bluuebunny/crossref_metadata_2025 huggingface dataset:
Experimental and numerical analysis of the static strength and fatigue life reliability of parabolic leaf springs in heavy commercial trucks
Authors: Ceyhanli Ufuk Taner , Bozca Mehmet
Published: July 2020

The objective of this study is to perform experimental and numerical analysis of the static strength and fatigue life reliability of parabolic leaf springs in heavy commercial trucks. To achieve this objective, stress and displacements under static loading were analytically calculated. A computer-aided design model of a parabolic leaf spring was created. The stress and displacements were calculated by the finite element method. The spring was modelled and analysed using CATIA Part Design and ANSYS Workbench. The stress and displacement distributions on a three-layer parabolic leaf spring were obtained. The high-strength 51CrV4 spring steel was used as sample parabolic leaf springs material, and heat treatments and shoot peening were applied to increase the material strength. Sample parabolic leaf springs were tested to obtain stress and displacement under static loading conditions. By comparing three methods, namely, the static analytical method, static finite elements method and static experimental method, it is observed that results of three methods are close to each other and all three methods are reliable for the design stage of the leaf spring. Similarly, sample parabolic leaf springs were tested to evaluate the fatigue life under working conditions. The reliability analysis of the obtained fatigue life test value was carried out. It was shown that both analytical model and finite element analysis are reliable methods for the evaluation of static strength and fatigue life behaviour in parabolic leaf springs. In addition, it is determined by a reliability analysis based on rig test results of nine springs that the spring achieves its life cycle of 100,000 cycles with a 99% probability rate without breaking. Furthermore, the calculated fatigue life is 2.98% greater than experimentally obtained fatigue life mean and the leaf spring can be used safely and reliably during the service period in heavy trucks.
Endpoints for randomized controlled clinical trials for COVID-19 treatments
Authors: Dodd Lori E , Follmann Dean , Wang Jing , Koenig Franz , Korn Lisa L , Schoergenhofer Christian , Proschan Michael , Hunsberger Sally , Bonnett Tyler , Makowski Mat , Belhadi Drifa , Wang Yeming , Cao Bin , Mentre France , Jaki Thomas
Published: July 2020

Background:

Endpoint choice for randomized controlled trials of treatments for novel coronavirus-induced disease (COVID-19) is complex. Trials must start rapidly to identify treatments that can be used as part of the outbreak response, in the midst of considerable uncertainty and limited information. COVID-19 presentation is heterogeneous, ranging from mild disease that improves within days to critical disease that can last weeks to over a month and can end in death. While improvement in mortality would provide unquestionable evidence about the clinical significance of a treatment, sample sizes for a study evaluating mortality are large and may be impractical, particularly given a multitude of putative therapies to evaluate. Furthermore, patient states in between “cure” and “death” represent meaningful distinctions. Clinical severity scores have been proposed as an alternative. However, the appropriate summary measure for severity scores has been the subject of debate, particularly given the variable time course of COVID-19. Outcomes measured at fixed time points, such as a comparison of severity scores between treatment and control at day 14, may risk missing the time of clinical benefit. An endpoint such as time to improvement (or recovery) avoids the timing problem. However, some have argued that power losses will result from reducing the ordinal scale to a binary state of “recovered” versus “not recovered.”

Methods:

We evaluate statistical power for possible trial endpoints for COVID-19 treatment trials using simulation models and data from two recent COVID-19 treatment trials.

Results:

Power for fixed time-point methods depends heavily on the time selected for evaluation. Time-to-event approaches have reasonable statistical power, even when compared with a fixed time-point method evaluated at the optimal time.

Discussion:

Time-to-event analysis methods have advantages in the COVID-19 setting, unless the optimal time for evaluating treatment effect is known in advance. Even when the optimal time is known, a time-to-event approach may increase power for interim analyses.
Consumer perception and experience regarding medicine packaging systems: A survey of medicine dispensing for outpatients
Authors: Wiedyaningsih Chairun , Rahmawati Fita , Lukitaningsih Endang
Published: July 2020

Background

Prescription unit packaging (PUP) and unit-of-dose packaging (UDP) are two types of medicine packaging systems utilized in hospital pharmacies across Indonesia. However, UDP is generally not used for outpatients.

Objectives

The purpose of this study was to investigate consumer perception and experience of the use of medicines in a packaging system for outpatients.

Methods

A cross-sectional descriptive study with quantitative and qualitative components was performed. A questionnaire about medicine distribution systems, involving packaging and usage was distributed from August to November 2018. During the same time frame, interviews were performed to identify participants’ experiences when using drugs that were distributed and packaged using the PUP system. Key findings: A total of 104 participants completed the questionnaire. Although 52.9% of the participants did not experience difficulties when using medicines distributed in PUP, 68.2% of participants preferred to use medicines in UDP. The reason for their choice of UDP was its practical use (80.8%), particularly if the medicine was taken when traveling (78.9%). Participants reported that UDP was very practical and helpful for geriatric patients, as UDP enables elderly people to use their medicine appropriately. Furthermore, they reported that UDP reminded consumers of the time to take their medicine. The problems with UDP were the number of packages and unfamiliarity.

