bluuebunny/crossref_metadata_2025 huggingface dataset:
The Significance of Evaluating the Femoral Head Blood Supply after Femoral Neck Fracture: A New Classification for Femoral Neck Fractures
Authors: Zhao Dewei , Wang Zihua , Cheng Liangliang , Tian Simiao , Liu Baoyi , Yang Lei , Ma Zhijie
Published: March 2022

Objective

To compare a new classification with the Garden classification by exploring their relationships with vascular injury.

Methods

This retrospective study enrolled 73 patients with subcapital femoral neck fracture from July 2015 to November 2018, including 32 males and 41 females with an average age of 47.2 years. All patients were classified by the Garden classification using anteroposterior X‐ray imaging and by a new classification system based on three‐dimensional CT imaging. The blood supply of the affected femoral head in these patients was evaluated based on DSA images. Correlations between the two classifications and the degree of vascular injury were assessed.

Results

The results of the DSA examination indicated that eight patients had no retinacular vessel injury, 20 patients had one retinacular vessel injury, 35 patients had two retinacular vessel injuries, and 10 patients had three retinacular vessel injuries. The degree of vascular injury was used to match the two fracture classifications. Forty‐nine Garden classifications (Type I‐IV: 8, 12, 23, 6, respectively, 67.12%) and 66 new classifications (Type I‐IV: 8, 20, 32, 6, respectively, 90.41%) corresponded to the degree of vascular injury (p < 0.05). The Garden classification showed moderate reliability, and the new classification showed near perfect agreement (Interobserver agreement of k = 0.564 [0.01] in Garden classification vs. Garden classification k = 0.902 [0.01] for the five observers).

Conclusions

The new classification system can accurately describe the degree of fracture displacement and judge the extent of vascular injury.
A “Plus” Model for Safe Transitions to Adulthood: Impacts of an Integrated Intervention Layered onto A National Social Protection Program on Sexual Behavior and Health Seeking among Tanzania's Youth
Authors: Waidler Jennifer , Gilbert Ulrike , Mulokozi Aroldia , Palermo Tia
Published: March 2022

Poverty is a structural driver of risky sexual behaviors. While cash transfers can mitigate some of this risk, complementary interventions have been posited as a way to further reduce multidimensional vulnerability. We examine the impacts of a multicomponent intervention targeted to Tanzanian adolescents on their sexual behaviors and reproductive health. The intervention comprised livelihood and life skills training, mentoring, and health facilities’ strengthening. Data come from a cluster randomized controlled trial, where one study arm received the intervention and the other was randomized to control, but both arms participated in a government cash transfer program. Among 1,933 adolescents interviewed over three rounds, we found increases in contraceptive and HIV knowledge. The program also increased health seeking and HIV testing among boys, but slightly reduced age at sexual debut among girls. There were no impacts on contraceptive use, number of sexual partners, or pregnancy. Findings support the value of an adolescent intervention, and the fact that it was delivered within a social protection platform suggests a potential for scalability. Additional efforts are required to delay sexual debut and reduce the number of sexual partners and pregnancy, possibly through addressing supply‐side barriers and social norms, or through additional linkages to economic opportunities.
Signatures of plant defense response specificity mediated by herbivore‐associated molecular patterns in legumes
Authors: Steinbrenner Adam D. , Saldivar Evan , Hodges Nile , Guayazán‐Palacios Natalia , Chaparro Antonio F. , Schmelz Eric A.
Published: March 2022

Chewing herbivores activate plant defense responses through a combination of mechanical wounding and elicitation by herbivore‐associated molecular patterns (HAMPs). HAMPs are wound response amplifiers; however, specific defense outputs may also exist that strictly require HAMP‐mediated defense signaling. To investigate HAMP‐mediated signaling and defense responses, we characterized cowpea (Vigna unguiculata) transcriptome changes following elicitation by inceptin, a peptide HAMP common in Lepidoptera larvae oral secretions. Following inceptin treatment, we observed large‐scale reprogramming of the transcriptome consistent with three different response categories: (i) amplification of mechanical wound responses, (ii) temporal extension through accelerated or prolonged responses, and (iii) examples of inceptin‐specific elicitation and suppression. At both early and late timepoints, namely 1 and 6 h, large sets of transcripts specifically accumulated following inceptin elicitation. Further early inceptin‐regulated transcripts were classified as reversing changes induced by wounding alone. Within key signaling‐ and defense‐related gene families, inceptin‐elicited responses included target subsets of wound‐induced transcripts. Transcripts displaying the largest inceptin‐elicited fold changes included transcripts encoding terpene synthases (TPSs) and peroxidases (POXs) that correspond with induced volatile production and increased POX activity in cowpea. Characterization of inceptin‐elicited cowpea defenses via heterologous expression in Nicotiana benthamiana demonstrated that specific cowpea TPSs and POXs were able to confer terpene emission and the reduced growth of beet armyworm (Spodoptera exigua) herbivores, respectively. Collectively, our present findings in cowpea support a model where HAMP elicitation both amplifies concurrent wound responses and specifically contributes to the activation of selective outputs associated with direct and indirect antiherbivore defenses.
In silico analysis of cis‐elements and identification of transcription factors putatively involved in the regulation of the OAS cluster genes SDI1 and SDI2
Authors: Rakpenthai Apidet , Apodiakou Anastasia , Whitcomb Sarah J. , Hoefgen Rainer
Published: March 2022

