bluuebunny/crossref_metadata_2025 huggingface dataset:
Predicting functional performance via classification of lower extremity strength in older adults with exergame-collected data
Authors: Becker Hagen , Garcia-Agundez Augusto , Müller Philipp Niklas , Tregel Thomas , Miede André , Göbel Stefan
Published: December 2020

Objective

The goal of this article is to present and to evaluate a sensor-based functional performance monitoring system. The system consists of an array of Wii Balance Boards (WBB) and an exergame that estimates whether the player can maintain physical independence, comparing the results with the 30 s Chair-Stand Test (30CST).

Methods

Sixteen participants recruited at a nursing home performed the 30CST and then played the exergame described here as often as desired during a period of 2 weeks. For each session, features related to walking and standing on the WBBs while playing the exergame were collected. Different classifier algorithms were used to predict the result of the 30CST on a binary basis as able or unable to maintain physical independence.

Results

By using a Logistic Model Tree, we achieved a maximum accuracy of 91% when estimating whether player’s 30CST scores were over or under a threshold of 12 points, our findings suggest that predicting age- and sex-adjusted cutoff scores is feasible.

Conclusion

An array of WBBs seems to be a viable solution to estimate lower extremity strength and thereby functional performance in a non-invasive and continuous manner. This study provides proof of concept supporting the use of exergames to identify and monitor elderly subjects at risk of losing physical independence.
Industry strategies in the parliamentary process of adopting a sugar-sweetened beverage tax in South Africa: a systematic mapping
Authors: Abdool Karim Safura , Kruger Petronell , Hofman Karen
Published: December 2020

Background

In 2016, the South African government became the first in the African region to announce the introduction of an SSB tax based on sugar content as a public health measure to reduce obesity. This tax was introduced against the backdrop of South Africa having a large sugar production and SSB manufacturing industry, as well as very high unemployment rates. The introduction of fiscal measures, such as a SSB tax, has been met with well-coordinated and funded opposition in other countries.

Methods

The aim of this study is to describe and analyse the arguments and strategies utilised by industry during policymaking processes to oppose regulatory actions in LMIC. This study analyses arguments and strategies used by the beverage and related industries during the public consultation phase of the process to adopt the South African SSB tax.

Results

Industry opposition to the SSB tax was comprehensive and employed several tactics. First, industry underscored its economic importance and the potential job losses and other economic harms that may arise from the tax. This argument was well-received by policymakers, and similar to industry tactics employed in other middle income countries like Mexico. Second, industry discussed self-regulation and voluntary measures as a form of policy substitution, which mirrors industry responses in the US, the Caribbean and Latin America. Third, industry misused or disputed evidence to undermine the perceived efficacy of the tax. Finally, considerations for small business and their ability to compete with multi-national corporations were a unique feature of industry response.

Conclusions

Industry opposition followed both general trends, and also introduced nuanced and context-specific arguments. The industry response experienced in South Africa can be instructive for other countries contemplating the introduction of similar measures.
Analysis of perioperative risk factors for deep vein thrombosis in patients with femoral and pelvic fractures
Authors: Wu Linqin , Cheng Bo
Published: December 2020

Objective

Clinical characteristics, anticoagulant protocols, and risk factors of deep vein thrombosis (DVT) in patients with femoral and pelvic fractures were analyzed throughout the perioperative period to provide references for early identification and optimization of risk factors.

Methods

This was a retrospective study. A total of 569 patients undergoing surgery of femoral and pelvic fractures from May 2018 to December 2019 were included.

The clinical data including general conditions, trauma, surgery, anticoagulant protocols, and laboratory indexes were collected. According to the results of deep vein Doppler ultrasonography of the lower extremities, the patients were divided into non-DVT group and DVT group. Univariate analysis and multivariate logistic regression analysis were used to identify the independent risk factors of preoperative and postoperative DVT.

Results

The incidence of DVT was 40.25% and preoperative DVT was 26.71%, which was higher than the incidence of postoperative DVT of 17.22%. Most of them were thrombus on the affected side (60.26%) and distal thrombus (81.66%). The average time of DVT formation was 6.55 ± 0.47 days after trauma and 6.67 ± 0.48 days after surgery. Chronic obstructive pulmonary disease (COPD), anemia, hypoproteinemia, non-anticoagulation before surgery, delayed anticoagulation after trauma and admission, high-energy trauma, multiple injuries, drinking history, and advanced age were independent risk factors for perioperative DVT. The increased level of fibrinogen degradation products was an independent risk factor for preoperative DVT. These risk factors were identified to be independently associated with postoperative DVT, including intraoperative blood transfusion, postoperative blood transfusion, pulmonary infection, preoperative non-anticoagulation, postoperative delayed anticoagulation, preoperative waiting time > 7 days, operative time > 2 h, c-reactive protein, fibrinogen level, platelet count 1 day after surgery, c-reactive protein, fibrinogen, and hemoglobin levels 3 days after surgery, comminuted fracture.

