bluuebunny/crossref_metadata_2025 huggingface dataset:
Personalpraxis im Spannungsfeld von Objektivität, Intersubjektivität und Subjektivität
Authors: Neuberger Oswald
Published: June 2021

Die Personalwirtschaftslehre als wissenschaftliche Reflexion der Personalpraxis hat ihren Gegenstand bislang überwiegend in einer objektivierenden oder verdinglichenden Weise betrachtet und vor allem Verfahren der Herstellung und Handhabung von “Personal” analysiert und entwickelt. Im Selbstverständnis von Personal- Verantwortlichen und -Beratern zeigt sich demgegenüber eine auffällige Tendenz, “Persönlichkeit” (oder: den Menschen) in den Mittelpunkt zu rücken und/oder gemeinsames Handeln als Strategie der Verlebendigung von Institutionen und Strukturen des Personalwesens zu empfehlen. Der vorliegende Beitrag schlägt dementsprechend drei theoretische Perspektiven vor, um die meist unausgesprochenen Vorannahmen in der Diskussion der Personal-Fachleute zu entschlüsseln: eine objektivierend-systemtheoretische, die sich auf die Institution Personalwesen beschränkt, eine intersubjektiv-handlungstheoretische, die die Zusammenarbeit von Personen in Rollen betont (Personalarbeit) und schließlich eine subjektiv-identitätstheoretische, die dem Eigenwert und Eigensinn von Persönlichkeit das größte Gewicht gibt. Es wird die These vertreten, daß jede Aktivität und Leistung der Personalpraxis unter allen drei Perspektiven analysiert werden muß und daß diese drei Sichtweisen nicht harmonisierbar sind.
Contesting Culture: The Grammar of ‘Kaala’
Authors: Menon Shailaja
Published: June 2021

Cinema as an art form vividly captures the aspirations and everyday life-worlds of the people in India. In more contemporary times, suffused with the global language of desire, popular Indian cinema has sought to project the nation as a global power, while invisibilizing the faultiness of caste, gender, race and ethnicity. The films are increasingly shot in exotic locales with the lead characters leading enchanted lives. Innovative technology is utilized to narrate stories in which the farmer/worker/maid/other laboring people are conspicuous by their absence. Very few films possess the courage to buck this trend to recount tales of struggle entwined with the language of rights and justice. My article focuses on one such film—Pa Ranjith’s Kaala (Black). The film interrogates the muscular religiosity, caste and patriarchy on which the nation state is tethered. The cinematic journey also infuses the locale of Dharavi in Mumbai, home to thousands of migrant workers, with an agency of its own.
Blood eosinophil counts in the general population and airways disease: a comprehensive review and meta-analysis
Authors: Benson Victoria S. , Hartl Sylvia , Barnes Neil , Galwey Nicholas , Van Dyke Melissa K. , Kwon Namhee
Published: June 2021

Background

The clinical context for using blood eosinophil (EOS) counts as treatment–response biomarkers in asthma and COPD requires better understanding of EOS distributions and ranges. We describe EOS distributions and ranges published in asthma, COPD, control (non-asthma/COPD) and general populations.

Methods

We conducted a comprehensive literature review and meta-analysis of observational studies (January 2008 to November 2018) that included EOS counts in asthma, severe asthma, COPD, control and general populations. Excluded studies had total sample sizes <200, EOS as inclusion criterion, hospitalised population only and exclusively paediatric participants.

Results

Overall, 91 eligible studies were identified, most had total-population-level data available: asthma (39 studies), severe asthma (12 studies), COPD (23 studies), control (seven studies) and general populations (14 studies); some articles reported data for multiple populations. Reported EOS distributions were right-skewed (seven studies). Reported median EOS counts ranged from 157–280 cells·µL−1(asthma, 22 studies); 200–400 cells·µL−1(severe asthma, eight studies); 150–183 cells·µL−1(COPD, six studies); and 100–160 cells·µL−1(controls, three studies); and 100–200 cells·µL−1(general populations, six studies). The meta-analysis showed that observed variability was mostly between studies rather than within studies. Factors reportedly associated with higher blood EOS counts included current smoking, positive skin-prick test, elevated total IgE, comorbid allergic rhinitis, age ≤18 years, male sex, spirometric asthma/COPD diagnosis, metabolic syndrome and adiposity.

Conclusion

EOS distribution and range varied by study population, and were affected by clinical factors including age, smoking history and comorbidities, which, regardless of severity, should be considered during treatment decision-making.
Non-dipping nocturnal blood pressure correlates with obstructive sleep apnoea severity in normotensive subjects and may reverse with therapy
Authors: Crinion Sophie J. , Kleinerova Jana , Kent Brian , Nolan Geraldine , Taylor Cormac T. , Ryan Silke , McNicholas Walter T.
Published: June 2021

Background

Obstructive sleep apnoea (OSA) is strongly associated with systemic hypertension, but there are limited data on the relationship with blood pressure (BP) in normotensive subjects. Here, we examined the relationship of OSA with nocturnal BP in a documented diurnal normotensive cohort, explored potential intermediate pathways and assessed the effects on BP of continuous positive airways pressure (CPAP) therapy.

Methods

65 males referred for assessment of possible OSA and normotensive on 24-hour BP monitoring underwent overnight inpatient polysomnography (age 41±7 years, body mass index (BMI) 34±6 kg·m−2, apnoea–hypopnoea index (AHI) 14 (interquartile range 5–26)). Urine and serum were assessed for markers of sympathetic activation, renin–angiotensin–aldosterone system activity, oxidative stress, endothelial function and systemic inflammation. In a subset of patients, 24-hour BP monitoring was repeated after CPAP therapy.