Arabidopsis thaliana sulfur deficiency‐induced 1 and sulfur deficiency‐induced 2 (SDI1 and SDI2) are involved in partitioning sulfur among metabolite pools during sulfur deficiency, and their transcript levels strongly increase in this condition. However, little is currently known about the cis‐ and trans‐factors that regulate SDI expression. We aimed at identifying DNA sequence elements (cis‐elements) and transcription factors (TFs) involved in regulating expression of the SDI genes. We performed in silico analysis of their promoter sequences cataloging known cis‐elements and identifying conserved sequence motifs. We screened by yeast‐one‐hybrid an arrayed library of Arabidopsis TFs for binding to the SDI1 and SDI2 promoters. In total, 14 candidate TFs were identified. Direct association between particular cis‐elements in the proximal SDI promoter regions and specific TFs was established via electrophoretic mobility shift assays: sulfur limitation 1 (SLIM1) was shown to bind SURE cis‐element(s), the basic domain/leucine zipper (bZIP) core cis‐element was shown to be important for HY5‐homolog (HYH) binding, and G‐box binding factor 1 (GBF1) was shown to bind the E box. Functional analysis of GBF1 and HYH using mutant and over‐expressing lines indicated that these TFs promote a higher transcript level of SDI1 in vivo. Additionally, we performed a meta‐analysis of expression changes of the 14 TF candidates in a variety of conditions that alter SDI expression. The presented results expand our understanding of sulfur pool regulation by SDI genes.
Developing a translational murine‐to‐canine pathway for anIL‐2/agonistanti‐CD40antibody cancer immunotherapy
Authors: Proksch Stephen Francis , Matthysen Clinton Petrus , Jardine John E. , Wyatt Ken Mark , Finlay Jessica Renee , Nelson Delia Jane
Published: March 2022

Human and canine sarcomas are difficult to treat soft tissue malignancies with an urgent need for new improved therapeutic options. Local recurrence rates for humans are between 10%–30%, and 30%–40% develop metastases. Outcomes for dogs with sarcoma vary with grade but can be similar. Pet dogs share the human environment and represent human cancer with genetic variation in hosts and tumours. We asked if our murine studies using genetically identical mice and cloned tumour cells were translatable to larger, genetically diverse domestic dogs with naturally occurring tumours, to (i) develop a canine cancer therapeutic, and (ii) to use as a translational pathway to humans. Our murine studies showed that intra‐tumoral delivery of interleukin‐2 (IL‐2) plus an agonist anti‐CD40 antibody (Ab) induces long‐term curative responses ranging from 30% to 100%, depending on tumour type. We developed an agonist anti‐canine‐CD40 Ab and conducted a phase I dose finding/toxicology 3 + 3 clinical trial in dogs (n = 27) with soft tissue sarcomas on account of suitability for intratumoral injection and straightforward monitoring. Dogs were treated with IL‐2 plus anti‐CD40 antibody for 2 weeks. Three dose levels induced tumour regression with minimal side effects, measured by monitoring, haematological and biochemical assays. Importantly, our mouse and canine studies provide encouraging fundamental proof‐of‐concept data upon which we can develop veterinary and human immunotherapeutic strategies.
Direito ao Desenvolvimento no Estado Neoliberal: a Renda Básica Universal e Incondicional Como Alternativa à Redução da Desigualdade Social no Brasil
Authors: Cavalcante Koury Suzy Elizabeth , Neirão Reymão Ana Elizabeth , Guimarães de Oliveira Felipe
Published: March 2022

: O artigo objetiva discutir a importância da renda básica universal e incondicional como uma política pública alternativa à redução das desigualdades sociais no Brasil e, por conseguinte, para a efetivação do direito ao desenvolvimento. Argumenta-se que a ordem social institucionalizada pelo neoliberalismo e seu modelo do homem empreendedor de si mesmo, competitivo, resulta em uma individualização radical e pouco contribui para o cumprimento dos Objetivos de Desenvolvimento Sustentável, promovendo diferentes formas de desigualdades econômica e social que violam os valores de igualdade e justiça. A partir de uma abordagem qualitativa, consultando fontes bibliográficas e documentais, esse estudo exploratório conclui que a renda básica universal e incondicional deve ser um direito de todos, não importando a condição socioeconômica da pessoa. Trata-se de um valor monetário que deve ser suficiente para atender suas despesas mínimas com alimentação, educação e saúde de cada pessoa. Assim, a materialização fática da Lei nº 10.835/2004, que institui a renda básica da cidadania, é essencial para refundar O Estado Social no Brasil.
El centro de parto normal en la red de atención de salud materno infantil brasileña
Authors: Belarmino Adriano da Costa , Soares Oliveira Vitória Lúcia , E Santiago Sâmela Abreu , Ferreira Júnior Antonio Rodrigues
Published: March 2022

Introdução. A implantação de centros de parto normal (CPN) é um instrumento da rede de saúde que estimula o protagonismo e a autonomia feminina, bem como a aplicação das boas práticas baseadas em evidências. Objetivo. Compreender o papel do CPN na rede de atenção à saúde materno-infantil do Brasil. Método. Estudo com abordagem qualitativa do tipo exploratório descritivo realizado em CPN no Ceará, com seis enfermeiras, em 2018. A coleta de dados ocorreu por meio de entrevistas individuais em profundidade. Utilizou-se a análise temática para a organização dos resultados, com discussão baseada na teoria da racionalidade limitada. Resultados. A articulação dos CPN com unidades de atenção primária através de visitas guiadas e hospitais de nível terciário para transferências em situações críticas é um elemento importante da rede de saúde, tendo o enfermeiro obstetra como articulador; no entanto, evidencia-se que há desafios a serem superados seja nas tomadas de decisões, seja nas relações profissionais intraequipe de saúde, seja na dinâmica dos fluxos de atendimento. Conclusões: Incertezas na tomada de decisão relacionadas a aspectos individuais constituem limitações para o desenvolvimento das boas práticas, para a qualidade dos cuidados e para o protagonismo da mulher, o que também limita o CPN na rede de saúde obstétrica para atingir seu potencial total, diminuir peregrinações da mulher e índices de mortalidade materno-infantil.
Implementación de precios de venta al público de referencia para optimizar el gasto en medicamentos en una obra social provincial argentina
Authors: Schlottke Jorge Anibal , Lifschitz Esteban , Alvarez-Risco Aldo
Published: March 2022

