bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effects of Implementing a “Waterfall” Emergency Physician Attending Schedule
Authors: Spiegelman Lindsey , Jen Maxwell , Matonis Danielle , Gibney Ryan , Soheil Saadat , Sakaria Sangeeta , Wray Alisa , Toohey Shannon
Published: July 2021

Introduction: Increases in emergency department (ED) crowding and boarding are a nationwide issue resulting in worsening patient care and throughput. To compensate, ED administrators often look to modifying staffing models to improve efficiencies.

Methods: This study evaluates the impact of implementing the waterfall model of physician staffing on door-to-doctor time (DDOC), door-to-disposition time (DDIS), left without being seen (LWBS) rate, elopement rate, and the number of patient sign-outs. We examined 9,082 pre-intervention ED visits and 8,983 post-intervention ED visits.

Results: The change in DDOC, LWBS rate, and elopement rate demonstrated statistically significant improvement from a mean of 65.1 to 35 minutes (P <0.001), 1.12% to 0.92% (P = 0.004), and 3.96% to 1.95% (P <0.001), respectively. The change in DDIS from 312 to 324.7 minutes was not statistically significant (P = 0.310). The number of patient sign-outs increased after the implementation of a waterfall schedule (P <0.001).

Conclusion: Implementing a waterfall schedule improved DDOC time while decreasing the percentage of patients who LWBS and eloped. The DDIS and number of patient sign-outs appears to have increased post implementation, although this may have been confounded by the increase in patient volumes and ED boarding from the pre- to post-intervention period.
Perceptions of Emergency Care by Sexual and Gender Minorities in Colorado: Barriers, Quality, and Factors Affecting Identity Disclosure
Authors: LaPlant William , Kattari Leonardo , Ross Lexie , Zhan Jennifer , Druck Jeffrey
Published: July 2021

Introduction: Expanding on data concerning emergency department (ED) use and avoidance by the sexual minority (those who identify as lesbian, gay, bisexual, queer, other [LGTBQ+]) and gender minority (those who identify as transgender, gender nonconforming, other) community may inform future ED LGTBQ+ training and clinical practice. Investigation objectives included characterizing rates of emergency care avoidance, identifying barriers to emergency care, and assessing emergency care quality and cultural competency for sexual and gender minorities.

Methods: In this population-based, cross-sectional needs assessment, sexual minority, gender minority, and/or cisgender heterosexual-identified participants were selected based on participants’ subscription to newsletters or social media accounts for One Colorado, an LGBTQ+ advocacy organization. Each participant completed a single digital survey that collected qualitative and quantitative data about ED perception, use, and demographics.

Results: A total of 477 LGBTQ+ or heterosexual-identified individuals (mean age = 44.3 (standard deviation [SD] = 16.7)) participated in the study. Lifetime emergency care avoidance rates for gender minorities were markedly increased (odds ratio [OR] 3.8, 95% confidence interval [CI], 2.2 – 6.6; P <.001), while avoidance rates for sexual minorities were similar to those of cisgender heterosexual respondents (17% vs 14%; P <.001). Gender minorities were more likely than sexual minorities to both avoid emergency care due to fear of discrimination (43% vs 15%; P =.002) and to have experienced discrimination during their last ED visit (OR 11, [95% CI, 5–24]; P <.001). No significant differences were observed between participants in care avoidance due to financial reasons or prior negative experiences. No cited ED factors that influenced identity disclosure decisions were distinctly predictive.

Conclusion: Gender minorities are more likely than sexual minorities and heterosexual cisgender individuals to report ED avoidance and discrimination at last ED visit. Future work characterizing deficits in LGBTQ+ ED care might reduce these avoidance and discrimination rates, enhancing the level of patient care provided to this population.
The Role of Gender in Nurse-Resident Interactions: A Mixed-methods Study
Authors: Cleveland Manchanda Emily , Chary Anita , Zanial Noor , Nadeau Lauren , Verstreken Jennifer , Shappell Eric , Macias-Konstantopoulos Wendy , Dobiesz Valerie
Published: July 2021

Introduction: The role of gender in interprofessional interactions is poorly understood. This mixed-methods study explored perceptions of gender bias in interactions between emergency medicine (EM) residents and nurses.

Methods: We analyzed qualitative interviews and focus groups with residents and nurses from two hospitals for dominant themes. An electronic survey, developed through an inductive-deductive approach informed by qualitative data, was administered to EM residents and nurses. Quantitative analyses included descriptive statistics and between-group comparisons.

Results: Six nurses and 14 residents participated in interviews and focus groups. Key qualitative themes included gender differences in interprofessional communication, specific examples of, and responses to, gender bias. Female nurses perceived female residents as more approachable and collaborative than male residents, while female residents perceived nurses’ questions as doubting their clinical judgment. A total of 134 individuals (32%) completed the survey. Females more frequently perceived interprofessional gender bias (mean 30.9; 95% confidence interval {CI}, 25.6, 36.2; vs 17.6 [95% CI, 10.3, 24.9). Residents reported witnessing interprofessional gender bias more frequently than nurses (58.7 (95% CI, 48.6, 68.7 vs 23.9 (95% CI, 19.4, 28.4). Residents reported that gender bias affected job satisfaction (P = 0.002), patient care (P = 0.001), wellness (P = 0.003), burnout (P = 0.002), and self-doubt (P = 0.017) more frequently than nurses.

