bluuebunny/crossref_metadata_2025 huggingface dataset:
Undergraduate Nursing Student Mental Health Clinical Experiences in Saudi Arabia: Findings From a Qualitative Study
Authors: Alhamidi Sami Abdulrahman , Alyousef Seham Mansour
Published: March 2021

BACKGROUND:

Clinical experience is an important way of resolving preregistration challenges. Negative feelings toward pursuing a career in mental health nursing may be modified by well-structured practicums.

AIMS:

To explore nursing student perspectives of clinical practicums in mental health in Saudi Arabia for the purpose of enhancement of nurse education in mental health care.

METHODS:

This qualitative study used thematic analysis from semistructured focus group interviews of 20 female undergraduate nursing students. Inductive outcomes and emergent conceptual data were reviewed by investigators, doctoral prepared faculty peers, and members of the sample. NVivo 10.1 software was used to suggest conceptual groupings into themes based on inductive codes.

RESULTS:

The core theme—enhancement of mental health care skills—comprised four emerging subthemes, including the application of theory for clinical improvement, positive feelings, and motivation toward removal of discrimination and stigmatization, experience with apprehension, anxiety, fear, and stress, and therapeutic communication skills.

DISCUSSION:

Clinical placement in mental health-related practice may assist undergraduate nursing students in addressing anxiety and stress related to contacting patients, confronting stigmatizing and negative emotions, applying theoretical knowledge to clinical practice, having therapeutic communication skills, and enhancing overall professional experiences of nursing students. It is hoped that undergraduate clinical mental health placement will contribute valuable skills and viewpoints to nursing students who aim to enter professional practice in all areas and especially mental health.
Impact of COVID-19 on keratoconus patients waiting for corneal cross linking
Authors: Shah Haider , Pagano Luca , Vakharia Anuj , Coco Giulia , Gadhvi Kunal A , Kaye Stephen B , Romano Vito
Published: March 2021

Purpose:

Royal College of Ophthalmologist recent guidance recommended delaying cross-linking services during the COVID-19 pandemic. This study investigates the effects of such delays in the delivery of cross-linking services in patients with keratoconus progression.

Methods:

Retrospective observational study of 46 patients with keratoconus progression, whose cross-linking was delayed due to the COVID-19 pandemic. Demographic and clinical details were obtained from assessments on the day of listing, and subsequent review on the day of the procedure. Topographic indices included keratometry of the posterior and anterior corneal surface, maximum keratometry ( Kmax), thinnest corneal thickness, ABCD progression and progression based on standard criteria recommendations (1.5 D Kmax & 20 microns thinning).

Results:

A total of 46 eyes were analysed with an average time between being listed for CXL and having the procedure done was 182 ± 65 days. The delay due to COVID-19 was of 3 months. In this time period they had a significant worsening of all keratometric indices and lost almost one line of visual acuity (0.19 ± 0.19 to 0.26 ± 0.18 LogMAR, p: 0.03). Thirty two eyes (70%) demonstrated progression in accordance with the ABCD progression criteria, while 18 eyes (39%) showed either an increase in Kmax of more than 1.5D or a thinning in corneal thickness of at least 20 μm.

Conclusions:

The treatment delay for the keratoconus patients caused further progression and vision worsening. We recommend that corneal collagen crosslinking needs to be considered as a high priority intervention.
Burden of disease assessment in patients with neovascular age-related macular degeneration in Spain: Results of the AMD-MANAGE study
Authors: Pina Marín Begoña , Gajate Paniagua Nuria María , Gómez-Baldó Laia , Gallego-Pinazo Roberto
Published: March 2021

Background/Aims:

The present study evaluates the burden of neovascular age-related macular degeneration (nAMD) to Healthcare System and patients, describing the management and treatment effectiveness in routine clinical practice in Spain.

Methods:

Observational, non-interventional, cross-sectional, retrospective (24 months), multicentre study including patients who started treatment with licensed vascular endothelial growth factor inhibitors (anti-VEGF) for nAMD with a minimum follow up of 24 months.

Results:

126 evaluable patients were included with mean (SD) age of 79.1 (7.5) years. From diagnosis, it took a mean (SD) of 0.5 (0.5) months for the first treatment. Throughout 24 months, mean (SD) number of visits per patient was 16.0 (5.0), 9.4 (4.3) associated intravitreal injection. There were 1186 injection visits, 53.6% of them only with injection and 46.3% with injection and tests. After loading phase, preferred treatment regimens were T&E (46.0%), PRN (44.4%), fixed regimen (4.0%), and others (5.6%). Total number of visits in patients with T&E and PRN were 16.5 (5.7) and 15.5 (4.7), respectively. After complete loading phase, mean (SD) time between two consecutive treatment injections was 2.2 (1.6) months. 27.8% patients underwent a treatment change, being lack of response the most frequent reason to change (43.2%). Mean (SD) best-corrected visual acuity change was 2.1 (15.9) letters at 24 months.