Introducción. Los medicamentos constituyen uno de los mayores determinantes de los costos en salud, por lo que su adecuada gestión representa un desafío para los financiadores a fin de garantizar su acceso equitativo y la sostenibilidad financiera del sistema en su conjunto. Objetivo. Analizar la situación de una obra social provincial en la cual los medicamentos representan el 35,14% del gasto asistencial. Métodos. Se utilizan los precios de venta al público de referencia como herramienta de optimización. Estos definen una cuantía máxima de financiamiento siguiendo un criterio de equivalencia química cualitativa y cuantitativa y con idénticas forma farmacéutica, dosis, vía de administración y presentación, sin restringir la lista de medicamentos disponibles ni al médico y ni al paciente. Resultados. Uno de los principales determinantes del precio de los medicamentos está dado por su variabilidad según la marca comercial. Al establecer un precio de venta al público de referencia se demostró que el 88,07% de las dispensas se encuentran por encima del mismo. Si se hubiera aplicado este precio de venta, el ahorro habría sido de USD$ 795 279,78 en el periodo estudiado. Este ahorro podría haberse utilizado para estrategias de cobertura prioritarias como las enfermedades cardiovasculares o el asma. Conclusiones. La optimización del gasto en medicamentos permite no solo reducir el gasto per se sino también disminuir el gasto de bolsillo de los afiliados. Esto permitiría mejorar la adherencia a los tratamientos y el control de las enfermedades, formando un círculo virtuoso que redunda en mejores resultados de salud para la población beneficiaria.
Programa intercultural de promotores de salud comunitaria: sistematización de experiencia en el municipio indígena de Jambaló, Colombia
Authors: Penagos Yerson , Arrivillaga Marcela
Published: March 2022

Objetivo. Reconstruir la experiencia del programa de Promotores de Salud Comunitaria Indígenas (PSC-I) en el municipio y resguardo indígena de Jambaló, Colombia. Métodos. Se realizó un análisis cualitativo de sistematización de experiencias con enfoque fenomenológico. Igualmente, se realizaron cinco entrevistas a miembros de PSC-I (dos coordinadores del programa y tres líderes comunitarios), además de una revisión documental. Resultados. Los resultados muestran que el programa de PSC-I se ha consolidado desde el año 1978 en el marco del proceso político del movimiento social indígena. Los PSC-I se han configurado como sujetos colectivos en defensa del derecho a la salud, y como un recurso humano necesario para la operación del modelo de salud indígena en el territorio. Estos PSC-I cuentan con capacidades para la atención primaria con enfoque intercultural, desarrollan actividades de fortalecimiento de los programas de salud, vigilancia de enfermedades prevalentes, recuperación de prácticas culturales y movilización social para la gestión de determinantes sociales de la salud. Conclusiones. Los PSC-I juegan un papel clave en la mejora del acceso, la aceptabilidad y la calidad de la atención en salud. Igualmente, los PSC-I promueven una verdadera interculturalidad en la salud, con la participación de la comunidad y de las instituciones, y reconociendo la medicina tradicional indígena. Objetivo. Reconstruir la experiencia del programa de Promotores de Salud Comunitaria Indígenas (PSC-I) en el municipio y resguardo indígena de Jambaló, Colombia. Métodos. Se realizó un análisis cualitativo de sistematización de experiencias con enfoque fenomenológico. Igualmente, se realizaron cinco entrevistas a miembros de PSC-I (dos coordinadores del programa y tres líderes comunitarios), además de una revisión documental. Resultados. Los resultados muestran que el programa de PSC-I se ha consolidado desde el año 1978 en el marco del proceso político del movimiento social indígena. Los PSC-I se han configurado como sujetos colectivos en defensa del derecho a la salud, y como un recurso humano necesario para la operación del modelo de salud indígena en el territorio. Estos PSC-I cuentan con capacidades para la atención primaria con enfoque intercultural, desarrollan actividades de fortalecimiento de los programas de salud, vigilancia de enfermedades prevalentes, recuperación de prácticas culturales y movilización social para la gestión de determinantes sociales de la salud. Conclusiones. Los PSC-I juegan un papel clave en la mejora del acceso, la aceptabilidad y la calidad de la atención en salud. Igualmente, los PSC-I promueven una verdadera interculturalidad en la salud, con la participación de la comunidad y de las instituciones, y reconociendo la medicina tradicional indígena.
On a quantum Weyl curvature hypothesis
Authors: Kiefer Claus
Published: March 2022

Roger Penrose's Weyl curvature hypothesis states that the Weyl curvature is small at past singularities, but not at future singularities. We review the motivations for this conjecture and present estimates for the entropy of our Universe. We then extend this hypothesis to the quantum regime by demanding that the initial state of primordial quantum fluctuations be the adiabatic vacuum in a (quasi-)de Sitter space. We finally attempt a justification of this quantum version from a fundamental theory of quantum gravity and speculate on its consequences in the case of a classically recollapsing universe.
High-Intensity Interval Exercise Performance in Judo Athletes: Physiological, Perceptual, and Pacing Responses
Authors: Kons Rafael L. , Detanico Daniele
Published: March 2022