Conclusion: Perceived interprofessional gender bias negatively impacts personal wellbeing and workplace satisfaction, particularly among female residents. Key institutional stakeholders including residency, nursing, and hospital leadership should invest the resources necessary to develop and integrate evidence-based strategies to improve interprofessional relationships that will ultimately enhance residency training, work climate, and patient care.
A Novel, Low-cost, Low-fidelity Pericardiocentesis Teaching Model
Authors: Lord Spencer , Lord Garrett , Geary Sean
Published: July 2021

Introduction: Pericardiocentesis is a high-risk/low-frequency procedure important to emergency medicine (EM). However, due to case rarity it is not often performed on a patient during residency training. Because the coronavirus disease 2019 pandemic limited cadaver-based practice, we developed a novel, low-cost, low-fidelity pericardiocentesis model using three dimensional-printing technology to provide advances on prior home-made models.

Methods: Residents watched a 20-minute video about performing a pericardiocentesis and practiced both a blind and ultrasound-guided technique. We assessed model fidelity, convenience, and perceived provider competence via post-workshop questionnaire.

Results: A total of 24/26 (93%) individuals practicing on the ultrasound-guided model and 22/24 (92%) on the blind approach model agreed or strongly agreed that the models reasonably mimicked a pericardial effusion.

Conclusion: Our low-cost, low-fidelity model is durable, mimics the clinical case, and is easy to use. It also addresses known limitations from prior low-fidelity models.
Evaluating Reproducibility and Transparency in Emergency Medicine Publications
Authors: Johnson Bradley , Rauh Shelby , Tritz Daniel , Schiesel Michael , Vassar Matt
Published: July 2021

Introduction: We aimed to assess the reproducibility of empirical research by determining the availability of components required for replication of a study, including materials, raw data, analysis scripts, protocols, and preregistration.

Methods: We used the National Library of Medicine catalog to identify MEDLINE-indexed emergency medicine (EM) journals. Thirty journals met the inclusion criteria. From January 1, 2014– December 31, 2018, 300 publications were randomly sampled using a PubMed search. Additionally, we included four high-impact general medicine journals, which added 106 publications. Two investigators were blinded for independent extraction. Extracted data included statements regarding the availability of materials, data, analysis scripts, protocols, and registration.

Results: After the search, we found 25,473 articles, from which we randomly selected 300. Of the 300, only 287 articles met the inclusion criteria. Additionally, we added 106 publications from high- impact journals of which 77 met the inclusion criteria. Together, 364 publications were included, of which 212 articles contained empirical data to analyze. Of the eligible empirical articles, 2.49%, (95% confidence interval [CI], 0.33% to 4.64%] provided a material statement, 9.91% (95% CI, 5.88% to 13.93%) provided a data statement, 0 provided access to analysis scripts, 25.94% (95% CI, 20.04% to 31.84%) linked the protocol, and 39.15% (95% CI, 32.58% to 45.72%) were preregistered.

Conclusion: Studies in EM lack indicators required for reproducibility. The majority of studies fail to report factors needed to reproduce research to ensure credibility. Thus, an intervention is required and can be achieved through the collaboration of researchers, peer reviewers, funding agencies, and journals.
Emergency Department-initiated High-flow Nasal Cannula for COVID-19 Respiratory Distress
Authors: Jarou Zachary , Beiser David , Sharp Willard , Ravi Chacko Ravi , Goode Deirdre , Rubin Daniel , Kurian Dinesh , Dalton Allison , Estime Stephen , O’Connor Michael , Patel Bhakti , Kress John , Spiegel Thomas
Published: July 2021

Introduction: Patients with coronavirus disease 2019 (COVID-19) can develop rapidly progressive respiratory failure. Ventilation strategies during the COVID-19 pandemic seek to minimize patient mortality. In this study we examine associations between the availability of emergency department (ED)-initiated high-flow nasal cannula (HFNC) for patients presenting with COVID-19 respiratory distress and outcomes, including rates of endotracheal intubation (ETT), mortality, and hospital length of stay.

Methods: We performed a retrospective, non-concurrent cohort study of patients with COVID-19 respiratory distress presenting to the ED who required HFNC or ETT in the ED or within 24 hours following ED departure. Comparisons were made between patients presenting before and after the introduction of an ED-HFNC protocol.

Results: Use of HFNC was associated with a reduced rate of ETT in the ED (46.4% vs 26.3%, P <0.001) and decreased the cumulative proportion of patients who required ETT within 24 hours of ED departure (85.7% vs 32.6%, P <0.001) or during their entire hospitalization (89.3% vs 48.4%, P <0.001). Using HFNC was also associated with a trend toward increased survival to hospital discharge; however, this was not statistically significant (50.0% vs 68.4%, P = 0.115). There was no impact on intensive care unit or hospital length of stay. Demographics, comorbidities, and illness severity were similar in both cohorts.

