bluuebunny/crossref_metadata_2025 huggingface dataset:
High-capacity stacking apparatus for thermoforming machine – Part I: Synthesis of intermittent mechanisms as stacker driving units
Authors: Čavić Maja , Penčić Marko , Oros Dragana , Čavić Dijana , Orošnjak Marko , Rackov Milan
Published: August 2021

The paper presents the type and dimensional synthesis of intermittent mechanisms for use in a thermoforming machine high-capacity stacking apparatus. The aim of this paper is to realize the intermittent motion of the working part of the stacker – conveyor, with a completely mechanical system that should enable the adjustment of the operating parameters of the stacker at a constant motor speed. Mechanical control ensures high positioning accuracy of the product ejection panel, as well as high repeatability of the motion cycle of the conveyor, which is key. Based on the set requirements, the concept of a planar mechanism of simple structure was chosen, which enables oscillatory movement of the output link for continuous motion of the input link, in combination with a one-way clutch (OWC). Four types of intermittent mechanisms have been proposed. However, multiple configurations of the same mechanism type can achieve the same output link motion interval, which is why 3 configurations for each mechanism type are considered, with a total of 4 output link motion intervals, which is 12 potential solutions for only one mechanism type. Afterwards, dimensional synthesis was performed for each type of mechanism by using the optimization method. Based on the analysis of the results, all of the mechanism types are potentially usable. After additional analyses, the optimal solution was chosen.
Numerical evaluation on aerodynamic design of pressure-regulating valve in trisonic intermittent wind tunnel
Authors: Zhang Yi , Xiao Yangyi , Zhang Shijie , Yin Yongtao , Wang Chaoqi
Published: August 2021

The pressure-regulating valve can realize the rapid adjustment and precise controlling of operating pressure and Mach number, to stabilize the flow field and avoid the test interference such as the air source loss or the unstable flow. This paper takes the design and optimization of pressure-regulating valve in trisonic intermittent wind tunnel as the research object to investigate its special pressure-regulating characteristic and performance in the wind tunnel. According to the requirement of the wind tunnel, the annular-gap type pressure-regulating valve is selected to match its wide adjustment range of operating parameter, high regulation accuracy, and low running resistance. The design and optimization of the pressure-regulating valve are carried out, including aerodynamic and structural design, analysis on pressure regulation characteristics, kinematics analysis, flow field analysis, vibration analysis, and structure optimization. The design and selection of some important components are carried out based on the pneumatic design and performance requirements. The pressure regulation characteristics of the pressure regulating valve are discussed and the affecting factors of the irregular flow are analyzed and evaluated by numerical simulation. The final structure of the pressure-regulating valve is determined and the test results perform well with prediction of characteristic curve.
Fatal Necrotizing Fasciitis as a Consequence of Blunt Trauma: A Case Report
Authors: HV Chandrakanth , RG Hemanth Kumar , Rani Smitha
Published: August 2021

Necrotizing fasciitis is an uncommon lethal bacterial infection that involves the subcutaneous tissue and fascia. It can be mono or polymicrobial infection. The diagnosis is mainly dependent on clinical signs and symptoms. Trauma is the commonest cause for it. The early signs and symptoms may mimic cellulitis. We present a case of necrotizing fasciitis following an assault. The patient was received in a state of shock. Despite all measures, the patient could not be saved. Early debridement and antibiotic therapy have a key role in the prognosis of the disease. Medicolegal issues can arise when the disease develops post-assault because of the vague and unpredictable nature of the disease and its challenging prognosis.
Improving Integrity in CS1 Course Using Formative Assessment and Version Control Tools
Authors: Lakshminarayanan Srinivasan , Rao N. J.
Published: August 2021

There are many grey areas in the interpretation of academic integrity in the course on Introduction to Programming, commonly known as CS1. Copying, for example, is a method of learning, a method of cheating and a reuse method in professional practice. Many institutions in India publish the code in the lab course manual. The students are expected to practice the programs in the manual and write them in the final examination without looking at the reference code. Many institutions apportion some marks for copying the program from the manual to record books. The system thus, inherently encourages copying. The student listens to the program’s explanation in the lecture, practices the same program in the lab, writes the same program in the record book and again studies the same program for the final examination conducted at the end of the semester. This process facilitates students, to some extent, to understand the concepts. However, a significant disadvantage of this system is that most students do not acquire the ability to write programs for authentic tasks. In the context of very rigid laboratory protocols that exist in CS1 courses across most of the Institutes in India, an additional lab protocol that focuses on students’ integrity can potentially improve the quality of learning. This article presents a method of using technology tools to improve integrity without disturbing the existing system.
Caste in the Time of the COVID-19 Pandemic
Authors: Mondal Sandip , Karmakar Ranjan
Published: August 2021

Historically, it is a glaring fact that any disaster or pandemic made the Dalit and Adivasi as the worst victim. Therefore, it is of utmost importance to unfold the caste dynamics and social realities around the debate of the COVID-19 pandemic. A unique feature of India’s caste system is in its flexibility. Therefore, even during the time of the COVID-19 pandemic, the prescribed medical guidelines of ‘social distancing’ encourages the Savarnas to strengthen the caste prejudices in the name of science. Apart from this, the prescribed guidelines for ‘social distancing’ and ‘home quarantine’ exposed the graded caste inequality in India. The empirical evidence from this study brings it to the forefront that a graded caste inequality persists in household’s availability of exclusive room with attached toilet facilities and adequate ventilation facilities, household’s access to exclusive drinking water source, household’s affordability in practising hand wash with soap or detergent, etc. Therefore, when the Forward caste become the most privileged in maintaining the home quarantine and complete isolation, it becomes an unaffordable luxury for the Dalits. It makes the Dalits most vulnerable during this pandemic. Therefore, this pandemic provides a stark example of the pervasiveness and perniciousness of social inequality in India.
Acid Attack: A Devastating Violence Against Women
Authors: Ghosal Banashree , Chattopadhyay Chandrani
Published: August 2021