Conclusions

Medicine was preferred in UDP by consumers but the model needs to be adapted to outpatients.
The Organization of Practices for Instituting Economic Processes: Alternative Food Networks in Beijing
Authors: Wahn I-Liang
Published: July 2020

Recurrent food safety scandals have prompted Beijing consumers to organize farmers’ markets and buyers’ clubs as a way to access organic food. This article draws on practice theory to understand the way in which these networks use the idea of “good food” to reorganize practices of farming, food purchase, cooking, and eating. The article uses the Polanyian concept of “instituted economic processes” to analyze specific modes of orientation and exchange between organic farmers and urban consumers and specific instituted forms of production and consumption. The article illustrates that “good food” became a shared element in practices and the system of provision. Through the qualification of food and associated discourse relating good food to practices and the food system, practices from production to exchange and consumption share an orientation and institute distinctive economic processes.
The effect of social deprivation on the incidence rate of carpal and cubital tunnel syndrome surgery
Authors: Johnson Nick A. , Darwin Oliver , Chasiouras Dimitrious , Selby Anna , Bainbridge Chris
Published: July 2020

We sought to establish whether carpal and cubital tunnel syndrome requiring surgery is associated with deprivation in England. Data from 10,496 adult patients who were treated in our hand unit over a 20-year period were reviewed. The Index of Multiple Deprivation was used to measure deprivation from the patients’ postcode. The mean age at surgery in the most deprived three quintiles was significantly lower than in the least deprived two quintiles for carpal tunnel release (55 vs 59 years, respectively) and cubital tunnel release (52 vs 57 years, respectively). The incidence rate was significantly lower for the three least deprived quintiles when compared with the most deprived quintile for both conditions. The incidence rate ratio of the least deprived quintile compared with the most deprived quintile for carpal tunnel release was 0.70 for men and 0.76 for women. The incidence rate ratio of the least deprived quintile compared with the most deprived quintile for cubital tunnel release was 0.79 for men and 0.49 for women. Carpal tunnel and cubital tunnel syndrome requiring surgery is more common in deprived patients and occurs at an earlier age.

Level of evidence: IV
The forearm interosseous ligament: comparative mechanical properties of the proximal, central, and distal bands
Authors: Kholinne Erica , Kwak Jae-Man , Sun Yucheng , Koh Kyoung Hwan , Jeon In-Ho
Published: July 2020

We compared the mechanical properties of the three parts of interosseous membranes in 12 fresh-frozen specimens. The proximal, central and distal bands of interosseous membranes were tested in a universal testing machine. Tensile strength, ultimate strain, ultimate load and elastic modulus were measured and compared. The stress–strain relationship curves of these bands were similar to those of ligaments. Tensile strength, ultimate load and elastic modulus were significantly higher in the central band than in the proximal and distal bands. Ultimate strain was significantly lower in the central band than in proximal and distal bands. We conclude that the interosseous membrane is similar to ligaments in structure with each band having distinct characteristics. The findings may aid in clinical choice of proper grafts used for interosseous membrane reconstruction.
Impact of microbiome-based interventions on gastrointestinal pathogen colonization in the intensive care unit
Authors: Choy Alexa , Freedberg Daniel E.
Published: July 2020

In the intensive care unit (ICU), colonization of the gastrointestinal tract by potentially pathogenic bacteria is common and often precedes clinical infection. Though effective in the short term, traditional antibiotic-based decolonization methods may contribute to rising resistance in the long term. Novel therapies instead focus on restoring gut microbiome equilibrium to achieve pathogen colonization resistance. This review summarizes the existing data regarding microbiome-based approaches to gastrointestinal pathogen colonization in ICU patients with a focus on prebiotics, probiotics, and synbiotics.
The role of melatonin in colorectal cancer treatment: a comprehensive review
Authors: Kvietkauskas Mindaugas , Zitkute Viktorija , Leber Bettina , Strupas Kestutis , Stiegler Philipp , Schemmer Peter
Published: July 2020

Colorectal cancer (CRC) is one of the most common types of cancer worldwide, known as the second leading cause of cancer-related deaths annually. Currently, multimodal treatment strategies, including surgical resection, combined with chemotherapy and radiotherapy, have been used as conventional treatments in patients with CRC. However, clinical outcome of advanced stage disease remains relatively discouraging, due mainly to appearance of CRC chemoresistance, toxicity, and other detrimental side effects. New strategies to overcome these limitations are essential. During the last decades, melatonin (MLT) has been shown to be a potent antiproliferative, anti-metastatic agent with cytotoxic effects on different types of human malignancies, including CRC. Hence, this comprehensive review compiles the available experimental and clinical data analyzing the effects of MLT treatment in CRC patients and its underlying molecular mechanisms.
A false promise of COVID-19 ‘big’ health data? Health data integrity and the ethics and realities of Australia’s health information management practice
Authors: Robinson Kerin
Published: July 2020

