bluuebunny/crossref_metadata_2025 huggingface dataset:
Living with Distal Renal Tubular Acidosis: Qualitative Research with Nephrologists, Patients, and Caregivers
Authors: Dalessandri-Silva Cynthia , Koochaki Patricia , Shah Selam , Manso-Silván Maria A. , Law Linda , Ogg Carol , Marrel Alexia
Published: April 2021

Rationale & Objective: Clinical consequences of distal renal tubular acidosis (dRTA) may include profound dehydration, failure to thrive, growth delay, rickets, hearing impairment/loss, nephrocalcinosis, and nephrolithiasis. Little has been published about patients’ and caregivers’ lived experiences with this rare disease. This study provides context and understanding of patients’ and caregivers’ perspectives as well as the nephrologists’ experiences managing the patient with dRTA.Study Design: Descriptive qualitative study. Setting & Participants: One-on-one, semi-structured, one-hour telephone/WebEx interviews were performed using an interview guide. Four pediatric nephrologists experienced in the treatment of dRTA, two adult patients, a pediatric patient and caregiver pair, and one caregiver of a pediatric patient participated from the United States. Analytical Approach: Thematic analysis of interview transcripts was conducted utilizing a qualitative data analysis software.Results: Three primary themes emerged from the analysis of the interviews: diagnostic challenges, burden of disease, and burden of treatment. Nephrologists provided complete insights into the diagnostic and clinical challenges associated with dRTA and its management, including previous misdiagnosis, and poor adherence to medication regimen. Patients and caregivers added to understanding the significant physical, social, emotional, educational/professional, and health-related quality of life (HRQoL) impacts of the disease. Patients, caregivers, and nephrologists were aligned on the significant unmet needs associated with current medicinal standard of care (SoC) due to high dosing frequency, low palatability, and tolerability of available treatments.Limitations: Due to rare disease recruitment challenges, the sample size was small and lacked geographic diversity. Conclusion: Interview findings bridge the gap in knowledge regarding patient and caregiver lived experience with dRTA and support the need for increased recognition of the disease and the use of algorithms to improve the diagnostic challenges. Key findings included frequent alkali dosing is a barrier to medication adherence and the need for improved social/emotional support for patients and caregivers.
Pharmacists in Advanced Clinical Practice Roles in Emergency Departments (PARED)
Authors: Terry David , Ganasan Shalini , Aiello Matthew , Huynh Chi , Wilkie Veronica , Hughes Elizabeth
Published: April 2021

Background
Following evidence published in the Pharmacists in Emergency Departments (PIED 2016) study Health Education England funded novel advanced clinical practitioner training for pharmacists (ACP-p), to support service delivery.
Objective
To explore experiences and clinical activity of trainee ACP-p, and opinions and recommendations of both trainees and clinical supervisors.
Setting and participants
Five Urgent/Emergency Care Departments in London UK. Registered UK pharmacists appointed as trainee ACP-p.
Method
Longitudinal mixed-methods study in three phases. Phase 1 – early semi-structured interviews and focus group using an experiences, opinions and recommendations (EOR) framework, Phase 2 – recording of trainee clinical activity using bespoke spreadsheet, Phase 3 – as Phase 1 but at conclusion of training.
Main outcome measure
Experiences, clinical activity, opinions and recommendations of study participants.
Results
Twelve (92%) eligible trainee ACP-p and five supervisors were recruited. Identified themes include: trainee personality, educational components, length of programme, support/supervision, career transition, university and placement training alignment, recommendations. Success was dependent on effective support and supervision. Clinical supervisors should be allocated supervision time. Trainees, their supervisors and emergency department staff should be given a clear brief. Study participants agreed that the programme could be successful. Trainee ACP-p reported that they could manage 82% of 713 reported cases. Additional training needs include: ECGs, Xrays and CT scans.
Conclusion
Pharmacists can successfully train as ACP-p in this setting over a two-year period. This career transition needs careful management and clear structures. Training ACP-p is a useful way of enhancing skills and supporting clinical services to large numbers of patients.
Development of a Snowdrift Model with the Lattice Boltzmann Method
Authors: Tanji Seika , Inatsu Masaru , Okaze Tsubasa
Published: April 2021

This study developed a new snowdrift model to evaluate the snowdrift height around a snow fence, often installed along a road in a snowy and windy environment. The model consisted of the conventional computational fluid dynamics (CFD) solver by the Lattice Boltzmann method (LBM) and a module for snow particles’ motion and accumulation. The calculation domain was a half channel with a flat free-slip boundary on the top and a non-slip boundary on the bottom, imposing an inflow with artificially generated turbulence from one side to the other outlet side. Besides the reference experiment with no fence, the experiment was set up with a two-dimensional and a three-dimensional fences normal to the dominant wind direction in the channel center. The estimated wind flow over the two-dimensional fence was characterized by a swirling eddy in the cross-section, whereas the wind flow in the three-dimensional fence experiment was horizontally diffluent with a dipole vortex pair in the leeward of the fence. As a result, almost all of snowdrift was formed in the windward of the two-dimensional and three-dimensional fences, but it was also formed as the split streak in the leeward of the three-dimensional fence. The result suggested that the fence should be as long as possible to avoid the snowdrift on roads.
α-Linolenic Acid Induces Breast Cancer Cell Apoptosis by Down-Regulating Human Fatty Acid Synthase
Authors: Huang Wenyuan , Guo Xing , Fan Huijin , Alzhan Amantay , Liu Zhengan , Ma Xiaofeng , Shu Qingyan
Published: April 2021