This study aimed to verify the behavior of physiological, perceptual, and performance responses during a high-intensity exercise in judo athletes and to identify if this protocol is able to discriminate athletes from different levels (national vs. state). Forty-five male judo athletes participated and were divided into two groups: state (age 24.2 ± 3.7 years) and national (22.1 ± 3.3 years). Judo athletes performed a judo-specific protocol contained high-intensity intermittent exercise consisted of 12 sets of 20 s in all-out intensity. During the protocol, the repetitions and heart rate were assessed over the sets, and at the end of the protocol, the rate of perceived exertion was measured. The results showed that the national group presented higher repetitions (29 ± 4 repetitions) during the high-intensity intermittent exercise compared with state (22 ± 2 repetitions). However, the national group showed a progressive decrease of repetitions up to the middle of the protocol, which coincided with higher values of heart rate compared with state (first and second sets). There was a decrease of repetitions from the first set (p < .001) and similar values of heart rate from the third set in the state. In conclusion, the performance (in repetitions) during the high-intensity intermittent exercise was able to discriminate athletes from different competitive levels. National athletes presented better performance, but worse pacing strategy compared with state.
Genomic Characteristics of Recently Recognized Vibrio cholerae El Tor Lineages Associated with Cholera in Bangladesh, 1991 to 2017
Authors: Monir Md Mamun , Hossain Talal , Morita Masatomo , Ohnishi Makoto , Johura Fatema-Tuz , Sultana Marzia , Monira Shirajum , Ahmed Tahmeed , Thomson Nicholas , Watanabe Haruo , Huq Anwar , Colwell Rita R. , Seed Kimberley , Alam Munirul
Published: March 2022

Cholera is a global disease with specific reference to the Bay of Bengal Ganges Delta where
Vibrio cholerae
O1 El Tor, the causative agent of the disease showed two circulating lineages, one dominant in Bangladesh and the other in India. Results of an in-depth genomic study of
V. cholerae
associated with endemic cholera during the past 27 years (1991 to 2017) indicate emergence and succession of the two lineages, BD-1 and BD-2, arising from a common ancestral paraphyletic group, BD-0, comprising the early strains and short-term evolution of the bacterium in Bangladesh.
Transcriptional Regulation and Functional Characterization of the Plasmid-Borne
oqxAB
Genes in
Salmonella
Typhimurium
Authors: Chan Bill Kwan-wai , Wong Marcus Ho-yin , Chan Edward Wai-chi , Chen Sheng
Published: March 2022

The transferable mechanisms of quinolone resistance (TMQR) gene,
oqxAB
, has been widely detected in
Salmonella
and is commonly associated with
aac(6′)-Ib-cr
. It is thought to be associated with fluoroquinolone resistance, while its ancestor gene from
K. pneumoniae
is not. This study evaluated the actual role of the plasmid-borne
oqxAB
genes in
Salmonella
and showed that it was not able to mediate intermediated resistance to fluoroquinolone and only did so when it coexisted with
aac(6′)-Ib-cr
.
Synergistic Activity of Imipenem in Combination with Ceftazidime/Avibactam or Avibactam against Non-MBL-Producing Extensively Drug-Resistant Pseudomonas aeruginosa
Authors: Zhang Yulin , Zhao Jiankang , Han Jiajing , Fan Yanyan , Xiong Zhujia , Zou Xiaohui , Li Binbin , Liu Xinmeng , Li Ziyao , Lu Binghuai , Cao Bin
Published: March 2022

Handling the infections by extensively drug-resistant
Pseudomonas aeruginosa
(XDRPA) strains is challenging due to their complicated antibiotic resistance mechanisms in immunosuppressed patients with pulmonary diseases (e.g., cystic fibrosis, chronic obstructive pulmonary disease, and lung transplant), ventilator-associated pneumonia, and bloodstream infections. The current study suggested the potentiality of the ceftazidime-avibactam-imipenem combination against XDRPA with
bla
AmpC
overexpression or mutation, decreased OprD porin, and/or upregulated efflux pumps.
Does the Earth have a pulse? Evidence relating to a potential underlying ~26–36-million-year rhythm in interrelated geologic, biologic, and astrophysical events
Authors: Rampino* Michael R.
Published: March 2022

The existence of an ~26–36 m.y. rhythm in interrelated global tectonism, sea-level oscillations, climate, and resulting sedimentation patterns during Phanerozoic time (the last 541 m.y.) has long been suspected. A similar underlying ~26.4–27.5 m.y. cycle was reported independently in episodes of extinctions of marine and non-marine species. Subsequent spectral analyses of individual geologic events of the last 260 m.y., including changes in seafloor spreading and subduction, times of hotspot initiation and intraplate volcanism, eruptions of Large Igneous Provinces (LIPs), tectonic events, sea-level fluctuations, oceanic anoxia, atmospheric carbon dioxide levels, and global climate have revealed evidence for the 26–36 m.y. cycle and the temporal association of events with an apparent overall periodicity of ~27.5 m.y. modulated by an ~8–9 m.y. cycle.