This article will explore the problem of acid attack as a gender-related crime. We analyse the socio-legal status of this crime as a form of violence in comparison of other forms of violence in the Indian context with the help of secondary data. The patriarchal notion of women is that the body is her only respect, and its violation is ultimate punishment. The number of acid attacks is increasing every passing year. The latest report of the National Crime Records Bureau (NCRB) 2016 recorded 283 incidents under the section of acid attack (‘Living in the shadows’- A project for acid attack victims by Haryana State legal Services Authority). It revealed that the most of the reported acid attack cases are due to refusal of marriage or rejection of romance. We discuss the consequences of acid attack and the legal framework available to address this problem.
KDM5A suppresses PML-RARα target gene expression and APL differentiation through repressing H3K4me2
Authors: Xu Siyuan , Wang Siqing , Xing Shenghui , Yu Dingdang , Rong Bowen , Gao Hai , Sheng Mengyao , Tan Yun , Zhang Yifan , Sun Xiaojian , Wang Kankan , Xue Kai , Shi Zhennan , Lan Fei
Published: August 2021

Epigenetic abnormalities are frequently involved in the initiation and progression of cancers, including acute myeloid leukemia (AML). A subtype of AML, acute promyelocytic leukemia (APL), is mainly driven by a specific oncogenic fusion event of promyelocytic leukemia–RA receptor fusion oncoprotein (PML-RARα). PML-RARα was reported as a transcription repressor through the interaction with nuclear receptor corepressor and histone deacetylase complexes leading to the mis-suppression of its target genes and differentiation blockage. Although previous studies were mainly focused on the connection of histone acetylation, it is still largely unknown whether alternative epigenetics mechanisms are involved in APL progression. KDM5A is a demethylase of histone H3 lysine 4 di- and tri-methylations (H3K4me2/3) and a transcription corepressor. Here, we found that the loss of KDM5A led to APL NB4 cell differentiation and retarded growth. Mechanistically, through epigenomics and transcriptomics analyses, KDM5A binding was detected in 1889 genes, with the majority of the binding events at promoter regions. KDM5A suppressed the expression of 621 genes, including 42 PML-RARα target genes, primarily by controlling the H3K4me2 in the promoters and 5′ end intragenic regions. In addition, a recently reported pan-KDM5 inhibitor, CPI-455, on its own could phenocopy the differentiation effects as KDM5A loss in NB4 cells. CPI-455 treatment or KDM5A knockout could greatly sensitize NB4 cells to all-trans retinoic acid–induced differentiation. Our findings indicate that KDM5A contributed to the differentiation blockage in the APL cell line NB4, and inhibition of KDM5A could greatly potentiate NB4 differentiation.
Analysis of biological models to predict clinical outcomes based on HLA-DPB1 disparities in unrelated transplantation
Authors: Buhler Stéphane , Baldomero Helen , Ferrari-Lacraz Sylvie , Mamez Anne-Claire , Masouridi-Levrat Stavroula , Heim Dominik , Halter Jörg , Nair Gayathri , Chalandon Yves , Schanz Urs , Güngör Tayfun , Nicoloso Grazia , Passweg Jakob R. , Villard Jean ,   on behalf of the Swiss Blood Stem Cell Transplantation Group
Published: August 2021

HLA compatibility is a key factor for survival after unrelated hematopoietic stem cell transplantation (HSCT). HLA-A, -B, -C, -DRB1, and -DQB1 are usually matched between donor and recipient. By contrast, HLA-DPB1 mismatches are frequent, although it is feasible to optimize donor selection and DPB1 matching with prospective typing. Because classical DPB1 allele mismatches are often unavoidable, however, several biological models have been developed to predict the optimal DPB1 mismatch combination for less graft-versus-host disease (GVHD) and better overall survival. In 909 recipient/donor pairs, we analyzed the role of 3 biological models: T-cell epitopes (TCEs) based on the immunogenicity of DPB1, cell surface expression of DPB1 molecules based on a single-nucleotide polymorphism located in the 3′ untranslated region, and the Predicted Indirectly ReCognizable HLA Epitopes (PIRCHE) model based on the presentation of allogeneic peptides derived from mismatched HLA, compared with the classical allele mismatch. Matching for both DPB1 alleles remains the best option to prevent acute GVHD. In the situation of one DPB1 allele mismatch, the donor associated with the lowest acute GVHD risks is mismatched for an allele with a low expression profile in the recipient, followed by a permissive TCE3/4 mismatch and/or the absence of PIRCHE II potential against the recipient. In the context of 2 DPB1 mismatches, the same considerations apply for a permissive TCE3/4 mismatch and no PIRCHE II. By combining the biological models, the most favorable DPB1 constellation can be defined. This approach will help optimize donor selection and improve post-HSCT complications and patient prognosis.
Predicting mortality from intracranial hemorrhage in patients who undergo allogeneic hematopoietic stem cell transplantation
Authors: Ren Xiying , Huang Qiusha , Qu Qingyuan , Cai Xuan , Fu Haixia , Mo Xiaodong , Wang Yu , Zheng Yawei , Jiang Erlie , Ye Yishan , Luo Yi , Chen Shaozhen , Yang Ting , Zhang Yuanyuan , Han Wei , Tang Feifei , Mo Wenjian , Wang Shunqing , Li Fei , Liu Daihong , Zhang Xiaoying , Zhang Yicheng , Feng Shuqing , Gao Feng , Yuan Hailong , Wang Dao , Wan Dingming , Chen Huan , Chen Yao , Wang Jingzhi , Chen Yuhong , Wang Ying , Xu Kailin , Lang Tao , Wang Xiaomin , Meng Hongbin , Li Limin , Wang Zhiguo , Fan Yanling , Chang Yingjun , Xu Lanping , Huang Xiaojun , Zhang Xiaohui
Published: August 2021