Results

Within this normotensive cohort, night-time systolic and diastolic BP and nocturnal BP dip were highest in the fourth OSA severity quartile (p<0.05). Nocturnal BP dip correlated with AHI (r=−0.327, p<0.05) and oxygen desaturation index (ODI) (r=−0.371, p<0.05), but only ODI was an independent predictor of BP dip (B=–0.351, p<0.01) and non-dipping status (B=0.046, p<0.05). Overnight urinary norepinephrine correlated with nocturnal systolic BP (r=0.387, p<0.01) with a trend towards correlation with systolic dipping (p=0.087). In 20 CPAP-treated patients, night-time systolic BP decreased (p<0.05) and mean nocturnal BP dip increased (p≤0.05).

Conclusion

In this normotensive cohort, OSA severity was associated with higher nocturnal BP, which improved following CPAP therapy, and intermittent hypoxia was the most important OSA-related variable in this relationship.
Comparative insights into genome signatures of ferric iron oxide- and anode-stimulated Desulfuromonas spp. strains
Authors: Guo Yong , Aoyagi Tomo , Hori Tomoyuki
Published: June 2021

Background

Halotolerant Fe (III) oxide reducers affiliated in the family Desulfuromonadaceae are ubiquitous and drive the carbon, nitrogen, sulfur and metal cycles in marine subsurface sediment. Due to their possible application in bioremediation and bioelectrochemical engineering, some of phylogenetically close Desulfuromonas spp. strains have been isolated through enrichment with crystalline Fe (III) oxide and anode. The strains isolated using electron acceptors with distinct redox potentials may have different abilities, for instance, of extracellular electron transport, surface recognition and colonization. The objective of this study was to identify the different genomic signatures between the crystalline Fe (III) oxide-stimulated strain AOP6 and the anode-stimulated strains WTL and DDH964 by comparative genome analysis.

Results

The AOP6 genome possessed the flagellar biosynthesis gene cluster, as well as diverse and abundant genes involved in chemotaxis sensory systems and c-type cytochromes capable of reduction of electron acceptors with low redox potentials. The WTL and DDH964 genomes lacked the flagellar biosynthesis cluster and exhibited a massive expansion of transposable gene elements that might mediate genome rearrangement, while they were deficient in some of the chemotaxis and cytochrome genes and included the genes for oxygen resistance.

Conclusions

Our results revealed the genomic signatures distinctive for the ferric iron oxide- and anode-stimulated Desulfuromonas spp. strains. These findings highlighted the different metabolic abilities, such as extracellular electron transfer and environmental stress resistance, of these phylogenetically close bacterial strains, casting light on genome evolution of the subsurface Fe (III) oxide reducers.
Chitin-rich heteroglycan from Sporothrix schenckii sensu stricto potentiates fungal clearance in a mouse model of sporotrichosis and promotes macrophages phagocytosis
Authors: Huang Lilin , Zhang Jing , Du Weian , Liang Zixian , Li Meirong , Wu Rong , Chen Sanmei , Hu Xuchu , Huang Huaiqiu
Published: June 2021

Background

Fungal cell wall polysaccharides maintain the integrity of fungi and interact with host immune cells. The immunomodulation of fungal polysaccharides has been demonstrated in previous studies. However, the effect of chitin-rich heteroglycan extracted fromSporothrix schenckiisensu strictoon the immune response has not been investigated.

Results

In this study, chitin-rich heteroglycan was extracted fromS. schenckiisensu stricto, and immunomodulation was investigated via histopathological analysis of skin lesions in a mouse model of sporotrichosis and evaluation of the phagocytic function and cytokine secretion of macrophages in vitro. The results showed that the skin lesions regressed and granulomatous inflammation was reduced in infected mice within 5 weeks. Moreover, heteroglycan promoted the fungal phagocytosis by macrophages and modulated the cytokine secretion. Heteroglycan upregulated TNF-α expression early at 24 h and IL-12 expression late at 72 h after incubation, which might result from moderate activation of macrophages and contribute to the subsequent adaptive immune response.

Conclusions

Chitin-rich heteroglycan extracted fromS. schenckiisensu strictopotentiated fungal clearance in a mouse model of sporotrichosis. Moreover, chitin-rich heteroglycan promoted fungus phagocytosis by macrophages and modulated cytokines secretion. These results might indicate that chitin-rich heteroglycan could be considered as an immunomodulator used in the treatment of sporotrichosis.
Mortality in Escherichia coli bloodstream infections: a multinational population-based cohort study
Authors: MacKinnon Melissa C. , McEwen Scott A. , Pearl David L. , Lyytikäinen Outi , Jacobsson Gunnar , Collignon Peter , Gregson Daniel B. , Valiquette Louis , Laupland Kevin B.
Published: June 2021

Background

Escherichia coli is the most common cause of bloodstream infections (BSIs) and mortality is an important aspect of burden of disease. Using a multinational population-based cohort of E. coli BSIs, our objectives were to evaluate 30-day case fatality risk and mortality rate, and determine factors associated with each.