Conclusions

At present, anticoagulation and other DVT prevention and treatment programs have not changed the current situation that the incidence of DVT is still high. Through the analysis of the risk factors of DVT throughout the perioperative period, optimizing the perioperative blood transfusion, preoperative lung disease, hypoproteinemia, anemia, inflammation, etc., and surgery as soon as possible after trauma may further reduce its incidence.
Anakinra treatment in critically ill COVID-19 patients: a prospective cohort study
Authors:   the RCI-COVID-19 Study Group, Kooistra Emma J. , Waalders Nicole J. B. , Grondman Inge , Janssen Nico A. F. , de Nooijer Aline H. , Netea Mihai G. , van de Veerdonk Frank L. , Ewalds Esther , van der Hoeven Johannes G. , Kox Matthijs , Pickkers Peter
Published: December 2020

Background

A subset of critically ill COVID-19 patients develop a hyperinflammatory state. Anakinra, a recombinant interleukin-1 receptor antagonist, is known to be effective in several hyperinflammatory diseases. We investigated the effects of anakinra on inflammatory parameters and clinical outcomes in critically ill, mechanically ventilated COVID-19 patients with clinical features of hyperinflammation.

Methods

In this prospective cohort study, 21 critically ill COVID-19 patients treated with anakinra were compared to a group of standard care. Serial data of clinical inflammatory parameters and concentrations of multiple circulating cytokines were determined and aligned on start day of anakinra in the treatment group, and median start day of anakinra in the control group. Analysis was performed for day − 10 to + 10 relative to alignment day. Clinical outcomes were analyzed during 28 days. Additionally, three sensitivity analyses were performed: (1) using propensity score-matched groups, (2) selecting patients who did not receive corticosteroids, and (3) using a subset of the control group aimed to match the criteria (fever, elevated ferritin) for starting anakinra treatment.

Results

Baseline patient characteristics and clinical parameters on ICU admission were similar between groups. As a consequence of bias by indication, plasma levels of aspartate aminotransferase (ASAT) (p = 0.0002), ferritin (p = 0.009), and temperature (p = 0.001) were significantly higher in the anakinra group on alignment day. Following treatment, no relevant differences in kinetics of circulating cytokines were observed between both groups. Decreases of clinical parameters, including temperature (p = 0.03), white blood cell counts (p = 0.02), and plasma levels of ferritin (p = 0.003), procalcitonin (p = 0.001), creatinine (p = 0.01), and bilirubin (p = 0.007), were more pronounced in the anakinra group. No differences in duration of mechanical ventilation or ICU length of stay were observed between groups. Sensitivity analyses confirmed these results.

Conclusions

Anakinra is effective in reducing clinical signs of hyperinflammation in critically ill COVID-19 patients. A randomized controlled trial is warranted to draw conclusion about the effects of anakinra on clinical outcomes.
Effects of whole body vibration exercise on lumbar-abdominal muscles activation for patients with chronic low back pain
Authors: Dong Yulin , Wang Huifang , Zhu Yan , Chen Binglin , Zheng Yili , Liu Xiaochen , Qiao Jun , Wang Xueqiang
Published: December 2020

Background

Whole body vibration (WBV) training as an intervention method can cure chronic low back pain (CLBP). Different WBV parameters exert different effects on lumbar-abdominal muscle performance. Currently, there is a lack of study researched the influence of WBV training on patients with CLBP by lumbar–abdominal muscle activity. Therefore, this study aimed to investigate how WBV and exercise and their interactions influence lumbar-abdominal muscle activity in patients with CLBP.

Methods

a group of ambulatory patients with chronic low back pain. Muscle activities of the multifidus (MF), erector spinae (ES), abdominal oblique externus muscle (AOE) and the rectus abdominis muscle (RA) were measured by surface electromyography, whereas participants performed 4 different exercises (single bridge, plank, side stay and V crunch) during three whole body vibration conditions and a no-vibration condition in a single experimental session.

Results

Compared with the same exercises without whole body vibration, muscle activity increased when whole body vibration was added to the exercises. MF; the WBV frequency (P = 0.002,) and exercise (P < 0.001) presented significant effects on the root mean square of MF, whereas exercise * frequency (P = 0.044) also resulted in significant interaction effects. ES: the significant differences were detected at WBV frequency (P < 0.001), exercise (P < 0.001), the interaction effect of exercise and frequency (P = 0.225) was no significant. RA: the significant difference was detected at WBV frequency (P = 0.018), the effect of exercise (P = 0.590) and the exercise * frequency interaction (P = 0.572) were no significant. AOE: the significant difference was detected at WBV frequency (P < 0.001), the effect of exercise (P = 0.152) and the exercise * frequency interaction (P = 0.380) were no significant.

Conclusion

Adding whole body vibration to exercise could increase muscle activation of lumbar–abdominal muscle in patients with CLBP. The optimum frequency for lumbar–abdominal muscles is 15 Hz. The best exercises include plank for multifidus and erector spinae, V crunch for rectus abdominis and single bridge for abdominal oblique externus.

Clinical registration

Trial registration: ChiCTR-TRC-13003708. Registered 19 October 2013.