Intracranial hemorrhage (ICH) is a rare but fatal central nervous system complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, factors that are predictive of early mortality in patients who develop ICH after undergoing allo-HSCT have not been systemically investigated. From January 2008 to June 2020, a total of 70 allo-HSCT patients with an ICH diagnosis formed the derivation cohort. Forty-one allo-HSCT patients with an ICH diagnosis were collected from 12 other medical centers during the same period, and they comprised the external validation cohort. These 2 cohorts were used to develop and validate a grading scale that enables the prediction of 30-day mortality from ICH in all-HSCT patients. Four predictors (lactate dehydrogenase level, albumin level, white blood cell count, and disease status) were retained in the multivariable logistic regression model, and a simplified grading scale (termed the LAWS score) was developed. The LAWS score was adequately calibrated (Hosmer-Lemeshow test, P > .05) in both cohorts. It had good discrimination power in both the derivation cohort (C-statistic, 0.859; 95% confidence interval, 0.776-0.945) and the external validation cohort (C-statistic, 0.795; 95% confidence interval, 0.645-0.945). The LAWS score is the first scoring system capable of predicting 30-day mortality from ICH in allo-HSCT patients. It showed good performance in identifying allo-HSCT patients at increased risk of early mortality after ICH diagnosis. We anticipate that it would help risk stratify allo-HSCT patients with ICH and facilitate future studies on developing individualized and novel interventions for patients within different LAWS risk groups.
An irradiated marrow niche reveals a small non-collagenous protein mediator of homing, dermatopontin
Authors: Kramer Ashley , Astuti Yuliana , Elfstrum Alexis , Lehrke Michael Jonathan , Tolar Jakub , Blazar Bruce R. , Blake Amanda , Taisto Mandy , Furcich Justin W , Nolan Erin E , Durose Wilaiwan W , Webber Beau R , Geisness Athena , Wood David K , Lund Troy
Published: August 2021

Hematopoietic cell homing after hematopoietic cell transplant (HCT) is governed by several pathways involving marrow niche cells that are evoked after pre-HCT conditioning. To understand the factors that play a role in homing, we performed expression analysis on the zebrafish marrow niche cells following conditioning. We determined that the non-collagenous protein extracellular matrix related protein dermatopontin (Dpt) was upregulated seven-fold in response to irradiation. Studies in mice revealed DPT induction both with radiation and lipopolysaccharide exposure. Interestingly, we found that co-incubation of zebrafish or murine hematopoietic cells with rDPT impedes hematopoietic stem and progenitor cell homing by 50% and 86%, respectively. Similarly, this translated into a 24% reduction in long term engraftment (versus control, p = 0.01). We found DPT to interact with VLA-4 and block hematopoietic - endothelial cell adhesion and transendothelial migration. Finally, a DPT knockout mouse displayed a 60% increase in homing of hematopoietic cells versus wildtype (p = 0.03) with slight improvement in long-term LSK-SLAM engraftment (2-fold, p = 0.04). These data show that the extracellular matrix (ECM)-related protein DPT increases with radiation and transiently impedes the transendothelial migration of hematopoietic cells to the marrow.
Multicenter analysis of geriatric fitness and real-world outcomes in older patients with classical Hodgkin lymphoma
Authors: Orellana-Noia Victor M. , Isaac Krista , Malecek Mary-Kate , Bartlett Nancy L. , Voorhees Timothy J. , Grover Natalie S. , Hwang Steven R. , Bennani N. Nora , Hu Rachel , Hill Brian T. , Mou Eric , Advani Ranjana H. , Carter Jordan , David Kevin A. , Ballard Hatcher J. , Svoboda Jakub , Churnetski Michael C. , Magarelli Gabriela , Feldman Tatyana A. , Cohen Jonathon B. , Evens Andrew M. , Portell Craig A.
Published: August 2021