The proposed episodes of geologic activity and environmental and biotic change may result from cyclical internal Earth processes that affect changes in mantle convection, plate motions, intraplate stresses, and/or periodic pulses of mantle-plume activity. Recently, the ~30 m.y. cycle has been linked to Earth’s long-term orbital changes within the Solar System, and it may also affect tectonism and climate. I also note considerable evidence for a similar ~30 m.y. cycle in the ages of terrestrial impact craters, which suggests possible astronomical connections. The shared geologic cycle time, formally ranging from ~26 to 36 m.y. (depending partly on varying data sets, geologic timescales, and statistical techniques utilized) is close to the estimated interval (~32 ± 3 m.y.) between our cyclical crossings of the crowded mid-plane region of the Milky Way Galaxy. Here I outline a proposed astrophysical pacing for the apparent pulses of both impact cratering and rhythmic geological episodes.
Deccan volcanism at K-Pg time
Authors: Mittal Tushar , Sprain Courtney J. , Renne* Paul R. , Richards Mark A.
Published: March 2022

The last major mass extinctions in Earth history (e.g., end-Guadalupian, end-Permian, end-Triassic, and end-Cretaceous) are all correlated closely in time with the main-phase eruptions of major flood basalt provinces (Emeishan, Siberian, Central Atlantic Magmatic Province, and Deccan Traps, respectively). The causal relationship between flood volcanism and mass extinction is not clear, but likely involves the climate effects of outgassed volatile species such as CO2, SO2, Cl, F, etc., from some combination of magma and country rocks. In a surprising “coincidence,” the end-Cretaceous (K-Pg boundary) micro-faunal extinction also corresponds precisely in time to what may have been the largest meteor impact of the past billion years of Earth history, the Chicxulub crater at 66.05 Ma. The Deccan Traps eruptions were under way well before K-Pg/Chicxulub time and are most likely the result of the mantle plume “head” that initiated the presently active Reunion hotspot track—thus the Deccan Traps were clearly not generated, fundamentally, by the impact. However, recent high-precision 40Ar/39Ar geochronology indicates that conspicuous changes in basalt geochemistry, lava flow morphology, emplacement mode, and a possible 50% increase in eruption rate at the Lonavala/Wai subgroup transition in the Deccan Traps lava group corresponded, within radioisotopic age precision, to the K-Pg boundary and the Chicxulub impact. This has led to the testable hypothesis that the Mw ~11 seismic disturbance of the Chicxulub impact may have affected the Deccan eruptions. Here we review a broad landscape of evidence regarding Deccan volcanism and its relation to the K-Pg boundary and attempt to define what we see as the most important questions than can and should be answered by further research to better understand both the onshore and largely unknown offshore components of Deccan-related volcanism, and what their climate and environmental impacts at K-Pg time may have been.
Marginalized identities, mistreatment, discrimination, and burnout among US medical students: cross sectional survey and retrospective cohort study
Authors: Teshome Bethelehem G , Desai Mayur M , Gross Cary P , Hill Katherine A , Li Fangyong , Samuels Elizabeth A , Wong Ambrose H , Xu Yunshan , Boatright Dowin H
Published: March 2022

Objective

To describe the association between mistreatment, burnout, and having multiple marginalized identities during undergraduate medical education.

Design

Cross sectional survey and retrospective cohort study.

Setting

140 US medical schools accredited by the Association of American Medical Colleges.

Participants

30 651 graduating medical students in 2016 and 2017.

Main outcome measures

Self-reported sex, race or ethnicity, and sexual orientation groups were considered, based on the unique combinations of historically marginalized identities held by students. Multivariable linear regression was used to determine the association between unique identity groups and burnout along two dimensions (exhaustion and disengagement) as measured by the Oldenburg Burnout Inventory for Medical Students while accounting for mistreatment and discrimination.

Results

Students with three marginalized identities (female; non-white; lesbian, gay, or bisexual (LGB)) had the largest proportion reporting recurrent experiences of multiple types of mistreatment (88/299, P<0.001) and discrimination (92/299, P<0.001). Students with a higher number of marginalized identities also had higher average scores for exhaustion. Female, non-white, and LGB students had the largest difference in average exhaustion score compared with male, white, and heterosexual students (adjusted mean difference 1.96, 95% confidence interval 1.47 to 2.44). Mistreatment and discrimination mediated exhaustion scores for all identity groups but did not fully explain the association between unique identity group and burnout. Non-white and LGB students had higher average disengagement scores than their white and heterosexual counterparts (0.28, 0.19 to 0.37; and 0.73, 0.52 to 0.94; respectively). Female students, in contrast, had lower average disengagement scores irrespective of the other identities they held. After adjusting for mistreatment and discrimination among female students, the effect among female students became larger, indicating a negative confounding association.

Conclusion

In this study population of US medical students, those with multiple marginalized identities reported more mistreatment and discrimination during medical school, which appeared to be associated with burnout.
Risk of hernia-related complications after transjugular intrahepatic portosystemic shunt creation in patients with pre-existing ventral abdominal hernias: 15-year experience at a quaternary medical center
Authors: McDaniel Charles , Bell Ruth , Farha Natalie , Vozzo Catherine , Bullen Jennifer , Rosen Michael , Romero-Marrero Carlos , Partovi Sasan , Kapoor Baljendra
Published: March 2022

Objective

Transjugular intrahepatic portosystemic shunt (TIPS) placement is used to treat the sequelae of portal hypertension, including refractory variceal bleeding, ascites and hepatic hydrothorax. However, hernia-related complications such as incarceration and small bowel obstruction can occur after TIPS placement in patients with pre-existing hernias. The aim of this study was to determine the incidence of hernia complications in the first year after TIPS placement and to identify patient characteristics leading to an increased risk of these complications.