Conclusions: The institution of an ED-HFNC protocol for patients with COVID-19 respiratory distress was associated with reductions in the rate of ETT. Early initiation of HFNC is a promising strategy for avoiding ETT and improving outcomes in patients with COVID-19
Cross-sectional Analysis of Food Insecurity and Frequent Emergency Department Use
Authors: Estrella Alex , Scheidell Joy , Khan Maria , Castelblanco Donna , Mijanovich Tod , Lee David , Gelberg Lillian , Doran Kelly
Published: July 2021

Introduction: Emergency department (ED) patients have higher than average levels of food insecurity. We examined the association between multiple measures of food insecurity and frequent ED use in a random sample of ED patients.

Methods: We completed survey questionnaires with randomly sampled adult patients from an urban public hospital ED (n = 2,312). We assessed food insecurity using four questions from the United States Department of Agriculture Household Food Security Survey. The primary independent variable was any food insecurity, defined as an affirmative response to any of the four items. Frequent ED use was defined as self-report of ≥4 ED visits in the past year. We examined the relationship between patient food insecurity and frequent ED use using bivariate and multivariable analyses and examined possible mediation by anxiety/depression and overall health status.

Results: One-third (30.9%) of study participants reported frequent ED use, and half (50.8%) reported any food insecurity. Prevalence of food insecurity was higher among frequent vs. non-frequent ED users, 62.8% vs 45.4% (P <0.001). After controlling for potential confounders, food insecurity remained significantly associated with frequent ED use (adjusted odds ratio 1.48, 95% confidence interval, 1.20-1.83). This observed association was partially attenuated when anxiety/depression and overall health status were added to models.

Conclusion: The high observed prevalence of food insecurity suggests that efforts to improve care of ED patients should assess and address this need. Further research is needed to assess whether addressing food insecurity may play an important role in efforts to reduce frequent ED use for some patients.
Racial Discrimination from Patients: Institutional Strategies to Establish Respectful Emergency Department Environments
Authors: Chary Anita , Fofana Mariam , Kohli Harajeshwar
Published: July 2021

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A Review of COVID-19-Related Publications and Lag Times During the First Six Months of the Year 2020
Authors: Carvalho Christopher , Fuller Matthew , Quaidoo Emmanuel , Haider Ahson , Rodriguez Jonathan , Wong Angela , Duong Mindy , Rodriguez Robert
Published: July 2021

Introduction: Considering the need for information regarding approaches to prevention and treatment of coronavirus disease 2019 (COVID-19), we sought to determine publication lag times of COVID-19-related original research articles published in top general medicine and emergency medicine (EM) journals. We further sought to characterize the types of COVID-19 publications within these journals.

Methods: We reviewed 125 top-ranked general medicine journals and 20 top-ranked EM-specific journals for COVID-19-related publications. We abstracted article titles and manuscript details for each COVID-19-related article published between January 1–June 30, 2020, and categorized articles as one of the following: original research; case report; review; or commentary. We abstracted data for preprint publications over the same time period and determined whether articles from the general medicine and EM journals had been previously published as preprint articles. Our primary outcomes were the following: 1) lag time (days) between global cumulative World Health Organization (WHO)-confirmed cases of COVID-19 and publications; 2) lag times between preprint article publication and peer-reviewed journal publication; and 3) lag times between submission and publication in peer-reviewed journals. Our secondary outcome was to characterize COVID-19-related publications.

Results: The first original research publications appeared in a general medicine journal 20 days and in an EM journal 58 days after the first WHO-confirmed case of COVID-19. We found median and mean lag times between preprint publications and journal publications of 32 days (19, 49) and 36 days (22) for general medicine journals, and 26 days (16, 36) and 25 days (13) for EM journals. Median and mean lag times between submission and publication were 30 days (19, 45) and 35 days (13) for general medicine journals, and 23 days (11, 39) and 27 days (19) for EM journals. Of 2530 general medicine journal articles and 351 EM journal articles, 28% and 23.6% were original research. We noted substantial closing of the preprint to peer-reviewed publication (160 days pre-pandemic) and peer-reviewed journal submission to publication (194 days pre-pandemic) lag times for COVID-19 manuscripts.

Conclusion: We found a rapid and robust response with shortened publication lag times to meet the need for the publication of original research and other vital medical information related to COVID-19 during the first six months of 2020.
Descriptive Analysis of Components of Emergency Medicine Residency Program Websites
Authors: Pollock Jordan , Weyand Jeffery , Reyes Amy , Senemar Shiva , Swenson Aunika , Lindor Rachel , Homme James
Published: July 2021

Introduction: Most emergency medicine (EM) applicants use the internet as a source of information when evaluating residency programs. Previous studies have analyzed the components of residency program websites; however, there is a paucity of information regarding EM program websites. The purpose of our study was to analyze information on EM residency program websites.

Methods: In April–May 2020, we evaluated 249 United States EM residency program websites for presence or absence of 38 items relevant to EM applicants. Descriptive statistics were performed, including means and standard deviations.

Results: Of the 249 EM websites evaluated, the websites contained a mean of 20 of 38 items (53%). Only 16 programs (6%) contained at least three-quarters of the items of interest, and no programs contained all 38 items. The general categories with the least amount of items were social media use (9%), research (46%), and lifestyle (49%), compared to the other general categories such as application process (58%), resident information (63%), general program information (67%), and facility information (69%). The items provided by programs most often included program description (98%), blocks and rotations (91%), and faculty listing (88%). The items provided least often included housing/neighborhood information (17%) and social media links (19%).

