bluuebunny/crossref_metadata_2025 huggingface dataset:
Expert Recommendations for Using Time-in-Range and Other Continuous Glucose Monitoring Metrics to Achieve Patient-Centered Glycemic Control in People With Diabetes
Authors: Bellido Virginia , Aguilera Eva , Cardona-Hernandez Roque , Diaz-Soto Gonzalo , González Pérez de Villar Noemi , Picón-César María J. , Ampudia-Blasco Francisco Javier
Published: April 2022

New metrics for assessing glycemic control beyond HbA1c have recently emerged due to the increasing use of continuous glucose monitoring (CGM) in diabetes clinical practice. Among them, time in range (TIR) has appeared as a simple and intuitive metric that correlates inversely with HbA1c and has also been newly linked to the risk of long-term diabetes complications. The International Consensus on Time in Range established a series of target glucose ranges (TIR, time below range and time above range) and recommendations for time spent within these ranges for different diabetes populations. These parameters should be evaluated together with the ambulatory glucose profile (AGP). Using standardized visual reporting may help people with diabetes and healthcare professionals in the evaluation of glucose control in frequent clinical situations. The objective of the present review is to provide practical insights to quick interpretation of patient-centered metrics based on flash glucose monitoring data, as well as showing some visual examples of common clinical situations and giving practical recommendations for their management.
Undiagnosed hypertension and associated factors among adults in Debre Markos town, North-West Ethiopia: A community-based cross-sectional study
Authors: Essa Enatnesh , Shitie Dessalegn , Yirsaw Mesenbet Terefe , Wale Mengistu Zelalem
Published: April 2022

Introduction:

Globally, hypertension is an important risk factor for cardiovascular diseases and all-cause mortality. Despite this high public health burden, no community-based evidence regarding the magnitude and related factors of hypertension has been reported in the study area.

Objective:

The aim of this study was to determine the prevalence and associated factors of undiagnosed hypertension in Debre Markos town, North-West Ethiopia, 2020.

Method:

A community-based cross- sectional study design was conducted from January to March 2020. Socio-demographic and behavioral characteristics of the participants were collected using interviewer-administered semi-structured questionnaires. Physical measurements including body mass index, waist circumference, and blood pressure were collected using standardized measuring instruments. Statistical analysis was collected using SPSS version 21 software. Univariate logistic regression model was used to present the results. The p value less than 0.05 in a multivariable analysis was considered statistically significant at 95% confidence interval.

Results:

From a total of 630 samples, 600 participants, 270 (45%) males and 330 (55%) females with a mean age of 36.32 ± 12.48 years, were participated giving a response rate of 95.2%. The prevalence of undiagnosed hypertension among adults was 12.7%. Of these, 5.5% were males and 7.2% were females. Factors including age (above 60 years) (adjusted odds ratio = 2.92, 95% confidence interval (1.05, 8.06), p = 0.03), body mass index (overweight and obese) (adjusted odds ratio = 3.85, 95% confidence interval (2.16, 6.87), p < 0.01), fatty diet consumption (adjusted odds ratio = 1.88, 95% confidence interval (1.03, 3.42), p = 0.04), family history of hypertension (adjusted odds ratio = 2.21, 95% confidence interval (1.04, 4.69), p = 0.04) were significantly associated with hypertension.

Conclusion:

The prevalence of undiagnosed hypertension among adults was found to be remarkable. Therefore, a community-based health education and hypertension screening strategies are needed to prevent the problem early in life in Debre Markos town and the nation at large.
Thai University Students’ Attitudes Toward Online Language Learning in a Time of Crisis
Authors: Pusey Kerry , Nanni Alexander
Published: April 2022

In the wake of the COVID-19 pandemic, transitions to online L2 learning have rapidly emerged. However, the impacts of these transitions on students’ attitudes toward online language learning are largely unknown. This study investigated how participation in remote EAP instruction impacted the attitudes of Thai university students ( n = 263) toward online language learning. The study employed a longitudinal survey design and utilized a questionnaire instrument designed for the study containing 33 Likert scale items. The questionnaire was administered at the beginning and end of students’ first fully remote semester. Within- and between-groups comparisons were made of participants’ mean attitudinal ratings on eight multi-item subscales to measure the extent to which, and in what ways, students’ attitudes changed over time. Statistically significant differences were evident in the subscales of open-mindedness, autonomy, effectiveness of instruction, interactivity, and engagement over time; the general trend was toward a more positive perspective on online learning. Results indicated no statistically significant differences on three of the multi-item subscales (motivation, anxiety, and convenience) over time. The analysis showed a significant interaction between proficiency level and time in ratings for the effectiveness of instruction subscale only. Most subscales were weakly correlated with motivation at the beginning of the term; however, all subscales except interactivity showed a higher correlation at the end of the term. The results of this study will be of interest to educators who are seeking to understand learners’ attitudes toward online language instruction during times of crisis and emergency remote teaching (ERT).
The Influence of Emotional Exhaustion on Organizational Cynicism: The Sequential Mediating Effect of Organizational Identification and Trust in Organization
Authors: Atalay Mustafa Ozgun , Aydemir Pınar , Acuner Taner
Published: April 2022