Conclusion:

This study showed an important burden to Healthcare System and patients related to monitoring visits. More efficacious and longer lasting treatments could be useful to increase treatment intervals, thus reducing the burden of patients and caregivers and the use of healthcare resources.
Ophthalmologists and WhatsApp: Teleophthalmology is already here
Authors: Barayev Edward , Vorobichik Berar Ofri , Dotan Gad , Skaat Alon , Gal-Or Orly , Gershoni Assaf , Gaton Dan
Published: March 2021

Purpose:

To estimate the extent of WhatsApp utilization using text and media messages for inter-physician consultations among ophthalmologists (residents and specialists) at various clinical settings and its perceived benefits for ophthalmologists and their patients. We also aimed to detect obstacles that concern ophthalmologists when using WhatsApp as a consultation platform.

Methods:

This was a cross-sectional study using a self-administered survey through Google Forms, which was sent to 660 practicing ophthalmologists during April to May 2020.

Results:

One hundred and ninety-two ophthalmologists completed the questionnaire, 151 of which (78.6%) were specialists and 41 (21.4%) were residents. Most ophthalmologists reported using WhatsApp at least once a day for both personal and professional use. Residents reported lower rates of contacting patients using WhatsApp than specialists (1.51 ± 0.98 vs 2.72 ± 1.32, p < 0.001). Respondents reported WhatsApp consultations frequently replaced referrals of patients to other physicians, with a median of once a week. 97.8% of residents and 91.4% of specialists reported the ability to share media is a major advantage of WhatsApp over other medias, followed by rapid responses for consultations.

Conclusion:

Many ophthalmologists already use WhatsApp as a tool for professional consultations with other providers, mainly thanks to its simplicity and wide availability. Residents use it more frequently than specialists, and ranked it higher when asked how much WhatsApp has improved the clinical setting. Policy makers should address concerns brought up by physicians, such as documentation in medical records and proper compensation for consulting ophthalmologists during and after work hours.
Impact of a trained vascular access coordinator on a vascular access program in India
Authors: Pundir Ekta , Sharma Ashish , Singh Sarbpreet , Patil Shivakumar , Pandey Gaurav Shankar , Rally Sahil , Kenwar Deepesh Benjamin
Published: March 2021

Background:

Native AV fistulas are the ideal access for hemodialysis but require monitoring and multiple interventions in some patients to keep them functioning. The aim of the study was to assess the impact of the appointment of a trained vascular access coordinator (VAC) for fistula monitoring, on the evolution of the vascular access program at our institute.

Method:

Data was retrieved from the departmental database for the baseline year 2014 and compared with the data from 2018. Initial review showed that appointment of the VAC in 2015 resulted in a steady increase in the number of AV fistula interventions over 2 years to a plateau in 2018 which was chosen as the comparison year. The number of AVF’s created, number of salvage procedures performed, and follow-up data were compared. Other parameters like number of operation theatre hours, surgeons, and nursing staff remained constant during this period.

Result:

Total numbers of AVFs increased from 511 to 713 (39.3%). The number of follow-up visits to surgeons reduced from an average of 4–0.25 visits per patient during this period. Follow up Doppler examinations increased from 761 to 1296 (70%) indicating improved follow up. The salvage procedures increased from 44 to 161 (272%) with early detection of fistula dysfunction. Primary and secondary patency rates of 86% and 92% at 3 months could be achieved whereas limited follow-up data was available for 2014.

Conclusion:

Appointment of trained VAC increased the number of vascular access procedures, improved follow-up care, and led to early detection and intervention for access dysfunction while reducing the workload of surgeons.
The Role of Implementation Science in Advancing Resource Generation for Health Interventions in Low- and Middle-Income Countries
Authors: Ojo Temitope , Kabasele Laetitia , Boyd Bethanny , Enechukwu Scholastica , Ryan Nessa , Gyamfi Joyce , Peprah Emmanuel
Published: March 2021

Low- and middle-income countries (LMICs) bear the brunt of communicable and non-communicable diseases and experience higher mortality and poor health outcomes compared to resource-rich countries. Chronic resource deficits in LMICs impede their ability to successfully address vexing health issues. Implementation science provides researchers with an approach to develop specific interventions that can generate and/or maximize resources to facilitate the implementation of other public health interventions, in resource-constrained LMIC settings. Resources generated from these interventions could be in the form of increased health workers’ skills, task shifting to free up higher-skilled health workers, increasing laboratory capacity, and using supply chain innovations to make medications available. Pivotal to the success of such interventions is ensuring feasibility in the LMIC context. We selected and appraised three case studies of evidence-based resource-generating health interventions based in LMICs (Zambia, Zimbabwe, and Madagascar), which generated or maximized resources to facilitate ongoing health services. We used a determinant implementation framework—Consolidated Framework for Implementation Research (CFIR) to identify and map contextual factors that are reported to influence implementation feasibility in an LMIC setting. Contextual factors influencing the feasibility of these interventions included leadership engagement, local capacity building and readiness for research and implementing evidence-based practices (EBPs), infrastructural support for multilevel scale-up, and cultural and contextual adaptations. These factors highlight the importance of utilizing implementation science frameworks to evaluate, guide, and execute feasible public health interventions and projects in resource-limited settings. Within LMICs, we recommend EBPs incorporate feasible resource-generating components in health interventions to ensure improved and sustained optimal health outcomes.
More-than-human methodologies in qualitative research: Listening to the Leafblower
Authors: Flint Maureen A.
Published: March 2021