The code of ethical approval

2014008.
Evaluation of image quality with four positron emitters and three preclinical PET/CT systems
Authors: Teuho Jarmo , Riehakainen Leon , Honkaniemi Aake , Moisio Olli , Han Chunlei , Tirri Marko , Liu Shihao , Grönroos Tove J. , Liu Jie , Wan Lin , Liang Xiao , Ling Yiqing , Hua Yuexuan , Roivainen Anne , Knuuti Juhani , Xie Qingguo , Teräs Mika , D’Ascenzo Nicola , Klén Riku
Published: December 2020

Background

We investigated the image quality of 11C, 68Ga, 18F and 89Zr, which have different positron fractions, physical half-lifes and positron ranges. Three small animal positron emission tomography/computed tomography (PET/CT) systems were used in the evaluation, including the Siemens Inveon, RAYCAN X5 and Molecubes β-cube. The evaluation was performed on a single scanner level using the national electrical manufacturers association (NEMA) image quality phantom and analysis protocol. Acquisitions were performed with the standard NEMA protocol for 18F and using a radionuclide-specific acquisition time for 11C, 68Ga and 89Zr. Images were assessed using percent recovery coefficient (%RC), percentage standard deviation (%STD), image uniformity (%SD), spill-over ratio (SOR) and evaluation of image quantification.

Results

68Ga had the lowest %RC (< 62%) across all systems. 18F had the highest maximum %RC (> 85%) and lowest %STD for the 5 mm rod across all systems. For 11C and 89Zr, the maximum %RC was close (> 76%) to the %RC with 18F. A larger SOR were measured in water with 11C and 68Ga compared to 18F on all systems. SOR in air reflected image reconstruction and data correction performance. Large variation in image quantification was observed, with maximal errors of 22.73% (89Zr, Inveon), 17.54% (89Zr, RAYCAN) and − 14.87% (68Ga, Molecubes).

Conclusions

The systems performed most optimal in terms of NEMA image quality parameters when using 18F, where 11C and 89Zr performed slightly worse than 18F. The performance was least optimal when using 68Ga, due to large positron range. The large quantification differences prompt optimization not only by terms of image quality but also quantification. Further investigation should be performed to find an appropriate calibration and harmonization protocol and the evaluation should be conducted on a multi-scanner and multi-center level.
Sustainable livelihood approach for assessing the impacts of slaughterhouses on livelihood strategies among pastoralists in Kenya
Authors: Gichure Josphat Njenga , Njeru Sarah Kangai , Mathi Pius Mwangi
Published: December 2020

The social, physical, financial, natural, and human dimensions within slaughterhouses have taken a central position in diversifying livelihoods among pastoralists in the arid and semi-arid lands (ASALs) in Kenya. There is a need to expound on the literature about these dimensions and assess how they impact on livelihood strategies and outcomes. This research aimed to bring out how these dimensions impact livelihood strategies among Kenyan pastoralists using the sustainable livelihood approach. Qualitative data was collected from four counties in Kenya’s ASALs predominantly inhabited by pastoralists, using focus group discussions, and narratives Observations were analysed using the RQDA package within the R statistical computing environment. The results revealed increasingly diversified social-economic activities, value addition of slaughter by-products, better rangeland management, and diversified diets. Gender, age, and roles significantly (P < 0.01) influenced the extent of diversification. Diversified social-economic activities and value addition directly impacted food security through increased utilization of slaughter by-products, provision of an alternative livelihood source, and better resilience during calamities. To conclude, social, economic, and human activities were central in diversified and advanced pastoral livelihoods.
Protracted viral shedding and viral load are associated with ICU mortality in Covid-19 patients with acute respiratory failure
Authors: Bitker L. , Dhelft F. , Chauvelot L. , Frobert E. , Folliet L. , Mezidi M. , Trouillet-Assant S. , Belot A. , Lina B. , Wallet F. , Richard J. C.
Published: December 2020

Background

Protracted viral shedding is common in hospitalized patients with COVID-19 pneumonia, and up to 40% display signs of pulmonary fibrosis on computed tomography (CT) after hospital discharge. We hypothesized that COVID-19 patients with acute respiratory failure (ARF) who die in intensive care units (ICU) have a lower viral clearance in the respiratory tract than ICU patients discharged alive, and that protracted viral shedding in respiratory samples is associated with patterns of fibroproliferation on lung CT. We, therefore, conducted a retrospective observational study, in 2 ICU of Lyon university hospital.

Results

129 patients were included in the study, of whom 44 (34%) died in ICU. 432 RT-PCR for SARS-CoV-2 were performed and 137 CT scans were analyzed. Viral load was significantly higher in patients deceased as compared to patients alive at ICU discharge (p < 0.001), after adjustment for the site of viral sampling and RT-PCR technique. The median time to SARS-CoV-2 negativation on RT-PCR was 19 days [CI95 %:15–21] in patients alive at ICU discharge and 26 days [CI95 %:17-infinity] in non-survivors at ICU discharge. Competitive risk regression identified patients who died in ICU and age as independent risk factors for longer time to SARS-CoV-2 negativation on RT-PCR, while antiviral treatment was independently associated with shorter time. None of the CT scores exploring fibroproliferation (i.e., bronchiectasis and reticulation scores) were significantly associated with time to SARS-CoV-2 negativation.