We performed a multicenter retrospective analysis across 10 US academic medical centers to evaluate treatment patterns and outcomes in patients age ≥60 years with classic Hodgkin lymphoma (cHL) from 2010-2018. Among 244 eligible patients, median age was 68, 63% had advanced stage (III/IV), 96% had Eastern Cooperative Oncology Group performance status (PS) 0-2, and 12% had documented loss of ≥1 activity of daily living (ADL). Medical comorbidities were assessed by the Cumulative Illness Rating Scale–Geriatric (CIRS-G), where n = 44 (18%) had total scores ≥10. Using multivariable Cox models, only ADL loss predicted shorter progression-free (PFS; hazard ratio [HR] 2.13, P = .007) and overall survival (OS; HR 2.52, P = .02). Most patients (n = 203, 83%) received conventional chemotherapy regimens, including doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD; 56%), AVD (14%), and AVD with brentuximab vedotin (BV; 9%). Compared to alternative therapies, conventional regimens significantly improved PFS (HR 0.46, P = .0007) and OS (HR 0.31, P = .0003). Survival was similar following conventional chemotherapy in those ages 60-69 vs ≥70: PFS HR 0.88, P = .63; OS HR 0.73, P = .55. Early treatment discontinuation due to toxicity was more common with CIRS-G ≥10 (28% vs 12%, P = .016) or documented geriatric syndrome (28% vs 13%, P = .02). A competing risk analysis demonstrated improved disease-related survival with conventional therapy (HR 0.29, P = .02) and higher mortality from causes other than disease or treatment with high CIRS-G or geriatric syndromes. This study suggests conventional chemotherapy regimens remain a standard of care in fit older patients with cHL, and highlights the importance of geriatric assessments in defining fitness for cHL therapy going forward.
Identification of coagulation factor IX variants with enhanced activity through ancestral sequence reconstruction
Authors: Knight Kristopher A. , Coyle Christopher W. , Radford Caelan E. , Parker Ernest T. , Fedanov Andrew , Shields Jordan M. , Szlam Fania , Purchel Anatolii , Chen Michelle , Denning Gabriela , Sniecinski Roman M. , Lollar Pete , Spencer H. Trent , Gaucher Eric A. , Doering Christopher B.
Published: August 2021

Orthologous proteins contain sequence disparity guided by natural selection. In certain cases, species-specific protein functionality predicts pharmacological enhancement, such as greater specific activity or stability. However, immunological barriers generally preclude use of nonhuman proteins as therapeutics, and difficulty exists in the identification of individual sequence determinants among the overall sequence disparity. Ancestral sequence reconstruction (ASR) represents a platform for the prediction and resurrection of ancient gene and protein sequences. Recently, we demonstrated that ASR can be used as a platform to facilitate the identification of therapeutic protein variants with enhanced properties. Specifically, we identified coagulation factor VIII (FVIII) variants with improved specific activity, biosynthesis, stability, and resistance to anti-human FVIII antibody–based inhibition. In the current study, we resurrected a panel of ancient mammalian coagulation factor IX (FIX) variants with the goal of identifying improved pharmaceutical candidates. One variant (An96) demonstrated 12-fold greater FIX activity production than human FIX. Addition of the R338L Padua substitution further increased An96 activity, suggesting independent but additive mechanisms. after adeno-associated virus 2 (AAV2)/8-FIX gene therapy, 10-fold greater plasma FIX activity was observed in hemophilia B mice administered AAV2/8-An96–Padua as compared with AAV2/8-human FIX–Padua. Furthermore, phenotypic correction conferred by the ancestral variant was confirmed using a saphenous vein bleeding challenge and thromboelastography. Collectively, these findings validate the ASR drug discovery platform as well as identify an ancient FIX candidate for pharmaceutical development.
Association between smokeless tobacco use and oral cavity cancer risk in women compared with men: a systematic review and meta-analysis
Authors: Mu Guangyan , Wang Jiayi , Liu Zhiyan , Zhang Hanxu , Zhou Shuang , Xiang Qian , Cui Yimin
Published: August 2021

Background

The impact of smokeless tobacco (SLT) use on the risk of oral cavity cancer (OCC) has been confirmed; however, the sex-based difference in this association remains inconclusive. Therefore, this study aimed to estimate the association between SLT use and OCC risk in women and compared it to that in men.

Methods

PubMed, Embase, and Cochrane Library databases were systematically searched for eligible studies from their inception up to August 2020. Studies reporting the effect estimates of SLT use on OCC risk in men and women, were eligible for inclusion. The relative risk ratio (RRR) was applied to calculate the sex-based difference in the relationship between SLT use and OCC risk, and pooled analysis was conducted using a random-effects model with inverse variance weighting.

Results

Nineteen studies reporting a total of 6593 OCC cases were included in the final meta-analysis. The pooled relative risk (RR) suggested that SLT use was associated with an increased risk of OCC in both men (RR, 2.94; 95% confidence interval [CI], 2.05–4.20; P < 0.001) and women (RR, 6.39; 95%CI, 3.16–12.93; P < 0.001). Moreover, the SLT-use-related risk of OCC was higher in women than that in men (RRR,1.79; 95%C, 1.21–2.64; P = 0.003). The risk of OCC related to SLT use in women was still significantly higher than that in men (RRR, 1.75; 95%CI, 1.15–2.66; P = 0.008) after excluding indirect comparison results. Finally, a subgroup analysis suggested significant sex-based differences only in individuals who received chewed smokeless products, regardless of the control definition. Pooled analysis of studies with high design quality confirmed the notably higher risk of OCC in women than in men.