Methods

During 2014–2018, we identified 30-day deaths from all incident E. coli BSIs from surveillance nationally in Finland, and regionally in Sweden (Skaraborg) and Canada (Calgary, Sherbrooke, western interior). We used a multivariable logistic regression model to estimate factors associated with 30-day case fatality risk. The explanatory variables considered for inclusion were year (2014–2018), region (five areas), age (< 70-years-old, ≥70-years-old), sex (female, male), third-generation cephalosporin (3GC) resistance (susceptible, resistant), and location of onset (community-onset, hospital-onset). The European Union 28-country 2018 population was used to directly age and sex standardize mortality rates. We used a multivariable Poisson model to estimate factors associated with mortality rate, and year, region, age and sex were considered for inclusion.

Results

From 38.7 million person-years of surveillance, we identified 2961 30-day deaths in 30,923 incident E. coli BSIs. The overall 30-day case fatality risk was 9.6% (2961/30923). Calgary, Skaraborg, and western interior had significantly increased odds of 30-day mortality compared to Finland. Hospital-onset and 3GC-resistant E. coli BSIs had significantly increased odds of mortality compared to community-onset and 3GC-susceptible. The significant association between age and odds of mortality varied with sex, and contrasts were used to interpret this interaction relationship. The overall standardized 30-day mortality rate was 8.5 deaths/100,000 person-years. Sherbrooke had a significantly lower 30-day mortality rate compared to Finland. Patients that were either ≥70-years-old or male both experienced significantly higher mortality rates than those < 70-years-old or female.

Conclusions

In our study populations, region, age, and sex were significantly associated with both 30-day case fatality risk and mortality rate. Additionally, 3GC resistance and location of onset were significantly associated with 30-day case fatality risk. Escherichia coli BSIs caused a considerable burden of disease from 30-day mortality. When analyzing population-based mortality data, it is important to explore mortality through two lenses, mortality rate and case fatality risk.
Impact of rural versus urban setting on kidney markers: a cross-sectional study in South-Kivu, DRCongo
Authors: Masimango Mannix Imani , Hermans Michel P. , Malembaka Espoir Bwenge , Wallemacq Pierre , Sumaili Ernest Kiswaya , Fillée Catherine , D’Hoore William , Winkler Cheryl A. , Limou Sophie , Jadoul Michel
Published: June 2021

Background

Most studies of chronic kidney disease (CKD) in Sub-Saharan Africa (SSA) have been conducted in urban settings. They relied on GFR estimated from serum creatinine alone and on the inexpensive, convenient urinary dipstick to assess proteinuria. The dipstick for proteinuria has not been directly compared with the gold standard albumin-to-creatinine ratio (ACR) in a large-sized study in SSA. We hereby assessed the influence of rural versus urban location on the level, interpretation, and diagnostic performance of proteinuria dipstick versus ACR.

Methods

In a cross-sectional population-based study of CKD in both urban (n = 587) and rural (n = 730) settings in South-Kivu, Democratic Republic of Congo (DRC), we assessed the prevalence, performance (sensitivity, specificity, positive predictive value and negative predictive value) and determinants of a positive dipstick proteinuria as compared with albuminuria (ACR). Albuminuria was subdivided into: A1 (< 30 mg/g creatinine), A2 (30 to 299 mg/g creatinine) and A3 (≥ 300 mg/g creatinine).

Results

The overall prevalence of positive dipstick proteinuria (≥ 1+) was 9.6 % (95 % CI, 7.9–11.3) and was higher in rural than in urban residents (13.1 % vs. 4.8 %, p < 0.001), whereas the prevalence of albuminuria (A2 or A3) was similar in both sites (6 % rural vs. 7.6 % urban, p = 0.31). In both sites, dipstick proteinuria ≥ 1 + had a poor sensitivity (< 50 %) and positive predictive value (< 11 %) for the detection of A2 or A3. The negative predictive value was 95 %. Diabetes [aOR 6.12 (1.52–24.53)] was a significant predictor of A3 whereas alkaline [aOR 7.45 (3.28–16.93)] and diluted urine [aOR 2.19 (1.35–3.57)] were the main predictors of positive dipstick proteinuria.

Conclusions

ACR and dipstick proteinuria have similar positivity rates in the urban site whereas, in the rural site, dipstick was 2-fold more often positive than ACR. The poor sensitivity and positive predictive value of the dipstick as compared with ACR makes it unattractive as a screening tool in community studies of CKD in SSA.
The impact of cultural beliefs and practices on parents’ experiences of bereavement following stillbirth: a qualitative study in Uganda and Kenya
Authors: Ayebare Elizabeth , Lavender Tina , Mweteise Jonan , Nabisere Allen , Nendela Anne , Mukhwana Raheli , Wood Rebecca , Wakasiaka Sabina , Omoni Grace , Kagoda Birungi Susan , Mills Tracey A.
Published: June 2021

Background

Stillbirth is an extremely traumatic and distressing experience for parents, with profound and long-lasting negative impacts. Cultural beliefs and practices surrounding death vary considerably across different contexts and groups, and are a key influence on individual experiences, impacting grief, adjustment, and support needs. Few studies have explored cultural influences surrounding stillbirth in an African context. This study explored the influence of cultural beliefs and practices on the experiences of bereaved parents and health workers after stillbirth in urban and rural settings in Kenya and Uganda.

Methods

A qualitative descriptive study design was employed. Face to face interviews were conducted with parents (N = 134) who experienced a stillbirth (≤ 1 year) and health workers (N = 61) at five facilities in Uganda and Kenya. Interviews were conducted in English or the participants’ local language, audio-recorded and transcribed verbatim. Analysis was conducted using descriptive thematic analysis.