Conclusion: Our comprehensive review of EM residency websites in the US revealed the absence of many variables on most programs’ websites. Use of this information to enhance accessibility of desired information stands to benefit both applicants and programs in the increasingly competitive specialty of EM.
Clinical, Operational, and Socioeconomic Analysis of EMS Bypass of the Closest Facility for Pediatric Asthma Patients
Authors: Finlay Erik , Palmer Sam , Abes Benjamin , Abo Benjamin , Fishe Jennifer
Published: July 2021

Introduction: Pediatric hospital care is becoming increasingly regionalized, with fewer facilities providing inpatient care for common conditions such as asthma. That trend has major implications for emergency medical services (EMS) medical care and operations because EMS historically transports patients to the closest facility. This study describes EMS transport patterns of pediatric asthma patients in greater depth, including an analysis of facility bypass rates and the association of bypass with demographics and clinical outcomes. Methods: This was a retrospective study of pediatric asthma patients ages 2-18 years transported by Lee County, FL EMS between March 1, 2018 – December 31, 2019. A priori, we defined bypass as greater than five minutes extra transport time. We performed geospatial analysis and mapping of EMS pediatric asthma encounters. We used the Pediatric Destination Tree (PDTree) project’s tiered approach to characterize receiving hospital facility pediatric capability. We analyzed incidence and characteristics of bypass, and bypass and non-bypass patient characteristics including demographics, emergency department (ED) clinical outcomes, and socioeconomic disadvantage (SED). Results: From the study period, there were a total of 262 encounters meeting inclusion criteria, 254 (96.9%) of which could be geocoded to EMS incident and destination locations. Most encounters (72.8%) bypassed at least one facility, and the average number of facilities bypassed per encounter was 1.52. For all 185 bypass encounters, there was a median additional travel time of 13.5 minutes (interquartile range 7.5 – 17.5). Using the PDTree’s classification of pediatric capability of destination facilities, 172 of the 185 bypasses (93%) went to a Level I facility. Bypass incidence varied significantly by age, but not by minority status, asthma severity, or by the area deprivation index of the patient’s home address. Overall, the highest concentrations of EMS incidents tended to occur in areas of greater SED. With regard to ED outcomes, ED length of stay did not vary between bypass and non-bypass patients (P = 0.54), and neither did hospitalization (P = 0.80). Conclusion: We found high rates of bypass for pediatric EMS encounters for asthma exacerbations, and that bypass frequency was significantly higher in younger age groups. With national trends pointing toward increasing pediatric healthcare regionalization, bypass has significant implications for EMS operations.
An Assessment of the Social Determinants of Health in an Urban Emergency Department
Authors: Ordonez Edgardo , Dowdell Katherine , Navejar Natasha , Dongarwar Deepa , Itani Aya , Salihu Hamisu
Published: July 2021

Introduction: Social determinants of health (SDOH) have significant impacts on patients who seek care in the emergency department (ED). We administered a social needs screening tool and needs assessment survey to assess SDOH and evaluate for trends in the population of patients visiting our ED.

Methods: A survey was distributed via convenience sampling to adult ED patients to capture self-reported demographic information and data about social needs. We categorized the questions related to SDOH based on the International Classification of Diseases, Tenth Revision, Clinical Modification coding format and created a composite variable called “SDOH Strata” based on the SDOH Index scores (0-5-low, 6-10-middle, or ≥11-high). We conducted bivariate analyses using the sociodemographic characteristics of the patients and their SDOH Strata using Fisher’s exact test. We then conducted multinomial logistic regression to examine the association between the patients’ sociodemographic characteristics and the SDOH Strata.

Results: A total of 269 surveys were collected. We observed that Hispanic/Latino patients were more than two times as likely (odds ratio: 2.04, 95% confidence interval [CI], 1.12,-6.51) to be in the higher impact stratum than in the lower impact stratum. Those who were undocumented had 3.43 times increased adjusted odds (95% CI, 1.98, 9.53) of being in the higher than the lower impact stratum compared to US citizens. Additionally, people speaking Spanish as their primary language were 5.16 times as likely to be in the higher impact stratum compared to the reference (English-speaking and lower impact stratum).

Conclusion: In our patient population, patients noted to have the highest impact burden of the SDOH were those who identified as Hispanic/Latino, Spanish-speaking, and undocumented immigrant status.
Comment on “Misunderstanding the Match: Do Students Create Rank Lists Based on True Preference
Authors: Connors Nicholas , French David
Published: July 2021

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Response to “Misunderstanding the Match: Do Students Create Rank Lists Based on True Preferences?”
Authors: Schnapp Benjamin , Ulrich Katie , Hess Jamie , Kraut Aaron , Tillman David , Westergaard Mary
Published: July 2021

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Comparison of Effects of High-Intensity Interval Training and Continuous Training on Memory and Correlation with Antioxidant Enzyme Activity in the Rat Brain
Authors: Taheri Chadorneshin Hossein , Nayebifar Shila , Abtahi-Eivary Seyed-Hosein , Nakhaei Hossein
Published: July 2021

