressive forms of racism triggered by the COVID-19 outbreak. Multiple factors, including their language capability, the COVID-19 pandemic, and their racial, ethnic, and diasporic identities, played an intersectional role in these women’s racialized experiences. Correspondingly, the participants developed diverse interpretations of and responses to their racialized experiences. This study reveals how the anti-Asian racism in the global West permeates the realm of queer women in the context of mobile dating. It contributes to understanding the digital dating practices and racialized experiences of queer women and the broader Chinese diaspora.
Spine Surgeons Social Dilemma: Benefits and Risks of Social Media for Spine Surgery Practice in the 21st Century
Authors: Samtani Rahul G. , Webb Antonio , Burleson John , Berven Sigurd , Theologis Alekos , Abotsi Edem , Burch Shane , Deviren Vedat , Haddas Ram
Published: August 2021

Study Design:

Cross-sectional observational.

Background:

The use of social media by providers can enhance patient education, complement offline information, facilitate patient support, stimulate brand building, and strengthen the organization’s market position. Risks of social media include, but are not limited to, a lack of quality, reliability, misrepresentation of credentials, influence of hidden and overt conflicts of interest, content that may jeopardize patient privacy, HIPAA regulations, and physicians’ credentials and licensure. Physicians’ use of social media may also expose him/her to lawsuits if providing specific medical advice on media platforms.

Objective:

To document the social media presence of a broad cohort of spine surgeons, and to discuss the benefits and risks of a social media presence.

Methods:

Cross-sectional observational of 325 Spine Surgeons from 76 institutions across the US. Description statistic and Pearson’s correlation were used to investigate the relationships between the variables.

Results:

Out of the 325 surgeons, 96% were male with an average age of 51.5 ± 10.7 years and 14.1 ± 9.6 years of experience. The frequency of social media use included 57.2% of surgeons had professional LinkedIn, 17.8% had professional Facebook, and less than 16% had other social media platforms. When combining all platforms together, 64.6% of all surgeons had at least one professional social media platform. 64.0% of these surgeons had no social media activity in the past 90 days, while 19.4% and 10.9% were active once and twice a month, respectively. Surgeon age ( P = 0.004), years in practice ( P < 0.001), and practice type ( P < 0.001) were strongly correlated with social media activity.

Conclusions:

Given the scarcity of research on this topic and the novelty of the platforms, social media and online services continue to be utilized at a low level by spine surgeons. Issues regarding the risks of privacy issues with social media users continue to be a concern among medical professionals adopting this technology. This can largely be mitigated with the combination of physician education and informed consent from patients. The ability to connect with patients directly, and provide access to high-quality education and information will be of considerable benefit to our field well into the future.
Ankle instability – review and new trends
Authors: Machado Marino , Amado Paulo , Babulal Jaime
Published: August 2021

Ankle instability is an old topic with increasing importance in Orthopaedics’ world, as we start now realising how underdiagnosed this pathology has been. A lot of effort has been made in recent years to better understand the pathomechanics of this injury, with new surgical techniques being tried and even new anatomic structures being described. The objective of this paper is to review and compile the most important and recent literature on this matter, in an academic way, but oriented to clinical practice, so it can help surgeons keep updated in this so important subject.
Influence of ground motion duration on the dynamic deformation capacity of reinforced concrete frame structures
Authors: Bhanu Vishvendra , Chandramohan Reagan , Sullivan Timothy J
Published: August 2021

This study investigates the influence of ground motion duration on the dynamic deformation capacity of a suite of 10 modern reinforced concrete moment frame buildings. A robust numerical algorithm is proposed to estimate the dynamic deformation capacity of a structure by conducting incremental dynamic analysis. The geometric mean dynamic deformation capacity of the considered buildings was, on average, found to be 26% lower under long duration ground motions, compared to spectrally equivalent short duration ground motions. A consistent effect of duration on dynamic deformation capacity was observed over a broad range of structural periods considered in this study. Response spectral shape, however, was found to not significantly influence dynamic deformation capacity. These results indicate that the effect of duration could be explicitly considered in seismic design codes by modifying the deformation capacities of structures.
An exact solution for blade coating of a second-grade fluid on a porous substrate
Authors: Mughees M , Sajid M , Shahzad H , Sadiq MN , Ali N
Published: August 2021