Results

Commonalities in cultural beliefs and practices existed across the two countries. Three main themes were identified: 1) Gathering round, describes the collective support parents received from family and friends after stillbirth. 2)‘It is against our custom’ addresses cultural constraints and prohibitions impacting parents’ behaviour and coping in the immediate aftermath of the baby’s death. 3) ‘Maybe it’s God’s plan or witchcraft’ summarises spiritual, supernatural, and social beliefs surrounding the causes of stillbirth.

Conclusions

Kinship and social support helped parents to cope with the loss and grief. However, other practices and beliefs surrounding stillbirth were sometimes a source of stress, fear, stigma and anxiety especially to the women. Conforming to cultural practices meant that parents were prevented from: holding and seeing their baby, openly discussing the death, memory-making and attending the burial. The conflict between addressing their own needs and complying with community norms hindered parents’ grief and adjustment. There is an urgent need to develop culturally sensitive community programmes geared towards demystifying stillbirths and providing an avenue for parents to grieve in their own way.
Racial/ethnic, gender, and age group differences in cardiometabolic risks among adults in a Northern California health plan: a cross-sectional study
Authors: Gordon Nancy P. , Hsueh Loretta
Published: June 2021

Background

In the U.S., the prevalence of diabetes and hypertension are higher among African American/Black (Black), Latinx, and Filipino adults than non-Hispanic White (White) and Chinese adults. We compared the racial/ethnic-specific prevalence of several modifiable cardiometabolic risks in an insured adult population to identify behaviors that may drive racial/ethnic differences in cardiometabolic health.

Methods

This cross-sectional study used data for middle-aged (35–64) and older (65–79) Kaiser Permanente Northern California (KPNC) adult health plan members. Smoking status and BMI were derived from electronic health record data. Weighted pooled self-reported data from the 2014/2015 and 2017 KPNC Member Health Survey cycles were used to estimate daily number of servings of fruits/vegetables, general sodium avoidance, sugar-sweetened beverage (SSB) consumption frequency, alcohol use within daily recommended limit, weekly exercise frequency, and number of hours of sleep daily. Age-standardized estimates of all cardiometabolic risks were produced for middle-aged and older-aged women and men in the five racial/ethnic groups. Analyses focused on racial/ethnic differences within age-gender groups and gender and age group differences within racial/ethnic groups.

Results

In both age groups, Black, Latinx, and Filipino adults were more likely than White and Chinese adults to have overweight and obesity and were less likely to engage in health promoting dietary (fruit/vegetable and SSB consumption, sodium avoidance (women only)) and sleep behaviors. Middle-aged Black and Filipino men were more likely than White men to be current smokers. Less racial/ethnic variation was seen in exercise frequency. Significant gender differences were observed for dietary behaviors overall and within racial/ethnic groups, especially among middle-aged adults; however, these gender differences were smaller for sleep and exercise. Age differences within gender and racial/ethnic groups were less consistent. Racial/ethnic and gender differences in these behaviors were also seen in the subsample of adults with diabetes and/or hypertension and in the subsample of adults who reported they were trying to engage in health promoting behaviors.

Conclusions

Black, Latinx, and Filipino adults were more likely than White and Chinese adults to report dietary and sleep behaviors associated with development and worsening of cardiometabolic conditions, with men exhibiting poorer dietary behaviors than women.
The relationship between dietary patterns and overweight and obesity among adult in Jiangsu Province of China: a structural equation model
Authors: Wang Yuan-yuan , Tian Ting , Pan Da , Zhang Jing-xian , Xie Wei , Wang Shao-kang , Xia Hui , Dai Yue , Sun Guiju
Published: June 2021

Aims

This study aimed to analyze the relationship between diet and overweight and obesity in Jiangsu Province by using structural equation modeling (SEM), and to determine dietary differences between genders in the model.

Methods

Data from 1739 individuals (53.8% female, n = 935) were analyzed. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to classify dietary patterns. SEM and multivariate logistic regression were used to explore the relationship between dietary patterns and overweight and obesity.

Results

Overweight and obesity was found in 49.1%, and no difference was found in gender (51.2% of men and 47.2% of women, respectively; P = 0.090). Three dietary patterns: the traditional dietary pattern (i.e., poultry, light-colored vegetables, red meat and its products, cereals and tubers products, condiment, oils and dark-colored vegetables), the fruit-egg dietary pattern (i.e., fruit, whole grains, pickled vegetables and eggs and eggs products) and nut-wine dietary pattern (i.e., nut, wine and pastry snacks) were established by using EFA and CFA. It was found that the traditional dietary pattern for adult male was positively associated with the overweight and obesity in Jiangsu Province of China through multivariate logistic regression and SEM (OR = 1.954; 95%CI: 1.258 ~ 3.036; β =0.121, P < 0.05, respectively).