This paper explores the methodological possibilities of listening to more-than-human sounds as an entry point to critical analysis. Through attending to the sound of a leafblower as it resonates across a university campus, this article draws lines between the resonances of the leafblower, higher education, and white supremacy to explore how sounds become embedded in bodies and spaces. In addition, this article offers a methodology of listening as a process of attunement that provokes readings beyond what is immediately heard, seen, or felt. To listen to the sound of the leafblower and what it does, how it resonates is to attune to how that sound works, how it operates in the production and discourses of place. In other words, this article wonders how listening, as a methodological practice, provokes critical questions about place and space, and how sound (and particularly nonhuman or more than human sounds) functions in qualitative methodology.
Budget Impact Analysis of Anticoagulation Clinics in Patients with Atrial Fibrillation under Chronic Therapy with Oral Anticoagulants
Authors: Uribe-Arango William , Reyes Sánchez Juan Manuel , Castaño Gamboa Natalia
Published: March 2021

Objectives

To assess budget impact of the implementation of an anticoagulation clinic (AC) compared to usual care (UC), in patients with non-valvular atrial fibrillation (NVAF).

Method

A decision tree was designed to analyze the cost and events rates over a 1-year horizon. The patients were distributed according to treatment, 30% Direct Oral Anticoagulant (DOAC) regimens and the rest to warfarin. The thromboembolism and bleeding were derived from observational studies which demonstrated that ACs had important impact in reducing the frequency of these events compared with UC, due to higher adherence with DOACs and proportion of time in therapeutic range (TTR) with warfarin. Costs were derived from the transactional platform of Colombian government, healthcare authority reimbursement and published studies. The values were expressed in American dollars (USD). The exchanged rate used was COP $3.693 per dollar.

Results

During 1 year of follow-up, in a cohort of 228 patients there were estimated 48 bleedings, 6 thromboembolisms in AC group versus 84 bleedings, and 12 thromboembolisms events in patients receiving UC. Total costs related to AC were $126 522 compared with $141 514 in UC. The AC had an important reduction in the cost of clinical events versus UC ($52 085 vs $110 749) despite a higher cost of care facilities ($74 436 vs $30 765). A sensibility analysis suggested that in the 83% of estimations, the AC produced savings varied between $27 078 and $135 391.

Conclusions

This study demonstrated that AC compared with UC, produced an important savings in the oral anticoagulation therapy for patients with NVAF.
Correlation of Oral Health Education by Community Health Workers with Changes in Oral Health Practices in Migrant Populations in Washington State
Authors: Ponce-Gonzalez Ileana Maria , Cheadle Allen D. , Parchman Michael Leo
Published: March 2021

Introduction

An important question for oral health education is whether knowledge gained during lay-led workshops is retained and applied in daily practice. This study assessed the knowledge retention and changes in oral health practices several months after oral health education workshops were held for migrant farmworkers by Community Health Workers (CHWs).

Methods and Results

Follow-up surveys were conducted with 32 participants 1 to 43 months post participation (60% between 6 and 21 months). The results showed a high degree of retention, in such areas as general oral health knowledge, and brushing/flossing frequency and technique among this sample. There was no relationship between length of time since the educational workshop and knowledge retained or behaviors changed.

Conclusions and Recommendations

An interactive, lay-led oral health education program run by CHWs can be an effective way to deliver sustained improvements in oral health knowledge and changes in oral health practice in migrant populations.
Higher Education in Times of COVID-19: University Students’ Basic Need Satisfaction, Self-Regulated Learning, and Well-Being
Authors: Holzer Julia , Lüftenegger Marko , Korlat Selma , Pelikan Elisabeth , Salmela-Aro Katariina , Spiel Christiane , Schober Barbara
Published: March 2021

In the wake of COVID-19, university students have experienced fundamental changes of their learning and their lives as a whole. The present research identifies psychological characteristics associated with students’ well-being in this situation. We investigated relations of basic psychological need satisfaction (experienced competence, autonomy, and relatedness) with positive emotion and intrinsic learning motivation, considering self-regulated learning as a moderator. Self-reports were collected from 6,071 students in Austria (Study 1) and 1,653 students in Finland (Study 2). Structural equation modeling revealed competence as the strongest predictor for positive emotion. Intrinsic learning motivation was predicted by competence and autonomy in both countries and by relatedness in Finland. Moderation effects of self-regulated learning were inconsistent, but main effects on intrinsic learning motivation were identified. Surprisingly, relatedness exerted only a minor effect on positive emotion. The results inform strategies to promote students’ well-being through distance learning, mitigating the negative effects of the situation.
Evaluating the Addition of a Clinical Pharmacist Service to a Midlevel Provider-Driven Culture Follow-up Program in a Community Emergency Department
Authors: Rainess Rebecca Ann , Patel Vishal V. , Cavanaugh Joseph Brian , Hill Jessica
Published: March 2021