Background/Aims: Fatty acid synthase (FASN) is a multi-enzyme complex that synthesizes endogenous fatty acids. The overexpression of FASN has been reported in variety of cancers, including breast, ovarian, prostrate, and colon cancers, which strongly indicates the involvement of FASN in cancer progression. α-Linolenic acid (ALA) has many biological activities, including anti-cancer effects. The aim of the present study was to investigate the inhibitory effect of ALA on fatty acid synthesis pathway and apoptosis of human breast cancer cells. Methods: Cytotoxicity of ALA in human breast cancer cells (MDA-MB-231 and MCF-7 cells) was assessed by MTT assay. Changes in protein expression were detected by immunoblot analysis. Cell migration was detected by wound healing and cell transwell assay. Apoptotic effects, mitochondrial membrane potential and cell cycle analysis were detected by flow cytometry. Molecular docking was carried out with the AutoDockTools program suite to analyze the binding abilities of ALA on thioesterase (TE) domain of FASN. Results: We found that the expression levels of FASN decreased significantly in ALA treated breast cancer cells. Compared with palmitic acid (PA), ALA reduced cell viability in a dose-dependent manner. ALA showed a higher affinity with the TE domain than PA. ALA induced breast cancer cells apoptosis, which effects were similar with the knockdown of FASN. In addition, ALA inhibited the invasion and metastasis, and arrested cell cycle in breast cancer cells. Conclusion: We propose a hypothesis that ALA could contribute to the treatment of human breast cancer by inhibiting FASN.
Developing an implementation strategy for a praziquantel mass drug administration for children aged five years and below: A conceptual framework
Authors: Ncube Mhlengi Vella , Mindu Tafadzwa , Chimbari Moses John
Published: April 2021

Background: Children aged five years and below in schistosomiasis endemic areas spend several years living with the schistosome infections before they can be treated as they are excluded from school based mass drug administration programs. The WHO has recommended that these children be included in schistosomiasis preventive chemotherapy in endemic areas. Including these children in schistosomiasis control mass drug administration programs is a complicated task involving translating clinical studies into clinical practice processes, contextualizing clinical practice processes to the resources that are available in the community and economic evaluations. Methodology: We conducted a scoping search on google scholar and the concepts we searched for included implementation strategies, contextualization strategies, resource planning and economic evaluations in health care, risk and quality assessments. We then developed a conceptual framework and explained how the conceptual framework could be used to develop an implementation strategy for a mass drug administration for children aged five year and belowResults: The most common methods/frameworks that were identified in our search for health care implementation strategy development include the following: Donabedian framework, scoping review, FMEA, scenario planning, resource planning and economic evaluation of healthcare interventions and cost-effectiveness analysis.Conclusion: We concluded that the Donabedian framework can be modified and used in conjunction with scoping reviews, FMEA, scenario planning and economic evaluations to develop an implementation strategy for a schistosomiasis control MDA program for children aged five years old and below.
Fifty years of change in the lower tree line in an arid coniferous forest in the Qilian Mountains, northwestern China
Authors: Fang Shu , He Zhibin
Published: April 2021

Background: Tree-line areas exhibit significant changes in response to climate change, including upward migration. Lower tree line dynamics are rarely studied, but as unique features in arid and semi-arid areas, they may influence forest distribution. Here, 8 lower tree-line plots in Picea crassifolia Kom. (Qinghai spruce) forest in the arid and semi-arid Qilian Mountains of northwestern China were used to determine changes in tree line location, landscape pattern, and relationships with meteorological factors during 1968-2018. Results: The results showed that the lower tree line descended by an average of 9.82 m during 1968 to 2018, and exhibited almost no change after 2008. The change in pattern was mainly related to the age of trees in which small trees were dense and clustered, and large trees became more scattered and evenly distributed. Tree regeneration rates changes in the lower tree line were highly positively correlated with temperature, and also positively related to annual precipitation. Conclusions: In the past 50 years, the lower tree line in arid areas exhibited a downward trend but it is unclear whether the downward trend of the lower tree line will stabilize or even reverse due to the weakening of climate warming degree.
Predicting the Development Trend of the Second Wave of COVID-19 in Five European Countries
Authors: Chen Zuobing , Lei Jiali , Li Mengyuan , Zhang Tianfang , Wang Xiaosheng
Published: April 2021