Conclusion

The traditional dietary pattern only have positive association with overweight and obesity in men in Jiangsu Province, China.
Slipped capital femoral epiphysis: an epidemiological Nationwide study in Italy from 2001 to 2015
Authors: Longo Umile Giuseppe , Papalia Rocco , De Salvatore Sergio , Ruzzini Laura , Candela Vincenzo , Piergentili Ilaria , Oggiano Leonardo , Costici Pier Francesco , Denaro Vincenzo
Published: June 2021

Background

Slipped capital femoral epiphysis (epiphysiolysis of the femoral head, SCFE) is the most common pediatric hip disease in 10–14 years old children. The most used procedure to correct a stable form of SCFE is in situ pinning. Instead, the proper treatment for unstable forms is controversial. The first purpose of this study was to estimate annual admissions for SCFE in Italian patients from 2001 to 2015, basing on the hospitalization reports. The second aim was to assess the difference between regions regarding SCFE procedures. Lastly, a statistical prediction of the volume of SCFE procedures performed in Italy based on data from 2001 to 2015 was performed.

Methods

Data of this study were collected from the National Hospital Discharge Reports (SDO) reported at the Italian Ministry of Health regarding the years of this paper. The yearly number of hospital admission for SCFE, the percentage of males and females, the average age, days of hospitalization, primary diagnoses and primary procedures in the whole Italian population were calculated using descriptive statistical analyses.

Results

From 2001 to 2015, 4893 hospitalizations for SCFE were recorded in Italy, with a mean incidence of 2.9 (cases/100.000 inhabitants). The majority of patients treated by SCFE were males (70.6%).

Conclusion

National health statistics for SCFE are attractive for an international audience, as different approaches to screening are reported between countries. These differences allow comparing outcomes internationally. Moreover, sharing national statistics and correlating those to other countries protocols, could be helpful to compare outcomes for different procedures internationally. However, further studies are required to understand the specific reasons for regional variation for SCFE procedures in Italy.

Level of evidence

III
Determinants of caries experience and the impact on the OHRQOL of 6-year-old Libyan children: a cross-sectional survey
Authors: Ballo Lamis , Arheiam Arheiam , Marhazlinda Jamaludin
Published: June 2021

Objective

The current study aimed to assess the caries experience and associated factors and its impact on the oral health-related quality of life (OHRQoL) among 6-year-old Libyan children.

Methods

A cross-sectional survey including 706 six-year-old children was conducted in 2017 in Benghazi, Libya. Data were collected through a self-administered questionnaire assessing socioeconomic status and oral health behaviours, and the Arabic version of the Early Childhood Oral Health Impact Scale (A-ECOHIS) to assess the OHRQoL. Clinical examination assessed caries experience at tooth level (dmft) and the number of decayed, missing due to caries and filled teeth (dt, mt and ft). Poisson regression analysis was performed to determine the association between dmft scores and the independent predictors. Linear regression analysis was conducted for ECOHIS scores with the children’s gender, SES and OHB. The statistical significance was set to ≤  0.05.

Results

Data were available for 706 children. Caries prevalence (dt) and dmft of ≥ 1 were 69.1% and 71% respectively. The mean ± SD dmft score was 3.23 ± 3.32. There was a significant and direct association between dmft scores and daily consumption of sugary snacks (B = 1.27, P = 0.011) and a significant inverse association with teethbrushing twice daily (B = 0.80, P = 0.041). There was a significant and direct association between A-ECOHIS and dmft (B = 1.14, P ≤ 0.001) and a significant and inverse association between A- ECOHIS and high and intermediate family income compared to low income (B = −3.82, P = 0.0001 and B = −2.06, P = 0.028).

Conclusions

6-year-old Libyan children had a relatively high caries experience an untreated decay with impact on OHRQoL. Social disparities, sugar consumption patterns and oral hygiene practices were associated with high caries experience.
Facilitating advance care planning in the general practice setting for patients with a chronic, life-limiting illness: protocol for a phase-III cluster-randomized controlled trial and process evaluation of the ACP-GP intervention
Authors: Stevens Julie , Pype Peter , Eecloo Kim , Deliens Luc , Pardon Koen , De Vleminck Aline
Published: June 2021

Background

Advance care planning (ACP), a process of communication about patients’ preferences for future medical care, should be initiated in a timely manner. Ideally situated for this initiation is the general practitioner (GP). The intervention to improve the initiation of ACP for patients with a chronic life-limiting illness in general practice (ACP-GP) includes an ACP workbook for patients, ACP communication training for GPs, planned ACP conversations, and documentation of ACP conversation outcomes in a structured template. We present the study protocol of a Phase-III randomized controlled trial (RCT) of ACP-GP that aims to evaluate its effects on outcomes at the GP, patient, and surrogate decision maker (SDM) levels; and to assess the implementation process of the intervention.

Methods

This RCT will take place in Flanders, Belgium. Thirty-six GPs, 108 patients with a chronic, life-limiting illness, and their (potential) SDM will be recruited, then cluster-randomized to the ACP-GP intervention or the control condition. The primary outcome for GPs is ACP self-efficacy; primary outcome for patients is level of ACP engagement. Secondary outcomes for GPs are ACP practices, knowledge and attitudes; and documentation of ACP discussion outcomes. Secondary outcomes for patients are quality of life; anxiety; depression; appointment of an SDM; completion of new ACP documents; thinking about ACP; and communication with the GP. The secondary outcome for the SDM is level of engagement with ACP. A process evaluation will assess the recruitment and implementation of the intervention using the RE-AIM framework.

Discussion

While the general practice setting holds promise for timely initiation of ACP, there is a lack of randomized trial studies evaluating the effectiveness of ACP interventions implemented in this setting. After this Phase-III RCT, we will be able to present valuable evidence of the effects of this ACP-GP intervention, with the potential for offering a well-tested and evaluated program to be implemented in general practice. The results of the process evaluation will provide insight into what contributes to or detracts from implementation success, as well as how the intervention can be adapted to specific contexts or needs.