Design

This retrospective analysis included patients with pre-existing abdominal hernias who underwent primary TIPS placement with covered stents at our institution between 2004 and 2018. The 1-year hernia complication rate and the average time to complications were documented. Using a Wilcoxon rank-sum test, the characteristics of patients who developed hernia-related complications versus the characteristics of those without complications were compared.

Results

A total of 167 patients with pre-existing asymptomatic abdominal hernias were included in the analysis. The most common reason for TIPS placement was refractory ascites (80.6%). A total of 36 patients (21.6%) developed hernia-related complications after TIPS placement, including 20 patients with acute complications and 16 with non-acute complications. The mean time to presentation of hernia-related complications was 66 days. Patients who developed hernia-related complications were more likely than those without complications to have liver cirrhosis secondary to alcohol consumption (p=0.049), although this association was no longer significant after multivariate analysis.

Conclusion

Within 1 year after TIPS placement, approximately 20% of patients with pre-existing hernias develop hernia-related complications, typically within the first 2 months after the procedure. Patients with pre-existing hernia undergoing TIPS placement should be educated regarding the signs and symptoms of hernia-related complications, including incarceration and small bowel obstruction.
Modelling study of the ability to diagnose acute rheumatic fever at different levels of the Ugandan healthcare system
Authors: Ndagire Emma , Ollberding Nicholas , Sarnacki Rachel , Meghna Murali , Pulle Jafesi , Atala Jenifer , Agaba Collins , Kansiime Rosemary , Bowen Asha , Longenecker Chris T , Oyella Linda , Rwebembera Joselyn , Okello Emmy , Parks Tom , Zang Huaiyu , Carapetis Jonathan , Sable Craig , Beaton Andrea Z
Published: March 2022

Objective

To determine the ability to accurately diagnose acute rheumatic fever (ARF) given the resources available at three levels of the Ugandan healthcare system.

Methods

Using data obtained from a large epidemiological database on ARF conducted in three districts of Uganda, we selected variables that might positively or negatively predict rheumatic fever based on diagnostic capacity at three levels/tiers of the Ugandan healthcare system. Variables were put into three statistical models that were built sequentially. Multiple logistic regression was used to estimate ORs and 95% CI of predictors of ARF. Performance of the models was determined using Akaike information criterion, adjusted R2, concordance C statistic, Brier score and adequacy index.

Results

A model with clinical predictor variables available at a lower-level health centre (tier 1) predicted ARF with an optimism corrected area under the curve (AUC) (c-statistic) of 0.69. Adding tests available at the district level (tier 2, ECG, complete blood count and malaria testing) increased the AUC to 0.76. A model that additionally included diagnostic tests available at the national referral hospital (tier 3, echocardiography, anti-streptolysin O titres, erythrocyte sedimentation rate/C-reactive protein) had the best performance with an AUC of 0.91.

Conclusions

Reducing the burden of rheumatic heart disease in low and middle-income countries requires overcoming challenges of ARF diagnosis. Ensuring that possible cases can be evaluated using electrocardiography and relatively simple blood tests will improve diagnostic accuracy somewhat, but access to echocardiography and tests to confirm recent streptococcal infection will have the greatest impact.
Efficacy, safety and cost-effectiveness of methotrexate, adalimumab or their combination in non-infectious non-anterior uveitis: a protocol for a multicentre, randomised, parallel three arms, active-controlled, phase III open label with blinded outcome assessment study
Authors: Rivas Ana Belen , Lopez-Picado Amanda , Calamia Valentina , Carreño Ester , Cocho Lidia , Cordero-Coma Miguel , Fonollosa Alex , Francisco Hernandez Felix M , Garcia-Aparicio Angel , Garcia-Gonzalez Javier , Mondejar Jose Juan , Lojo-Oliveira Leticia , Martínez-Costa Llucí , Munoz Santiago , Peiteado Diana , Pinto Jose Antonio , Rodriguez-Lozano Beatriz , Pato Esperanza , Diaz-Valle David , Molina Elena , Tebar Luis Alberto , Rodriguez-Rodriguez Luis
Published: March 2022

Introduction

Non-infectious uveitis include a heterogeneous group of sight-threatening and incapacitating conditions. Their correct management sometimes requires the use of immunosuppressive drugs (ISDs), prescribed in monotherapy or in combination. Several observational studies showed that the use of ISDs in combination could be more effective than and as safe as their use in monotherapy. However, a direct comparison between these two treatment strategies has not been carried out yet.

Methods and analysis

The Combination THerapy with mEthotrexate and adalImumAb for uveitis (CoTHEIA) study is a phase III, multicentre, prospective, randomised, single-blinded with masked outcome assessment, parallel three arms with 1:1:1 allocation, active-controlled, superiority study design, comparing the efficacy, safety and cost-effectiveness of methotrexate, adalimumab or their combination in non-infectious non-anterior uveitis. We aim to recruit 192 subjects. The duration of the treatment and follow-up will last up to 52 weeks, plus 70 days follow-up with no treatment. The complete and maintained resolution of the ocular inflammation will be assessed by masked evaluators (primary outcome). In addition to other secondary measurements of efficacy (quality of life, visual acuity and costs) and safety, we will identify subjects’ subgroups with different treatment responses by developing prediction models based on machine learning techniques using genetic and proteomic biomarkers.

Ethics and dissemination

The protocol, annexes and informed consent forms were approved by the Reference Clinical Research Ethic Committee at the Hospital Clínico San Carlos (Madrid, Spain) and the Spanish Agency for Medicines and Health Products. We will elaborate a dissemination plan including production of materials adapted to several formats to communicate the clinical trial progress and findings to a broad group of stakeholders. The promoter will be the only access to the participant-level data, although it can be shared within the legal situation.