Background: The impact that an antimicrobial stewardship program can have on an inpatient setting has been well documented, but there are limited data on the use of an antimicrobial stewardship program in the emergency department (ED). Objective: The objective of this study was to assess the impact of adding a pharmacist service to a midlevel provider-driven culture follow-up program in the ED on achieving optimal therapy. Methods: This was a quasi-experimental study with designations of pre- and post-interventions conducted at a large community hospital with the pre-intervention phase occurring from June 1, 2019, to August 31, 2019, and the post-intervention phase occurring from January 1, 2020, to March 31, 2020. The primary outcome was optimal antimicrobial therapy: a composite of optimal antibiotic, dose, and duration, prescribed after the culture resulted. Secondary outcomes included optimal antibiotic, dose, duration, and return to the ED within 30 days due to infection. Results: Optimal antimicrobial therapy received after the culture resulted occurred in 59 patients (26.81%) in the pre-implementation phase and 40 patients (43.96%) in the implementation phase ( P = .003). For the secondary outcomes, optimal antibiotic choice occurred in 115 patients (52.27%) in the pre-implementation phase and 66 patients (72.53%) in the implementation phase ( P = .001). Optimal antibiotic dose occurred in 113 patients (51.36%) in the pre-implementation phase and 65 patients (71.43%) in the implementation phase ( P = .001). Optimal antibiotic duration occurred in 65 patients (29.55%) in the pre-implementation phase and 40 patients (43.96%) in the implementation phase ( P = .014). Conclusions: The addition of a clinical pharmacist service in a midlevel provider-driven ED culture callback program resulted in an increased rate of achieving optimal antimicrobial therapy.
Radiography Versus Sonography in the Detection of Acute Fractures: A Case Series
Authors: Al-Baghdadi Rula , Yu Timothy J. , Ferro Aaron , Roberts Jeffrey
Published: March 2021

Plain radiography is often considered a first-line diagnostic tool and gold standard for bony fractures. This case series and brief literature review highlight the need for increased training in musculoskeletal sonography. A case is presented of a distal radial fracture that was not detected on radiography but diagnosed with sonography on the same day. Similarly, two fractures of the distal fibula were diagnosed using sonography after negative radiographs at follow-up appointments, led to misdiagnoses and mismanagement. A fourth case is presented to show an acute rib fracture diagnosed by sonography. These cases emphasize the importance of musculoskeletal sonography training in the diagnosis of acute fractures and its underutilization at the bedside. Collaboration between sonographers and physicians may increase utilization of musculoskeletal sonography which in turn may improve patient care and outcomes.
Circulating proteins associated with allergy development in infants—an exploratory analysis
Authors: Stockfelt Marit , Hong Mun-Gwan , Hesselmar Bill , Adlerberth Ingegerd , Wold Agnes E. , Schwenk Jochen M. , Lundell Anna-Carin , Rudin Anna
Published: March 2021

Background

Protein profiles that can predict allergy development in children are lacking and the ideal sampling age is unknown. By applying an exploratory proteomics approach in the prospective FARMFLORA birth cohort, we sought to identify previously unknown circulating proteins in early life that associate to protection or risk for development of allergy up to 8 years of age.

Methods

We analyzed plasma prepared from umbilical cord blood (n = 38) and blood collected at 1 month (n = 42), 4 months (n = 39), 18 months (n = 42), 36 months (n = 42) and 8 years (n = 44) of age. We profiled 230 proteins with a multiplexed assay and evaluated the global structure of the data with principal component analysis (PCA). Protein profiles informative to allergic disease at 18 months, 36 months and/or 8 years were evaluated using Lasso logistic regression and random forest.

Results

Two clusters emerged in the PCA analysis that separated samples obtained at birth and at 1 month of age from samples obtained later. Differences between the clusters were mostly driven by abundant plasma proteins. For the prediction of allergy, both Lasso logistic regression and random forest were most informative with samples collected at 1 month of age. A Lasso model with 27 proteins together with farm environment differentiated children who remained healthy from those developing allergy. This protein panel was primarily composed of antigen-presenting MHC class I molecules, interleukins and chemokines.

Conclusion

Sampled at one month of age, circulating proteins that reflect processes of the immune system may predict the development of allergic disease later in childhood.
Clinical outcomes of pediatric macular edema associated with non-infectious uveitis
Authors: Nguyen Anh Hong , Mekonnen Bethlehem , Kim Eric , Acharya Nisha R.
Published: March 2021

Background

Macular edema (ME) is the most frequent cause of irreversible visual impairment in patients with uveitis. To date, little data exists about the clinical course of ME in pediatric patients. A retrospective, observational study was performed to examine the visual and macular thickness outcomes of ME associated with chronic, noninfectious uveitis in pediatric patients.

Methods

Pediatric patients with noninfectious uveitis complicated by ME seen in the University of California San Francisco Health System from 2012 to 2018 were identified using ICD-9 and ICD-10 codes. Data were collected from medical records including demographics, diagnoses, ocular history, OCT imaging findings, complications, and treatments at first encounter and at 3, 6, 9, and 12-month follow-up visits. Cox proportional hazards regression was used to investigate the association between different classes of treatment (steroid drops, steroid injections, oral steroids and other immunosuppressive therapies) and resolution of macular edema.

Results

The cohort comprised of 21 children (26 eyes) with a mean age of 10.5 years (SD 3.3). Undifferentiated uveitis was the most common diagnosis, affecting 19 eyes (73.1%). The majority of observed macular edema was unilateral (16 patients, 76.2%) and 5 patients had bilateral macular edema. The mean duration of follow-up at UCSF was 35.3 months (SD 25.7).

By 12 months, 18 eyes (69.2%) had achieved resolution of ME. The median time to resolution was 3 months (IQR 3–6 months). Median best-corrected visual acuity (BCVA) at baseline was 0.54 logMAR (Snellen 20/69, IQR 20/40 to 20/200). Median BCVA at 12 months was 0.1 logMAR (Snellen 20/25, IQR 20/20 to 20/50) Corticosteroid injections were associated with a 4.0-fold higher rate of macular edema resolution (95% CI 1.3–12.2, P = 0.01).