Background: Because the COVID-19 pandemic has made comprehensive and profound impacts on the world, an accurate prediction of its development trend is significant. In particular, the second wave of COVID-19 is rampant to cause a dramatic increase in COVID-19 cases and deaths globally. Methods: Using the Eureqa algorithm, we predicted the development trend of the second wave of COVID-19 in five European countries, including France, Germany, Italy, Spain, and UK. We first built models to predict daily numbers of COVID-19 cases and deaths based on the data of the first wave of COVID-19 in these countries. Based on these models, we built new models to predict the development trend of the second wave of COVID-19. Results: We predicted that the second wave of COVID-19 would have peaked around on November 16, 2020, January 10, 2021, December 1, 2020, March 1, 2021, and January 10, 2021 in France, Germany, Italy, Spain, and UK, respectively. It will be basically under control on April 26, 2021, September 20, 2021, August 1, 2021, September 15, 2021, August 10, 2021 in these countries, respectively. Their total number of COVID-19 cases will reach around 4,745,000, 7,890,000, 6,852,000, 8,071,000, and 10,198,000, respectively, and total number of COVID-19 deaths will be around 262,000, 262,000, 231,000, 253,000, and 350,000 during the second wave of COVID-19. The COVID-19 mortality rate in the second wave of COVID-19 is expected to be about 3.4%, 3.5%, 3.4%, 3.4%, and 3.1% in France, Spain, Germany, France, and UK, respectively. Conclusions: the second wave of COVID-19 is expected to cause many more cases and deaths, last for much longer time, and have lower COVID-19 mortality rate than the first wave.
Ancient Gypsum Mortars from Ornaments of Seyyed Shams al-Din Mausoleum(Yazd, Iran) Characterization; Identification of Technology of Making
Authors: Hamzavi Yaser , Goharbin Behnood
Published: April 2021

Gypsum mortar in mausoleum of Seyed Shams al-Din in Yazd, shows incomparable reliefs and molded ornaments. A notable instance of these is the partially damaged gypsum inscription that adorns the iwan of the mausoleum and extends over three sides of it. Apposite conservation of this valuable inscription would call for a structural and technological analysis before its structure-related damages and erosion process could be precisely and systematically examined and documented. Samples were obtained from both the surface and deeper layers of the inscription in question as well as the molded gypsum ornament and the fine coat underlying the latter. The samples were then evaluated using XRD, XRF, and SEM-EDS analyses before the mortars were compared. The results revealed that the interior and surface of this inscription vary structurally, which is partly related to the processing of the mortar and executing the inscription and is partly a function of the mortar erosion process. Erosion and structural alterations in the inner inscription are far more extensive than in the surface, leading to the reduced strength, a main reason for it being the permeation of moisture and soluble salts from the retaining wall to the deeper layers of the gypsum inscription.
Does Descending Health Resources Reform Impact Patient Low-level Hospital Selection Behavior? Evidence from Zhejiang, China
Authors: SUN Zesheng , Wang Shuhong , Zhao Hongjun , Zhou Xu , Zhang Ludan , Shi Jiongping
Published: April 2021

Background: Since 2013, China launched descending resources reform, which is a new attempt to correct unbalanced allocation of health resources through human capital spillovers and brand implantation from high-level hospitals. The purpose of this paper is to explore the patients’ hospital selection response to this reform with the focus of low-level hospitals to better understand the effect of this reform on correcting regional inequality of health resources allocation. Methods: The European Consumer Satisfaction Index model (ECSI) was used to design a questionnaire, and cross-sectional data from 17 hospitals were collected through 1,287 questionnaires from Zhejiang Province. Patient hospital selection (loyalty) is measured using ordinary variables by considering patient willingness to choose a low-level hospital when suffering an illness or severe illness. Analysis of variance (ANOVA) and the structure equation model are applied to examine the effect of reforms on patient behavior. Results: The descending resources reform promotes improvements in the capabilities and medical environment of low-level hospitals, and descending doctors also have high accessibility. Perceived quality, patient expectations, and hospital image have significant positive effects on patient satisfaction, and the explanatory power of brand implantation from cooperative high-level hospitals and descending doctors is stronger than the image of the low-level hospital itself. And descending resources reform and patient satisfaction have significant positive impacts on patient’s choice for low-level hospitals with the existence of mediating effect of satisfaction. Conclusions: This paper provides supporting empirical evidence of the descending resources reform’s impact on patients’ low-level hospital selection. This reform has been effective in improving the capabilities of low-level hospitals, and brand implantation of high-level hospitals shows strong explanatory power. China’s reform offers a distinct and valuable approach to correcting the uneven allocation of health resources. Besides, the findings also suggest that policymakers could pay more attention to the importance of information channels in impacting patient awareness, responses, and hospital selection.
A Retrospective Study of 51 Pediatric Cases of Traumatic Asphyxia
Authors: huirong luo , jin xin
Published: April 2021

Backgroundtraumatic asphyxia (TA) is a rarely reported disease characterized as thoraco-cervico-facial petechiae, facial edema and cyanosis, subconjunctival hemorrhage and neurological symptoms. This study aimed to report 51 children of TA at the pediatric medical center of west China.Methodsscanned medical reports were reviewed and specific variables as age, sex, cause of injury, clinical manifestations and associated injuries were analyzed using SPSS 25.0.Resultsaged as 5.3±2.9 (1.3-13.2), 30 (58.8%) were boys and 21 (41.2%) were girls. Most TAs occurred during vehicle accident, object compression and stampede. All patients showed facial petechiae (100.0%, CI 93.0%-100.0%), 25 (49.0%, CI 34.8%-63.2%) out of 51 presented with facial edema, 29 (56.9%, CI 42.8%-70.9%) presented with subconjunctival hemorrhage, including bilateral 27 and unilateral 2. 6 patients had facial cyanosis (11.8%, CI 2.6%-20.9%). Other symptoms were also presented as epileptic seizure, vomiting, incontinence, paraplegia, etc. The most frequent companion injury was pulmonary contusion (76.5%, CI 64.4%-88.5%). Other companion injuries included mediastinal emphysema, fracture, cerebral contusion and hemorrhage, hypoxic-ischemic brain injury, abdominal organ contusion, mastoid hemorrhage, hematocele of paranasal sinuses, spinal injury, hepatic insufficiency, myocardial injury and retinal hemorrhage and edema. Treatment was mainly supportive. No death occurred in our study. The prognosis is rather good if without damage of central nervous system.ConclusionTA could bring out multiple symptoms, among which retinal hemorrhage and edema, spinal injury and viscera impairment have been less observed. Comprehensive physical and auxiliary examination should be performed considering TA. Its prognosis is rather good with focus on life-threatening complications.
The aging whole blood transcriptome reveals a potential role of FASLG in COVID-19
Authors: Chuffa Luiz Gustavo , Freire Paula Paccielli , Souza Jeferson dos Santos , Mello Mariana Costa de , Neto Mario de Oliveira , Carvalho Robson Francisco
Published: April 2021