This study explores the blade coating process with a simple fixed blade for a second-grade fluid over a moving porous substrate. The article investigates both plane and exponential blade coating. The analysis simplifies the governing equations via lubrication approximation theory by assuming that blade length is much larger than the coating layer thickness. Suitable scales normalize the governing equations. The expressions for pressure gradient and velocity are analytically obtained whereas pressure is attained using a so-called “shooting method” numerical technique. How the Reynolds number [Formula: see text], suction velocity [Formula: see text] and non-Newtonian second-grade parameter [Formula: see text] affect the velocity, pressure gradient, pressure, coating layer thickness and load on the blade are observed and displayed graphically and as tables. Interesting engineering quantities like velocity, pressure gradient and pressure are highlighted in graphical form whereas load and thickness are presented as tables. It is observed that the pressure gradient, pressure, velocity, load and thickness decrease as the parameters [Formula: see text] and [Formula: see text] and [Formula: see text] icrease for the cases of both plane and exponential coaters while all these physical quantities are observed to increase when the parameter [Formula: see text] increases. The most important physical quantity is the load for it is responsible in maintaining the coating quality and thickness. Moreover, it is perceived that the load decreases as the Reynolds number [Formula: see text] and [Formula: see text] increases get accelerated and it increases when parameter [Formula: see text] is increased.
Clonal hematopoiesis in patients receiving chimeric antigen receptor T-cell therapy
Authors: Miller Peter G. , Sperling Adam S. , Brea Elliott J. , Leick Mark B. , Fell Geoffrey G. , Jan Max , Gohil Satyen H. , Tai Yu-Tzu , Munshi Nikhil C. , Wu Catherine J. , Neuberg Donna S. , Maus Marcela V. , Jacobson Caron , Gibson Christopher J. , Ebert Benjamin L.
Published: August 2021

Chimeric antigen receptor (CAR) T-cells have emerged as an efficacious modality in patients with non-Hodgkin lymphoma (NHL) and multiple myeloma (MM). Clonal hematopoiesis of indeterminate potential (CHIP), a state in which mutations in hematopoietic cells give rise to a clonal population of cells, is more common in patients exposed to cytotoxic therapies, has been shown to influence inflammatory immune programs, and is associated with an adverse prognosis in patients with NHL and MM receiving autologous transplantation. We therefore hypothesized that CHIP could influence clinical outcomes in patients receiving CAR T-cell therapy. In a cohort of 154 patients with NHL or MM receiving CAR T-cells, we found that CHIP was present in 48% of patients and associated with increased rates of complete response and cytokine release syndrome severity, but only in patients younger than age 60 years. Despite these differences, CHIP was not associated with a difference in progression-free or overall survival, regardless of age. Our data suggest that CHIP can influence CAR T-cell biology and clinical outcomes, but, in contrast to autologous transplantation, CHIP was not associated with worse survival and should not be a reason to exclude individuals from receiving this potentially life-prolonging treatment.
Reverse complementary matches simultaneously promote both back-splicing and exon-skipping
Authors: Cao Dong
Published: August 2021

Background

Circular RNAs (circRNAs) play diverse roles in different biological and physiological environments and are always expressed in a tissue-specific manner. Especially, circRNAs are enriched in the brain tissues of almost all investigated species, including humans, mice, Drosophila, etc. Although circRNAs were found in C. elegans, the neuron-specific circRNA data is not available yet. Exon-skipping is found to be correlated to circRNA formation, but the mechanisms that link them together are not clear.