Conclusions

Although only 15% of the pediatric patients with uveitis in the study cohort had ME, it is clinically important to conduct OCTs to detect ME in this population. Treatment resulted in 69% of eyes achieving resolution of ME by 12 months, accompanied with improvement in visual acuity. Corticosteroid injections were significantly associated with resolution of macular edema.
Correction for both common and rare cell types in blood is important to identify genes that correlate with age
Authors:   BIOS Consortium, Pellegrino-Coppola Damiano , Claringbould Annique , Stutvoet Maartje , Boomsma Dorret I. , Ikram M. Arfan , Slagboom P. Eline , Westra Harm-Jan , Franke Lude
Published: March 2021

Background

Aging is a multifactorial process that affects multiple tissues and is characterized by changes in homeostasis over time, leading to increased morbidity. Whole blood gene expression signatures have been associated with aging and have been used to gain information on its biological mechanisms, which are still not fully understood. However, blood is composed of many cell types whose proportions in blood vary with age. As a result, previously observed associations between gene expression levels and aging might be driven by cell type composition rather than intracellular aging mechanisms. To overcome this, previous aging studies already accounted for major cell types, but the possibility that the reported associations are false positives driven by less prevalent cell subtypes remains.

Results

Here, we compared the regression model from our previous work to an extended model that corrects for 33 additional white blood cell subtypes. Both models were applied to whole blood gene expression data from 3165 individuals belonging to the general population (age range of 18–81 years). We evaluated that the new model is a better fit for the data and it identified fewer genes associated with aging (625, compared to the 2808 of the initial model;P≤ 2.5⨯10−6). Moreover, 511 genes (~ 18% of the 2808 genes identified by the initial model) were found using both models, indicating that the other previously reported genes could be proxies for less abundant cell types. In particular, functional enrichment of the genes identified by the new model highlighted pathways and GO terms specifically associated with platelet activity.

Conclusions

We conclude that gene expression analyses in blood strongly benefit from correction for both common and rare blood cell types, and recommend using blood-cell count estimates as standard covariates when studying whole blood gene expression.
Supraventricular tachycardias in the first year of life: what is the best pharmacological treatment? 24 years of experience in a single centre
Authors: Capponi Guglielmo , Belli Gilda , Giovannini Mattia , Remaschi Giulia , Brambilla Alice , Vannuccini Francesca , Favilli Silvia , Porcedda Giulio , De Simone Luciano
Published: March 2021

Background

Supraventricular tachycardias (SVTs) are common in the first year of life and may be life-threatening. Acute cardioversion is usually effective, with both pharmacological and non-pharmacological procedures. However, as yet no international consensus exists concerning the best drug required for a stable conversion to sinus rhythm (maintenance treatment). Our study intends to describe the experience of a single centre with maintenance drug treatment of both re-entry and automatic SVTs in the first year of life.

Methods

From March 1995 to April 2019, 55 patients under one year of age with SVT were observed in our Centre. The SVTs were divided into two groups: 45 re-entry and 10 automatic tachycardias. As regards maintenance therapy, in re-entry tachycardias, we chose to start with oral flecainide and in case of relapses switched to combined treatment with beta-blockers or digoxin. In automatic tachycardias we first administered a beta-blocker, later combined with flecainide or amiodarone when ineffective.

Results

The patients’ median follow-up time was 35 months. In re-entry tachycardias, flecainide was effective as monotherapy in 23/45 patients (51.1%) and in 20/45 patients (44.4%) in combination with nadolol, sotalol or digoxin (overall 95.5%). In automatic tachycardias, a beta-blocker alone was effective in 3/10 patients (30.0%), however, the best results were obtained when combined with flecainide: overall 9/10 (90%).

Conclusions

In this retrospective study on pharmacological treatment of SVTs under 1 year of age the combination of flecainide and beta-blockers was highly effective in long-term maintenance of sinus rhythm in both re-entry and automatic tachycardias.
Understanding the influence of substrate when growing tumorspheres
Authors: Benítez Lucía , Barberis Lucas , Vellón Luciano , Condat Carlos A.
Published: March 2021

Background

Cancer stem cells are important for the development of many solid tumors. These cells receive promoting and inhibitory signals that depend on the nature of their environment (their niche) and determine cell dynamics. Mechanical stresses are crucial to the initiation and interpretation of these signals.

Methods

A two-population mathematical model of tumorsphere growth is used to interpret the results of a series of experiments recently carried out in Tianjin, China, and extract information about the intraspecific and interspecific interactions between cancer stem cell and differentiated cancer cell populations.

Results

The model allows us to reconstruct the time evolution of the cancer stem cell fraction, which was not directly measured. We find that, in the presence of stem cell growth factors, the interspecific cooperation between cancer stem cells and differentiated cancer cells induces a positive feedback loop that determines growth, independently of substrate hardness. In a frustrated attempt to reconstitute the stem cell niche, the number of cancer stem cells increases continuously with a reproduction rate that is enhanced by a hard substrate. For growth on soft agar, intraspecific interactions are always inhibitory, but on hard agar the interactions between stem cells are collaborative while those between differentiated cells are strongly inhibitory. Evidence also suggests that a hard substrate brings about a large fraction of asymmetric stem cell divisions. In the absence of stem cell growth factors, the barrier to differentiation is broken and overall growth is faster, even if the stem cell number is conserved.