Conclusions

This study found that SLT use was associated with a higher risk of OCC in women than in men. Further large-scale prospective cohort studies should be conducted to verify sex-based differences in the association between use of specific smokeless products and OCC risk.
Trends in food insecurity rates at an academic primary care clinic: a retrospective cohort study
Authors: Montez Kimberly , Brown Callie L. , Garg Arvin , Rhodes Scott D. , Song Eunyoung Y. , Taxter Alysha J. , Skelton Joseph A. , Albertini Laurie W. , Palakshappa Deepak
Published: August 2021

Background

Healthcare organizations are increasingly screening and addressing food insecurity (FI); yet, limited data exists from clinic-based settings on how FI rates change over time. The objective of this study was to evaluate household FI trends over a two-year period at a clinic that implemented a FI screening and referral program.

Methods

In this retrospective cohort study, data were extracted for all visits at one academic primary care clinic for all children aged 0–18 years whose parents/guardians had been screened for FI at least once between February 1, 2018 to February 28, 2019 (Year 1) and screened at least once between March 1, 2019 to February 28, 2020 (Year 2). Bivariate analyses tested for differences in FI and demographics using chi-square tests. Mixed effects logistic regression was used to assess change in FI between Years 1 and 2 with random intercept for participants controlling for covariates. The interaction between year and all covariates was evaluated to determine differences in FI change by demographics.

Results

Of 6182 patients seen in Year 1, 3691 (59.7%) were seen at least once in Year 2 and included in this study. In Year 1, 19.6% of participants reported household FI, compared to 14.1% in Year 2. Of those with FI in Year 1, 40% had FI in Year 2. Of those with food security in Year 1, 92.3% continued with food security in Year 2. Compared to Hispanic/Latinx participants, African American/Black (OR: 3.53, 95% CI: 2.33, 5.34; p < 0.001) and White (OR: 1.88, 95% CI: 1.06, 3.36; p = 0.03) participants had higher odds of reporting FI. African American/Black participants had the largest decrease in FI between Years 1 and 2 (− 7.9, 95% CI: − 11.7, − 4.1%; p < 0.0001).

Conclusions

Because FI is transitional, particularly for racial/ethnic minorities, screening repeatedly can identify families situationally experiencing FI.
Ultrasound-guided single popliteal sciatic nerve block is an effective postoperative analgesia strategy for calcaneal fracture: a randomized clinical trial
Authors: Li Yanan , Zhang Qi , Wang Ying , Yin Chunping , Guo Junfei , Qin Shiji , Zhang Yahui , Zhu Lian , Hou Zhiyong , Wang Qiujun
Published: August 2021

Objectives

The aim of this study was to evaluate the postoperative analgesia effect of ultrasound-guided single popliteal sciatic nerve block for calcaneal fracture.

Methods

A total of 120 patients scheduled for unilateral open reduction and internal fixation of calcaneal fracture were enrolled in this prospective randomized study. Patients in group B received ultrasound-guided single popliteal sciatic nerve block after operation, but Patients in group A did not. All patients received patient-controlled intravenous analgesia (PCIA) after operation. The time to initiation of PCIA, the time of first pressing the analgesia pump, duration of analgesia pump use and the total number of times the patient pressed the analgesia pump were recorded. The time of rescue analgesia and the adverse reactions were recorded. Pain magnitude of the patients immediately after discharge from operating room (T1), and at 4th (T2), 8th (T3), 12th (T4), 16th (T5), 24th (T6) and 48th (T7) h after the operation were assessed with visual analog scale (VAS). In addition, patient, surgeon and nurse satisfaction were recorded.

Results

The VAS scores at T2 ~ T5, the time of rescue analgesia and the adverse reactions, the total number of times the patient pressed the analgesia pump were significantly declined in group B (p < 0.001). The time to initiation of PCIA, the time of first pressing the analgesia pump, duration of analgesia pump use were prolonged and patient surgeon and nurse satisfaction were improved in group B (p < 0.05).

Conclusion

Ultrasound-guided single popliteal sciatic nerve block is an effective postoperative analgesia strategy for calcaneal fracture.

Trial registration

ChiCTR, ChiCTR2100042340. Registered 19 January 2021, URL of trial registry record: http://www.chictr.org.cn/showproj.aspx?proj=66526.
Field note use in family medicine residency training: learning needs revealed or avoided?
Authors: Zaki Nicole , Cavett Teresa , Halas Gayle
Published: August 2021

Background

Field notes (FNs) are used in Family Medicine residency programs to foster reflective learning and facilitate formative assessment. Residents assess their strengths and weaknesses and develop action plans for further improvement. This study explored the use of FNs in the University of Manitoba’s Family Medicine residency program 5 years after their implementation.

Methods

This multi-method study examined 520 FNs from 16 recent graduates from the University of Manitoba Family Medicine residency program. Quantitative analysis (frequencies and means) enabled descriptions and comparisons between training sites. Four themes emerged from inductive content analysis highlighting common ideas reflected upon.

Results

Residents displayed cyclical variation in the FN generation over 2 years. Eight of the 99 Priority Topics (addressing complex psychosocial issues) were not captured in this data set. The domains of Care of First Nations, Inuit, and Metis; Care of the Vulnerable and Underserved; and Behavioural Medicine and the CanMEDS-FM roles of FM – Procedural Skill, Leader/Manager, and Professional were less frequently reflected upon. Four themes (Patient-Centered Care, Patient Safety, Achieving Balance, and Confidence) were identified from qualitative analysis of residents’ narrative notes.