Trial registration

Prospectively registered at with ISRCTN (ISRCTN12995230); registered 19/06/2020.
Usefulness of smartphone use among surgeons in clinical practice during the pandemic of COVID-19: a cross-sectional study
Authors: Buabbas Ali Jasem , Aldousari Saad , Ayed Adel K. , Safar Maryam , Alkandari Omar
Published: June 2021

Background

With the magnitude and severity of the COVID-19 pandemic, the usual face-to-face consultation within a clinical setting is no longer feasible. Thus, this led to the need for alternate means to provide adequate patient care for surgical patients. This is where the role of smartphones comes into play, in which it is thus of paramount importance. This research study aimed to assess the usefulness of smartphones in surgical practice during COVID-19 pandemic.

Methods

This cross-sectional study is based on a questionnaire distributed among surgeons in different levels of practice working at Kuwait governmental hospitals during the COVID-19 pandemic. The questionnaire was developed via Google Docs to collect data for the current study.

Results

Out of 600 surgeons, 180 have responded to the questionnaire, giving a response rate of 30%. Of these, 42.8%, 85.5%, and 58.9% were aged between 35 and 44 years, were male, and Kuwaiti nationals, respectively. Almost all of the respondents (99.5%) were using smartphones for hospital-related work. The most common uses of the smartphones involved texting (70%), and viewing or taking images and videos using built-in cameras (60%) either in the emergency department, outpatient clinics, wards, or operating rooms. The majority of the respondents (88%) rated the use of smartphones in practice as important.

Conclusion

This study revealed that using smartphones in surgical practice was prevalent among the respondent surgeons in Kuwait during the pandemic. The majority of them considered using smartphones in practice to be important, due to its benefits in facilitating doctor–doctor and patient–doctor communication, reviewing the literature, and making clinical decisions. Guidelines are required for proper and legal use of smartphone devices in medical practice. Accordingly, recommendations are suggested.
Access to water, sanitation and hygiene services in health facilities in sub-Saharan Africa 2013–2018: Results of health facility surveys and implications for COVID-19 transmission
Authors: Kanyangarara Mufaro , Allen Savannah , Jiwani Safia S , Fuente David
Published: June 2021

Background

The COVID-19 pandemic has highlighted important needs in water, sanitation and hygiene (WASH) services and standard practices for infection prevention and control in sub-Saharan Africa. We assessed the availability of WASH and standard precautions for infection prevention in health facilities across 18 countries in sub-Saharan Africa, as well as inequalities by location (rural/urban) and managing authority (public/private). Data from health facility surveys conducted between 2013 and 2018 in 18 sub-Saharan African countries were used to estimate the access to an improved water source within 500 m, an improved toilet, soap and running water or alcohol-based hand rub, and standard precautions for infection prevention at health facilities. Rural-urban differences and public-private differences in access to services were calculated. We also compared population level access to health facility access to services.

Result

Overall, 16,456 health facilities from 18 countries were included. Across countries, an estimated 88 % had an improved water source, 94 % had an improved toilet, 74 % had soap and running water or alcohol-based hand rub, and 17 % had standard precautions for infection prevention available. There was wide variability in access to water, sanitation and hygiene services between rural and urban health facilities and between public and private facilities, with consistently lower access in both rural and public facilities. In both rural and urban areas, access to water, sanitation and hygiene services was ubiquitously better at health facilities than households.

Conclusions

Availability of WASH services in health facilities in sub-Saharan Africa has improved but remains below the global target of 80 % in many countries. Ensuring adequate access to WASH services and enforcing adherence to safety and hygiene practices in health facilities will be essential to minimize the risk of COVID-19 transmission.
Can intersectionality help with understanding and tackling health inequalities? Perspectives of professional stakeholders
Authors: Holman Daniel , Salway Sarah , Bell Andrew , Beach Brian , Adebajo Adewale , Ali Nuzhat , Butt Jabeer
Published: June 2021

Background

The concept of “intersectionality” is increasingly employed within public health arenas, particularly in North America, and is often heralded as offering great potential to advance health inequalities research and action. Given persistently poor progress towards tackling health inequalities, and recent calls to reframe this agenda in the United Kingdom and Europe, the possible contribution of intersectionality deserves attention. Yet, no existing research has examined professional stakeholder understandings and perspectives on applying intersectionality to this field.

Methods

In this paper we seek to address that gap, drawing upon a consultation survey and face-to-face workshop (n = 23) undertaken in the United Kingdom. The survey included both researchers (n = 53) and policy and practice professionals (n = 20) with varied roles and levels of engagement in research and evaluation. Topics included familiarity with the term and concept “intersectionality”, relevance to health inequalities work, and issues shaping its uptake. Respondents were also asked to comment on two specific policy suggestions: intersectionally targeting and tailoring interventions, and evaluating the intersectional effects of policies. The workshop aims were to share examples of applying intersectionality within health inequalities research and practice; understand the views of research and practice colleagues on potential contributions and challenges; and identify potential ways to promote intersectional approaches.

Results

Findings indicated a generally positive response to the concept and a cautiously optimistic assessment that intersectional approaches could be valuable. However, opinions were mixed and various challenges were raised, especially around whether intersectionality research is necessarily critical and transformative and, accordingly, how it should be operationalized methodologically. Nonetheless, there was general agreement that intersectionality is concerned with diverse inequalities and the systems of power that shape them.