Trial registration number

2020-000130-18;NCT04798755.
Does difficulty in chewing induce subjective musculoskeletal symptoms? A case-control study
Authors: Tani Naomichi , Ohta Masanori , Higuchi Yoshiyuki , Yamamoto Ryoko , Akatsu Junichi
Published: March 2022

Objectives

Risk factors associated with the development of musculoskeletal disorders and symptoms remain an important issue worldwide. This study aimed to investigate the relationship between oral health problems such as difficulty chewing and the occurrence of stiff neck/shoulders (SN/S) and low back pain (LBP).

Design

Case-control study.

Setting and participants

This study was conducted from 1 April 2018 to 31 March 2020. The subjects were 77 341 workers among 646 281 workers from several employers in Japan.

Outcome measures

Participants were asked to evaluate their subjective SN/S and LBP symptoms using a self-administered questionnaire.

Methods

We defined the chewing condition using a questionnaire, and workers who responded with ‘I can chew anything’ were classified as the good condition group (GCG), and those who responded with ‘Sometimes I have difficulty chewing due to problems with the teeth, gums, or bite’ or ‘I can hardly chew’ were classified as the poor condition group (PCG). Setting the year 2018 as the baseline, we performed a logistic regression model using propensity score and inverse probability weighting (IPW) methods and chewing condition groups as explanatory variables and SN/S and LBP as objective variables.

Results

The IPW-adjusted logistic regression model showed that the OR of SN/S was approximately 1.25 (95% CI 1.17 to 1.33) times higher in the PCG than that in the GCG (p<0.001). Similarly, the OR of LBP was about 1.37 (95% CI 1.27 to 1.48) times higher in the PCG than that in the GCG in the IPW-adjusted logistic regression model (p<0.001).

Conclusions

Our study suggests that the occurrence of SN/S and LBP symptoms in workers could be predicted depending on the presence of difficulty in chewing. Therefore, oral health and health guidance are gaining importance for the prevention of subjective musculoskeletal symptoms.
Gender diversity in UK surgical specialties: a national observational study
Authors: Newman Thomas Hedley , Parry Matthew G , Zakeri Roxanna , Pegna Victoria , Nagle Amy , Bhatti Farah , Vig Stella , Green James Stephen Arthur
Published: March 2022

Objectives

To compare gender diversity between UK surgical specialties, assess trends over time, and estimate when gender parity might be achieved.

Design

Observational study.

Setting

National Health Service, UK.

Participants

NHS Hospital & Community Health Service workforce statistics for 2011 to 2020

Main outcome measures

Logistic regression was used to compare female representation in 2020 between surgical specialties, and to examine for any significant trends between 2011 and 2020. The method of least squares was used to estimate when female representation of specialty registrars would reach 50% (‘gender parity’) for specialties with <40% female representation.

Results

In 2020, female consultant and specialty registrar representation was significantly different between surgical specialties (both p<0.001). Female representation for each specialty were as follows (from highest to lowest): Specialty Registrars—Ophthalmology 49.7%, Otolaryngology 48.2%, Paediatric Surgery 45.5%, Plastic Surgery 42.2%, General Surgery 39.8%, Urology 31.6%, Vascular Surgery 25.0%, Neurosurgery 24.7%, Cardiothoracic Surgery 21.3%, and Trauma and Orthopaedics 20.6%; Consultants—Ophthalmology 32.4%, Paediatric Surgery 31.7%, Plastic Surgery 20.9%, General Surgery 17.5%, Otolaryngology 17%, Vascular Surgery 13.7%, Urology 11.7%, Cardiothoracic Surgery 10.8%, Neurosurgery 8.2%, and Trauma and Orthopaedics 7.3%. There was a significant positive trend in female representation of specialty registrars between 2011 and 2020 for all specialties except for Paediatric Surgery (representation consistently >45%) and Vascular Surgery (representation consistently <30%). General Surgery was estimated to achieve gender parity of their specialty registrars by 2028, Urology by 2033, Neurosurgery by 2064, Trauma and Orthopaedics by 2070, and Cardiothoracic Surgery by 2082.

Conclusions

Despite improvements over the last decade, gender disparity persists in the UK surgical workforce and there are significant differences between surgical specialties. Further work is necessary to establish the reasons for these observed differences with a specific focus on Vascular Surgery, Cardiothoracic Surgery, Neurosurgery, and Trauma and Orthopaedics.
Association of adolescents’ independent mobility with road traffic injuries in Karachi, Pakistan: a cross-sectional study
Authors: Khan Uzma Rahim , Razzak Junaid , Gerdin Wärnberg Martin
Published: March 2022

Objective

Participation in walking, cycling and taking public transportation without adult supervision is defined as independent mobility of children and adolescents. The association between adolescents’ independent mobility and road traffic injury (RTI) is unclear. The purpose of this study is to determine measures of adolescents’ independent mobility associated with RTIs in an urban lower middle-income setting.

Study design

Cross-sectional survey.

Setting

Schools in Karachi, Pakistan.

Participants

Adolescents aged 10–19 years in grades 6–10 were enrolled from private and public schools.

Outcome

Any self-reported lifetime RTI sustained as a pedestrian, as a cyclist or while in a car or another vehicle that resulted in any first aid at home/school or consultation in a healthcare setting.