Objectives: This study aimed to investigate the effects of six-week continuous training (CT) and high-intensity interval training (HIIT) protocols on brain superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPX) activities and their associations with short-, mid-, and long-term memory in albino Wistar rats. Methods: In this study, 18 male albino Wistar rats (5 months old) were randomly assigned to three equal (n = 6) groups of sedentary control (SC), CT, and HIIT. Both CT and HIIT regimens were performed for 6 consecutive days per week for 6 weeks. Results: Both HIIT and CT regimens increased short-, mid-, and long-term memory, and the alterations were greater following HIIT than CT. In addition, both HIIT and CT regimens significantly increased SOD activity, with a higher elevation following HIIT than CT. Moreover, brain SOD activity positively correlated with short-, mid-, and long-term memory. However, neither CT nor HIIT had a significant effect on brain GPX and CAT activities. Conclusions: The HIIT regimen is highly potential, as opposed to the CT regimen, to improve memory function through a greater increase in the SOD activity of the brain.
Comparative Study Between Serum Level of Total L-carnitine in Neonatal Hypoxic Ischemic Encephalopathy (HIE) and Transient Tachypnea of the Newborn (TTN)
Authors: Shalaby Amira M. , Gad Eman Fathala , Eldin Eman Mohammed Salah , El-Deeb Safiea A. , Abdel-Aziz Safwat M.
Published: July 2021

Background: Neonatal hypoxic-ischemic encephalopathy (HIE) is one of the most common causes of cerebral palsy. Objectives: We aimed to compare the serum levels of total L-carnitine in newborns with HIE and Transient tachypnea of the newborn and to determine the correlation between associated demographic data, associated changes in laboratory findings, and outcome in cases with HIE. Methods: This comparative, prospective, and observational study was conducted at the Neonatal Intensive Care Unit (NICU) of Assiut University Children Hospital. All the cases of perinatal asphyxia and TTN admitted to the NICU during 2016 - 2018 were included. Results: It was found that the serum level of total L-carnitine decreased in both HIE (I) and TTN (II) cases, but the difference was not significant (5.51 ± 1.30 µmol/L in group I vs. 6.22 ± 2.56 µmol/l in group II). Male factor with changes in the serum sodium level (132.63 ± 9.30) and abnormal serum creatinine level (1.4 [0.7 - 15.0]) were significantly related to the outcome of HIE cases. Conclusions: The serum level of total L-carnitine declined in both HIE and TTN cases. Male factor with changes in serum sodium level and abnormal serum creatinine level were significantly related to the mortality of cases with HIE.
Status of Knowledge Sharing Intention Among the Faculty Members of Kermanshah University of Medical Sciences, Iran (2019)
Authors: Khosravifar Mina , Jalili Cyrus , Jalilian Farzad , Mirzaei-Alavijeh Mehdi , Morovati Sanaz
Published: July 2021

Background: Knowledge sharing within an organization plays a key role in developing scientific production. Objectives: The present study aimed to predict the knowledge sharing intention among the faculty members of Kermanshah University of Medical Sciences (KUMS), Iran. Methods: This cross-sectional study was conducted on 154 faculty members of KUMS in the spring of 2019. Participants were selected via random sampling with a probability proportional to size. Data were collected using self-report questionnaires. Data analysis was performed in SPSS version 16 using independent t-test, one-way analysis of variance (ANOVA), bivariate correlations, and linear regression analysis at 95% significance level. Results: The most significant predictors of knowledge sharing intention were attitude (β = 0.387) and perceived behavioral control (β = 0.215). In addition, the predictive constructs of attitude, subjective norms, and perceived behavioral control constituted 25% of the variation in the outcome measure of knowledge sharing intention. Conclusions: According to the results, designing interventions focusing on the constructs of attitude and perceived behavior control could yield beneficial findings for promoting knowledge sharing among faculty members.
Combined First-trimester Screening of Trisomy 21 in Women of Different Ages in Southwest Iran
Authors: Dorostghoal Mehran , Barati Mojgan , Harfsheno Mojgan
Published: July 2021

Background: There is evidence that the incidence of trisomy 21 has a direct linear relationship with maternal age, and older women are at a higher risk for giving birth to neonates with Down syndrome (DS). Objectives: The present study aimed to evaluate the performance and effectiveness of combined first-trimester screening (FTS) for DS in women of different ages in Southwest Iran. Methods: In this cross-sectional study, FTS was conducted on 7192 pregnant women in the 11th to 13th week of gestational age, referred to the Narges Medical Genetics and Prenatal Diagnosis Laboratory, Ahvaz, Iran. Amniocentesis and cytogenetic analysis were performed in all women with an estimated risk of 1 in 100 and above. Results: The FTS detection rate of DS was 83.3%, with the false positive rates of 2.1% and 13.5% in young women and those over 35 years, respectively. A significant correlation (r = 0.137, P < 0.001) was observed between the high risk of DS (1:100) and maternal age. The high risk of DS was found to be higher in women over 35 years of age than those under 35 years old (6.67% vs. 1.95%). Total DS prevalence was 2.64 per 1000 cases. The prevalence of DS in women under and over 35 years of age was 1.95 and 6.67 per 1000 pregnancies, respectively. Conclusions: First-trimester screening is an effective method for estimating the risk of DS in women under or over 35 years of age. Although an advanced maternal age is associated with a higher prevalence of DS, clinicians should recommend FTS as the first-line screening method regardless of maternal age.
Scientific Publishing in Biomedicine: How to Write a Cover Letter?
Authors: Bahadoran Zahra , Mirmiran Parvin , Kashfi Khosrow , Ghasemi Asghar
Published: July 2021