Conclusions

We position intersectionality within the wider context of health inequalities policy and practice, suggesting potential ways forward for the approach in the context of the United Kingdom. The views of policy and practice professionals suggest that intersectionality has far to travel to help counter individualistic narratives and to encourage an approach that is sensitive to subgroup inequalities and the processes that generate them. Examples of promising practice, albeit mostly in North America, suggest that it is possible for intersectionality to gain traction.
Frailty and pre-frailty in cardiac surgery: a systematic review and meta-analysis of 66,448 patients
Authors: Lee Jessica Avery , Yanagawa Bobby , An Kevin R. , Arora Rakesh C. , Verma Subodh , Friedrich Jan O. ,   on behalf of the Canadian Cardiovascular Surgery Meta-Analysis Working Group
Published: June 2021

Background

The burden of frailty on cardiac surgical outcomes is incompletely understood. Here we perform a systematic review and meta-analysis of studies comparing frail versus pre-frail versus non-frail patients following cardiac surgery.

Methods

We searched MEDLINE and EMBASE databases until July 2018 for studies comparing cardiac surgery outcomes in “frail”, “pre-frail” and “non-frail” patients. Data was extracted in duplicate. Primary outcome was operative mortality.

Results

There were 19 observational studies with 66,448 patients. Frail patients were more likely female (risk ratio [RR]1.7; 95%CI:1.5–1.9), older (mean difference: 2.4; 95%CI:1.3–3.5 years older) with greater comorbidities and higher STS-PROM. Frailty (RR2.35; 95%CI:1.57–3.51; p < 0.0001) and pre-frailty (RR2.03; 95%CI:1.52–2.70; p < 0.00001) were associated with increased operative mortality compared with non-frail patients. Frailty was also associated with greater risk of prolonged hospital stay (RR1.83; 95%CI:1.61–2.08; p < 0.0001) and intermediate care facility discharge (RR2.71; 95%CI:1.45–5.05; p = 0.002). Frail (Hazard Ratio [HR]3.27; 95%CI:1.93–5.55; p < 0.0001) and pre-frail patients (HR2.30; 95%CI:1.29–4.09; p = 0.005) had worse mid-term mortality (median follow-up 1 years [range 0.5–4 years]). After adjustment for baseline imbalances, frailty was still associated with greater operative mortality (odds ratio [OR]1.97; 95%CI:1.51–2.57; p < 0.00001), intermediate care facility discharge (OR4.61; 95%CI:2.78–7.66; p < 0.00001) and midterm mortality (HR1.37; 95%CI:1.03–1.83; p = 0.03).

Conclusion

In patients undergoing cardiac surgery, frailty and pre-frailty were associated with 2-fold and 1.5-fold greater adjusted operative mortality, respectively, greater adjusted perioperative complications and frailty was associated with almost 5-fold risk of non-home discharge.

Graphical abstract

Burden of frailty and pre-frailty on cardiac surgical outcomes.
The impact of lung parenchyma attenuation on nodule volumetry in lung cancer screening
Authors: Penha Diana , Pinto Erique , Hochhegger Bruno , Monaghan Colin , Marchiori Edson , Taborda-Barata Luís , Irion Klaus
Published: June 2021

Background

Recent recommendations for lung nodule management include volumetric analysis using tools that present intrinsic measurement variability, with possible impacts on clinical decisions and patient safety. This study was conducted to evaluate whether changes in the attenuation of the lung parenchyma adjacent to a nodule affect the performance of nodule segmentation using computed tomography (CT) studies and volumetric tools.

Methods

Two radiologists retrospectively applied two commercially available volumetric tools for the assessment of lung nodules with diameters of 5–8 mm detected by low-dose chest CT during a lung cancer screening program. The radiologists recorded the success and adequacy of nodule segmentation, nodule volume, manually and automatically (or semi-automatically) obtained long- and short-axis measurements, mean attenuation of adjacent lung parenchyma, and presence of interstitial lung abnormalities or disease, emphysema, pleural plaques, and linear atelectasis. Regression analysis was performed to identify predictors of good nodule segmentation using the volumetric tools. Interobserver and intersoftware agreement on good nodule segmentation was assessed using the intraclass correlation coefficient.

Results

In total, data on 1265 nodules (mean patient age, 68.3 ± 5.1 years; 70.2% male) were included in the study. In the regression model, attenuation of the adjacent lung parenchyma was highly significant (odds ratio 0.987, p < 0.001), with a large effect size. Interobserver and intersoftware agreement on good segmentation was good, although one software package performed better and measurements differed consistently between software packages.

Conclusion

For lung nodules with diameters of 5–8 mm, the likelihood of good segmentation declines with increasing attenuation of the adjacent parenchyma.
Venetoclax in relapsed/refractory blastic plasmacytoid dendritic cell neoplasm with central nervous system involvement: a case report and review of the literature
Authors: Albiol Nil , Novelli Silvana , Mozos Anna , Pratcorona Marta , Martino Rodrigo , Sierra Jorge
Published: June 2021

Background

We describe a patient with blastic plasmacytoid dendritic cell neoplasm with central nervous system involvement and the outcome of venetoclax use in this setting.