The risk for severe COVID-19 increases with age as older patients are at the highest risk. Identifying how Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) interacts with blood components during aging is urgent. We investigated the aging whole blood transcriptome from the Genotype-Tissue Expression (GTEx) database to explore differentially expressed genes (DEGs) translated into proteins interacting with viral proteins. From 22 DEGs in aged blood, FASLG, CTSW, CTSE, VCAM1, and BAG3 changed their expression with involvement in immune response, inflammation, cell component and adhesion, and platelet activation/aggregation. Males and females older than 50 overexpress FASLG possibly inducing a hyper-inflammatory cascade. The expression of cathepsins (CTSW and CTSE) and the anti-apoptotic co-chaperone molecule BAG3 was increased throughout aging in both gender. By exploring publicly available Single-Cell RNA-Sequencing data on peripheral blood of SARS-CoV-2-infected patients, we found FASLG and CTSW expressed in natural killer cells and CD8 + T lymphocytes, whereas BAG3 was expressed in CD4 + T cells, naive T cells, and CD14 + monocytes. The expression of FASLG in aged blood may explain why older patients are more prone to viral infection complications. The results indicate FASLG as a prognostic candidate and potential therapeutic target for the more aggressive clinical manifestation of COVID-19. The reduction of FASLG could be helpul against disease progression.
Increasing Perioperative Risk Scoring in Emergency Laparotomy: A Surgical Trainee-Led Nationwide Quality Improvement Programme
Authors: Nally Deirdre M , Lonergan Peter E , Connell Emer P O , McNamara Deborah
Published: April 2021

Background: Emergency laparotomy is associated with high morbidity and mortality. The early identification of high-risk patients allows for the provision of timely perioperative care and appropriate resource allocation. The aim of this study was to develop a nationwide surgical trainee-led quality improvement (QI) programme to increase the use of perioperative risk scoring in emergency laparotomy.Methods: The programme was structured using the active implementation framework in 15 state-funded Irish hospitals to guide the staged implementation of perioperative risk scoring. The primary outcome was a documented preoperative risk score for patients undergoing an emergency laparotomy at each site.Results: The percentage of patients undergoing emergency laparotomy who received perioperative risk scoring increased from 0-11% during the exploratory phase to 35-100% during the full implementation phase. This change was consistently maintained throughout the full implementation phase of the programme.Conclusions: A trainee-led QI programme increased the use of perioperative risk assessment in patients undergoing emergency laparotomy, suggesting that such an approach may be feasible for improving patient outcomes and care delivery performance.
Warming enhanced the climate temporal effects on vegetation across Siberia
Authors: Shi Shangyu , Wang Ping , Zhang Yichi , Yu Jingjie
Published: April 2021

Widespread climate warming and growing season greening have been observed across most of the Northern Hemisphere in recent decades. However, the response of greening to amplified warming remains unclear with regard to the temporal effects (cumulative and time-lag effects) in cold regions of the Northern Hemisphere. We therefore provide a comprehensive analysis of the relationship between the enhanced vegetation index (EVI) and climate factors (e.g., land surface temperature (LST), precipitation, and solar radiation) across Siberia, which is experiencing rapid warming and greening, during 2000–2016 by using a random forest regression model. We found that solar radiation was the dominant driving factor of vegetation greening in 55.95% of the study area (concentrated in southwest Siberia), followed by temperature (41.28%, concentrated in northeast Siberia) and precipitation (2.78%). Furthermore, the cumulative and time-lag effects increased the explanation of vegetation variation by climate factors, from 0.71 to 0.78, and were observed in more than 80% of the area of Siberia. The average cumulative duration was 3.61 ± 1.97 months, and the time-lag period was 1.51 ± 1.20 months, with the longest term found in deciduous broadleaf forests and the shortest term found in shrublands. Our results indicated that the vegetation activities were influenced by cumulative effects combined with time-lag effects. The temporal effects varied with land cover categories, and the complex ecosystem generally corresponded to long-term temporal effects, and vice versa. Hence, the tundra shrub converted to boreal forest caused by warming in Siberia enhanced the climate temporal effects.
Eliminating Mosquitoes with Precision Guided Sterile Males
Authors: Li Ming , Yang Ting , Bui Michelle , Gamez Stephanie , Wise Tyler , Kandul Nikolay , Liu Junru , Alcantara Lenissa , Lee Haena , Edula Jyotheeswara , Raban Robyn , Zhan Yinpeng , Wang Yijin , DeBeaubien Nick , Chan Jieyan , Sanchez Hector , Bennett Jared , Antoshechkin Igor , Montell Craig , Marshall John , Akbari Omar
Published: April 2021