Conclusions

Our interpretation of the experimental results validates the centrality of the concept of stem cell niche when tumor growth is fueled by cancer stem cells. Niche memory is found to be responsible for the characteristic population dynamics observed in tumorspheres. The model also shows why substratum stiffness has a deep influence on the behavior of cancer stem cells, stiffer substrates leading to a larger proportion of asymmetric doublings. A specific condition for the growth of the cancer stem cell number is also obtained
‘Listen and learn:’ participant input in program planning for a low-income urban population at cardiovascular risk
Authors: Kirzner Rachel S. , Robbins Inga , Privitello Meghan , Miserandino Marianne
Published: March 2021

Background

Poverty increases the risk of cardiac disease, while diminishing the resources available to mitigate that risk. Available prevention programs often require resources that low-income residents of urban areas do not possess, e.g. membership fees, resources to purchase healthy foods, and safe places for physical activity. The aim of this study is to obtain participant input in order to understand the health-related goals, barriers, and strengths as part of planning a program to reduce cardiovascular risk.

Methods

In a mixed methods study, we used written surveys and focus groups as part of planning an intervention specifically designed to meet the needs of lower income individuals. Based on prior research, we used Self-Determination Theory (SDT) and its core constructs of autonomy, competence, and relatedness as the theoretical framework for analysis. The study collected information on the perspectives of low-income urban residents on their risks of cardiovascular disease, their barriers to and supports for addressing health needs, and how they addressed barriers and utilized supports. Focus group transcripts were analyzed using standard qualitative methods including paired coding and development of themes from identified codes.

Results

Participants had health goals that aligned with accepted approaches to reducing their cardiovascular risks, however they lacked the resources to reach those goals. We found a lack of support for the three SDT core constructs. The barriers that participants reported suggested that these basic psychological needs were often thwarted by their environments.

Conclusions

Substantial disparities in both access to health-promoting resources and in support for autonomy, competence, and relatedness must be addressed in order to design an effective intervention for a low-income population at cardiac risk.
Joint association of cigarette smoking and PM2.5 with COPD among urban and rural adults in regional China
Authors: Su Jian , Ye Qing , Zhang Dandan , Zhou Jinyi , Tao Ran , Ding Zhen , Lu Gan , Liu Jiannan , Xu Fei
Published: March 2021

Background

Cigarette smoking and PM2.5 are important risk factors of Chronic Obstructive Pulmonary Disease (COPD). However, the joint association of cigarette smoking and PM2.5 with COPD is unknown.

Methods

A community-based study was conducted among urban and rural adults aged 40 + years between May and December of 2015 in Jiangsu Province, China. The outcome variable was spirometry-defined COPD. Explanatory measures were smoking status (non-smokers or smokers) and PM2.5 exposure [low level (< 75 μg/m3) or high level (≥ 75 μg/m3)]. Mixed-effects logistic regression models were applied to calculate the odds ratio (OR) and 95% confidence interval (CI) to investigate the associations of cigarette smoking and PM2.5 with COPD.

Results

The prevalence of COPD was 11.9% (95% CI = 10.9%, 13.0%) within the overall 3407 participants in this study. After adjustment for potential confounders and community-level clustering effect, smokers tended to develop COPD relative to non-smokers (OR = 2.46, 95% CI 1.76, 3.43), while only smokers exposed to high level PM2.5 were more likely to experience COPD (OR = 1.36; 95% CI 1.01, 1.83) compared to their counterparts exposed to low level PM2.5. Meanwhile, compared to non-smokers who exposed to low level PM2.5, non-smokers who exposed to high level PM2.5 (OR = 1.10, 95% CI 0.74, 1.64), smokers who exposed to low (OR = 2.22, 95% CI 1.51, 3.27) or high level PM2.5 (OR = 3.14, 95% CI 2.15, 4.59) were, respectively, more like to develop COPD.

Conclusions

Cigarette smoking was positively associated with COPD among overall participants, while PM2.5 was in positive relation to COPD among smokers only. Moreover, cigarette smoking and PM2.5 might have an additive effect on the risk of COPD among adult smokers aged 40 years or older in China.
Height difference between the vestibular and palatal walls and palatal width: a cone beam computed tomography approach
Authors: López-Jarana P. , Díaz-Castro C. M. , Falcão A. , Falcão C. , Ríos-Santos J. V. , Fernández-Palacín A. , Herrero-Climent M.
Published: March 2021

Background

The objective of this study was to measure two parameters involved in tri-dimensional implant planning: the position of the buccal and palatal bone wall and the palatal thickness.

Methods

Cone beam computed tomography (CBCT) images (Planmeca ProMax 3D) of 403 teeth (208 upper teeth and 195 lower teeth) were obtained from 49 patients referred to the Dental School of Seville from January to December 2014. The height difference between the palatal and buccal walls was measured on the most coronal point of both walls. The thickness of the palatal wall was measured 2 mm from the most coronal point of the palatal wall.