Conclusions

Viral load in respiratory samples is significantly lower and viral shedding significantly shorter in ICU survivors of COVID-19 associated acute respiratory failure. Protracted viral shedding is unrelated to occurrence of fibrosis on lung CT.
Adherence to personal protective equipment use among healthcare workers caring for confirmed COVID-19 and alleged non-COVID-19 patients
Authors: Neuwirth Meike M. , Mattner Frauke , Otchwemah Robin
Published: December 2020

Adherence observations of health care workers (HCW) revealed deficiencies in the use of recommended personal protective equipment (PPE) among HCW caring in COVID-19 and non-COVID-19 wards during the first period of the SARS-CoV-2 pandemic in a university hospital in Germany. The adherence to wearing surgical face or FFP2-masks and disinfecting hands prior to donning and after doffing the PPE was significantly higher in COVID-19 wards However, there was no total adherence of 100% in COVID-19 wards.
Structural Performance of PC Double Beam–Column Connection Under Gravity and Seismic Loading
Authors: Baek Jang-Woon , Kang Su-Min , Kim Tae-Ho , Kim Jin-Yong
Published: December 2020

Recently, as a new precast concrete (PC) construction method for increasing economy and constructability, the PC double-beam system has been developed for factories or logistic centers, where construction duration is particularly important. In this study, half-scaled PC double beam–column connection was tested under gravity loading and cyclic lateral loading. The major test parameters included the use of the spliced PC column and the addition of reinforcement at the beam–column joint. In the gravity loading test, the flexural behavior of the PC double beam was investigated. The test results showed satisfactory flexural capacity at the PC double-beam section, validating the composite action between the PC and RC members. In the cyclic lateral loading test, the seismic performance of the PC double beam–column connection was investigated. Based on the test results, the failure mode, load-carrying capacity, deformation capacity, energy dissipation capacity, secant stiffness, and shear strength of the PC double-beam system were evaluated and compared with those of a conventional RC double beam–column connection. According to the test results, the structural performance of the PC double beam–column connection was comparable to that of the RC double beam–column connection and satisfied the acceptance criteria of moment frame in the ACI 374.1-05 provision.
Estrogen-related receptor alpha directly binds to p53 and cooperatively controls colon cancer growth through the regulation of mitochondrial biogenesis and function
Authors: De Vitto Humberto , Ryu Joohyun , Calderon-Aparicio Ali , Monts Josh , Dey Raja , Chakraborty Abhijit , Lee Mee-Hyun , Bode Ann M. , Dong Zigang
Published: December 2020

Background

Of the genes that control mitochondrial biogenesis and function, ERRα emerges as a druggable metabolic target to be exploited for cancer therapy. Of the genes mutated in cancer, TP53 remains the most elusive to target. A clear understanding of how mitochondrial druggable targets can be accessed to exploit the underlying mechanism(s) explaining how p53-deficient tumors promote cell survival remains elusive.

Methods

We performed protein-protein interaction studies to demonstrate that ERRα binds to p53. Moreover, we used gene silencing and pharmacological approaches in tandem with quantitative proteomics analysis by SWATH-MS to investigate the role of the ERRα/p53 complex in mitochondrial biogenesis and function in colon cancer. Finally, we designed in vitro and in vivo studies to investigate the possibility of targeting colon cancers that exhibit defects in p53.

Results

Here, we are the first to identify a direct protein-protein interaction between the ligand-binding domain (LBD) of ERRα and the C-terminal domain (CTD) of p53. ERRα binds to p53 regardless of p53 mutational status. Furthermore, we show that the ERRα and p53 complex cooperatively control mitochondrial biogenesis and function. Targeting ERRα creates mitochondrial metabolic stresses, such as production of reactive oxygen species (ROS) and mitochondrial membrane permeabilization (MMP), leading to a greater cytotoxic effect that is dependent on the presence of p53. Pharmacological inhibition of ERRα impairs the growth of p53-deficient cells and of p53 mutant patient-derived colon xenografts (PDX).

Conclusions

Therefore, our data suggest that by using the status of the p53 protein as a selection criterion, the ERRα/p53 transcriptional axis can be exploited as a metabolic vulnerability.
Perceived barriers and enablers to physical activity participation in people with Alopecia Areata: a constructivist grounded theory study
Authors: Rajoo Yamuna , Wong J. , Raj I. S. , Kennedy G. A.
Published: December 2020

Background

Alopecia Areata (AA) is an autoimmune disease that is characterised by hair loss. Individuals diagnosed with it often describe feelings of trauma and social rejection due to cosmetic repercussions and are at high risk of experiencing psychological distress. Physical activity (PA) participation has been associated with better mental health outcomes in diverse populations. A preliminary study of individuals with AA indicated that severe hair loss is associated with symptomatic depression, anxiety and stress, which negatively impacted PA participation. While strategies to increase PA participation in the general population have been established, little is known about PA participation in people with AA. This study aimed to understand barriers and enablers to PA participation in people with AA to inform the development of evidence-based interventions.