Context: Coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has precipitated an unprecedented volume of medical research. Articles reporting two studies were recently retracted from prestigious journals for reasons including the (thus far) unverifiable provenance of data. This commentary adopts a health information management lens to focus on aspects of data in one of the studies (investigating the use of hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19). The issues: Referencing the Australian context, the current article considers some of the study’s reported hospital administrative and coded data categories within the context of Australian hospitals’ health information management practices. It highlights potential risks associated with the collection and interpretation of ‘big’ health data. Implications: This article identifies pitfalls that confront researchers undertaking multi-country studies and the need to consider country-specific: (i) collected administrative data items; (ii) health information-related ethical, legal and management policy constraints on the use of confidential hospital records and derived data; and (iii) differences in health classification systems and versions used in the coding of diagnoses and related procedures, interventions and health behaviours. Conclusions: The article concludes that the inclusion of a qualified, senior Health Information Manager in research teams and on institutional Human Research Ethics Committees would help to prevent potential problems.
New kindergarten teachers’ career development trajectories in China: A problem-solving perspective
Authors: Wan Dan , Gu Rongfang , McLachlan Claire
Published: July 2020

Since the 1960s, concerns for beginning teachers have attracted extensive attention. High attrition rates among beginning teachers have been an international challenge, which is costly for a nation’s budget. To improve the retention of new teachers, it is imperative to understand what beginning teachers have experienced in their professional practice. This qualitative research examined the career development trajectories of beginning kindergarten teachers in China. The experiences of 23 kindergarten teachers from Nanjing were investigated through semi-structured interviews. Using grounded theory, this research identified four main themes and four career development trajectories. Themes include orientation, mastery, re-examination and self-validation, while career development trajectories reveal that teacher career development is not unilinear, but diverse. These findings are crucial in raising the awareness of researchers and practitioners about the diversities and possibilities of teacher career development trajectories. Further implications for researchers, teacher educators and kindergarten teachers are discussed.
Early precursor T-cell acute lymphoblastic leukemia: current paradigms and evolving concepts
Authors: Castaneda Puglianini Omar , Papadantonakis Nikolaos
Published: July 2020

Early precursor T cell-acute lymphoblastic leukemia (ETP-ALL) is a rare entity characterized by chemo-resistance and a paucity of data regarding optimal management. We review here the literature regarding the management of ETP-ALL and focus on the recent, emerging data, regarding the potential role of molecularly targeted approaches with a focus on venetoclax.
bmlTUX: Design and Control of Experiments in Virtual Reality and Beyond
Authors: Bebko Adam O. , Troje Nikolaus F.
Published: July 2020

Advances in virtual reality technology have made it a valuable new tool for vision and perception researchers. Coding virtual reality experiments from scratch can be difficult and time-consuming, so researchers rely on software such as Unity game engine to create and edit virtual scenes. However, Unity lacks built-in tools for controlling experiments. Existing third-party add-ins requires complicated scripts to define experiments. This can be difficult and requires advanced coding knowledge, especially for multifactorial experimental designs. In this article, we describe a new free and open-source tool called the BiomotionLab Toolkit for Unity Experiments (bmlTUX) that provides a simple interface for controlling experiments in Unity. In contrast to existing tools, bmlTUX provides a graphical interface to automatically handle combinatorics, counterbalancing, randomization, mixed designs, and blocking of trial order. The toolbox works out-of-the-box since simple experiments can be created with almost no coding. Furthermore, multiple design configurations can be swapped with a drag-and-drop interface allowing researchers to test new configurations iteratively while maintaining the ability to easily revert to previous configurations. Despite its simplicity, bmlTUX remains highly flexible and customizable, catering to coding novices and experts alike.
Pyoderma gangrenosum treated with secukinumab: A case report
Authors: McPhie Meghan L , Kirchhof Mark G
Published: July 2020

Pyoderma gangrenosum is a challenging disease to manage, due in part to the lack of approved treatment therapies. Recently, the emergence of biologic agents has expanded treatment options, with tumour necrosis factor alpha inhibitors being the best supported in the literature. In our report, we present a 50-year-old female with pyoderma gangrenosum who was successfully treated with the anti-interleukin-17 biologic agent, secukinumab, after failing other systemic therapies.
Balò’s concentric sclerosis in a case of cocaine-levamisole abuse
Authors: Grasso Daniela , Borreggine Carmela , Castorani Giulia , Vergara Doriana , Dimitri Lucia Maria Cecilia , Catapano Domenico , Simeone Annalisa , Popolizio Teresa
Published: July 2020

Baló’s concentric sclerosis is a rare variant of multiple sclerosis. It belongs to the group of primary inflammatory central nervous system demyelinating diseases having no clear etiology. Peculiar radiological findings on magnetic resonance imaging are alternating rings of demyelinated and myelinated axons resembling an “onion bulb.” We report on a case of a patient with cocaine abuse who presented with Balò’s-like acute multifocal leukoencephalopathy supported by histological and radiological findings. The abuse of cocaine and its most frequent adulterant, levamisole, may induce ischemic or hemorrhagic stroke and metabolic or multifocal inflammatory leukoencephalopathy. Only a few studies described levamisole-induced leukoencephalopathy mimicking Balò round lesions. Nevertheless, it has not yet been established the correlation between them; it might also be possible that the cocaine/levamisole addiction represents just a coincidence in some of those patients affected by Balò sclerosis disease.
Knockdown of Ezrin inhibited migration and invasion of cervical cancer cells in vitro
Authors: Xi Meili , Tang Wenbin
Published: July 2020