Case presentation

A 54-year-old Caucasian male was referred to the Haematology Unit with an enlarged inguinal lymph node which was diagnostic of a blastic plasmacytoid dendritic cell neoplasm. The staging revealed disseminated disease (skin, visceral, lymph nodes, and bone marrow). He received chemotherapy with an acute myeloid leukaemia-like regime. Afterwards, he underwent allogeneic haematopoietic stem cell transplantation, though it was not successful, showing a relapse 14 months later with hepatic and central nervous system dissemination. Intrathecal chemotherapy was administered, and venetoclax (anti-bcl2 agent) was started in an off-label indication based on most recent literature. The disease halted its course for 3 months. In the end, the patient’s disease progressed and so he succumbed due to infectious complications.

Conclusions

Venetoclax monotherapy seems not enough to control the disease progression under CNS involvement and other treatments should be investigated.
Proceedings of the Canadian Thyroid Cancer Active Surveillance Study Group 2019 national investigator meeting
Authors: Goldstein David P. , Ghai Sangeet , Corsten Martin , Bissada Eric , Audet Nathalie , Zhang Han , Nichols Anthony , Morrison Deric , Johnson-Obeski Stephanie , Anderson Donald W. , Prisman Eitan , Baxter Nancy N. , Jones Jennifer , Gafni Amiram , Witterick Ian , Sawka Anna M.
Published: June 2021

Active surveillance (AS) in the management of small, low risk papillary thyroid cancer (PTC) as an alternative option to thyroidectomy, is an area of active research. A national Canadian study is proposed to evaluate the long-term outcomes of patients with small, low risk PTC who choose AS or surgery. This letter describes the proceedings of a national investigator meeting to plan the study.

Graphical abstract
Instructional improv to analyze inquiry-based science teaching: Zed’s dead and the missing flower
Authors: Dahn Maggie , Lee Christine , Enyedy Noel , Danish Joshua
Published: June 2021

In inquiry-based science lessons teachers face the challenge of adhering to curricular goals while simultaneously following students’ intuitive understandings. Improvisation (improv) provides a useful frame for understanding teaching in these inquiry-based contexts. This paper builds from prior work that uses improv as a metaphor for teaching to present a translated model for analysis of teaching in an inquiry-based, elementary school science lesson context. We call our model instructional improv, which shows how a teacher spontaneously synthesizes rules of improv with teaching practices to support student learning, engagement, and agency. We illustrate instructional improv through case study analysis of video recorded classroom interactions with one teacher and 26 first and second grade students learning about the complex system of honey bee pollination in a mixed reality environment. Our model includes the following defining features to describe how teaching happens in this context: the teacher 1) tells a story; 2) reframes mistakes as opportunities; 3) agrees; 4) yes ands; 5) makes statements (or asks questions that elicit statements); and 6) puts the needs of the classroom ensemble over individuals. Overall, we show how instructional improv helps explain how teachers can support science discourse and collective storytelling as a teacher (a) shifts power and agency to students; (b) balances learning and agency; and (c) makes purposeful instructional decisions. Findings have immediate implications for researchers analyzing interactions in inquiry-based learning environments and potential future implications for teachers to support inquiry learning.
Towards probing Earth’s upper mantle with daily magnetic field variations: exploring a physics-based parametrization of the source
Authors: Zenhäusern Géraldine , Kuvshinov Alexey , Guzavina Martina , Maute Astrid
Published: June 2021

The electromagnetic (EM) field variations capable of probing the electrical conductivity of the upper mantle and mantle transition zone have a period range between a few hours and 1 day. At these periods, the dominant source of the EM signals is the ionospheric current system, which has a complex spatial and temporal structure. A concept of global-to-local (G2L) transfer functions can handle spatially complex source by relating global source expansion coefficients with locally measured magnetic (or/and electric) fields. When estimating the G2L transfer functions, the source is commonly expanded into spherical harmonics (SH). In this paper, we explore an alternative parametrization of the source based on a principal component analysis (PCA) of the Fourier transformed output from the physics-based Thermosphere Ionosphere Electrodynamics General Circulation Model (TIE-GCM). Specifically, we investigate whether magnetic fields computed in the realistic three-dimensional conductivity model of Earth excited by the PCA-based source agree better with observatory data than those computed in the same model but induced by the SH-based source. Using PCA to capture the source current compared to SH parametrization, we find that agreement with the observatory data is better during magnetically disturbed times and at shorter periods. Vice versa, it is poorer during magnetically quiet times and at longer periods.
Application of deep learning-based neural networks using theoretical seismograms as training data for locating earthquakes in the Hakone volcanic region, Japan
Authors: Sugiyama Daisuke , Tsuboi Seiji , Yukutake Yohei
Published: June 2021

In the present study, we propose a new approach for determining earthquake hypocentral parameters. This approach integrates computed theoretical seismograms and deep machine learning. The theoretical seismograms are generated through a realistic three-dimensional Earth model, and are then used to create spatial images of seismic wave propagation at the Earth’s surface. These snapshots are subsequently utilized as a training data set for a convolutional neural network. Neural networks for determining hypocentral parameters such as the epicenter, depth, occurrence time, and magnitude are established using the temporal evolution of the snapshots. These networks are applied to seismograms from the seismic observation network in the Hakone volcanic region in Japan to demonstrate the suitability of the proposed approach for locating earthquakes. We demonstrate that the determination accuracy of hypocentral parameters can be improved by including theoretical seismograms for different earthquake locations and sizes, in the learning data set for the deep machine learning. Using the proposed method, the hypocentral parameters are automatically determined within seconds after detecting an event. This method can potentially serve in monitoring earthquake activity in active volcanic areas such as the Hakone region.