The mosquito Aedes aegypti is the principal vector for arboviruses including dengue/yellow fever, chikungunya, and zika, infecting hundreds of millions of people annually. Unfortunately, traditional control methodologies are insufficient, so innovative control methods are needed. To complement existing measures, here we develop a molecular genetic control system termed precision guided sterile insect technique (pgSIT) in Aedes aegypti. PgSIT uses a simple CRISPR-based approach to generate sterile males that are deployable at any life stage. Supported by mathematical models, we empirically demonstrate that released pgSIT males can compete, suppress, and eliminate mosquitoes in multigenerational population cages. This platform technology could be used in the field, and adapted to many vectors, for controlling wild populations to curtail disease in a safe, confinable, and reversible manner.
The Fusion Circular RNA F-circEA1 Promotes Non-small Cell Lung Carcinoma Progression through ALK Downstream Signaling
Authors: Huo yinping , Lv Tangfeng , Ye Mingxiang , Zhu Suhua , Liu Jiaxin , Liu Hongbing , Song Yong
Published: April 2021

Background Circular RNA has a stable closed structure, which plays an important role in the occurrence and development of tumors. However, there are no reports on the relationship between fusion circular RNA and EML4-ALK variant 1, or their underlying molecular mechanisms in non-small cell lung carcinoma (NSCLC). Methods To test F-circEA1 in NCI-H3122 cells (carrying the EML4-ALK variant 1 gene) by RT-PCR, FISH and Sanger sequencing; To determine cell proliferation with a CCK-8 assay. Transwell experiments were used to detect cell migration and invasion. Cell cycle stage and apoptosis were detected by flow cytometry. The sensitivity of cells to crizotinib was tested using a CCK-8 assay. RT-PCR and western blots were used to measure the expression of EML4-ALK1 and downstream signaling factors associated with ALK. Subcutaneously transplanted tumors were used in nude mice to determine the effect of F-circEA1 on tumor formation and the expression of EML4-ALK1 by immunohistochemistry. Statistical analyses were carried by GraphPad Prism 8.0 and differences between groups were compared using Student's t test. Difference with p value <0.05 is statistically significant.Results F-circEA1 was present both in the cytoplasm and nucleus of NCI-H3122 cells. F-circEA1 was contributed to cell proliferation, metastasis, invasion. F-circEA1 induced cell arrest, promoted cell apoptosis and improved drug sensitivity to crizotinib. After knockdown with F-circEA1, subcutaneously transplanted tumors in nude mice grew slowly, the expression of EML4-ALK1 in tumor tissues decreased significantly. The mRNA and protein levels of EML4-ALK1 decreased after knockdown of F-circEA1 but increased after its overexpression. The protein expression of downstream ALK signaling factors increased after overexpression of F-circEA1, but not at the mRNA level.Conclusions We have confirmed a potential carcinogenenic and therapeutic role for F-circEA1 in NSCLC. Our experimental results may provide a new biomarker, treatment method, and prognostic monitoring index for use in the clinic.
FCTC Ratification, Smoking Prevalence and GDP per Capita : Lesson Learn for Indonesia
Authors: Ahsan Abdillah , Afin Rifai , Amalia Nadira , Hindriyani Martha , Jacinda Ardhini Risfa
Published: April 2021

Background The stagnated tobacco control progress in Indonesia needs to be accelerated through a more comprehensive implementation of Framework Convention of Tobacco Control (FCTC) measurement. Nevertheless, the tobacco industry argument concerning the negative economic impacts of tobacco control still hinders the government to ratify or even sign the FCTC, which has been ratified by more than 180 countries. This study aims to bring the empirical evidence on the tobacco industry argument concerning FCTC. This study applied two stage least square estimation strategy to unbalanced panel data at country level. On the first stage we estimate the impact FCTC ratification on smoking activity, and on the second step, estimating the influence of smoking activities on macroeconomic performance.Results The result of this study shows that FCTC ratification is negatively related to a country’s smoking prevalence, in which the ratifying party of FCTC has lower smoking prevalence. Moreover, country who ratifies FCTC longer is also associated with lower smoking prevalence. Whereas FCTC ratification is beneficial in reducing smoking prevalence, the declining smoking prevalence is not related to the decline in GDP per capita.Conclusions The result of this study shows the decrease in smoking prevalence has nothing to do with the macroeconomic indicator. Hence, FCTC ratification, which is an important driver for tobacco control actions acceleration, should not be seen as a backfire to the economy. Instead, FCTC ratification could be mutually beneficial for the health and economic aspects as it provides comprehensive guidance and protocols by taking into account the well-being states of both aspects.
Pilot Study to Explore the Use of Mobile Spaced Learning as a Digital Learning Platform When Teaching Symptom Management to Undergraduate Nursing Students: Splendids Study
Authors: Veigh Clare Mc , Carlisle Susan , Birch Matt , Ace Lindsay , Oliver Christine , Kerr Helen
Published: April 2021