Cervical cancer is the fourth most common malignancy in women. The aim of this study was to investigate the functions of Ezrin in cervical cancer cells. Two cervical cancer cell lines, SiHa and CaSki, were cultured in vitro. Following the knockdown of Ezrin using siRNA, real-time reverse transcription-polymerase chain reaction (RT-PCR) and Western blot analysis were applied to analyze Ezrin expression at the messenger RNA (mRNA) and protein levels. Subsequently, wound healing assay, transwell assay, and sulforhodamine B (SRB) assay were used to detect the migration, invasion, and viability of cervical cancer cells, respectively. Results revealed that Ezrin siRNA can notably inhibit the migration and invasion of SiHa and CaSki cells ( P  < 0.05). However, knockdown of Ezrin shows no effects on the viability of SiHa and CaSki cells ( P  < 0.05). It is indicated that Ezrin plays a possible role in promoting the migration and invasion of cervical cancer cells and may be a therapeutic target to prevent metastasis of cervical cancer.
Drug-related talaromycosis: A case report
Authors: Lu Yongsheng , Shi Quan , Yu Jing
Published: July 2020

Talaromycosis is a rare deep fungal infection caused by Talaromyces marneffei. Currently, methamphetamine has become the second-largest drug abuse category in the world after cannabis and has become a serious public health problem. Methamphetamine can inhibit human immune system and increase the probability of pathogenic microorganism infection. On 8 October 2016, a 20-year-old man with a fever history of 2 months was admitted to our hospital. He had bloody stools and abdominal pain during hospitalization. There was no significant abnormality in physical examination. Because of the misdiagnosis, he underwent improper treatment. Periodic acid-Schiff stain (PAS) staining showed that the mucosa of distal ileum, ascending colon, transverse colon, and sigmoid colon were infiltrated by a large number of tissue cells, which contained a large number of blue purple particles. In addition, a large number of histiocytes and multinucleated giant cells can be seen in the lamina propria of ileum mucosa, and fungal spores can be seen in histiocytes. Finally, he was diagnosed as talaromycosis and took itraconazole 0.2 g twice a day. After 5 days, the temperature dropped to normal and the inflammation disappeared, and he continued to take itraconazole for 6 months. Due to the neglect of the history of drug abuse and the concealment, drug-related talaromycosis is often misdiagnosed. Pathological examination is warranted for diagnosis talaromycosis. This condition requires a long-term anti-fungal therapy.
A new treatment for ulcerative colitis: Intracolonic Bifidobacterium and xyloglucan application
Authors: Bozkurt Huseyin Sancar , Kara Banu
Published: July 2020

Ulcerative colitis (UC) pathogenesis includes the altered gut microbiota, environmental factors, and human immune and genetic predisposition. Recently, its association with reduced bifidobacteria quantity in the microbiota is reported. Xyloglucan, a plant-based prebiotic oligosaccharide, causes increase in bifidobacteria quantity. In this article, we share the results of our UC cases treated by intracolonic single-dose administration of Bifidobacterium animalis subsp. lactis and xyloglucan combination. Intracolonic single-dose administration of 200 billion colony-forming units (CFUs) of B. animalis subsp. lactis and 4 g of xyloglucan combination was administrated to 10 severe UC patients, who were either unresponsive or had inadequate response to treatment. All patients continued treatment after the procedure. Treatment responses were evaluated by colonoscopic, laboratory, and clinical examination after 6 weeks. Intracolonic single-dose administration of B. animalis subsp. lactis and xyloglucan was found effective in the mucosal healing and resolution of colonic symptoms in UC patients. Intracolonic administration of B. animalis subsp. lactis and xyloglucan in UC is a new single-strain and strain-specific prebiotic combination method. It is easy to apply and has no observable side effect. Its effectiveness on mucosal healing could be attributed to the enhancement of non-stimulatory status and biodiversity in colonic mucosa. Nonetheless, it is still necessary to develop diagnostic strategies to determine the patients to whom this method would be the most applicable.
A Prescription for Wellness: Exercise Referrals at a Federally Qualified Health Center
Authors: Ylitalo Kelly R. , Cox Wendy , Gutierrez Mariela , Benavidez Gabriel , Umstattd Meyer M. Renée , Niceler Brock , Griggs Jackson O.
Published: July 2020