Conclusions

Vygotsky’s Sociocultural Theory of Cognitive Development was proposed as a lens through which to examine factors influencing resident learning. Residents’ discomfort with certain topics may lead to avoidance in reflecting upon certain competencies in FNs, impacting skill acquisition. Further research should explore factors influencing residents’ perceptions FNs and how to best assist residents in becoming competent, confident practitioners.
The risks and benefits of using social media to engage consumers in service design and quality improvement in Australian public hospitals: findings from an interview study of key stakeholders
Authors: Walsh Louisa , Hyett Nerida , Howley Jayne , Juniper Nicole , Li Chi , MacLeod-Smith Belinda , Rodier Sophie , Hill Sophie J.
Published: August 2021

Background

Engaging consumers - patients, families, carers and community members who are current or potential service users - in the planning, design, delivery, and improvement of health services is a requirement of public hospital accreditation in Australia. There is evidence of social media being used for consumer engagement in hospitals internationally, but in Australia this use is uncommon and stakeholders’ experiences have not been investigated. The aim of the study was to explore the experiences and beliefs of key Australian public hospital stakeholders around using social media as a consumer engagement tool. This article focuses on the study findings relating to methods, risks, and benefits of social media use.

Methods

Semi-structured interviews were conducted with Australian public hospital stakeholders in consumer representative, consumer engagement/patient experience, communications or quality improvement roles. Qualitative data were analysed using a deductive content analysis method. An advisory committee of consumer and service provider stakeholders provided input into the design and conduct of this study.

Results

Twenty-six Australian public hospital service providers and consumers were interviewed. Participants described social media being used to: recruit consumers for service design and quality improvement activities; as an online space to conduct consultations or co-design; and, to gather feedback and patient experience data. The risks and benefits discussed by interview participants were grouped into five themes: 1)overcoming barriers to engagement, 2)consumer-initiated engagement; 3) breadthvsdepth of engagement,4)organisational transparencyvscontroland 5)users causing harm.

Conclusions

Social media can be used to facilitate consumer engagement in hospital service design and quality improvement. However, social media alone is unlikely to solve broader issues commonly experienced within health consumer engagement activities, such as tokenistic engagement methods, and lack of clear processes for integrating consumer and patient feedback into quality improvement activities.
Bacterial factors required for Streptococcus pneumoniae coinfection with influenza A virus
Authors: Chen Yi-Yin , Huang Ching-Tai , Li Shiao-Wen , Pan Yi-Jiun , Lin Tzu-Lung , Huang Ya-Yu , Li Ting-Hsuan , Yang Yu-Ching , Gong Yu-Nong , Hsieh Yu-Chia
Published: August 2021

Background

Streptococcus pneumoniaeis a common cause of post-influenza secondary bacterial infection, which results in excessive morbidity and mortality. Although 13-valent pneumococcal conjugate vaccine (PCV13) vaccination programs have decreased the incidence of pneumococcal pneumonia, PCV13 failed to prevent serotype 3 pneumococcal disease as effectively as other vaccine serotypes. We aimed to investigate the mechanisms underlying the co-pathogenesis of influenza virus and serotype 3 pneumococci.

Methods

We carried out a genome-wide screening of a serotype 3S. pneumoniaetransposon insertion mutant library in a mouse model of coinfection with influenza A virus (IAV) to identify the bacterial factors required for this synergism.

Results

Direct, high-throughput sequencing of transposon insertion sites identified 24 genes required for both coinfection and bacterial infection alone. Targeted deletion of the putative aminotransferase (PA) gene decreased bacterial growth, which was restored by supplementation with methionine. The bacterial burden in a coinfection with thePAgene deletion mutant and IAV in the lung was lower than that in a coinfection with wild-type pneumococcus and IAV, but was significantly higher than that in an infection with thePAgene deletion mutant alone. These data suggest that IAV infection alters host metabolism to benefit pneumococcal fitness and confer higher susceptibility to pneumococcal infection. We further demonstrated that bacterial growth was increased by supplementation with methionine or IAV-infected mouse lung homogenates.

Conclusions

The data indicates that modulation of host metabolism during IAV infection may serve as a potential therapeutic intervention against secondary bacterial infections caused by serotype 3 pneumococci during IAV outbreaks in the future.
Cyclin G2 reverses immunosuppressive tumor microenvironment and potentiates PD-1 blockade in glioma
Authors: Li Sen , Zhao Chenyang , Gao Jinlan , Zhuang Xinbin , Liu Shuang , Xing Xuesha , Liu Qi , Chen Chen , Wang Shusen , Luo Yang
Published: August 2021

Background

Expression of aberrant cyclin G2 is a key factor contributing to cancer biological processes, including glioma. However, the potential underlying mechanisms of cyclin G2 in the glioma tumor immune microenvironment remain unclear.

Methods

Co-immunoprecipitation (co-IP), in situ proximity ligation assay (PLA), and in vitro kinase assay were conducted to reveal the underlying mechanism by which cyclin G2 regulates Y10 phosphorylation of LDHA. Further, the biological roles of cyclin G2 in cell proliferation, migration, invasion capacity, apoptosis, glycolysis, and immunomodulation were assessed through in vitro and in vivo functional experiments. Expressions of cyclin G2 and Foxp3 in glioma specimens was determined by immunohistochemistry.

Results

In this study, we found that cyclin G2 impeded the interaction between LDHA and FGFR1, thereby decreasing Y10 phosphorylation of LDHA through FGFR1 catalysis. Cyclin G2 inhibited proliferation, migration, invasion capacity, and glycolysis and promoted apoptosis glioma cells via suppressing Y10 phosphorylation of LDHA. Moreover, we further verified that cyclin G2 reversed the immunosuppressive to antitumor immune microenvironment through inhibiting lactate production by glioma cells. Besides, cyclin G2 potentiated PD-1 blockade and exerted strong antitumor immunity in the glioma-bearing mice model.