Background: The management of patients’ holistic symptom needs are often complex and challenging. The education needs of undergraduate nursing students must be optimally addressed to have a significant positive impact on patient care. Mobile spaced learning has been recognised as a form of online education which can provide a novel approach to delivering effective evidence based healthcare education to undergraduate students. The objective of this pilot study was to explore the experiences of undergraduate nursing students in a university setting, of using mobile spaced learning as a digital platform for symptom management education.Methods: This pilot study used a mixed methods approach. Online spaced learning material, which utilised both case based scenarios and multiple choice questions, was delivered to first year undergraduate nursing students over a period of 2 weeks. Participants were then invited to participate in an online survey related to the usability of mobile spaced learning. A focus group was conducted to further explore the participants’ views.Results: Findings conveyed that students viewed mobile spaced learning as an acceptable platform that enhanced both their learning and their ability to transfer knowledge into clinical practice. Conclusions: Implementation of a digital spaced learning intervention would be acceptable to undergraduate nursing students learning about holistic symptom management. Further research is needed to explore the feasibility of implementing this intervention within the undergraduate nursing curriculum, and also to explore the impact on long-term knowledge retention.
Differences in Clinical Nature and Outcome Among Youth and Older Patients Suffering from an Acute Coronary Syndrome
Authors: Al-Shahrani Mohammad Saeed , Katbi Faisal Ahmad , Al-Sharydah Abdulaziz Mohammad , AlShahrani Saad Dhafer , Al-Ghamdi Talal Mosfer , Al-Sharidah Mohammad Adnan
Published: April 2021

Objective: Acute coronary disease (ACS) is an acute regional reduction in coronary blood flow. Pathophysiology, clinical appearance, risk factors and clinical outcomes may vary between younger and older patients. The purpose of this study was to assess these factors in patients less than 45 years of age compared to older adults admitted with a ACS diagnosis.Patients and methods: Retrospective chart review study of ACS patients admitted between 2015 and 2020. Results: Overall, 652 patients were enrolled. Of these, 109 patients (16.7%) were under 45, with a mean age of 38 ± 7. Younger patients showed a higher rate of palpitation (23.9% versus. 13.6%; P = 0.019). A positive smoking history and a family history of CAD were seen more often in younger patients (42.2% vs. 27.3%, P < 0.001; 22.9% vs. 9.4%, P < 0.001, respectively). Older patients had greater renal impairment with higher creatinine (median = 1.10 mg /dl (range, 0.3-13.0) vs. 1.0 (0.3-19.0; p = 0. 001), BUN (median = 16.0 (mange, 0.9-141.0) vs 12.0 (0.9-49.0); P < 0.001)).Younger patients had higher levels of LDL and total cholesterol (median 138c. 115; p < 0.001) and cholesterol (median 209 vs. 178.5; p < 0.001). Hospital mortality was 0.9% in younger patients versus 7.4% in older patients (P=0.004). Conclusion: Palpitations, smoking, family history, higher LDL levels, and total cholesterol levels were more prevalent in adults younger than 45 years old with ACS. Impaired renal function, hypertension, and diabetes were more in older patients with ACS.
Factors Related to Interprofessional Collaboration and Teamwork Climate in the Family Health Strategy
Authors: Vasconcelos Jader , Higashijima MARCIA Naomi Santos , Costa Marcelo Viana , Probst Livia Fernandes , Santos Mara Lisiane Moraes dos , Souza Albert Schiaveto , Carli Alessandro Diogo De
Published: April 2021

Background: Working with an interprofessional focus is increasingly necessary, in view of the growing complexity of the population's health needs. This study aims to assess interprofessional collaboration and the teamwork climate in primary health care and determine whether there is a relationship between these two variables. In addition, the relationship of these two measures with the participants' sociodemographic variables was also analyzed. Methods: The AITCS-II instrument was used to measure interprofessional collaboration, while to diagnose teamwork climate, the ECTE instrument was used, a version adapted to the SUS context of the Teamwork Climate Inventory instrument. These two instruments were applied online together with a questionnaire for the sociodemographic characterization of the 544 participants, who belonged to 97 Family Health Strategy teams in a Brazilian municipality. Results: The study showed a strong correlation between interprofessional collaboration and teamwork climate. The studied sample had an unsatisfactory overall score regarding interprofessional collaboration. In addition, there was no relationship between teamwork climate or interprofessional collaboration and the participants' sociodemographic data; including the time of training and the presence or absence of postgraduate studies in public health or family health in the curriculum. Conclusions: The study corroborates the literature, by indicating a correlation between teamwork and interprofessional collaboration, pointing to ECTE as another way to evaluate interprofessional work and the health work process. As for the sociodemographic variables, the results raise an alert towards the strengthening of interprofessional education actions, both during the training of new professionals and in the work process of professionals who are already working.
Frequency of Psychosomatic-Prone Myofascial Pain Syndrome in Patients with Incurable Cancer and its Association with the Armchair Sign: A Secondary Analysis of A Prospective, Multicenter, Observational Clinical Study
Authors: Hasuo Hideaki , Ishiki Hiroto , Matsuda Yoshinobu , Matsuoka Hiromichi , Hiramoto Shuji , Kinkawa Junya , Nojima Masanori
Published: April 2021

Background

Few studies have reported psychosomatic-prone functional damage in cancer patients. Because psychosomatic diseases are pathological conditions, it is difficult to identify their degrees. The armchair sign is a test used to assess voluntary muscle relaxation. This study aimed to evaluate the frequency of psychosomatic-prone functional damage in cancer patients and its association with the armchair sign.
Methods