Results

Here, through large-scale neuron isolation from the first larval (L1) stage of C. elegans followed by RNA sequencing with ribosomal RNA depletion, the neuronal circRNA data in C. elegans were obtained. Hundreds of novel circRNAs were annotated with high accuracy. circRNAs were highly expressed in the neurons of C. elegans and were positively correlated to the levels of their cognate linear mRNAs. Disruption of reverse complementary match (RCM) sequences in circRNA flanking introns effectively abolished circRNA formation. In the zip-2 gene, deletion of either upstream or downstream RCMs almost eliminated the production of both the circular and the skipped transcript. Interestingly, the 13-nt RCM in zip-2 is highly conserved across five nematode ortholog genes, which show conserved exon-skipping patterns. Finally, through in vivo one-by-one mutagenesis of all the splicing sites and branch points required for exon-skipping and back-splicing in the zip-2 gene, I showed that back-splicing still happened without exon-skipping, and vice versa.

Conclusions

Through protocol optimization, total RNA obtained from sorted neurons is increased to hundreds of nanograms. circRNAs highly expressed in the neurons of C. elegans are more likely to be derived from genes also highly expressed in the neurons. RCMs are abundant in circRNA flanking introns, and RCM-deletion is an efficient way to knockout circRNAs. More importantly, these RCMs are not only required for back-splicing but also promote the skipping of exon(s) to be circularized. Finally, RCMs in circRNA flanking introns can directly promote both exon-skipping and back-splicing, providing a new explanation for the correlation between them.
Delayed reversibility of complete atrioventricular block: cardio-biliary reflex after alcohol septal ablation in a patient with hypertrophic obstructive cardiomyopathy
Authors: Fang Shu , Gao Lan , Yang Fan , Gong Yan-jun
Published: August 2021

Background

Complete atrioventricular block (AVB) is a life-threatening condition that usually occurs in elderly people with organic heart disease. We herein describe a rare case of complete AVB in a young man with hypertrophic obstructive cardiomyopathy (HOCM) complicated by cholecystitis and cholangitis. Both cardio-biliary reflex and alcohol septal ablation (ASA) can cause conduction block, but the latter is often irreversible. However, their simultaneous occurrence in a patient has not been reported.

Case presentation

A 31-year-old man presented with acute cholecystitis and cholangitis and complete AVB, which had been diagnosed at a local hospital on the third day after onset. On the fourth day, he was transferred to the emergency department of our hospital because of persistent complete AVB, although his abdominal pain had been partially relieved. An echocardiogram showed a remarkably elevated left ventricular outflow tract (LVOT) gradient (105.2 mmHg) despite the performance of ASA 9 years previously. The abdominal pain gradually disappeared, and normal sinus rhythm was completely recovered 11 days after onset. We determined that cardio-biliary reflex was the cause of the AVB because of the absence of other common causes. Finally, the patient underwent implantation of a permanent pacemaker to reduce the LVOT obstruction and avoid the risk of AVB recurrence.

Conclusions

Cholecystitis is a rare cause of complete AVB, which is a difficult differential diagnosis when complicated by HOCM after ASA. Clinicians should be alert to the possibility of cholecystitis in patients with abdominal pain and an unknown cause of bradycardia, complete AVB, or even sinus arrest.
Building on existing tools to improve chronic disease prevention and screening in public health: a cluster randomized trial
Authors: Lofters A. K. , O’Brien M. A. , Sutradhar R. , Pinto A. D. , Baxter N. N. , Donnelly P. , Elliott R. , Glazier R. H. , Huizinga J. , Kyle R. , Manca D. , Pietrusiak M. A. , Rabeneck L. , Riordan B. , Selby P. , Sivayoganathan K. , Snider C. , Sopcak N. , Thorpe K. , Tinmouth J. , Wall B. , Zuo F. , Grunfeld E. , Paszat L.
Published: August 2021

Background

The BETTER (Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care) intervention was designed to integrate the approach to chronic disease prevention and screening in primary care and demonstrated effective in a previous randomized trial.