Introduction/Objectives: Physical activity (PA) improves quality of life and prevents chronic disease, but many adults are inactive. Planning with a health care provider in the form of an exercise “prescription” or referral may increase PA, but determinants of referral utilization are not well understood among underserved populations. This study examined sociodemographic and theory-based psychosocial determinants of exercise referral program utilization. Methods: Patients at a large, federally qualified health center with an on-site exercise facility (ie, “Wellness Center”) referral were eligible to exercise with a personal fitness advisor. Self-reported PA behavior, self-efficacy, and self-regulation strategies were measured via survey and merged with electronic health records and attendance data. Negative binomial regression was used to estimate the rate of Wellness Center utilization. Results: Patients with exercise referrals (n = 1136) were, on average, 45.6 ± 14.6 years, 78.8% female, and 78.0% Hispanic/Latino or non-Hispanic Black. Approximately half (593/1136; 52.2%) initiated exercise at the Wellness Center; initiators completed 8.8 ± 12.4 visits during follow-up. Older age was associated with higher utilization ( P < .001) and patients meeting PA recommendations had lower utilization than patients not meeting recommendations (incident rate ratio = 0.72, 95% CI 0.53-0.97; P = .03). Baseline self-efficacy ( P < .001) and self-regulation strategies ( P = .03) were significantly associated with follow-up PA, even after adjusting for baseline PA. Conclusions: In this racially/ethnically diverse patient population, older and less active patients at baseline had higher program utilization. Patients with higher self-efficacy and self-regulation strategies reported higher PA over time. Community health centers have a unique opportunity to support PA through exercise referral programs to public health priority populations.
Starting the Conversation About Interdisciplinary Counselor and Teacher Training
Authors: Foxx Sejal Parikh , Anderson Kelly
Published: July 2020

School counselors and special education teachers are most often the professionals called upon to support students with intensive, challenging behavioral and emotional needs. However, research suggests that many preparation programs fail to provide training specific for intensive evidence-based interventions. We review the context and need for interdisciplinary school counselor and special education teacher training and provide a perspective on potential directions for addressing this need in professional preparation.
Early Failures After Lumbar Discectomy Surgery: An Analysis of 62 690 Patients
Authors: Samuel Andre M. , Morse Kyle , Lovecchio Francis , Maza Noor , Vaishnav Avani S. , Katsuura Yoshihiro , Iyer Sravisht , McAnany Steven J. , Albert Todd J. , Gang Catherine Himo , Qureshi Sheeraz A.
Published: July 2020

Study Design:

Retrospective cohort study.

Objective:

To determine the rate of early failures (readmission or reoperation for new or recurrent pain/neurological symptoms) within 30 days after lumbar discectomy and identify associated risk factors.

Methods:

A retrospective cohort study was conducted of patients undergoing lumbar discectomy in the National Surgical Quality Improvement Program database between 2013 and 2017. Rates of readmission for new or recurrent symptoms or reoperation for revision discectomy or fusion within 30 days postoperatively were measured and correlated with risk factors.

Results:

In total 62 690 patients were identified; overall rate of readmission within 30 days was 3.3%, including 1.2% for pain or neurological symptoms. Populations at increased risk of readmission were those with 3 or more levels of treatment (2.0%, odds ratio [OR] 2.8%, P < .01), age >70 years (1.8%, OR 1.6, P < .01), class 3 obesity (1.5%, OR 1.4, P = .04), and female gender (1.4%, OR 1.2, P = .02). The overall rate of reoperation within 30 days was 2.2%, including 1.2% for revision decompression or lumbar fusion surgery. Populations at increased risk of reoperation were revision discectomies (1.4%, OR 1.7, P < .01) and females (1.1%, OR 1.4, P < 0.01). Extraforaminal discectomies were associated with lower rates of readmission (0.7%, OR 0.6, P = 0.02) and reoperation (0.4%, OR 0.4, P = .01).

Conclusions:

Early failures after lumbar discectomy surgery are rare. However, certain subpopulations are associated with increased rates of early failure: obesity, multilevel surgery, females, and revision discectomies.
Patient Experience Research in Children and Young People’s Mental Health Services in England: A Route to Genuine Service Transformation or Just Pretty Pictures and Tasteful Color Schemes?
Authors: Crosier Adam , Knightsmith Pooky
Published: July 2020

The personalization of service provision and responding to patients’ expressed needs are key components of government plans to improve children and young people’s mental health services in England. This qualitative study explored the use of patient experience research in these services. Despite national level commitments to listening to and acting on the “patient’s voice,” both service users (young people) and parents of this group reported never having been invited to participate in patient experience research. Most professional respondents reported that such research was frequently tokenistic and conducted solely to meet an administrative requirement. Senior policy makers justified the limited investment in, and use made of patient experience research, by pointing to what they felt were more urgent priorities facing children and young people’s mental health services. These included unprecedented levels of demand and critical underfunding of mental health services and related youth- and community-based services. The conceptualization of patient experience research within the National Health Service (NHS) as a service improvement issue was found to have led to its status being diminished to one concerned with relatively cosmetic matters, such as the color scheme or choice of pictures on the walls of clinics. Senior policy makers argued that it was important to rethink the role and value of patient experience research, and to recognize its unique contribution to addressing the existential questions facing services.
Using Laddering Interviews and Hierarchical Value Mapping to Gain Insights Into Improving Patient Experience in the Hospital: A Systematic Literature Review
Authors: Kumar Pankaj , Follen Michele , Huang Chi-Cheng , Cathey Amy
Published: July 2020