Conclusions

Cyclin G2 acts as a potent tumor suppressor in glioma and enhances responses to immunotherapy. Our findings may be helpful in selecting glioma patients for immunotherapy trials in the future.
Socio-economic and demographic impacts on the full awareness of the methods for controlling/preventing the spread of COVID-19 among social media users in some African countries at the onset of the pandemic
Authors: Okorie Idika E. , Afuecheta Emmanuel , Alaebo Chinonso G. , Nadarajah Saralees
Published: August 2021

Objective

In Africa, most countries continue to battle COVID-19 with cases of newly infected still being recorded. In this note, we investigate how socioeconomic and demographic factors affected individuals awareness on the methods for controlling/preventing the spread of COVID-19 in some parts of Africa at the onset of the pandemic.

Results

Based on regression modelling, we find that having full awareness does not depend on religious affiliation. Men, urban dwelling, holding bachelors or higher degrees, operating multiple social media accounts or being employed are associated with having full awareness of the recommended practices for the prevention and control of COVID-19 at the early stage of the pandemic. No occupation, business or older people are associated with not having full awareness.
DNA methyltransferase inhibitors combination therapy for the treatment of solid tumor: mechanism and clinical application
Authors: Hu Chunhong , Liu Xiaohan , Zeng Yue , Liu Junqi , Wu Fang
Published: August 2021

DNA methylation, an epigenetic modification, regulates gene transcription and maintains genome stability. DNA methyltransferase (DNMT) inhibitors can activate silenced genes at low doses and cause cytotoxicity at high doses. The ability of DNMT inhibitors to reverse epimutations is the basis of their use in novel strategies for cancer therapy. In this review, we examined the literature on DNA methyltransferase inhibitors. We summarized the mechanisms underlying combination therapy using DNMT inhibitors and clinical trials based on combining hypomethylation agents with other chemotherapeutic drugs. We also discussed the efficacy of such compounds as antitumor agents, the need to optimize treatment schedules and the regimens for maximal biologic effectiveness. Notably, the combination of DNMT inhibitors and chemotherapy and/or immune checkpoint inhibitors may provide helpful insights into the development of efficient therapeutic approaches.
Who buys certified firewood? Individual determinants of clean fuel adoption for promoting the sustainable energy transition in southern Chile
Authors: Álvarez Boris , Boso Àlex , Rodríguez Ignacio , Hofflinger Álvaro , Vallejos-Romero Arturo
Published: August 2021

Background

Temuco and Padre Las Casas, Chile, have severe problems of air pollution due to the extensive use of firewood for heating. The local authorities have made various efforts to improve fuel quality and introduce greater regulation into the market. Certified firewood guarantees low levels of humidity (< 25%) and has better combustion, but its distribution is still limited and the variables that determine its purchase have scarcely been studied. The aim of this study is to identify the determinants of certified firewood consumption in urban southern Chile.

Methods

This study was conducted with a cross-sectional non-experimental design. Following a non-probability sampling by convenience, we applied 355 surveys to participants who use a firewood system. Nonparametric comparisons analyses were made to identify differences in the use of certified wood by socio demographic variables. In addition, an Ordinal Logistic Regression was used to analyze the relation between the use of certified firewood and various psycho-social variables.

Results

Half of the users of wood-burning stoves participating in the study declared that they “never” (38%) or “almost never” (12%) used certified firewood to heat their home. Situational and product-related variables, such as price, availability, convenience and time are fundamental to people’s purchase behavior, partially explaining the low public interest shown in this product. On the other hand, the results indicate the influence of socio-demographic variables such as income level and the presence of older adults at home, as well as psycho-social variables which include how much participants pay attention to air quality, the information level they have about it, the feelings of discomfort due to air pollution and concern for its effects on health.

Conclusions

First, increasing information levels and awareness among the population through communication campaigns is necessary to promote the sustainable urban energy transition in southern Chile. Second, information strategies may be complemented by boosting employment, driving investment, improving income, and strengthening the mechanisms of social protection, especially for the most vulnerable groups, to be effective. Finally, protecting and stimulating the formal trade in firewood could increase the points of sale of certified firewood, which would facilitate user access to cleaner fuels.
Mental health outcomes in communities exposed to Armed Conflict Experiences
Authors: Trujillo Sandra , Giraldo Luz Stella , López José David , Acosta Alberto , Trujillo Natalia
Published: August 2021

Background

Populations exposed to Armed Conflict Experiences (ACE) show different levels of impact in their mental health (i.e. clinical and positive components); however, there is limited evidence related to mental health of general population (civilians not classified as victims) exposed to ACE. Government guided mental health assessments exclude this population. The use of a newly validated Extreme Experiences Scale (EX2) seems appropriate to classify victims, ex-combatants, and civilians for their mental health assessment.

Methods

Here, we propose a novel approach to identify relationships between individuals classified with different levels of ACE exposure—independent of their legal role in the armed conflict, and mental health outcomes. According to the cut-off points derived from the scores of EX2, we classified the sample in low and high exposure to ACE.