Although many scholars have investigated the influence of emotional exhaustion on an organization, there has been relatively minimal research regarding emotional exhaustion’s impacts on organizational cynicism as well as the underlying mechanisms of it. Considering the research gaps, we attempt to find underlying mechanisms that drive the relationship between emotional exhaustion and organizational cynicism in the present research. In particular, we propose a sequential mediation model that investigates the relationship between emotional exhaustion and the sub-dimensions of organizational cynicism with the sequential mediating of organizational identification and trust in the organization. In order to empirically test these links, we utilized two waves lagged study design with 465 employees working in different sectors in Turkey. Our results provide empirical support that organizational identification and trust in an organization sequentially mediate the relationship between emotional exhaustion and cognitive cynicism with affective cynicism. However, the indirect effect of emotional exhaustion on behavioral cynicism through sequential mediators was not statistically significant. This study theoretically and empirically contributes to the emotional exhaustion literature by revealing the sequential mechanisms through which employees’ perceptions of emotional exhaustion affect their cynical attitudes in organizations and offers practical implications by stressing the importance of employees’ perceptions of emotional exhaustion. Theoretical and managerial implications are discussed, along with limitations and future research directions.
Goal Orientation and Its Impact on University Students’ Academic Achievement During the COVID-19 Pandemic
Authors: Alasqah Sumayyah S.
Published: April 2022

The study explored (1) the relationship between university students’ goal orientations (according to the 3 × 2 model) and their academic achievement during COVID-19 pandemic, (2) differences in academic achievement by students’ levels in goal orientations, and (3) differences in university students’ goal orientations and academic achievement by gender, specialization, study level, and the interaction among them. Participants were 149 male and female students whose ages ranged between 18 and 42. The instrument used to collect data was the 3 × 2 (task-approach goals, task-avoidance goals, self-approach goals, self-avoidance goals, other-approach goal, and other-avoidance goals) Achievement Goal Questionnaire. A statistically significant relationship was found between goal orientations and academic achievement of university students. Total goal orientations did not affect students’ academic achievement during COVID-19 pandemic. However, self-avoidance goals and other-approach goals affected academic performance in favor of the average level of self-avoidance and the high level of other-approach. No statistically significant differences in goal orientations and academic achievement were found by gender. Yet, significant differences were found by specialization, the interaction between study level and gender, the interaction between specialization and gender, and the interaction among the three variables.
Decent Work and Turnover Intention Among New Generation Employees: The Mediating Role of Job Satisfaction and the Moderating Role of Job Autonomy
Authors: Wan Wei , Duffy Ryan D.
Published: April 2022

New generation employees have become a major force in the workplace, and their high turnover rate is a major issue in academia and business. Drawing from the psychology of working theory and the job characteristics model, this study aims to explore the influence of decent work on new generation employees’ turnover intention and the roles of job satisfaction and job autonomy in this relationship. After collecting a sample of 391 new generation employees in China through online questionnaires, we utilized SPSS 21.0 and AMOS 21.0 to analyze the data. The results show that decent work has a negative impact on turnover intention and job satisfaction plays a mediating role in the relationship between decent work and turnover intention. Moreover, job autonomy is found to positively moderate the relationship between decent work and job satisfaction, and also moderate the indirect effect of job satisfaction on the relationship between decent work and turnover intention. Finally, the theoretical and practical implications are discussed, and limitations and future directions are highlighted.
ASEAN-5 and Crypto Hedge Fund: Dynamic Portfolio Approach
Authors: Widarto Andreas Renard , Muharam Harjum , Wahyudi Sugeng , Pangestuti Irene Rini Demi
Published: April 2022

This study aims to compose a portfolio consisting crypto hedge fund and ASEAN-5 stock market and to examine the hedging effect of crypto hedge fund against those stock markets. This study employs dynamic portfolio approach using data from the period of July 2013 to August 2021. This analysis finds that crypto hedge fund can provide hedging effect against ASEAN-5 stock portfolio resulting in hedging effectiveness with positive value. Crypto hedge fund is also proven to be able to increase the risk adjusted performance of all ASEAN-5 portfolio observed under this study, shown by an increase in Sharpe ratio and Sortino ratio.
Synchronous Online Learning During COVID-19: Chinese University EFL Students’ Perspectives
Authors: Zhang Kun , Wu Haoxian
Published: April 2022

The outbreak of COVID-19 in late 2019 had soon become a pandemic, leading to the lockdown of schools all around the world. To mitigate the negative impacts brought by COVID-19, the educational institutions of all levels have inevitably shifted from face-to-face teaching to online teaching. For English language teaching, fully synchronous online learning has been implemented worldwide, posing a great challenge for both instructors and learners. This study reports on findings of Chinese university English as a foreign language students’ perspectives’ on synchronous online language learning during the pandemic, with a special focus on their encountered difficulties. Drawing on the qualitative interview method, the study investigated 14 EFL learners at a public comprehensive university in a coastal city in southern China. Using thematic analysis, there are four main difficulties identified in the interviews, namely the lack of learning climate, the cultivation of learner autonomy, changes of interaction patterns, and the adaptation to remote assessment. The paper ends with a discussion of findings and implications for English learning and teaching in the “new normal.”
Mortality due to COVID-19 in Spain and its association with environmental factors and determinants of health
Authors: Culqui Lévano Dante R. , Díaz Julio , Blanco Alejandro , Lopez José A. , Navas Miguel A. , Sánchez-Martínez Gerardo , Luna M. Yolanda , Hervella Beatriz , Belda Fernando , Linares Cristina
Published: April 2022