This was a secondary analysis of a prospective, multicenter, observational clinical study. We evaluated the frequency of psychosomatic-prone myofascial pain syndrome (MPS) in patients with incurable cancer who were at the start of palliative care and how it is associated with the armchair sign. Moreover, we assessed the usefulness of the armchair sign for the diagnosis of psychosomatic-prone MPS.
Results

A total of 101 patients were enrolled from March 2018 to December 2018, of whom 44 met MPS diagnostic criteria. Of these, 27 patients (61.3%) had psychosomatic-prone MPS. There was a significant association between the armchair sign and psychosomatic-prone MPS (p = 0.002). Sensitivity and specificity were 40.7% (95% confidence interval: 18.0–63.4) and 100.0%, respectively. The area under the curve score was 0.704 (95% confidence interval: 0.553–0.855).
Conclusions

MPS in patients with incurable cancer has a high frequency of psychosomatic pathology. The armchair sign may be useful as an ancillary test for the diagnosis of psychosomatic-prone MPS.
Trial registration:
UMIN000031338. Registered 16 February 2018.
The Role of Small Dense Low-Density Lipoprotein Cholesterol in the Prediction of Acute Myocardial Infarction
Authors: Ma Ke-Lin , Liu Yi-Xiang , Lian Huang , Sun Li-Xian , Liu Chao , Zhang Ying
Published: April 2021

Background: Acute myocardial infarction (AMI) is a common acute and severe cardiovascular disease. A growing body of evidence suggests that small dense low-density lipoprotein cholesterol (sdLDL-C) is associated with an increased risk of cardiovascular disease. This study aimed to evaluate the predictive value of different lipid indicators, particularly sdLDL-C, in the assessment of AMI.Methods: We retrospectively reviewed the hospital database for all consecutive participants who underwent coronary angiography due to the experience of chest pain in our hospital from September 2019 to June 2020. The basic demographic and clinical data and laboratory assay results for all participants were collected and evaluated at admission. Statistical analysis was performed using SPSS version 26.0.Results: A total of 216 patients with AMI, 154 patients with unstable angina pectoris (UAP) and 103 healthy subjects were included. The levels of LDL3-7 were significantly different among the three groups (P<0.05). Significant positive correlations were observed between the Gensini score and several variables, including hypertension and levels of glucose, sdLDL-C, TC, and LDL-C (r > 0.1, P < 0.001). The sdLDL-C level in the AMI group was significantly higher than that in the control group in individuals with normal LDL-C (P < 0.001). Based on the receiver operating characteristic (ROC) curves, the area under the curve (AUC) of sdLDL-C for AMI risk was 0.666, which was better than that of other lipids. Multivariate logistic regression analysis demonstrated that the sdLDL-C level was significantly correlated with AMI. A logistic regression model were established based on sdLDL-C and other variables to identify people at high cardiovascular risk, with an AUC of 0.868.Conclusions: Increased sdLDL-C level was an independent risk factor for AMI. sdLDL-C may be a useful parameter for the assessment of AMI and help clinicians classify high-risk cardiovascular disease.
Unexpected DMD Gene Mutations Detected by CMA and CNV-seq in amniotic Fluid and Aborted Fetus Samples
Authors: Wu Qiuhua , Yang Lihui , Jin Qiujie , Wang Rui , Zhai Wen , Wang Yating , Shi Fengrui , Cheng Wenjing , Cai Bo , Qiang Rong , Lou Chao
Published: April 2021

Background: Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD) are common X chromosome-linked recessive hereditary diseases. The mechanism is that the exon mutations of anti-myatrophy protein gene (Dystrophin gene) and lead to muscle dysfunction. Prenatal diagnosis can prevent the birth of children with defects and have good clinical significance. Methods: CMA and CNV-seq were used to detect the amniotic fluid after amniocentesis,. CNV-seq was used to detect spontaneous abortion tissue. The DMD gene mutations were found in 6 amniotic fluid samples and one spontaneous abortion sample. DMD gene mutations were confirmed by MLPA and new DMD mutations were found.Results: CMA found DMD mutations :1.Xp21.1, 75.5kb del (E52-53); 2.Xp21.2, 334.92kb dup (E61-79); 3.Xp21.2, 292.25kb dup (E58-74); 4.Xp21.1, 374.20 kb dup (E45-51). CNV-seq found DMD mutations: 5.X p21.2, E64-79 dup; 6.X p21.1, E1-7dup; 7.Xp21.1, E 44-52 del. Conclusions: 4 fetuses harboring DMD gene mutations were found by CMA, 2 fetuses and 1 induced abortion carrying DMD gene mutations was detected by CNV-seq. CMA/CNV-seq jointed with MLPA test can provide more comprehensive evidence for prenatal diagnosis.
Knowledge, Attitude, Practice, Risk Perception and Challenges Towards COVID-19 in East Gojjam Zone, North West Ethiopia, Cross Sectional Study
Authors: Tesfaye Bekele , Alene Muluneh , Gietaneh Wodaje , Lamore Yonnas , Mola Mulu , Wube Moges , Mekonen Nackachew , Agazhe Moges , Tafere Yilkal , Gedif Getenet , Alle Atsede , kassie Bekalu , Degu Genet , Gebrie Alemu
Published: April 2021