: A cover (covering) letter is a brief business letter introducing the scientific work alongside the submission process of a manuscript and is required by most scientific peer-review journals. A typical cover letter includes the name of the editor and the journal, date of submission, the characteristics of the manuscript, the importance of the work and its relevance to prospective audiences, declarations such as author agreements, conflicts of interest statement, funding source (s), and ethical statements. The letter also includes the contact information of the corresponding author (s) and may also include suggestions of potential reviewers. Spending enough time to draft an informative, comprehensive, and concise cover letter is quite worthwhile; a poorly drafted one would not persuade the editor that the submitted work is fit for publication and may lead to immediate rejection. Here, we provide a practical guide to draft a well-written, concise, and professional cover letter for a scientific medical paper.
The Multi-slice Spiral Computed Tomography (MSCT) Features of Thin-Walled Cystic Lung Cancer with Ground Glass Opacity
Authors: Yu Yejun
Published: July 2021

Background: Lung cancer is the leading cause of cancer-related mortality worldwide. Thin-walled cystic lung cancer with ground glas s opacity (GGO) is a type of lung carcinoma with specific computed tomography (CT) features. Objectives: To investigate the imaging features of multi-slice spiral computed tomography (MSCT) of GGO and to improve the imaging diagnosis of this type of lung cancer. Patients and Methods: The clinical data of 24 patients with pathologically confirmed thin-walled cystic lung cancer with GGO were retrospectively analyzed in this study. The imaging features of preoperative MSCT, including vascular convergence, burr signs, pleural depression signs, lobulation signs, thickness and uniformity of the cavity wall, partitive membranes, and position of the ground-glass cavity, were examined. The relationship between the imaging features and postoperative pathological findings of lung carcinoma were also explored. Results: Most of the lesions (75.0%) were located in the upper lobe of the lungs. The size range of the cavity was 5.8 - 28.1 mm, with a mean of 13.6 ± 7.2 mm. Fifteen patients (62.5%) had a cavity wall thickness < 2 mm, 6 (25.0%) patients had a cavity wall thickness in the range of 2 - 3 mm, and 3 (12.5%) patients had a cavity wall thickness of about 3 - 4 mm. A uniform cavity wall was found in 10 (41.7%) cases, while a non-uniform cavity wall was observed in 14 (58.3%) cases. Eleven patients showed pure GGO (45.8%), while 13 patients showed mixed GGO (54.2%). Besides, nine patients (37.5%) showed lobular signs, 12 (50.0%) patients showed spicule signs, and 6 (28.6%) patients showed vascular convergence signs. Twelve patients (50.0%) had signs of pleural indentation, while 14 (66.7%) patients showed thick or thin small blood vessel opacity or fine partitive membranes. Twenty-three patients were diagnosed with lung adenocarcinoma, while one patients was diagnosed with mixed adenosquamous carcinoma. Conclusion: Thin-walled cystic lung cancer with GGO is a rare clinical phenomenon. The imaging features of this type of lung cancer on MSCT are consistent with the characteristics of lung cancers.
Population Age Structures of Nations with COVID-19 and Attributed Deaths
Authors: Mahzoon Ali Akbar , Ghasemi Saleh , Dabbagh Ali , Akbari Mohammad , Ashrafizadeh Hadis , Javadinasab Hamideh , Akbari Mohammad Esmaeil
Published: July 2021

Background: The COVID-19 pandemic is one of the greatest challenges the world has faced during the last decades that has affected every aspect of human life. Objectives: This study aimed to identify the effects of the age composition of the countries on global mortality and the final outcome of the COVID-19 outbreak. Methods: This ecological observational study used the World Health Organization (WHO) reports for information on COVID-19 in 42 countries with more than 1000 formal COVID-19 reports. The correlation coefficient between age composition pattern and COVID-19 deaths was calculated in selected countries by SPSS. Results: This study demonstrated a positive relationship between COVID-19-attributed death and the country population share of the 50 - 64 years age group at the significance level of 90.8%. The only age range that could affect the nationwide mortality rate was the age range of 50 - 64 years. There was not a significant correlation between COVID-19-attributed death and the population share of 65 years and over. Conclusions: The young population is protective against COVID-19-related death, and they are productive and responsible for community needs during this pandemic crisis. Population aging and the increasing share of the elderly in population is one of the most critical social changes in the 21st century, and its consequences affect almost all sections of the society.
Erectile Dysfunction and Infertility: A Pilot Study in Male Partners of Infertile Couples
Authors: Trinh The Son , Hoang Xuan Su , Hoang Van Ai , Nguyen Ba Trinh , Le Hoang , Quan Van Trang , Pham Duc Minh , Nguyen Thanh Tung , Ngo Anh Tuan , Vu Thi Thu Trang , Do Quyet , Do Nhu Binh
Published: July 2021