Background

The objective of this study was to identify which air pollutants, atmospheric variables and health determinants could influence COVID-19 mortality in Spain. This study used information from 41 of the 52 provinces in Spain (from Feb. 1, to May 31, 2021). Generalized Linear Models (GLM) with Poisson link were carried out for the provinces, using the Rate of Mortality due to COVID-19 (CM) per 1,000,000 inhabitants as dependent variables, and average daily concentrations of PM10 and NO2 as independent variables. Meteorological variables included maximum daily temperature (Tmax) and average daily absolute humidity (HA). The GLM model controlled for trend, seasonalities and the autoregressive character of the series. Days with lags were established. The relative risk (RR) was calculated by increases of 10 g/m3 in PM10 and NO2 and by 1 ℃ in the case of Tmax and 1 g/m3 in the case of HA. Later, a linear regression was carried out that included the social determinants of health.

Results

Statistically significant associations were found between PM10, NO2 and the CM. These associations had a positive value. In the case of temperature and humidity, the associations had a negative value. PM10 being the variable that showed greater association, with the CM followed of NO2 in the majority of provinces. Anyone of the health determinants considered, could explain the differential geographic behavior.

Conclusions

The role of PM10 is worth highlighting, as the chemical air pollutant for which there was a greater number of provinces in which it was associated with CM. The role of the meteorological variables—temperature and HA—was much less compared to that of the air pollutants. None of the social determinants we proposed could explain the heterogeneous geographical distribution identified in this study.
Metagenomic analysis reveals the different characteristics of microbial communities inside and outside the karst tiankeng
Authors: Jiang Cong , Sun Xiao-Rui , Feng Jie , Zhu Su-Feng , Shui Wei
Published: April 2022

Background

Karst tiankengs serve as a reservoir of biodiversity in the degraded karst landscape areas. However, the microbial diversity of karst tiankengs is poorly understood. Here, we investigated the composition and function of the microbial community in a karst tiankeng.

Results

We found that habitat differences inside and outside the karst tiankeng changed the composition and structure of the soil microbial communities, and the dominant phyla were Proteobacteria, Actinobacteria, Chloroflexi and Acidobacteria. The Shannon–Wiener diversity of microbial communities inside and outside the tiankeng was significantly different, and it was higher inside the tiankeng (IT). Venn and LEfSe analysis found that the soil microbial communities inside the tiankeng had 640 more endemic species and 39 more biomarker microbial clades than those identified outside of the tiankeng (OT)..Functional prediction indicated that soil microorganisms in outside the tiankeng had a high potential for carbohydrate metabolism, translation and amino acid metabolism. There were biomarker pathways associated with several of human diseases at both IT and OT sites. Except for auxiliary activities (AA), other CAZy classes had higher abundance at IT sites, which can readily convert litter and fix carbon and nitrogen, thereby supporting the development of underground forests. The differences in microbial communities were mainly related to the soil water content and soil total nitrogen.

Conclusions

Our results provide a metagenomic overview of the karst tiankeng system and provide new insights into habitat conservation and biodiversity restoration in the area.
Lymphocyte-to-monocyte ratio associated with severe post-stenotic aortic dilation in a case–control study
Authors: Chen Shanghao , Wu Zezhong , Yun Yan , Shen Hechen , Zhao Diming , Liu Yanwu , Zou Chengwei , Zhang Haizhou , Wang Zhengjun , Ma Xiaochun
Published: April 2022

Background

Calcific aortic valve stenosis (CAVS) represents a serious health threat to elderly patients. Post-stenotic aortic dilation, a common feature in CAVS patients, might progress into aneurysm and even dissection, potential consequences of CAVS, and predicts a poor prognosis. This study sought to investigate the association of lymphocyte-to-monocyte ratio (LMR), an inflammatory biomarker, with severe post-stenotic aortic dilation in a case–control study in Chinese population.

Materials and methods

208 consecutive patients with CAVS were recruited retrospectively in a case–control study in Chinese population, from July 1, 2015 to June 31, 2018. LMR was statistically analyzed using the ROC curve and binary logistic regression analyses for its prognostic value in severe post-stenotic aortic dilation.

Results

LMR was significantly reduced in patients with severe post-stenotic aortic dilation (2.72 vs. 3.53, p = 0.002 < 0.05) compared to patients without severe post-stenotic aortic dilation. There was an inverse correlation observed between the maximal diameter of ascending aorta and LMR in the overall patients (r = − 0.217, p = 0.002 < 0.05). For post-stenotic aortic dilation, the prevalence of high-LMR group was statistically lower than that of low-LMR group (19.7% vs. 43.9%, p < 0.001). The maximal diameter of ascending aorta was significantly reduced in the high-LMR group (4.35 vs. 4.76, p = 0.003 < 0.05) compared to low-LMR group. Additionally, LMR was identified in the multivariate analysis independently associated with severe post-stenotic aortic dilation (AUC 0.743, 95% CI: [0.573–0.964], p = 0.025).