Hospitals are continuously facing pressures to mitigate the gap between patient’s expectations and the quality of services provided. Now with Medicare reimbursements tied to Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, institutions are attempting interventions to increase satisfaction scores. However, a standard framework to understand patient values and perceptions and subsequently translate it into reliable measures of patient satisfaction does not exist, particularly in the inpatient settings. This article highlights opportunity for the addition of qualitative customer value research to augment the information providers gain from HCAHPS scores and provide additional indicators that can be used in improving the patient experience. In this article, patient laddering interviews and hierarchical value mapping are reviewed as methodologies to understand patient core satisfaction values during their hospital stay. A systematic literature search was performed to identify articles addressing laddering interviews and hierarchical value mapping as applied to health care. Inclusion criteria involved studies relating to health care and using laddering interviews. Exclusion criteria included non-health-care studies. Only 3 studies were found eligible for this review. Our systematic review of literature revealed only few studies which may help to guide us to improve patient experience using laddering interviews. These interviews can help compose a personalized bedside survey which may be more meaningful than current widely used HCAHPS survey.
Impact of partially non-ergodic site-specific probabilistic seismic hazard on risk assessment of single buildings
Authors: Kohrangi Mohsen , Kotha Sreeram Reddy , Bazzurro Paolo
Published: July 2020

The growth of global ground-motion databases has allowed generation of non-ergodic ground-motion prediction equations (GMPEs) based on specific on-site recordings. Several studies have investigated the differences between the hazard estimates from ergodic versus non-ergodic GMPEs. Here instead we focus on the impact of non-ergodic PSHA estimates on the seismic risk of nonlinear single-degree-of-freedom systems representing ductile structures and compare it with the traditional risk estimates obtained using ergodic GMPEs. The structure-and-site-specific risk estimates depend not only on the difference in the hazard estimates but also on the different hazard-consistent ground-motion record selection that informs the response calculation. The more accurate structure-and-site-specific non-ergodic risk estimates show that traditional ones may be biased in a way impossible to predict a priori. Hence, the use of the non-ergodic approach is recommended, whenever possible. However, further advancements of non-ergodic GMPEs are necessary before being routinely utilized in real-life risk assessment applications.
Factor VIII–driven changes in activated factor IX explored by hydrogen-deuterium exchange mass spectrometry
Authors: Freato Nadia , Ebberink Eduard H. T. M. , van Galen Josse , Fribourg Caroline , Boon-Spijker Mariëtte , van Alphen Floris P. J. , Meijer Alexander B. , van den Biggelaar Maartje , Mertens Koen
Published: July 2020

The assembly of the enzyme-activated factor IX (FIXa) with its cofactor, activated factor VIII (FVIIIa) is a crucial event in the coagulation cascade. The absence or dysfunction of either enzyme or cofactor severely compromises hemostasis and causes hemophilia. FIXa is a notoriously inefficient enzyme that needs FVIIIa to drive its hemostatic potential, by a mechanism that has remained largely elusive to date. In this study, we employed hydrogen–deuterium exchange-mass spectrometry (HDX-MS) to investigate how FIXa responds to assembly with FVIIIa in the presence of phospholipids. This revealed a complex pattern of changes that partially overlaps with those changes that occur upon occupation of the substrate-binding site by an active site-directed inhibitor. Among the changes driven by both cofactor and substrate, HDX-MS highlighted several surface loops that have been implicated in allosteric networks in related coagulation enzymes. Inspection of FVIIIa-specific changes indicated that 3 helices are involved in FIXa–FVIIIa assembly. These are part of a basic interface that is also known as exosite II. Mutagenesis of basic residues herein, followed by functional studies, identified this interface as an extended FVIIIa-interactive patch. HDX-MS was also applied to recombinant FIXa variants that are associated with severe hemophilia B. This revealed that single amino acid substitutions can silence the extended network of FVIIIa-driven allosteric changes. We conclude that HDX-MS has the potential to visualize the functional impact of disease-associated mutations on enzyme–cofactor complexes in the hemostatic system.
Methylmercury toxic mechanism related to protein degradation and chemokine transcription
Authors: Lee Jin-Yong , Hwang Gi-Wook , Naganuma Akira , Satoh Masahiko
Published: July 2020

Methylmercury is an environmental pollutant that causes neurotoxicity. Recent studies have reported that the ubiquitin-proteasome system is involved in defense against methylmercury toxicity through the degradation of proteins synthesizing the pyruvate. Mitochondrial accumulation of pyruvate can enhance methylmercury toxicity. In addition, methylmercury exposure induces several immune-related chemokines, specifically in the brain, and may cause neurotoxicity. This summary highlights several molecular mechanisms of methylmercury-induced neurotoxicity.
Isolation of TSCD11 Gene for Early Chloroplast Development under High Temperature in Rice
Authors: Fang Guonan , Yang Shenglong , Ruan Banpu , Liu Chaolei , Zhang Anpeng , Jiang Hongzhen , Ding Shilin , Tian Biao , Zhang Yu , Jahan Noushin , Zhu Li , Zhang Guangheng , Dong Guojun , Zhang Qiang , Zeng Dali , Guo Longbiao , Gao Zhenyu , Qian Qian
Published: July 2020

Background

Chloroplasts are essential for photosynthesis and play key roles in plant development. High temperature affects structure of chloroplasts and metabolism in plants. The seryl-tRNA synthetase plays an important role in translation of proteins. Although seryl-tRNA synthetase has been widely studied in microbes and animals, few studies have reported about its role in chloroplast development under high temperature in rice.