Results

The mean values in the maxilla were 1.7 ± 0.9 mm for central and lateral incisors, 2.2 ± 1.7 mm for canines, 1.6 ± 0.9 mm for premolars and 1.9 ± 1.5 mm for molars. In the lower jaw, the mean values were 1.3 ± 0.8 mm for incisors, 1.7 ± 1.2 mm for canines, 2.3 ± 1.3 mm for premolars, and 2.6 ± 1.7 mm for molars. In the upper jaw, more than 55% of maxillary teeth (excluding second premolars and molars) presented mean height differences greater than 1 mm. In the mandible, more than 60% of incisors showed a buccal bone thickness of 1 mm from the apical to lingual aspect. All teeth except the second premolar presented a buccal wall located more than 1 mm more apically than the lingual bone wall.

Conclusions

The buccal bone wall is located more apically (greater than 1 mm) than the palatal or lingual table in most of the cases assessed. The thickness of the palatal or lingual table is also less than 2 mm in the maxilla and mandible, except in the upper canines and premolars and the lower molars.
Insulin resistance, diabetic kidney disease, and all-cause mortality in individuals with type 2 diabetes: a prospective cohort study
Authors:   for the Renal Insufficiency And Cardiovascular Events (RIACE) Study Group, Penno Giuseppe , Solini Anna , Orsi Emanuela , Bonora Enzo , Fondelli Cecilia , Trevisan Roberto , Vedovato Monica , Cavalot Franco , Zerbini Gianpaolo , Lamacchia Olga , Nicolucci Antonio , Pugliese Giuseppe
Published: March 2021

Background

It is unclear whether insulin resistance (IR) contributes to excess mortality in patients with type 2 diabetes independent of diabetic kidney disease (DKD), which is strongly associated with IR and is a major risk factor for cardiovascular disease (CVD), the main cause of death in these individuals. We tested this hypothesis in patients with type 2 diabetes from the Renal Insufficiency And Cardiovascular Events Italian Multicentre Study.

Methods

This observational, prospective, cohort study enrolled 15,773 patients with type 2 diabetes attending 19 Italian Diabetes Clinics in 2006–2008. Insulin sensitivity was assessed as estimated glucose disposal rate (eGDR), which was validated against the euglycaemic-hyperinsulinemic clamp technique. Vital status on October 31, 2015, was retrieved for 15,656 patients (99.3%). Participants were stratified by eGDR tertiles from T1 (≥ 5.35 mg/kg/min) to T3 (≤ 4.14 mg/kg/min, highest IR).

Results

CVD risk profile was worse in T2 and T3 vs T1. eGDR tertiles were independently associated with micro- and macroalbuminuria and the albuminuric DKD phenotypes (albuminuria with preserved or reduced estimated glomerular filtration rate [eGFR]) as well as with eGFR categories or the nonalbuminuric DKD phenotype. Over a 7.4-year follow-up, unadjusted death rates and mortality risks increased progressively across eGDR tertiles, but remained significantly elevated after adjustment only in T3 vs T1 (age- and gender- adjusted death rate, 22.35 vs 16.74 per 1000 person-years, p < 0.0001, and hazard ratio [HR] adjusted for multiple confounders including DKD, 1.140 [95% confidence interval [CI], 1.049–1.238], p = 0.002). However, eGDR was independently associated with mortality in participants with no DKD (adjusted HR, 1.214 [95% CI, 1.072–1.375], p = 0.002) and in those with nonalbuminuric DKD (1.276 [1.034–1.575], p = 0.023), but not in those with the albuminuric DKD phenotypes. Moreover, the association was stronger in males and in younger individuals and was observed in those without but not with prior CVD, though interaction was significant only for age.

Conclusions

The proxy of insulin sensitivity eGDR predicts all-cause mortality in type 2 diabetes, independent of confounders including DKD. However, the impact of IR in individuals with albuminuric DKD may be mediated by its relationship with albuminuria.

Trial registration

ClinicalTrials.gov, NCT00715481, retrospectively registered 15 July 2008.
Correction to: Does pulmonary subspecialty referral from primary care affect the adherence to vaccination recommendations in COPD patients?
Authors: Ehteshami‑Afshar Solmaz , Crothers Kristina , Rodwin Benjamin , Bade Brett , Brandt Cynthia , Akgün Kathleen M.
Published: March 2021

An amendment to this paper has been published and can be accessed via the original article.
Fractional unit-root tests allowing for a fractional frequency flexible Fourier form trend: predictability of Covid-19
Authors: Omay Tolga , Baleanu Dumitru
Published: March 2021

In this study we propose a fractional frequency flexible Fourier form fractionally integrated ADF unit-root test, which combines the fractional integration and nonlinear trend as a form of the Fourier function. We provide the asymptotics of the newly proposed test and investigate its small-sample properties. Moreover, we show the best estimators for both fractional frequency and fractional difference operator for our newly proposed test. Finally, an empirical study demonstrates that not considering the structural break and fractional integration simultaneously in the testing process may lead to misleading results about the stochastic behavior of the Covid-19 pandemic.
Recommendations for Face Coverings While Exercising During the COVID-19 Pandemic
Authors: Shurlock Jonathan , Muniz-Pardos Borja , Tucker Ross , Bachl Norbert , Papadopoulou Theodora , Holloway Graham , Jones Nigel , Bigard Xavier , Vonbank Karin , Niederseer David , Meyer Joachim , Nowak Dennis , Debruyne Andre , Zupet Petra , Löllgen Herbert , Steinacker Juergen M. , Wolfarth Bernd , Bilzon James L. J. , Ionescu Anca , Dohi Michiko , Swart Jeroen , Constantinou Demitri , Badtieva Victoriya , Zelenkova Irina , Casasco Maurizio , Geistlinger Michael , Fossati Chiara , Fagnani Federica , Di Luigi Luigi , Webborn Nick , Angeloudis Konstantinos , Guppy Fergus M. , Singleton Patrick , Miller Mike , Pigozzi Fabio , Pitsiladis Yannis P.
Published: March 2021