Conclusions

This study provided the evidence of an inverse correlation between severe post-stenotic aortic dilation and LMR. LMR is potentially independently associated with severe post-stenotic aortic dilation.
High-risk pregnant women’s experiences of the receiving prenatal care in COVID-19 pandemic: a qualitative study
Authors: Mirzakhani Kobra , Shoorab Nahid Jahani , Akbari Azam , Khadivzadeh Talat
Published: April 2022

Background

Women with high-risk pregnancies are among the most vulnerable groups that require additional precautionary measures against the spread of COVID-19 plus receiving prenatal care. Yet, there is limited information on the status of prenatal care in women with high-risk pregnancies. The purpose of this study was to explore the experiences of women with high-risk pregnancies who were receiving prenatal care during the COVID-19 pandemic.

Methods

The present qualitative study was conducted on mothers with high-risk pregnancies from September 2020 to March 2021. Purposeful sampling continued until achieving data saturation. Ghaem, Ommolbanin, and Imam Reza in Mashhad, Iran served as the research environment. Face-to-face and semi-structured interviews were effective data collection methods. Each interview lasted between 20 to 45 min (on average 30). The total number of participants was 31. Data analysis was carried out simultaneously with data collection using the qualitative content analysis method developed by Granheim and Landman (2004).

Results

Following the reduction and analysis of data from women in high-risk pregnancies, as well as their perceptions and experiences with health services during the COVID-19 pandemic, eight subcategories and three main categories were identified, including 1) “Negative psychology responses,” 2) “Adoption behavior,” and 3) “Adjustment of health services in mutual protection.”

Fear, anxiety, stress, feelings of loneliness, sadness, depression, guilt, doubt and conflict in receiving services were examples of negative psychological responses. The adaptive behaviors’ category reflected the behaviors of women with high-risk pregnancies in the context of the COVID COVID-19 pandemic. The Adjustment of health services in mutual protection indicated that health workers took preventive and protective measures against COVID-19, which, in addition to protecting themselves and their clients against COVID-19, gave women a sense of security.

Conclusion

Receiving prenatal care during the COVID-19 pandemic presents challenges for women with high-risk pregnancies, negatively impacting their psychological state and health-seeking behavior. Supportive and preventive care can ensure that women with high-risk pregnancies receive optimal prenatal care that focuses on COVID-19 prevention. We recommend implementing screening, psychological counseling, and education for women with high-risk pregnancies, as well as ensuring that they have access to women-centered health care services.
Alcohol use during pregnancy and associated factors among pregnant women in Sub-Saharan Africa: further analysis of the recent demographic and health survey data
Authors: Mulat Bezawit , Alemnew Wallelign , Shitu Kegnie
Published: April 2022

Background

Alcohol drinking during pregnancy is towering despite the well-established proof of its unfavorable pregnancy results and destitute child improvement. Despite such enormous consequences, there are limited data that explore the extent of alcohol drinking and its associated factors among mothers during pregnancy in sub-Saharan Africa.

Objective

This study aimed to assess the prevalence and associated factors of alcohol consumption during pregnancy among pregnant mothers in sub-Saharan Africa.

Method

A community-based crossectional demographic and health survey was conducted from 2013 to 2017 among four Sub-Sahara African countries: Burundi, Ethiopia, Liberia, and Zimbabwe. A two-stage stratified sampling technique was employed to select the participants. Multivariable Logistic regression analysis was used to identify factors associated with alcohol consumption during pregnancy. A p-value less than 0.05 and a 95% confidence interval were used to declare statistical significance.

Result

A total of 3953 weighted sample of pregnant mothers were included in the study. The mean age of the participants was 27.3 (± 6.8) years with an age range of 15–49 years. The overall prevalence of alcohol use during pregnancy was 22.8% with (95% CI (21.5, 24)) and it was significantly associated with increased age (AOR = 1.02, 95% CI (1.01, 1.04)), Muslim religion follower ( AOR = 0.07, 95% CI (0.05,0.11), husband/partner’s educational status( primary (AOR = 0.7,95% CI (0.55,0.84), secondary (AOR = 0.53, 95% CI ( 0.41,0.7)) and higher (AOR = 0.49, 95% CI (0.31,0.8), being currently working (AOR = 1.5,95% CI ( 1.09,1.55), having ANC visit ( AOR = 0.82, 95% C I(0.68,0.98) and increased gravidity ( AOR = 0.93,95% CI( 0.86,0.99).

Conclusion

Alcohol drinking during pregnancy was high among pregnant women in sub-Saharan African countries. Maternal age, religion, husband educational status, current working status of the mother, presence of ANC visit, and gravidity of the mother were factors that have a significant association with alcohol drinking during pregnancy. This calls for a tailored behavior change intervention to reduce alcohol use during pregnancy. More emphasis should also be given to pregnant women with no ANC visit, lower gravidity, and an illiterate husband, currently working and Christianity followers.
Tryptophan hydroxylase 1 drives glioma progression by modulating the serotonin/L1CAM/NF-κB signaling pathway
Authors: Zhang Jie , Guo Zhangchao , Xie Qiangli , Zhong Chuanhong , Gao Xiangyu , Yang Qiumei
Published: April 2022

Background

Glioma is one of the main causes of cancer-related mortality worldwide and is associated with high heterogeneity. However, the key players determining the fate of glioma remain obscure. In the present study, we shed light on tumor metabolism and aimed to investigate the role of tryptophan hydroxylase 1 (TPH-1) in the advancement of glioma.