Results

The high-level ACE group (scores > 2.5) included 119 subjects, and the low-level ACE was constituted by 66 subjects. Our results evidence that people with high exposure to ACE experiment higher odds to present anxiety disorders, risk of suicide, or post-traumatic stress disorder, as well as increased cognitive empathy (i.e., fantasy dimension).

Conclusion

These findings allowed us to identify the influence of ACE on mental health outcomes beyond the conventional frame (victim or ex-combatant), and to discuss effective interventions and implementation of mental health strategies in these communities. We expect to help the health system to focus on key vulnerable subjects by including civilians not recognized as victims, which are neglected from most of the public health screening, assessment, and interventions.
Secretory expression of cyclohexanone monooxygenase by methylotrophic yeast for efficient omeprazole sulfide bio-oxidation
Authors: Li Ya-Jing , Zheng Yu-Cong , Geng Qiang , Liu Feng , Zhang Zhi-Jun , Xu Jian-He , Yu Hui-Lei
Published: August 2021

Prochiral pyrmetazole can be asymmetrically oxidized into (S)-omeprazole, a proton pump inhibitor that is used to treat gastroesophageal reflux, by an engineered cyclohexanone monooxygenase (CHMOAcineto-Mut) that has high stereoselectivity. CHMOAcineto-Mut is produced by heterologous expression in Escherichia coli, where it is expressed intracellularly. Thus, isolating this useful biocatalyst requires tedious cell disruption and subsequent purification, which hinders its use for industrial purposes. Here, we report the extracellular production of CHMOAcineto-Mut by a methylotrophic yeast, Pichia pastoris, for the first time. The recombinant CHMOAcineto-Mut expressed by P. pastoris showed a higher flavin occupation rate than that produced by E. coli, and this was accompanied by a 3.2-fold increase in catalytic efficiency. At a cell density of 150 g/L cell dry weight, we achieved a recombinant CHMOAcineto-Mut production rate of 1,700 U/L, representing approximately 85% of the total protein secreted into the fermentation broth. By directly employing the pH adjusted supernatant as a biocatalyst, we were able to almost completely transform 10 g/L of pyrmetazole into the corresponding (S)-sulfoxide, with  >  99% enantiomeric excess.
A robust optimization model for influence maximization in social networks with heterogeneous nodes
Authors: Agha Mohammad Ali Kermani Mehrdad , Ghesmati Reza , Pishvaee Mir Saman
Published: August 2021

Influence maximization is the problem of trying to maximize the number of influenced nodes by selecting optimal seed nodes, given that influencing these nodes is costly. Due to the probabilistic nature of the problem, existing approaches deal with the concept of the expected number of nodes. In the current research, a scenario-based robust optimization approach is taken to finding the most influential nodes. The proposed robust optimization model maximizes the number of infected nodes in the last step of diffusion while minimizing the number of seed nodes. Nodes, however, are treated as heterogeneous with regard to their propensity to pass messages along; or as having varying activation thresholds. Experiments are performed on a real text-messaging social network. The model developed here significantly outperforms some of the well-known existing heuristic approaches which are proposed in previous works.
Influence of the topographic effect on the seismic response of buried pipelines
Authors: Elyasi Jahangir , Bastami Morteza , Kamalian Mohsen , Derakhshandi Mehdi
Published: August 2021

Detailed study of the response of pipelines during seismic excitation can help reduce physical and financial losses during and after an earthquake. The current research investigated the seismic behavior of pipelines passing through variations in topography using two-dimensional and three-dimensional modeling. Their behavior has been modeled at the crest and toe of a slope and during longitudinal passage through the topography. The effects of the soil stiffness, diameter-to-thickness ratio of the pipeline, height-to-half-width ratio (shape factor), and input wave characteristics on the performance of the pipeline have been investigated. The results indicate that topographic effects can increase the strain on pipelines and the factors studied are crucial to accommodating this potential hazard.
Postoperative changes in the pharyngeal airway space through computed tomography evaluation after mandibular setback surgery in skeletal class III patients: 1-year follow-up
Authors: Kang No Eul , Lee Dae Hun , In Seo Ja , Lee Jeong Keun , Song Seung Il
Published: August 2021

Background

This study evaluated the pharyngeal airway space changes up to 1 year after bilateral sagittal split osteotomy mandibular setback surgery and bimaxillary surgery with maxillary posterior impaction through three-dimensional computed tomography analysis.

Methods

A total of 37 patients diagnosed with skeletal class III malocclusion underwent bilateral sagittal split osteotomy setback surgery only (group 1, n = 23) or bimaxillary surgery with posterior impaction (group 2, n = 14). Cone-beam computed tomography scans were taken before surgery (T0), 2 months after surgery (T1), 6 months after surgery (T2), and 1 year after surgery (T3). The nasopharynx (Nph), oropharynx (Oph), hypopharynx (Hph) volume, and anteroposterior distance were measured through the InVivo Dental Application version 5.

Results

In group 1, Oph AP, Oph volume, Hph volume, and whole pharynx volume were significantly decreased after the surgery (T1) and maintained. In group 2, Oph volume and whole pharynx volume were decreased (T2) and relapsed at 1 year postoperatively (T3).

Conclusion

In class III malocclusion patients, mandibular setback surgery only showed a greater reduction in pharyngeal airway than bimaxillary surgery at 1 year postoperatively, and bimaxillary surgery was more stable in terms of airway. Therefore, it is important to evaluate the airway before surgery and include it in the surgical plan.