Methods

The study used a grounded theory (GT) methodology, relying on an iterative and simultaneous process of data collection, coding, theory development, and data comparisons to explore the perceived barriers and enablers to PA. Data were collected through a focus group (8 participants [33.38 ± 10.81 years]) and individual telephone interviews (8 participants [33.89 ± 11.87 years]). The study was conducted in Melbourne, Australia. Interview data were recorded digitally, transcribed verbatim and analysed. Recruitment continued until theoretical saturation was achieved.

Results

The constructivist grounded theory method used has assisted to develop an explanatory model which is used to explain the themes for barriers and enablers to PA participation. The four phases in the explanatory model are as follows (1) onset of AA; (2) reaction towards the condition; (3) adjustment; and (4) acceptance.

Conclusion

The findings highlighted perceived barriers and enablers to PA participation in people with AA. Future interventions could consider addressing these barriers specifically to maximise effectiveness and to improve mental health status based on the phases of the explanatory model.
Volumetric changes in edentulous alveolar ridge sites utilizing guided bone regeneration and a custom titanium ridge augmentation matrix (CTRAM): a case series study
Authors: Hofferber Craig E. , Beck J. Cameron , Liacouras Peter C. , Wessel Jeffrey R. , Getka Thu P.
Published: December 2020

Background

The purpose of this study was to evaluate the volumetric changes in partially edentulous alveolar ridges augmented with customized titanium ridge augmentation matrices (CTRAM), freeze-dried bone allograft, and a resorbable collagen membrane.

Methods

A pre-surgical cone beam computed tomography (CBCT) scan was obtained for CTRAM design/fabrication and to evaluate pre-surgical ridge dimensions. Ridge augmentation surgery using CTRAM, freeze-dried bone allograft, and a resorbable collagen membrane was performed at each deficient site. Clinical measurements of the area of augmentation were made at the time of CTRAM placement and re-entry, and a 2nd CBCT scan 7 months after graft placement was used for volumetric analysis. Locations of each CTRAM in situ were also compared to their planned positions. Re-entry surgery and implant placement was performed 8 months after CTRAM placement.

Results

Nine subjects were treated with CTRAM and freeze-dried bone allograft. Four out of the nine patients enrolled (44.4%) experienced premature CTRAM exposure during healing, and in two of these cases, CTRAM were removed early. Early exposure did not result in total graft failure in any case. Mean volumetric bone gain was 85.5 ± 30.9% of planned augmentation volume (61.3 ± 33.6% in subjects with premature CTRAM exposure vs. 104.9% for subjects without premature exposure, p = 0.03). Mean horizontal augmentation (measured clinically) was 3.02 mm, and vertical augmentation 2.86 mm. Mean surgical positional deviation of CTRAM from the planned location was 1.09 mm.

Conclusion

The use of CTRAM in conjunction with bone graft and a collagen membrane resulted in vertical and horizontal bone gain suitable for implant placement.
Interpersonal counselling for adolescent depression delivered by youth mental health workers without core professional training: a feasibility randomised controlled trial study protocol
Authors: Abotsie Gabriel , Cestaro Viktoria , Gee Brioney , Murdoch Jamie , Katangwe Thando , Meiser-Stedman Richard , Shepstone Lee , Turner David , Tulk Susie , Jarrett Sharon , Wilson Jon , Clarke Tim , Teague Bonnie , Wilkinson Paul
Published: December 2020

Background

Depression is a common health problem during adolescence and is associated with adverse academic, social and health outcomes. To meet the demand for treatment for adolescent depression, there is a need for evidence-based interventions suitable for delivery outside of specialist Child and Adolescent Mental Health Services (CAMHS). Interpersonal Counselling for Adolescents (IPC-A) is a brief manualised intervention for adolescent depression suitable for delivery by staff who are not qualified health professionals following participation in a brief training course. While initial piloting within Local Authority services has generated promising results, the effectiveness and cost-effectiveness of IPC-A has yet to be established. This study aims to assess the feasibility of a randomised controlled trial (RCT), evaluating the effectiveness and cost-effectiveness of IPC-A delivered by staff without core professional training in comparison to current provision.

Method

Feasibility RCT with process evaluation using ethnographic methodology. Eligible young people (n = 60) will be randomised in a 1:1 ratio to receive either IPC-A or treatment as usual (TAU). Participants will be assessed pre-randomisation (baseline) and followed up at 5, 10 and 23 weeks post-randomisation. A parallel process evaluation will generate understanding of intervention implementation across services and explore the acceptability of the intervention from the perspective of young people and other key stakeholders.

Participants

Young people aged 12–18 years presenting to non-specialist services with symptoms of depression. Youth workers, young people and stakeholders will participate in the process evaluation.

Discussion

The need for effective and accessible interventions for young people with mild/sub-threshold depression who, in most cases, do not meet the threshold for mainstream mental health services is long overdue. The primary output of this feasibility trial will be the design of the subsequent full-scale trial. If the results of the current study indicate that this would be feasible, we intend to progress to a multi-site, assessor-blind, superiority RCT of the effectiveness and cost-effectiveness of IPC-A in comparison to TAU for adolescents presenting to non-specialist services with depressive symptoms. If satisfactory solutions to any problems encountered cannot be identified, alternative research designs will be considered. If proven effective, an IPC-A training programme could be implemented.