Method

Herein, the levels of TPH-1 expression in glioma tissues were evaluated using The Cancer Genome Atlas (TCGA) database. Further, the proliferative characteristics and migration ability of TPH-1 overexpressing LN229/T98G cells were evaluated. Additionally, we performed a cytotoxicity analysis using temozolomide (TMZ) in these cells. We also examined the tumor growth and survival time in a mouse model of glioma treated with chemotherapeutic agents and a TPH-1 inhibitor.

Results

The results of both clinical and experimental data showed that excess TPH-1 expression resulted in sustained glioma progression and a dismal overall survival in these patients. Mechanistically, TPH-1 increased the production of serotonin in glioma cells. The elevated serotonin levels then augmented the NF-κB signaling pathway through the upregulation of the L1-cell adhesion molecule (L1CAM), thereby contributing to cellular proliferation, invasive migration, and drug resistance. In vivo experiments demonstrated potent antitumor effects, which benefited further from the synergistic combination of TMZ and LX-1031.

Conclusion

Taken together, these data suggested that TPH-1 facilitated cellular proliferation, migration, and chemoresistance in glioma through the serotonin/L1CAM/NF-κB pathway. By demonstrating the link of amino acid metabolic enzymes with tumor development, our findings may provide a potentially viable target for therapeutic manipulation aimed at eradicating glioma.
Disc repositioning by open suturing vs. mini-screw anchor: stability analysis when combined with orthognathic surgery for hypoplastic condyles
Authors: Hua Jiangshan , Lu Chuan , Zhao Jieyun , Yang Zhi , He Dongmei
Published: April 2022

Background

Disc repositioning by Mitek anchors for anterior disc displacement (ADD) combined with orthognathic surgery gained more stable results than when disc repositioning was not performed. But for hypoplastic condyles, the implantation of Mitek anchors may cause condylar resorption. A new disc repositioning technique that sutures the disc to the posterior articular capsule through open incision avoids the implantation of the metal equipment, but the stability when combined with orthognathic surgery is unknown. The purpose of this study was to evaluate the stability of temporomandibular joint (TMJ) disc repositioning by open suturing in patients with hypoplastic condyles when combined with orthographic surgery.

Methods

Patients with ADD and jaw deformity from 2017 to 2021 were included. Disc repositioning by either open suturing or mini-screw anchor were performed simultaneously with orthognathic surgery. MRI and CT images before and after operation and at least 6 months follow-ups were taken to evaluate and compare the TMJ disc and jaw stability. ProPlan CMF 1.4 software was used to measure the position of the jaw, condyle and its surface bone changes.

Results

Seventeen patients with 20 hypoplastic condyles were included in the study. Among them, 12 joints had disc repositioning by open suturing and 8 by mini-screw anchor. After an average follow-up of 18.1 months, both the TMJ disc and jaw position were stable in the 2 groups except 2 discs moved anteriorly in each group. The overall condylar bone resorption was 8.3% in the open suturing group and 12.5% in the mini-screw anchor group.

Conclusions

Disc repositioning by open suturing can achieve both TMJ and jaw stability for hypoplastic condyles when combined with orthognathic surgery.
Global use of SGLT2 inhibitors and GLP-1 receptor agonists in type 2 diabetes. Results from DISCOVER
Authors: Arnold Suzanne V. , Tang Fengming , Cooper Andrew , Chen Hungta , Gomes Marilia B. , Rathmann Wolfgang , Shimomura Iichiro , Vora Jiten , Watada Hirotaka , Khunti Kamlesh , Kosiborod Mikhail
Published: April 2022

Background

Despite strong evidence of benefit, uptake of newer glucose-lowering medications that reduce cardiovascular risk has been low. We sought to examine global trends and predictors of use of SGLT2i and GLP-1 RA in patients with type 2 diabetes.

Methods

DISCOVER is a global, prospective, observational study of patients with diabetes enrolled from 2014–16 at initiation of second-line glucose-lowering therapy and followed for 3 years. We used hierarchical logistic regression to examine factors associated with use of either an SGLT2i or GLP-1 RA at last follow-up and to assess country-level variability.

Results

Among 14,576 patients from 37 countries, 1579 (10.8%) were started on an SGLT2i (1275; 8.7%) or GLP-1 RA (318; 2.2%) at enrollment, increasing to 16.1% at end of follow-up, with large variability across countries (range 0–62.7%). Use was highest in patients treated by cardiologists (26.1%) versus primary care physicians (10.4%), endocrinologists (16.9%), and other specialists (22.0%; p < 0.001). Coronary artery disease (OR 1.29, 95% CI 1.08–1.54) was associated with greater use of SGLT2i or GLP-1 RA while peripheral artery disease (OR 0.73, 95% CI 0.54–1.00) and chronic kidney disease (OR 0.73, 95% CI 0.58–0.94) were associated with lower use (OR 0.73, 95% CI 0.54–1.00). The country-level median odds ratio was 3.48, indicating a very large amount of variability in the use of SGLT2i or GLP-1 RA independent of patient demographic and clinical factors.