In an effort to reduce transmission and number of infections of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) virus, governments and official bodies around the world have produced guidelines on the use of face masks and face coverings. While there is a growing body of recommendations for healthcare professionals and the wider population to use facial protection in “enclosed spaces” where minimal distancing from other individuals is not possible, there is a dearth of clear guidelines for individuals undertaking exercise and sporting activity. The present viewpoint aims to propose recommendations for face coverings while exercising during the COVID-19 pandemic that consider physical distancing, the environment, the density of active cases associated with the specific sports activity, and the practical use of face coverings in order to reduce potential viral transmission. Recommendations are provided on the basis of very limited available evidence in conjunction with the extensive collective clinical experience of the authors and acknowledging the need to consider the likelihood of the presence of the SARS-CoV-2 in the general population. We recommend that face coverings should be used in any environment considered to be of a high or moderate transmission risk, where tolerated and after individual risk assessment. In addition, as national caseloads fluctuate, individual sporting bodies should consider up to date guidance on the use of face coverings during sport and exercise, alongside other preventative measures.
Cardioprotective effect of Malva verticillata against doxorubicin -induced toxicity in rats
Authors: Ibrahim Doa’a Anwar , Almutawakel Mohammad Abdualqodous , Al-Badani Rowida
Published: March 2021

Background

M. verticillata (Malvaceae) is a medicinal plant used in the treatment of wounds, boils, and liver injuries. The plant leaf extracts possess anti-inflammatory and antioxidant activities. Doxorubicin (DOX) is a potent chemotherapeutic agent used in the treatment of various cancers, but its clinical use is limited by acute and chronic cardiotoxicity. This study aims to evaluate the possible cardioprotective role of Malva verticillata against doxorubicin-induced cardiotoxicity.

Method

Thirty-six male albino rats were divided into six groups, (n = 6): G1: normal control (was given 1 ml/kg of NaCl, 0.9%, twice a week IP), G2: cardiotoxic group (was given 1 mg/kg of DOX twice a week IP). G3 and G4 were given 250 mg/kg and 500 mg/kg of M. verticillata, respectively, while G5 and G6: were given 250, 500 mg/kg of M. verticillata PO and 1 mg/kg IP of DOX. for 6 weeks. Total body weight was taken weekly and Heart: body weight ratio was calculated. Blood samples were collected for determination of serum lactate dehydrogenase (LDH), creatine phosphokinase (CPK) and Troponin, the hearts were removed and processed for histopathological examination.

Results

M. verticillata showed a significant dose-dependent reduction in the cardiac enzyme levels, LDH, CPK activities, and Troponin levels. The histopathological studies in rat hearts also supported those findings.

Conclusion

The present study suggests that M. verticillata may have a novel and worthwhile cardioprotective effect against DOX-induced cardiotoxicity.
Recognition and management of depression in early psychosis
Authors: Bashir Zainab , Griffiths Sian Lowri , Upthegrove Rachel
Published: March 2021

Aims and method

Depression in first-episode psychosis (FEP) is highly prevalent and associated with poor outcomes; it has become increasingly recognised and adopted in national and international guidelines for psychosis. Using a 26-item questionnaire, this study aimed to explore if this shift has led to greater recognition among UK psychiatrists, and more effective management of depression in FEP.

Results

Of the 297 respondents, 54.4% observed depression occurring in chronic psychosis, with the least number of respondents (17.7%) identifying depression occurring frequently during FEP. Although there was reasonable agreement in the use of antidepressants as a first-line treatment for depression (70% prescribing antidepressants), there was uncertainty around assessing depression and delineating from psychosis symptoms, and particularly negative symptoms.

Clinical implications

Evidence-based treatments for comorbid depression in psychosis will lead to clearer national guidelines, allowing for optimal management of depression in early psychosis, potentially leading to improved outcomes for these individuals.
Popularizing and Promoting Nene Hatun as an Iconic Turkish Mother in Early Cold War Turkey
Authors: Emen-Gökatalay Gözde
Published: March 2021

This article traces Nene Hatun’s popularity and legacy for women’s image in Turkey. The rediscovery of Nene Hatun and the political construction of her public image during the rule of the Democratic Party (DP), as an icon of anticommunist Turkish mothers, not only maps out the gendered effects of intensified anticommunist policies in Turkey in the period under consideration but also showcases the immediate consequences of the growing conservative discourses and gender anxieties on the public images and roles of women. Exemplified by Nene Hatun’s sudden popularity, the 1950s witnessed a change in the references to motherhood in the discourses of politicians and other public figures. Framing the family roles of women as a question of security, such discourses referred to mothers as the protectors of family values against communist threats, which assigned further domestic duties to women in Turkey, already living in a strongly patriarchal society.