Trial registry

ISRCTN registry, ISRCTN82180413, Registered 31 December 2019.
Exploring the consequences of teachers’ self-efficacy: a case of teachers of English as a foreign language
Authors: Alibakhshi Goudarz , Nikdel Fariborz , Labbafi Akram
Published: December 2020

Teacher self-efficacy has been abundantly studied. However, it seems that the consequences of teachers’ self-efficacy have not been appropriately explored yet. The research objective was to investigate the consequences of teachers’ teaching self-efficacy. The researchers used a qualitative research method. They collected the data through semi-structured interviews with 20 EFL teachers who were selected through purposive sampling. The interviews were content analyzed thematically. Findings showed that self-efficacy has different consequences: pedagogical, learner-related, and psychological. Each consequence has several sub-categories. It is concluded that high self-efficacy affects teachers’ teaching practices, learners’ motivation, and achievement. It also affects teachers’ burn-out status, psychological being, as well as their job satisfaction. The findings can be theoretically and pedagogically important to EFL teachers, teacher-trainers, and administrators of educational settings.
The humanitarian-development nexus: humanitarian principles, practice, and pragmatics
Authors: Lie Jon Harald Sande
Published: December 2020

The humanitarian–development nexus is increasingly being cast as the solution to humanitarian concerns, new and protracted crises, and to manage complex war-to-peace transitions. Despite widely endorsed amongst policymakers, this nexus presents some challenges to those implementing it. Humanitarian action and development assistance represent two distinct discursive and institutional segments of the international system that are hard to juxtapose. Humanitarianism’s apolitical and imminent needs-based approaches building on established humanitarian principles are fundamentally different from the more long-term, political, rights-based approaches of development. As they rub shoulders, as intentionally instigated by the nexus, they affect and challenge each other. These challenges are more acute to the humanitarian domain given the constitutive status of the humanitarian principles, which, when challenged, may cause changes to the humanitarian space and a mission-cum-ethics creep. This article explores the formation and effects of the humanitarian–development nexus as rendered both at the top, amongst policymakers, and from the bottom. The latter explores the discursive transition from conflict to reconstruction in Northern Uganda. Humanitarian organisations’ different response to the transition demonstrate more pragmatic approaches to the humanitarian principles and thus how the nexus itself is also formed bottom up and further exacerbates the mission creep.
Integrative analysis of mRNA and miRNA sequencing data for gliomas of various grades
Authors: Gvaldin Dmitry Y. , Pushkin Anton A. , Timoshkina Nataliya N. , Rostorguev Eduard E. , Nalgiev Arbi M. , Kit Oleg I.
Published: December 2020

Background

The purpose of this study was to characterize subtype-specific patterns of mRNA and miRNA expression of gliomas using The Cancer Genome Atlas (TCGA) data to search for genetic determinants that predict prognosis in terms of overall survival and to create interaction networks for grade 2 and 3 (G2 and G3) astrocytomas, oligodendrogliomas and grade 4 (G4) glioblastoma multiforme. Based on open-access TCGA data, 5 groups were formed: astrocytoma G2 (n = 58), astrocytoma G3 (n = 128), oligodendroglioma G2 (n = 102), oligodendroglioma G3 (n = 72) and glioblastoma G4 (n = 564); normal samples of brain tissue were also analysed (n = 15). Data of patient age, sex, survival and expression patterns of mRNA and miRNA were extracted for each sample. After stratification of the data into groups, a differential analysis of expression was carried out, genes and miRNAs that affect overall survival were identified and gene set enrichment analysis (GSEA) and interaction analysis were performed.

Results

A total of 939 samples of glial tumours were analysed, for which subtype-specific expression profiles of genes and miRNAs were identified and networks of mRNA-miRNA interactions were constructed. Genes whose aberrant expression level was associated with survival were determined, and pairwise correlations between differential gene expression (DEG) and differential miRNA expression (DE miRNA) were calculated.

Conclusions

The developed panel of genes and miRNAs allowed us to differentiate glioma subtypes and evaluate prognosis in terms of the overall survival of patients. The regulatory miRNA-mRNA pairs unique to the five glioma subtypes identified in this study can stimulate the development of new therapeutic approaches based on subtype-specific mechanisms of oncogenesis.
Psychiatry in the federal correctional system in Canada
Authors: Cameron Colin , Khalifa Najat , Bickle Andrew , Safdar Hira , Hassan Tariq
Published: December 2020

The unique challenges of the correctional healthcare environment are well-documented. Access to community-equivalent care, voluntary informed consent of offenders with mental disorder, violence risk, suicide risk, medication misuse, and clinical seclusion, confinement and segregation are just a few of the challenges faced by correctional psychiatric services. This paper shares experiences for dealing with the ongoing challenges for psychiatrists working in the field. It provides an overview of the current state of mental healthcare in the federal correctional system in Canada, the legislative framework and initiatives aimed at addressing the healthcare needs of federal inmates.
Contemporary Multi-Institutional Cohort of 550 Cases of Phyllodes Tumors (2007-2017) Demonstrates a Need for More Individualized Margin Guidelines
Authors: Rosenberger Laura H. , Thomas Samantha M. , Nimbkar Suniti N. , Hieken Tina J. , Ludwig Kandice K. , Jacobs Lisa K. , Miller Megan E. , Gallagher Kristalyn K. , Wong Jasmine , Neuman Heather B. , Tseng Jennifer , Hassinger Taryn E. , King Tari A. , Jakub James W.
Published: December 2020

PURPOSE

Phyllodes tumors (PTs) are rare breast neoplasms, which have little granular data on margins. Current guidelines recommend ≥ 1 cm margins; however, recent data suggest narrower margins are sufficient, and for benign PT, a negative margin may not be necessary.