Conclusions

Global use of glucose-lowering medications with established cardiovascular benefits has increased over time but remains suboptimal, particularly in sub-groups most likely to benefit. Substantial country-level variability exists independent of patient factors, suggesting structural barriers may limit more widespread use of these medications.
Do physicians with academic affiliation have lower burnout and higher career-related satisfaction?
Authors: Zhuang Chu , Hu Xiaochu , Dill Michael J.
Published: April 2022

Background

Physicians report increasing burnout and declining career-related satisfaction, negatively impacting physician well-being and patient care quality. For physicians with academic affiliations, these issues can directly affect future generations of physicians. Previous research on burnout and satisfaction has focused on factors like work hours, gender, race, specialty, and work setting. We seek to contribute to the literature by examining these associations while controlling for demographic, family, and work-related characteristics. Furthermore, we aim to determine any differential effects of faculty rank.

Methods

We analyzed data on practicing physicians in the U.S. from the Association of American Medical College’s (AAMC) 2019 National Sample Survey of Physicians (NSSP,) which includes variables adapted from the Maslach Burnout Inventory. We used ordinal logistic regressions to explore associations between academic affiliation and burnout. We conducted a factor analysis to consolidate satisfaction measures, then examined their relationship with academic affiliation using multivariate linear regressions. All regression analyses controlled for physicians’ individual, family, and work characteristics.

Results

Among respondents (n = 6,000), 40% were affiliated with academic institutions. Physicians with academic affiliations had lower odds than their non-affiliated peers for feeling emotional exhaustion every day (Odds Ratio [OR] 0.87; 95% CI: 0.79–0.96; P < .001) and reported greater career-related satisfaction (0.10–0.14, SE, 0.03, 0.02; P < .001). The odds of feeling burnt out every day were higher for associate professors, (OR 1.57; 95% CI: 1.22–2.04; P < .001) assistant professors, (OR 1.64; 95% CI: 1.28–2.11; P < .001), and instructors (OR 1.72; 95% CI, 1.29–2.29; P < .001), relative to full professors.

Conclusions

Our findings contribute to the literature on burnout and career satisfaction by exploring their association with academic affiliation and examining how they vary among different faculty ranks. An academic affiliation may be an essential factor in keeping physicians’ burnout levels lower and career satisfaction higher. It also suggests that policies addressing physician well-being are not “one size fits all” and should consider factors such as academic affiliation, faculty rank and career stage, gender identity, the diversity of available professional opportunities, and institutional and social supports. For instance, department chairs and administrators in medical institutions could protect physicians’ time for academic activities like teaching to help keep burnout lower and career satisfaction higher.
Assessment of safety attitudes, professionalism and exploration of medical students’ experiences
Authors: Keshmiri Fatemeh , Raadabadi Mehdi
Published: April 2022

Background

The present study was conducted to examine the interns’ perceptions of safety attitude and professionalism and to explore their experiences about adherence to the principles during the COVID-19 pandemic.

Method

The present study was a mixed-method that was performed in two quantitative and qualitative stages. The medical interns at X University (n = 140) were entered. In the quantitative phase, the assessment of the interns’ Safety Attitudes and Professionalism was conducted by a survey. In the qualitative phase, data were gathered by semi-structured interviews. The experiences of participants were analyzed by the inductive content analysis approach of Graneheim and Lundman.

Results

Participants’ perception scores on safety attitude and professionalism were 98.02 (14.78). The results were explained in a theme of “weakness in systemic accountability in compliance with professionalism and safety”. The theme included three categories: ‘support system inadequacy’, and ‘null curriculum in safety and professionalism education’.

Conclusion

The present results showed participants’ perception scores on safety attitude and professionalism were below the moderate level. The systemic issues were explored as influencing factors in the occurrence of unsafe and unprofessional behaviors. They reported the weakness of the support system (individual, teamwork, mental health, well-being, management, and culture), and the null curriculum in education of professional, and safety principles effective on unprofessional and unsafe behaviors. During the COVID-19 pandemic, it is recommended to create mechanisms to support the development of professionalism of healthcare workers, especially, novice providers and students, and pay attention to the safety and professionalism in formal and informal educational programs.
Priorities among effective clinical preventive services in British Columbia, Canada
Authors: Krueger Hans , Robinson Sylvia , Hancock Trevor , Birtwhistle Richard , Buxton Jane A. , Henry Bonnie , Scarr Jennifer , Spinelli John J.
Published: April 2022

Background

Despite the long-standing experience of rating the evidence for clinical preventive services, the delivery of effective clinical preventive services in Canada and elsewhere is less than optimal. We outline an approach used in British Columbia to assist in determining which effective clinical preventive services are worth doing.

Methods

We calculated the clinically preventable burden and cost-effectiveness for 28 clinical preventive services that received a ‘strong or conditional (weak) recommendation for’ by the Canadian Task Force on Preventive Health Care or an ‘A’ or ‘B’ rating by the United States Preventive Services Task Force. Clinically preventable burden is the total quality adjusted life years that could be gained if the clinical preventive services were delivered at recommended intervals to a British Columbia birth cohort of 40,000 individuals over the years of life that the service is recommended. Cost-effectiveness is the net cost per quality adjusted life year gained.