Methods

We tested the effectiveness of the BETTER HEALTH intervention, a public health adaptation of BETTER, at improving participation in chronic disease prevention and screening actions for residents of low-income neighbourhoods in a cluster randomized trial, with ten low-income neighbourhoods in Durham Region Ontario randomized to immediate intervention vs. wait-list. The unit of analysis was the individual, and eligible participants were adults age 40–64 years residing in the neighbourhoods. Public health nurses trained as “prevention practitioners” held one prevention-focused visit with each participant. They provided participants with a tailored prevention prescription and supported them to set health-related goals. The primary outcome was a composite index: the number of evidence-based actions achieved at six months as a proportion of those for which participants were eligible at baseline.

Results

Of 126 participants (60 in immediate arm; 66 in wait-list arm), 125 were included in analyses (1 participant withdrew consent). In both arms, participants were eligible for a mean of 8.6 actions at baseline. At follow-up, participants in the immediate intervention arm met 64.5% of actions for which they were eligible versus 42.1% in the wait-list arm (rate ratio 1.53 [95% confidence interval 1.22–1.84]).

Conclusion

Public health nurses using the BETTER HEALTH intervention led to a higher proportion of identified evidence-based prevention and screening actions achieved at six months for people living with socioeconomic disadvantage.

Trial registration

NCT03052959, registered February 10, 2017.
Clinically contextualised ECG interpretation: the impact of prior clinical exposure and case vignettes on ECG diagnostic accuracy
Authors: Viljoen Charle André , Millar Rob Scott , Manning Kathryn , Hoevelmann Julian , Burch Vanessa Celeste
Published: August 2021

Background

ECGs are often taught without clinical context. However, in the clinical setting, ECGs are rarely interpreted without knowing the clinical presentation. We aimed to determine whether ECG diagnostic accuracy was influenced by knowledge of the clinical context and/or prior clinical exposure to the ECG diagnosis.

Methods

Fourth- (junior) and sixth-year (senior) medical students, as well as medical residents were invited to complete two multiple-choice question (MCQ) tests and a survey. Test 1 comprised 25 ECGs without case vignettes. Test 2, completed immediately thereafter, comprised the same 25 ECGs and MCQs, but with case vignettes for each ECG. Subsequently, participants indicated in the survey when last, during prior clinical clerkships, they have seen each of the 25 conditions tested. Eligible participants completed both tests and survey. We estimated that a minimum sample size of 165 participants would provide 80% power to detect a mean difference of 7% in test scores, considering a type 1 error of 5%.

Results

This study comprised 176 participants (67 [38.1%] junior students, 55 [31.3%] senior students, 54 [30.7%] residents). Prior ECG exposure depended on their level of training, i.e., junior students were exposed to 52% of the conditions tested, senior students 63.4% and residents 96.9%. Overall, there was a marginal improvement in ECG diagnostic accuracy when the clinical context was known (Cohen’s d = 0.35, p < 0.001). Gains in diagnostic accuracy were more pronounced amongst residents (Cohen’s d = 0.59, p < 0.001), than senior (Cohen’s d = 0.38, p < 0.001) or junior students (Cohen’s d = 0.29, p < 0.001). All participants were more likely to make a correct ECG diagnosis if they reported having seen the condition during prior clinical training, whether they were provided with a case vignette (odds ratio [OR] 1.46, 95% confidence interval [CI] 1.24–1.71) or not (OR 1.58, 95% CI 1.35–1.84).

Conclusion

ECG interpretation using clinical vignettes devoid of real patient experiences does not appear to have as great an impact on ECG diagnostic accuracy as prior clinical exposure. However, exposure to ECGs during clinical training is largely opportunistic and haphazard. ECG training should therefore not rely on experiential learning alone, but instead be supplemented by other formal methods of instruction.
The effects of traffic-related air pollutants on chronic obstructive pulmonary disease in the community-based general population
Authors: Hsu Hui-Tsung , Wu Chih-Da , Chung Mu-Chi , Shen Te-Chun , Lai Ting-Ju , Chen Chiu-Ying , Wang Ruey-Yun , Chung Chi-Jung
Published: August 2021

Background

Previous studies have shown inconsistent results regarding the impact of traffic pollution on the prevalence of chronic obstructive pulmonary disease (COPD). Therefore, using frequency matching and propensity scores, we explored the association between traffic pollution and COPD in a cohort of 8284 residents in a major agricultural county in Taiwan.