Background: Erectile dysfunction (ED) and infertility are important health concerns with negative impacts on the quality of life and couple’s relationship, which is emerging as an early marker for decreased general health. Objectives: This pilot study intended to investigate the prevalence and risk factors of erectile dysfunction in men of infertile couples referred to an in vitro fertility center in northern Vietnam. Methods: A total of 138 men of infertile couples were enrolled in this study from January to May 2018. The International Index of Erectile Function questionnaire scale was used to evaluate the severity of ED. Also, several related factors were collected to determine potential risk factors. Results: The prevalence of ED among was 18.1%, including 13 mild ED (9.4%), 7 mild to moderate ED (5.1%), 2 moderate ED (1.4%), and 1 severe ED (0.7%). The logistic regression analysis showed that risk factors associated ED were smoking > 5 pack/years (OR = 3.16, CI = 0.98 - 10.18; P = 0.05), not graduating from junior high school (OR = 5.11; CI = 1.11 - 23.8; P = 0.03) and azoospermia (OR = 7.55; CI = 2.18 - 26.16; P = 0.001). We observed relatively high OR in men with smoking < 5 pack/years (OR = 2.51) and abnormal semen analysis (hypospermia, oligozoospermia, asthenozoospermia, or teratozoospermia) (OR = 2.36), but there was no significant difference compared to the reference group. Conclusions: In the present study, the prevalence of ED among men of infertile couples was higher than non-infertile men. Low level of education, smoking for a long period, and azoospermia were the main risk factors of ED in men. Further large-scale studies are needed to extend the results.
Parvovirus: Uncommon Causes of Anemia and Kidney Failure in a Kidney Transplant Patient
Authors: Yarmohamadi Maliheh , Yaghoubi Fatemeh
Published: July 2021

: Parvovirus is one of the uncommon causes of anemia in a kidney transplant patient. We reported a kidney transplant patient with parvovirus infection who developed severe anemia three weeks after kidney transplantation. Suspicion of infections increased due to the decrease in erythrocyte level. The patient's anemia became normal with a decrease in the amount of immunosuppressant and treatment with intravenous immunoglobulin (IVIG). Parvovirus B19 infection should be considered in all patients with persistent anemia with or without graft failure after renal transplant.
Factors Associated with Chemotherapy Induced Nausea in Cancer Patients: A Case-Control Study
Authors: Khatiban Mahnaz , Khalili Zahra , Akbarzadeh Mahdi , Moghadarikoosha Mahnaz , Seyedtabib Maryam
Published: July 2021

Background: Chemotherapy-induced nausea (CIN) is one of the most common and uncomfortable symptoms in cancer patients, and different factors can be associated with it. Objectives: This study aimed to determine different factors associated with CIN in cancer patients. Methods: A total of 144 cancer patients were selected by convenience sampling. The patients at acute phase of chemotherapy were assigned to case group (n = 58) if they had nausea or to control group (n = 86) if they did not have nausea. The patients' data were collected using a researcher-made questionnaire including items on potential factors for CIN through interviews with the patients and according to their medical records. Logistic regression models were used to conduct data analysis, and the correlations in question were expressed as odds ratio (OR) at 95% confidence interval (CI). Results: The results showed that the chance of nausea increased by 6.4, 2.4, 1.2, and 1.5 times in case of expected nausea, pain, carbohydrate intake, and smelling a specific odor, respectively. The increasing nausea-inducing effect of drugs led to increased chance of post-chemotherapy nausea (OR = 2.366). Conclusions: Having pain, expecting nausea, carbohydrate intake, smelling a certain odor, and high emetogenic potential of chemotherapy are effective in the development of CIN.
Book review: Llegir la Imatge. Il·lustrar la Paraula. Reflexions al voltant del llibre il·lustrat i el còmic.
Authors: Martínez-Hernández Ana Isabel
Published: July 2021

Llegir la imatge. Il·lustrar la paraula. Reflexions al voltant del llibre il·lustrat i el còmic (Reading the image. Drawing the word. Reflections on comic books and illustrated literature, in English), edited by Julia Haba-Osca and Robert Martínez-Carrasco (2020), is a compendium of short articles written in Catalan. The book is the resulting outcome of a series of conferences, International Symposium of Innovation about Illustrated Literature, celebrated at the Universitat de València. Each of these articles acts as an individual chapter within the book, which compiles a total of fourteen of these. Speakers from different professional backgrounds and fields of knowledge related to the role of the printed image as a means of communication were invited to participate in the symposia and the subsequent compendium. This variety is reflected in the different thoughts, ideas, and views on the role of image in literature that encourage the reader to analyse and consider other perspectives. The book champions the view of illustrated literature as a graphic and visual literary genre in its own right. The book aims to open the reader’s critical eye towards the use of illustrated literature to convey meaning and stimulate the reader’s interpretive skills.
Disrupting cortico-cerebellar communication impairs dexterity
Authors: Guo Jian-Zhong , Sauerbrei Britton A , Cohen Jeremy D , Mischiati Matteo , Graves Austin R , Pisanello Ferruccio , Branson Kristin M , Hantman Adam W
Published: July 2021