Exposure

Self-reported independent mobility was assessed by four variables. (1) Any travel companion from school to home on the survey day, (2) parental permission to cross main roads alone, (3) parental permission to travel by public bus alone and (4) activity/activities outside the home on the previous weekend alone.

Results

Data from 1264 adolescents, 10–19 years old, were included. Most were females (60%). Adolescents who had parental permission to cross main roads alone (adjusted OR (aOR) 1.39; 95% CI 1.04 to 1.86) and who participated in one or more activities outside the home alone on the previous weekend (aOR 2.61; 95% CI 1.42 to 5.13) or participated in a mixture of activities with and without adult accompaniment (aOR 2.50; 95% CI 1.38 to 4.89) had higher odds of RTIs.

Conclusions

Parental permission to cross main roads alone and participation in activity/activities outside the home on the previous weekend alone were two measures of independent mobility associated with higher odds of RTIs among adolescents. The study provides an understanding of the risk posed by adolescents’ independent mobility in road traffic environments.
Sustaining interventions in care homes initiated by quality improvement projects: a qualitative study
Authors: Devi Reena , Martin Graham P , Banerjee Jaydip , Gladman John RF , Dening Tom , Barat Atena , Gordon Adam Lee
Published: March 2022

Introduction

Inadequate and varied quality of care in care homes has led to a proliferation of quality improvement (QI) projects. This study examined the sustainability of interventions initiated by such projects.

Method

This qualitative study explored the sustainability of seven interventions initiated by three QI projects between 2016 and 2018 in UK care homes and explored the perceived influences to the sustainability of interventions. QI projects were followed up in 2019. Staff leading QI projects (n=9) and care home (n=21, from 13 care homes) and healthcare (n=2) staff took part in semi-structured interviews. Interventions were classified as sustained if the intervention was continued at the point of the study. Thematic analysis of interview data was performed, drawing on the Consolidated Framework for Sustainability (CFS), a 40-construct model of sustainability of interventions.

Results

Three interventions were sustained and four interventions were not. Seven themes described perceptions around what influenced sustainability: monitoring outcomes and regular check-in; access to replacement intervention materials; staff willingness to dedicate time and effort towards interventions; continuity of staff and thorough handover/inductions in place for new staff; ongoing communication and awareness raising; perceived effectiveness; and addressing care home priorities. All study themes fell within 18 of the 40 CFS constructs.

Discussion

Our findings resonate with the CFS and are also consistent with implementation theories, suggesting sustainability is best addressed during implementation rather than treated as a separate process which follows implementation. Commissioning and funding QI projects should address these considerations early on, during implementation.
Hydroxychloroquine in the pregnancies of women with lupus: a meta-analysis of individual participant data
Authors: Clowse Megan E B , Eudy Amanda M , Balevic Stephen , Sanders-Schmidler Gillian , Kosinski Andrzej , Fischer-Betz Rebecca , Gladman Dafna D , Molad Yair , Nalli Cecilia , Mokbel Abir , Tincani Angela , Urowitz Murray , Bay Caroline , van Noord Megan , Petri Michelle
Published: March 2022

Objective

Multiple guidelines recommend continuing hydroxychloroquine (HCQ) for SLE during pregnancy based on observational data. The goal of this individual patient data meta-analysis was to identify the potential benefits and harms of HCQ use within lupus pregnancies.

Methods

Eligible studies included prospectively collected pregnancies in women with lupus. After a systematic literature search, seven datasets meeting inclusion criteria were obtained. Pregnancy outcomes and lupus activity were compared for pregnancies with a visit in the first trimester in women who did or did not take HCQ throughout pregnancy. Birth defects were not systematically collected. This analysis was conducted in each dataset, and results were aggregated to provide a pooled OR.

Results

Seven cohorts provided 938 pregnancies in 804 women. After selecting one pregnancy per patient with a first trimester visit, 668 pregnancies were included; 63% took HCQ throughout pregnancy. Compared with pregnancies without HCQ, those with HCQ had lower odds of highly active lupus, but did not have different odds of fetal loss, preterm delivery or pre-eclampsia. Among women with low lupus activity, HCQ reduced the odds of preterm delivery.

Conclusions

This large study of prospectively-collected lupus pregnancies demonstrates a decrease in lupus activity among woman who continue HCQ through pregnancy and no harm to pregnancy outcomes. Like all studies of HCQ in lupus pregnancy, this study is confounded by indication and non-adherence. As this study confirms the safety of HCQ and diminished SLE activity with use, it is consistent with current recommendations to continue HCQ throughout pregnancy.
Genus two nilpotent graphs of finite commutative rings
Authors: Kalaimurugan G. , Vignesh P. , Tamizh Chelvam T.
Published: March 2022

Let [Formula: see text] be a finite commutative ring and [Formula: see text] is nilpotent for some [Formula: see text]. The nilpotent graph [Formula: see text] of [Formula: see text] is the simple undirected graph with vertex set [Formula: see text] in which two vertices [Formula: see text] and [Formula: see text] are adjacent if and only if [Formula: see text] is nilpotent. In this paper, we observe a relationship between zerodivisor graphs, essential graphs and nilpotent graphs of [Formula: see text]. In continuation of genus characterizations in [T. Asir K. Mano and T. Tamizh Chelvam, Correction to: Classification of non-local rings with genus two zerodivisor graphs, Soft Comput. 25 (2021) 3355–3356; K. Selvakumar and M. Subajini, Finite commutative ring with genus two essential 10 graph, J. Algebra Appl. 16(2) (2018) 1850121], we classify all finite commutative rings (up to isomorphism) whose nilpotent graphs are of genus two.