Results

Clinical preventive services with the highest population impact and best value for money include services that address tobacco use in adolescents and adults, exclusive breastfeeding, and screening for hypertension and other cardiovascular disease risk factors followed by appropriate pharmaceutical treatment. In addition, alcohol misuse screening and brief counseling, one-time screening for hepatitis C virus infection in British Columbia adults born between 1945 and 1965, and screening for type 2 diabetes approach these high-value clinical preventive services.

Conclusions

These results enable policy makers to say with some confidence what preventive manoeuvres are worth doing but further work is required to determine the best way to deliver these services to all those eligible and to establish what supportive services are required. After all, if a clinical preventive service is worth doing, it is worth doing well.
Survival among people hospitalized with COVID-19 in Switzerland: a nationwide population-based analysis
Authors: Anderegg Nanina , Panczak Radoslaw , Egger Matthias , Low Nicola , Riou Julien
Published: April 2022

Background

Increasing age, male sex, and pre-existing comorbidities are associated with lower survival from SARS-CoV-2 infection. The interplay between different comorbidities, age, and sex is not fully understood, and it remains unclear if survival decreases linearly with higher ICU occupancy or if there is a threshold beyond which survival falls.

Method

This national population-based study included 22,648 people who tested positive for SARS-CoV-2 infection and were hospitalized in Switzerland between February 24, 2020, and March 01, 2021. Bayesian survival models were used to estimate survival after positive SARS-CoV-2 test among people hospitalized with COVID-19 by epidemic wave, age, sex, comorbidities, and ICU occupancy. Two-way interactions between age, sex, and comorbidities were included to assess the differential risk of death across strata. ICU occupancy was modeled using restricted cubic splines to allow for a non-linear association with survival.

Results

Of 22,648 people hospitalized with COVID-19, 4785 (21.1%) died. The survival was lower during the first epidemic wave than in the second (predicted survival at 40 days after positive test 76.1 versus 80.5%). During the second epidemic wave, occupancy among all available ICU beds in Switzerland varied between 51.7 and 78.8%. The estimated survival was stable at approximately 81.5% when ICU occupancy was below 70%, but worse when ICU occupancy exceeded this threshold (survival at 80% ICU occupancy: 78.2%; 95% credible interval [CrI] 76.1 to 80.1%). Periods with higher ICU occupancy (>70 vs 70%) were associated with an estimated number of 137 (95% CrI 27 to 242) excess deaths. Comorbid conditions reduced survival more in younger people than in older people. Among comorbid conditions, hypertension and obesity were not associated with poorer survival. Hypertension appeared to decrease survival in combination with cardiovascular disease.

Conclusions

Survival after hospitalization with COVID-19 has improved over time, consistent with improved management of severe COVID-19. The decreased survival above 70% national ICU occupancy supports the need to introduce measures for prevention and control of SARS-CoV-2 transmission in the population well before ICUs are full.
Left ventricular high frame rate echo-particle image velocimetry: clinical application and comparison with conventional imaging
Authors: Strachinaru Mihai , Voorneveld Jason , Keijzer Lana B. H. , Bowen Daniel J. , Mutluer Ferit O. , Cate Folkert ten , de Jong Nico , Vos Hendrik J. , Bosch Johan G. , van den Bosch Annemien E.
Published: April 2022

Background

Echo-Particle Image Velocimetry (echoPIV) tracks speckle patterns from ultrasound contrast agent(UCA), being less angle-sensitive than colour Doppler. High frame rate (HFR) echoPIV enables tracking of high velocity flow in the left ventricle (LV). We aimed to demonstrate the potential clinical use of HFR echoPIV and investigate the feasibility and accuracy in patients.

Methods

Nineteen patients admitted for heart failure were included. HFR contrast images were acquired from an apical long axis view (ALAX), using a fully-programmable ultrasound system. A clinical UCA was continuously infused with a dedicated pump. Additionally, echocardiographic images were obtained using a clinical system, including LV contrast-enhanced images and pulsed-wave (PW) Doppler of the LV inflow and outflow in ALAX. 11 patients underwent CMR and 4 cardiac CT as clinically indicated. These CMR and CT images were used as reference. In 10 patients with good echoPIV tracking and reference imaging, the intracavitary flow was compared between echoPIV, conventional and UCA echocardiography.

Results

EchoPIV tracking quality was good in 12/19 (63%), moderate in 2/19 (10%) and poor in 5/19 (26%) subjects. EchoPIV could determine inflow velocity in 17/19 (89%), and outflow in 14/19 (74%) patients. The correlation of echoPIV and PW Doppler was good for the inflow (R2 = 0.77 to PW peak; R2 = 0.80 PW mean velocity) and moderate for the outflow (R2 = 0.54 to PW peak; R2 = 0.44 to PW mean velocity), with a tendency for echoPIV to underestimate PW velocities. In selected patients, echoPIV was able in a single acquisition to demonstrate flow patterns which required multiple interrogations with classical echocardiography. Those flow patterns could also be linked to anatomical abnormalities as seen in CMR or CT.