Methods

All subjects completed a structured questionnaire interview and health checkups. Subjects with COPD were identified using Taiwan National Health Insurance Research Databases. A hybrid kriging/LUR model was used to identify levels of traffic-related air pollutants (PM2.5 and O3). Multiple logistic regression models were used to calculate the prevalence ratios (PRs) of COPD and evaluate the role played by traffic-related indices between air pollutants and COPD. The distributed lag nonlinear model was applied in the analysis; we excluded current or ever smokers to perform the sensitivity analysis.

Results

Increased PRs of COPD per SD increment of PM2.5 were 1.10 (95% CI 1.05–1.15) and 1.25 (95% CI 1.13–1.40) in the population with age and sex matching as well as propensity-score matching, respectively. The results of the sensitivity analysis were similar between the single and two pollutant models. PM2.5 concentrations were significantly associated with traffic flow including sedans, buses, and trucks (p < 0.01). The higher road area and the higher PM2.5 concentrations near the subject’s residence correlated with a greater risk of developing COPD (p for interaction < 0.01).

Conclusions

Our results suggest that long-term exposure to traffic-related air pollution may be positively associated with the prevalence of COPD.

Graphical abstract
Inequalities in life expectancy in Australia according to education level: a whole-of-population record linkage study
Authors: Welsh J , Bishop K , Booth H , Butler D , Gourley M , Law HD , Banks E , Canudas-Romo V , Korda RJ
Published: August 2021

Background

Life expectancy in Australia is amongst the highest globally, but national estimates mask within-country inequalities. To monitor socioeconomic inequalities in health, many high-income countries routinely report life expectancy by education level. However in Australia, education-related gaps in life expectancy are not routinely reported because, until recently, the data required to produce these estimates have not been available. Using newly linked, whole-of-population data, we estimated education-related inequalities in adult life expectancy in Australia.

Methods

Using data from 2016 Australian Census linked to 2016-17 Death Registrations, we estimated age-sex-education-specific mortality rates and used standard life table methodology to calculate life expectancy. For men and women separately, we estimated absolute (in years) and relative (ratios) differences in life expectancy at ages 25, 45, 65 and 85 years according to education level (measured in five categories, from university qualification [highest] to no formal qualifications [lowest]).

Results

Data came from 14,565,910 Australian residents aged 25 years and older. At each age, those with lower levels of education had lower life expectancies. For men, the gap (highest vs. lowest level of education) was 9.1 (95 %CI: 8.8, 9.4) years at age 25, 7.3 (7.1, 7.5) years at age 45, 4.9 (4.7, 5.1) years at age 65 and 1.9 (1.8, 2.1) years at age 85. For women, the gap was 5.5 (5.1, 5.9) years at age 25, 4.7 (4.4, 5.0) years at age 45, 3.3 (3.1, 3.5) years at 65 and 1.6 (1.4, 1.8) years at age 85. Relative differences (comparing highest education level with each of the other levels) were larger for men than women and increased with age, but overall, revealed a 10–25 % reduction in life expectancy for those with the lowest compared to the highest education level.

Conclusions

Education-related inequalities in life expectancy from age 25 years in Australia are substantial, particularly for men. Those with the lowest education level have a life expectancy equivalent to the national average 15–20 years ago. These vast gaps indicate large potential for further gains in life expectancy at the national level and continuing opportunities to improve health equity.
Decreased angiotensin receptor 1 expression in ± AT1 Knockout mice testis results in male infertility and GnRH reduction
Authors: Zhao Fangfang , Zou Yun , Li Hui , Zhang Yaheng , Liu Xuele , Zhao Xuehao , Wu Xinyi , Fei Wenyi , Xu Ziling , Yang Xuejun
Published: August 2021

Background

This study aimed to detect the effect of angiotensin receptor 1 (AT1) knock out (KO) on spermatogenesis and hypothalamic-pituitary–gonadal (HPG) axis hormone expression.