Results

In this study, we isolated a novel temperature-sensitive chlorophyll-deficient 11 (tscd11) mutant by ethyl methane sulfonate (EMS) mutagenesis of japonica variety Wuyujing7. The tscd11 mutant developed albino leaves at the 3-leaf stage under high temperature (35 °C), but had normal green leaves under low temperature (25 °C). Consistent with the albino phenotype, impaired chloroplasts, decreased chlorophyll content and increased ROS accumulation were found in the tscd11 mutant at 35 °C. Fine mapping and DNA sequencing of tscd11 revealed a missense mutation (G to A) in the eighth exon of LOC_Os11g39670 resulted in amino acid change (Glu374 to Lys374). The TSCD11 gene encodes a seryl-tRNA synthetase localized to chloroplast. Complementation test confirmed that the point mutation in TSCD11 is responsible for the phenotype of tscd11. TSCD11 is highly expressed in leaves. Compared with the wild type (WT), mutation in TSCD11 led to significant alteration in expression levels of genes associated with chlorophyll biosynthesis, photosynthesis and chloroplast development under high temperature.

Conclusions

TSCD11, encoding a seryl-tRNA synthetase localized to chloroplast, is vital to early chloroplast development at high temperature in rice, which help to further study on the molecular mechanism of chloroplast development under high temperature.
Between attraction and avoidance: from perfume application to fragrance-free policies
Authors: Klaschka Ursula
Published: July 2020

Background

According to a national representative survey, 19.9% of the German population describe various adverse effects on personal health upon exposure to fragranced consumer products. This study investigates whether these fragrance-sensitive persons have a higher risk awareness compared to the general public, whether they show a different safety behavior concerning fragrances and whether they reduce exposure and hence risk.

Results

The presence of fragrances can have a major impact on the participation in public activities. Half of the fragrance-sensitive persons have ever been prevented from going to some place to avoid exposure to fragrances. More than half of them prefer fragrance-free alternatives (products, laundry, hotels, airplanes, health care facilities, or workplaces), while there are also fragrance-sensitive individuals, who indicate to prefer fragranced products and spaces. Half of fragrance-sensitive persons use perfumes to feel themselves more attractive. Furthermore, there is a large number of persons who prefer fragrance-free alternatives without being fragrance-sensitive. Around half of the general population indicate not to use a fragranced product if they know that it emits hazardous air pollutants. This shows that health effects associated with the presence of fragrances proved to be one out of several factors, but not the only one, which influences attitudes towards fragrances and their usage. The answers given reveal the multitude of aspects influencing risk awareness and safety behavior. According to the survey results, 7.4 workdays were lost due to illness from fragranced product exposure in the workplace per person on average, with estimated personal economic costs of 14.5 * 109Euro/year in Germany.

Conclusions

The high prevalence of persons who correlate their health effects with exposure to fragrances shows that existing risk communication instruments are too weak, even for people who are aware of a risk, like fragrance-sensitive persons. The data substantiate how important it is to respect cognitive dissonance, confirmation bias and the inadequacy of the deficit model in risk management. The issue of adverse health effects associated with fragrances has reached a dimension, which requires immediate action: The results of this study are strong supporting arguments in favor of fragrance-free policies.
Precise annotation of tick mitochondrial genomes reveals multiple copy number variation of short tandem repeats and one transposon-like element
Authors: Chen Ze , Xuan Yibo , Liang Guangcai , Yang Xiaolong , Yu Zhijun , Barker Stephen C. , Kelava Samuel , Bu Wenjun , Liu Jingze , Gao Shan
Published: July 2020

Background

In the present study, we used long-PCR amplification coupled with Next-Generation Sequencing (NGS) to obtain complete mitochondrial (mt) genomes of individual ticks and unprecedently performed precise annotation of these mt genomes. We aimed to: (1) develop a simple, cost-effective and accurate method for the study of extremely high AT-content mt genomes within an individual animal (e.g. Dermacentor silvarum) containing miniscule DNA; (2) provide a high-quality reference genome for D. silvarum with precise annotation and also for future studies of other tick mt genomes; and (3) detect and analyze mt DNA variation within an individual tick.