To control reaching, the nervous system must generate large changes in muscle activation to drive the limb toward the target, and must also make smaller adjustments for precise and accurate behavior. Motor cortex controls the arm through projections to diverse targets across the central nervous system, but it has been challenging to identify the roles of cortical projections to specific targets. Here, we selectively disrupt cortico-cerebellar communication in the mouse by optogenetically stimulating the pontine nuclei in a cued reaching task. This perturbation did not typically block movement initiation, but degraded the precision, accuracy, duration, or success rate of the movement. Correspondingly, cerebellar and cortical activity during movement were largely preserved, but differences in hand velocity between control and stimulation conditions predicted from neural activity were correlated with observed velocity differences. These results suggest that while the total output of motor cortex drives reaching, the cortico-cerebellar loop makes small adjustments that contribute to the successful execution of this dexterous movement.
Reduced antibody cross-reactivity following infection with B.1.1.7 than with parental SARS-CoV-2 strains
Authors: Faulkner Nikhil , Ng Kevin W , Wu Mary Y , Harvey Ruth , Margaritis Marios , Paraskevopoulou Stavroula , Houlihan Catherine , Hussain Saira , Greco Maria , Bolland William , Warchal Scott , Heaney Judith , Rickman Hannah , Spyer Moria , Frampton Daniel , Byott Matthew , de Oliveira Tulio , Sigal Alex , Kjaer Svend , Swanton Charles , Gandhi Sonia , Beale Rupert , Gamblin Steve J , McCauley John W , Daniels Rodney Stuart , Howell Michael , Bauer David , Nastouli Eleni , Kassiotis George
Published: July 2021

Background:

The degree of heterotypic immunity induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strains is a major determinant of the spread of emerging variants and the success of vaccination campaigns, but remains incompletely understood.

Methods:

We examined the immunogenicity of SARS-CoV-2 variant B.1.1.7 (Alpha) that arose in the United Kingdom and spread globally. We determined titres of spike glycoprotein-binding antibodies and authentic virus neutralising antibodies induced by B.1.1.7 infection to infer homotypic and heterotypic immunity.

Results:

Antibodies elicited by B.1.1.7 infection exhibited significantly reduced recognition and neutralisation of parental strains or of the South Africa variant B.1.351 (Beta) than of the infecting variant. The drop in cross-reactivity was significantly more pronounced following B.1.1.7 than parental strain infection.

Conclusions:

The results indicate that heterotypic immunity induced by SARS-CoV-2 variants is asymmetric.

Funding:

This work was supported by the Francis Crick Institute and the Max Planck Institute for Dynamics of Complex Technical Systems, Magdeburg.
Challenges of and Opportunities for Market Access by Pineapple Agripreneurs in Rangwe Sub County, Homa Bay County, Kenya
Authors: Nyaguti Winstone Asugo , Lagat Job Kibiwot , Bett Hillary , Ogutu Fredrick Onyango
Published: July 2021

Pineapple farming is among the fastest-growing agricultural sub-sectors in Homa Bay County, Kenya specifically Rangwe sub-county. However, limited attention has been given to the market access of this produce. Evidenced by vast quantities of pineapples harvested from the farms and stacked along main highways without targeting a specific market. This result to a small portion being sold and the rest deteriorating, consequently reducing returns for pineapple agripreneurs. Therefore, this paper sought to determine those factors that influences access to formal market by pineapple agripreneurs and as well as find out challenges of and opportunities for accessing formal markets by the Rangwe pineapple agripreneurs. The survey was undertaken in Rangwe Sub-county, and multisampling method was used to select a sample of 183 pineapple agripreneurs from the study area, primary data was collected using a semi-structured survey tool. Data was analyzed by descriptive analysis and Logistic regression model. Results indicated that pineapple agripreneurs were faced with numerous challenges in accessing pineapple market, also there existed several market access opportunities for pineapple agripreneurs. The results of logistic regression analysis revealed extension contacts, education level and price of pineapple as factors that were positively and statistically significant in influencing access to formal markets. While those that were statistically and negatively influencing access to formal market comprised of; age of household head, household size, and type of road. The study recommends;  improvement of road infrastructure in pineapple producing areas so as to improve on their market access; development of policies that encourages capacity building of pineapple agripreneurs in Rangwe sub-county
Fishbone Flour (Definition, Analysis of Quality Characteristics, Manufacture): A Review
Authors: Yusrina Adzhani , Rochima Emma , Handaka Asep Agus , Rostini Iis
Published: July 2021

Fish bones are the largest contributor of waste from the fish processing industry which has not been used optimally. Fish bones have a high calcium content so they can be used as raw material for fish bone flour. This article aims to explain the use of fish bone into fish bone flour, how to process it, and the quality of fish bone flour by physicochemical testing. Fish bone flour can be obtained by extraction using water, alkaline solution and acid solution. The quality characteristics of bone flour can be seen from the water content, ash content, protein content and fat content. Based on several studies, the drying time and temperature affect the physicochemical characteristics of the resulting product.