Methods

Normal C57BL/6 male mice were used as control group or treated with angiotensin receptor blocker, in addition heterozygous ± AT1KO mice were generated. After caged at a ratio of 2 to 1 with females, pregnancy rates of female mice were determined by detection of vaginal plugs. Deformity rate of spermatozoa was evaluated by eosin staining and morphology evaluation. The AT1 mRNA expression in the testes of male ± AT1KO mice was detected by quantitative real-time polymerase chain reaction (QRT-PCR). Serum GnRH level was determined by ELISA.

Results

Compared to control, ± AT1KO mice showed reduced expression of AT1 in testes, pituitary and hypothalamus. In addition, decreased level of GnRH, but not follicle stimulating hormone (FSH) or luteinizing hormone (LH), in ± AT1KO mice was detected. Treatment with angiotensin receptor blocker (ARB) did not have significant effects on HPG hormones. ± AT1KO mice exhibited male infertility and significant abnormality of sperm morphology.

Conclusion

Reduced AT1 knockout resulted in male infertility, potentially by inducing abnormal spermatogenesis. Both testis and HPG axis signaling may be involved.
Implementation science issues in understanding, collecting, and using cost estimates: a multi-stakeholder perspective
Authors: Eisman Andria B. , Quanbeck Andrew , Bounthavong Mark , Panattoni Laura , Glasgow Russell E.
Published: August 2021

Understanding the resources needed to achieve desired implementation and effectiveness outcomes is essential to implementing and sustaining evidence-based practices (EBPs). Despite this frequent observation, cost and economic measurement and reporting are rare, but becoming more frequent in implementation science, and when present is seldom reported from the perspective of multiple stakeholders (e.g., the organization, supervisory team), including those who will ultimately implement and sustain EBPs.

Incorporating a multi-level framework is useful for understanding and integrating the perspectives and priorities of the diverse set of stakeholders involved in implementation. Stakeholders across levels, from patients to delivery staff to health systems, experience different economic impacts (costs, benefit, and value) related to EBP implementation and have different perspectives on these issues. Economic theory can aid in understanding multi-level perspectives and approaches to addressing potential conflict across perspectives.

This paper provides examples of key cost components especially important to different types of stakeholders. It provides specific guidance and recommendations for cost assessment activities that address the concerns of various stakeholder groups, identifies areas of agreement and conflict in priorities, and outlines theoretically informed approaches to understanding conflicts among stakeholder groups and processes to address them. Involving stakeholders throughout the implementation process and presenting economic information in ways that are clear and meaningful to different stakeholder groups can aid in maximizing benefits within the context of limited resources. We posit that such approaches are vital to advancing economic evaluation in implementation science. Finally, we identify directions for future research and application.

Considering a range of stakeholders is critical to informing economic evaluation that will support appropriate decisions about resource allocation across contexts to inform decisions about successful adoption, implementation, and sustainment. Not all perspectives need to be addressed in a given project but identifying and understanding perspectives of multiple groups of key stakeholders including patients and direct implementation staff not often explicitly considered in traditional economic evaluation are needed in implementation research.
Traditional Chinese Medicine in nonalcoholic fatty liver disease: molecular insights and therapeutic perspectives
Authors: Dai Xianmin , Feng Jiayi , Chen Yi , Huang Si , Shi Xiaofei , Liu Xia , Sun Yang
Published: August 2021