METHODS

We performed an 11-institution contemporary (2007-2017) review of PT practices. Demographics, surgical, and histopathologic data were captured. Logistic regression was used to estimate the association of select covariates with local recurrence (LR).

RESULTS

Of 550 PT patients, the majority underwent excisional biopsy (55.3%, n = 302/546) or lumpectomy (wide excision) (38.5%, n = 210/546). Median tumor size was 30 mm, 68.9% (n = 379) were benign, 19.6% (n = 108) borderline, and 10.5% (n = 58) malignant. Surgical margins were positive in 42% (n = 231) and negative in 57.3% (n = 311). A second operation was performed in 38.0% (n = 209) of the total cohort, including 51 patients with an initial negative margin (82.4% with < 2 mm), and 157 with an initial positive margin, with residual disease only found in six (2.9%). Notably, 32.0% (n = 74) of those with an initial positive margin did not undergo a second operation, among whom only 2.7% (n = 2) recurred. Recurrence occurred in 3.3% (n = 18) of the total cohort (n = 15 LR, n = 3 distant), at median follow-up of 36.7 months. LR (all PT grades) was not reduced with wider negative margin width (≥ 2 mm v < 2 mm: odds ratio [OR] = 0.39; 95% CI, 0.07 to 2.10; P = .27) or final margin status (positive v negative: OR = 0.96; 95% CI, 0.26 to 3.52; P = .96).

CONCLUSION

In current practice, many patients are managed outside of current guidelines. For the entire cohort, a wider margin width was not associated with a reduced risk of LR. We do not recommend re-excision of a negative margin for benign PT, regardless of margin width, as a progressively wider surgical margin is unlikely to reduce LR.
Comparative analysis of the clinical effect and safety of Laparoscopic Radical Cystectomy + Orthotopic Ileal Neobladder and Open Surgery
Authors: Liu Yuan-hua , Dai Hai-tao , Liu Chang-mao , Zheng Jiang
Published: December 2020

Objectives: To explore the clinical effect and safety of laparoscopic radical cystectomy + orthotopic ileal neobladder and open surgery.

Methods: The study was conducted at Jingzhou First People’s Hospital from January 2017 to July 2018. In this study 87 patients undergoing radical cystectomy + orthotopic ileal neobladder were chosen and classified into an observation group (48 cases) and a control group (39 cases) according to the surgical methods. The observation group underwent laparoscopic surgery, while the control group underwent open surgery. Perioperative period and prognostic conditions were compared in both groups.

Results: The intraoperative bleeding amount obviously decreased. The recovery time of gastroenteric function and postoperative hospitalization time were significantly shortened. Postoperative pain was significantly alleviated. Compared with the control group, the observation group showed significant differences (P<0.05). The time, amount and difference in pelvic lymph node dissection in both groups were not significantly different (P>0.05). The differences in both groups in terms of the daytime/nighttime urinary continence rate, maximum urinary flow rate, internal bladder pressure, maximum bladder pressure during urination, internal urethral pressure, bladder capacity, and residual urine volume six months after the operation were not statistically significant (P>0.05). There was no significant difference in postoperative complications, including urinary fistula, bleeding, urinary tract infection, pulmonary infection, dysuria, lymphatic leakage, ureterostenosis, or relapse (P>0.05). The ileus incidence rate in the observation group was obviously lower than that in the control group, and the difference was statistically significant (P<0.05).

Conclusion: Laparoscopic radical cystectomy + orthotopic ileal neobladder has the characteristics of limited trauma, a minimal amount of bleeding and a fast recovery. The functions of orthotopic neobladders are good, and the occurrence rate of postoperative complications is low. In addition, body immunity is protected. Hence, this procedure deserves to be promoted clinically.

doi: https://doi.org/10.12669/pjms.37.1.2273

How to cite this:Liu YH, Dai HT, Liu CM, Zheng J. Comparative analysis of the clinical effect and safety of Laparoscopic Radical Cystectomy + Orthotopic Ileal Neobladder and Open Surgery. Pak J Med Sci. 2021;37(1):59-64. doi: https://doi.org/10.12669/pjms.37.1.2273

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Frequency of Cryptosporidiosis in Children having Persistent Diarrhea
Authors: Iqbal Mariam Danish , Naeem Tahir , Khurshid Umar , Hameed Fatima
Published: December 2020

Objective: Globally childhood diarrheal diseases continue to be the second leading cause of death. Cryptosporidium spp are important intestinal parasites that cause diarrhea in humans and animals particularly in developing countries. This investigation was carried out to find out the frequency of cryptosporidiosis in children presenting with persistent diarrhea.