Background: Understanding how people perceive the risk of the coronavirus disease outbreak and its impact on undertaking protective behavior can guide the public health policymakers in taking the required measures to limit the magnitude of this outbreak.Objective: This study aimed to assess the knowledge, risk perceptions, and uptake of preventive measures towards COVID-19 in East Gojjam zone.Methods: A mixed method study in order to obtain in-depth behavioral insights related to COVID-19 pandemic prevention measures was conducted in the four randomly selected Woredas of East Gojjam Zone. A flexible data collection tool adapted from World Health Organization (WHO) for quantitative component, and in-depth interview for qualitative component was used. Binary logistic regression analysis was conducted to analyze quantitative data, and while content analysis was used for qualitative component.Results: In this study, a total of 661 study participants were included. Nearly two-third (65.5%) of respondents is residing in the rural area. Only 59.6% of respondents had better understanding of COVID-19 pandemic. Similarly, less-than one-fifth (14.5%) of individuals had favorable attitude towards COVID-19. This study showed that only one-fifth (20.9%) of study participants had good preventive practices. Respondent’s residing in urban area (AOR: 0.1, 95%CI: 0.08, 0.2), who had age between 35 and 45 (AOR: 0.4, 95%CI: 0.2, 0.8), and having secondary and above education level (AOR: 0.2, 95%CI: 0.1, 0.5) had better awareness towards COVID-19 as compared to its counterparts. Similarly, study participants who had better knowledge ((AOR: 3.0, 95%CI: 1.7, 5.5), and residing in urban area had favorable attitude towards COVID-19. Furthermore, respondents with confirmed comorbidity had good preventive practice towards COVID-19.Conclusion and recommendation: In this study, the level of knowledge, attitude and preventive practice towards COVID-19 is low. Residing in rural area, not having formal education, being housewife were factors significantly associated with the poor level of knowledge, attitude, and preventive practice towards COVID-19. Address peoples living in rural area through health professional to create public awareness towards COVID-19 is recommended.
First Isolation, Molecular Characterization, and Serological Survey of Bovine Adenovirus Type 2 in Japan
Authors: Kubota Naoki , Orihara Sho , Kumagai Asuka , Kimura Kumiko , Hatama Shinichi
Published: April 2021

Bovine adenovirus type 2 (BAdV-2), a member of the Mastadenovirus genus of the Adenoviridae family, is involved in mild respiratory disease and is rarely isolated from cattle in the world. Here, we isolated BAdV-2 for the first time in Japan, from the feces of cattle with severe respiratory symptoms. The isolate, designated strain KY19-1, was identified morphologically and genetically. Electron microscopic observation of infected cells showed intranuclear, non-enveloped virus particles, approximately 70 nm in diameter and with typical adenoviral morphology. Whole-genome sequencing revealed that the viral genome is 33,175 bp long, with 105 bp inverted terminal repeats and encoding 32 predicted genes. KY19-1 has a similar genomic organization to the prototype BAdV-2 strain No. 19 with overall 99.1% nucleotide identity. Notable differences were found in the E3 region of the genome, which may affect various biological properties, including pathogenicity. The seroepidemiology of BAdV-2 was also investigated, using a virus-neutralization test, and 92.8 % of the Japanese cattle (n=1,325) were seropositive, with the positivity rate increased by age. Further experimental infections with KY19-1 may elucidate the pathogenic properties of BAdV-2 and the importance of this virus as a causal agent of bovine respiratory disease.
Exploring the Attitudes of Men who Have Sex with Men on Anal Self-Examination for Early Detection of Primary Anorectal Syphilis: A Qualitative Study
Authors: Aung Ei T , Fairley Christopher K , Ong Jason J , Bilardi Jade E , Chen Marcus Y , Chow Eric P.F. , Phillips Tiffany R
Published: April 2021

Background: Studies show men who have sex with men (MSM) practising receptive anal sex are more likely to present with secondary syphilis, suggesting anorectal primary lesions are being missed. Regular anal self-examination might be able to detect anorectal syphilis lesions, hence potentially reducing transmission. This study aimed to explore the attitudes of MSM on performing anal self-examination to detect primary syphilis.Methods: In this qualitative study, 20 MSM over 18 years of age were purposively sampled from a sexual health clinic to participate in semi-structured interviews. Interviews were recorded, transcribed verbatim and data analysed thematically.Results: Four major themes and 12 sub-themes emerged from the study: (1) reasons for performing anal self-examination, (2) preferred resources for anal self-examination, (3) attitudes towards partner anal examination, and (4) acceptability of anal self-examination.Most participants had performed some form of anal self-examination in the past, and, just over half performed regularly for mostly health-related concerns. Most participants who infrequently or never performed anal self-examination were agreeable to perform regularly if it was recommended by health professionals with appropriate guidance. Participants preferred education on anal self-examination from health professionals and trusted online learning resources. Conclusion: Our study showed MSM were agreeable to anal self-examination however would like to receive education and training to gain more confidence in conducting anal self-examination as a screening tool. Further studies are required to explore the adherence and acceptability of anal self-examination for syphilis prior to studies examining efficacy. Policy implications: The study provides foundation for any future policy aiming at utilising anal self-examination as a screening tool for syphilis among MSM.