Conclusion

HFR echoPIV tracks multidirectional and complex flow patterns which are unapparent with conventional echocardiography, while having comparable feasibility. EchoPIV tends to underestimate flow velocities as compared to PW Doppler. It has the potential to provide in one acquisition all the functional information obtained by conventional imaging, overcoming the angle dependency of Doppler and low frame rate of classical contrast imaging.
Replication kinetics and infectivity of SARS-CoV-2 variants of concern in common cell culture models
Authors: Mautner Lena , Hoyos Mona , Dangel Alexandra , Berger Carola , Ehrhardt Anja , Baiker Armin
Published: April 2022

Background

During the ongoing Covid-19 pandemic caused by the emerging virus SARS-CoV-2, research in the field of coronaviruses has expanded tremendously. The genome of SARS-CoV-2 has rapidly acquired numerous mutations, giving rise to several Variants of Concern (VOCs) with altered epidemiological, immunological, and pathogenic properties.

Methods

As cell culture models are important tools to study viruses, we investigated replication kinetics and infectivity of SARS-CoV-2 in the African Green Monkey-derived Vero E6 kidney cell line and the two human cell lines Caco-2, a colon epithelial carcinoma cell line, and the airway epithelial carcinoma cell line Calu-3. We assessed viral RNA copy numbers and infectivity of viral particles in cell culture supernatants at different time points ranging from 2 to 96 h post-infection.

Results

We here describe a systematic comparison of growth kinetics of the five SARS-CoV-2 VOCs Alpha/B.1.1.7, Beta/B.1.351, Gamma/P.1, Delta/B.1.617.2, and Omicron/B.1.1.529 and a non-VOC/B.1.1 strain on three different cell lines to provide profound information on the differential behaviour of VOCs in different cell lines for researchers worldwide. We show distinct differences in viral replication kinetics of the SARS-CoV-2 non-VOC and five VOCs on the three cell culture models Vero E6, Caco-2, and Calu-3.

Conclusion

This is the first systematic comparison of all SARS-CoV-2 VOCs on three different cell culture models. This data provides support for researchers worldwide in their experimental design for work on SARS-CoV-2. It is recommended to perform virus isolation and propagation on Vero E6 while infection studies or drug screening and antibody-based assays should rather be conducted on the human cell lines Caco-2 and Calu-3.
Effectiveness of the world anti-doping agency's e-learning programme for anti-doping education on knowledge of, explicit and implicit attitudes towards, and likelihood of doping among Chinese college athletes and non-athletes
Authors: Deng Zhangyan , Guo Jinyang , Wang Dong , Huang Tao , Chen Zuosong
Published: April 2022

Background

This study aimed to evaluate the effects of the World Anti-Doping Agency's e-learning programme for anti-doping education on knowledge of, explicit and implicit attitudes towards, and likelihood of doping among Chinese college athletes and non-athletes.

Method

Thirty-two young adults (including 16 college athletes) were recruited to receive the Athlete Learning Program about Health and Anti-Doping (ALPHA) intervention (Zh-hans version). Another 32 young adults were recruited for no-treatment control purposes. Before and immediately after the intervention, the ALPHA test, performance enhancement attitude scale, doping likelihood scale, and brief implicit association test (BIAT) were performed. Cortical activity during the BIAT test was monitored using a functional near-infrared spectroscopy instrument.

Results

Significant intervention effects were observed for knowledge (p < 0.01, η2 = 0.21) and explicit attitude (p < 0.05, η2 = 0.12) but not for doping likelihood (p > 0.05; benefit situation: η2 = 0.04; cost situation: η2 = 0.02). Compared with the non-athletes, the college athletes reported lower doping likelihood scores in benefit situations (e.g., financial gain, p < 0.05, η2 = 0.10). Regarding the BIAT task, the experimental effect was successfully induced by different semantic associations between the concepts and the attitude (doping + like vs. doping + dislike). The mean reaction times (p < 0.01, η2 = 0.36) and error rate (p < 0.01, η2 = 0.34) in the doping-like block were higher than those in the doping-dislike block. Moreover, oxygenated haemoglobin (oxy-Hb) in response to BIAT interference in the temporoparietal junction-related channels was increased during the post-intervention test (p < 0.05, η2 varied from 0.09 to 0.16).

Conclusions

The findings suggest that the online anti-doping education programme is partially effective among Chinese college athletes and non-athletes. Furthermore, our findings reflect enhanced cognitive control after the education intervention to suppress a prepotent implicit attitude towards doping.
Efficient privacy-preserving variable-length substring match for genome sequence
Authors: Nakagawa Yoshiki , Ohata Satsuya , Shimizu Kana
Published: April 2022

The development of a privacy-preserving technology is important for accelerating genome data sharing. This study proposes an algorithm that securely searches a variable-length substring match between a query and a database sequence. Our concept hinges on a technique that efficiently applies FM-index for a secret-sharing scheme. More precisely, we developed an algorithm that can achieve a secure table lookup in such a way that$$V[V[\ldots V[p_0] \ldots ]]$$V[V[…V[p0]…]]is computed for a given depth of recursion where$$p_0$$p0is an initial position, andVis a vector. We used the secure table lookup for vectors created based on FM-index. The notable feature of the secure table lookup is that time, communication, and round complexities are not dependent on the table lengthN, after the query input. Therefore, a substring match by reference to the FM-index-based table can also be conducted independently against the database length, and the entire search time is dramatically improved compared to previous approaches. We conducted an experiment using a human genome sequence with the length of 10 million as the database and a query with the length of 100 and found that the query response time of our protocol was at least three orders of magnitude faster than a non-indexed database search protocol under the realistic computation/network environment.