Results

These annotations were confirmed by the PacBio full-length transcriptome data to cover both entire strands of the mitochondrial genomes without any gaps or overlaps. Moreover, two new and important findings were reported for the first time, contributing fundamental knowledge to mt biology. The first was the discovery of a transposon-like element that may eventually reveal much about mechanisms of gene rearrangements in mt genomes. Another finding was that Copy Number Variation (CNV) of Short Tandem Repeats (STRs) account for mitochondrial sequence diversity (heterogeneity) within an individual tick, insect, mouse or human, whereas SNPs were not detected. The CNV of STRs in the protein-coding genes resulted in frameshift mutations in the proteins, which can cause deleterious effects. Mitochondria containing these deleterious STR mutations accumulate in cells and can produce deleterious proteins.

Conclusions

We proposed that the accumulation of CNV of STRs in mitochondria may cause aging or diseases. Future tests of the CNV of STRs hypothesis help to ultimately reveal the genetic basis of mitochondrial DNA variation and its consequences (e.g., aging and diseases) in animals. Our study will lead to the reconsideration of the importance of STRs and a unified study of CNV of STRs with longer and shorter repeat units (particularly polynucleotides) in both nuclear and mt genomes.
Study protocol: older people in retirement villages. A survey and randomised trial of a multi-disciplinary invention designed to avoid adverse outcomes
Authors: Peri K. , Broad J. B. , Hikaka J. , Boyd M. , Bloomfield K. , Wu Z. , Calvert C. , Tatton A. , Higgins A-M , Bramley D. , Connolly M. J.
Published: July 2020

Background

There is increasing interest among older people in moving into retirement villages (RVs), an attractive option for those seeking a supportive community as they age, while still maintaining independence. Currently in New Zealand there is limited knowledge of the medical, service supports, social status and needs of RV residents. The objective of this study is to explore RV facilities and services, the health and functional status of RV residents, prospectively study their healthcare trajectories and to implement a multidisciplinary team intervention to potentially decrease dependency and impact healthcare utilization.

Methods

All RVs located in two large district health boards in Auckland, New Zealand were eligible to participate. This three-year project comprised three phases: The survey phase provided a description of RVs, residents’ characteristics and health and functional status. RV managers completed a survey of size, facilities and recreational and healthcare services provided in the village. Residents were surveyed to establish reasons for entry to the village and underwent a Gerontology Nurse Specialist (GNS) assessment providing details of demographics, social engagement, health and functional status. The cohort study phase examines residents’ healthcare trajectories and adverse outcomes, over three years. The final phase is a randomised controlled trial of a multidisciplinary team intervention aimed to improve health outcomes for more vulnerable residents.

Residents who triggered potential unmet health needs during the assessment in the survey phase were randomised to intervention or usual care groups. Multidisciplinary team meetings included the resident and support person, a geriatrician or gerontology nurse practitioner, GNS, pharmacist and General Practitioner. The primary outcome of the randomised controlled trial will be first acute hospitalization. Secondary outcomes include all acute hospitalizations, long-term care admissions, and all-cause mortality.

Discussion

This paper describes the study protocol of this complex study. The study aims to inform policies and practices around health care services for residents in retirement villages. The results of this trial are expected early 2020 with publication subsequently.

Trial registration

Australia and New Zealand Clinical Trials Registry: ACTRN12616000685415. Registered 25.5.2016.

Universal Trial Number (UTN): U111–1173-6083.
Cerebral hemodynamic response to short-term maternal hyperoxygenation in fetuses with borderline small left hearts
Authors: Zeng Shi , Zhou Jiawei , Peng Qinghai , Deng Wen , Zhou Qichang
Published: July 2020

Background

Hypoxia delays brain maturation and contributes to neurodevelopmental morbidity in fetuses with congenital heart defects (CHDs). Maternal hyperoxygenation (MH) can, in theory, promote oxygen/nutrient delivery to the fetal brain, owing to an improved heart structure/function and increased fetal oxygen content. We aimed to determine whether MH alters fetal cerebral hemodynamics in fetuses with CHD.

Methods

Twenty-eight fetuses with borderline small left hearts and 28 age-matched normal fetuses were enrolled and subdivided by gestational age (GA): 23+ 0 ~ 27+ 6 weeks and 28+ 0 ~ 36+ 6 weeks. The middle cerebral artery pulsatility index (MCA-PI), vascular index (VI), flow index (FI) and vascular/flow index (VFI) were measured with baseline room air, after 10 min of MH and after 10 min of recovery for all subjects.

Results

MCA-PI, VI, FI and VFI did not differ with MH in the normal fetuses. In fetuses with borderline small left hearts, MCA-PI increased and VI, FI and VFI significantly decreased during the 3rd trimester (from 1.44 ± 0.27, 3.19 ± 0.87, 56.91 ± 9.19, and 1.30 ± 0.33 at baseline to 1.62 ± 0.15, 2.37 ± 0.37, 45.73 ± 4.59, and 0.94 ± 0.15 during MH, respectively, P < 0.05), but this response was not apparent during mid-gestation (p > 0.05). These parameters returned to the baseline levels during the recovery phase. The change in cerebral perfusion depended on the baseline MCA-PI and increased the combined cardiac index (CCOi).

Conclusions

MH alters the cerebral hemodynamics of fetuses with borderline small left hearts during the third trimester. Further investigation is needed to determine whether MH may benefit brain growth and neurodevelopment in this high-risk population.