Nonalcoholic fatty liver disease (NAFLD) has become the world's largest chronic liver disease, while there is still no specific drug to treat NAFLD. Traditional Chinese Medicine (TCM) have been widely used in hepatic diseases for centuries in Asia, and TCM’s holistic concept and differentiation treatment of NAFLD show their advantages in the treatment of this complex metabolic disease. However, the multi-compounds and multi-targets are big obstacle for the study of TCM. Here, we summarize the pharmacological actions of active ingredients from frequently used single herbs in TCM compounds. The combined mechanism of herbs in TCM compounds are further discussed to explore their comprehensive effects on NAFLD. This article aims to summarize multiple functions and find the common ground for TCM treatment on NAFLD, thus providing enrichment to the scientific connotation of TCM theories and promotes the exploration of TCM therapies on NAFLD.
Five-year overall survival following chemoradiation therapy for locally advanced cervical carcinoma in women living with and without HIV infection in Botswana
Authors: MacDuffie Emily , Bvochora-Nsingo Memory , Chiyapo Sebathu , Balang Dawn , Chambers Allison , George Jessica M. , Tuli Shawna , Lin Lilie L. , Zetola Nicola M. , Ramogola-Masire Doreen , Grover Surbhi
Published: August 2021

Purpose

To compare updated prospective 5-year survival outcomes of cervical cancer patients living with and without human immunodeficiency virus (HIV) infection who initiated curative chemoradiation therapy (CRT) in a resource-limited setting.

Methods & Materials

Women in Botswana with locally advanced cervical cancer were enrolled in a prospective, observational, cohort study from July 2013 through January 2015. Survival outcomes were analyzed after 5 years of follow-up.

Results

This cohort included 143 women initiating curative CRT. Sixty-seven percent (n = 96) of cohort were women living with HIV (WLWH), all of whom were receiving antiretroviral therapy (ART) at the time of treatment initiation and boasted a median CD4 count of 481 cells/μL (IQR, 351-579 μL). The 5-year overall survival (OS) rates were 56.8% (95% CI, 40.0–70.5%) for patients without HIV infection and 55.1% (95% CI, 44.2–64.7%) for WLWH (p = 0.732). Factors associated with superior 5-year OS on multivariate analyses included baseline hemoglobin > 10 g/dL (hazard ratio (HR) 0.90, 95% CI, 0.83–0.98, p = 0.015), lower stage at diagnosis (stage I and II vs. III and IV) (HR 1.39, 95% CI 1.09–1.76, p = 0.007), and higher EQD2 (HR 0.98, 95% CI 0.97–0.99, p = 0.001).

Conclusions

Five-year OS was not impacted by HIV status in this population of WLWH with well-managed infection who initiated curative treatment for cervical cancer in Botswana. Regardless of HIV status, hemoglobin levels and stage at diagnosis were associated with survival. These findings suggest that treatment for cervical cancer in WLWH with well-controlled infection need not be altered solely due to HIV status.
The role of MMP-14 in ovarian cancer: a systematic review
Authors: Vos M. Caroline , van der Wurff Anneke A. M. , van Kuppevelt Toin H. , Massuger Leon F. A. G.
Published: August 2021

Aim

In order to evaluate the role of MMP-14 in ovarian cancer, a systematic review was conducted.

Methods

In March 2020, a search in Pubmed was performed with MMP-14 and ovarian cancer as search terms. After exclusion of the references not on MMP-14 or ovarian cancer or not in English, the studies found were classified into two categories: basic research and clinicopathological research.

Results

In total, 94 references were found of which 33 were excluded. Two additional articles were found in the reference lists of the included studies. Based on the full texts, another 4 were excluded. Eventually, 59 studies were included in the review, 32 on basic research and 19 on clinicopathological research. 8 studies fell in both categories. The basic research studies show that MMP-14 plays an important role in ovarian cancer in the processes of proliferation, invasion, angiogenesis and metastasis. In clinocopathological research, MMP-14 expression is found in most tumours with characteristics of poor prognosis but this immunohistochemical MMP-14 determination does not seem to be an independent predictor of prognosis.

Conclusions

From this systematic review of the literature concerning MMP-14 in ovarian cancer it becomes clear that MMP-14 plays various important roles in the pathophysiology of ovarian cancer. The exact translation of these roles in the pathophysiology to the importance of MMP-14 in clinicopathological research in ovarian cancer and possible therapeutic role of anti-MMP-14 agents needs further elucidation.