Methods: Two hundred stool samples were collected in this descriptive cross-sectional study conducted at Microbiology Department, Combined Military Hospital, Lahore Pakistan between the months of July to Dec 2014. Children aged five years to 12 years who presented with persistent diarrhea were included in the study. Stool specimens were processed using the modified acid-fast staining method, and microscopically examined for Cryptosporidium infection.

Results: The average age of study participants was 7.95 with a standard deviation of 2.21 years. Among the participants 66% were males whereas 34% were females. Twenty eight percent had presence of oocysts in stool samples.

Conclusions: The frequency of Cryptosporidiosis among children with persistent diarrhea was 28%. This high frequency indicates that this population is uniquely susceptible to infection. It also highlights the need for education about hygiene, accurate diagnosis, and treatment of Cryptosporidiosis. There is also a need for additional studies regarding the occurrence of this pathogen.

doi: https://doi.org/10.12669/pjms.37.1.2700

How to cite this:Iqbal MD, Naeem T, Khurshid U, Hameed F. Frequency of Cryptosporidiosis in Children having Persistent Diarrhea. Pak J Med Sci. 2021;37(1):121-124. doi: https://doi.org/10.12669/pjms.37.1.2700

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
SGLT 2 Inhibitors; glycemic control, weight loss and safety profile in patients with type 2 Diabetes, at Medicell Institute (MIDEM)
Authors: Nathani Erum Sohail , Ahsan Tasnim , Ghaus Saima , Aijaz Wasfa
Published: December 2020

Background & Objective: Sodium glucose co-transporter-2 inhibitors (SGLT 2 inhibitors) are newer anti-hyperglycemic agents, which improve glycemic control independent of insulin secretion with a low risk of hypoglycemia. This study aimed to assess the efficacy of SGLT 2 inhibitors in terms of glycemic control, weight reduction and safety profile in our patients with type 2 Diabetes (T2D).

Methods: This is a prospective analysis, conducted at Medicell Institute of Diabetes, Endocrinology and Metabolism (MIDEM), Karachi Pakistan from January 2018 till July 2019. This study included patients with T2D, who were treated with SGLT 2 inhibitors add on to other anti-diabetic drugs. Baseline and follow up weight, BMI, HbA1c, blood pressure (BP), renal function and side effect profile was assessed.

Results: Study included 140 patients; 53% females and 47% males. Mean Age was 55.6 ± 10.3 years. Mean weight at baseline was 81.5 ±16.5 kg. Mean duration of T2D was 10.3 ± 6.75 years, with a mean HbA1C at baseline of 9.1± 1.6%. Follow up data was available for 90 patients at the time of analysis. HbA1C improved considerably to 7.6± 0.9 (P< 0.001) and mean weight reduced to 78.5 ± 16.1 kg (P≤0.003), at first follow-up.

Conclusion: Dapagliflozin and Empagliflozin offer a significant additional drug in improving glycemic control with the additional advantage of weight loss and hypoglycemia safety.

doi: https://doi.org/10.12669/pjms.37.1.2701

How to cite this:Sohail E, Ahsan T, Ghaus S, Aijaz W. SGLT 2 Inhibitors; glycemic control, weight loss and safety profile in patients with type 2 Diabetes, at Medicell Institute (MIDEM). Pak J Med Sci. 2021;37(1):87-92. doi: https://doi.org/10.12669/pjms.37.1.2701

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Analysis of the effect of Lyophilized Recombinant Human Brain Natriuretic Peptide on Endothelial Function in patients with acute myocardial infarction
Authors: Wang Bosong , Xu Hong , Li Chengqin , Wang Xiaoding , Sun Weidong , Li Jinlong
Published: December 2020

Objective: This study aims to analyze the effect of lyophilized recombinant human brain natriuretic peptide on the endothelial function of patients with acute myocardial infarction.

Methods: One hundred and thirty-six patients with acute myocardial infarction in our hospital were randomly divided into a control group and an experimental group (68 cases each). The patients in the control group were treated by conventional treatment. The patients in the experimental group were treated with lyophilized recombinant human brain natriuretic peptide besides the conventional treatment. The levels of flow-mediated dilatation (FMD), serum nitric oxide (NO), and endothelin-1 were compared between the two groups before and after treatment.

Results: Before treatment, there was no significant difference between the two groups in the level of FMD (P>0.05); after treatment, the level of FMD in the experimental group was higher than that in the control group, and the difference was statistically significant (P<0.05); before treatment, there was no significant difference between the two groups in the levels of serum NO and endothelin-1 (P>0.05); after treatment, the levels of serum NO and endothelin-1 in the experimental group significantly improved, which were better than those in the control group (P<0.05).

Conclusion: Lyophilized recombinant human brain natriuretic peptide can improve the FMD, increase the content of NO in the blood, and effectively reduce the level of endothelin-1, which is of great significance to improve the endothelial function of patients with acute myocardial infarction and is worth clinical application.

doi: https://doi.org/10.12669/pjms.37.1.2706

How to cite this:Wang B, Xu H, Li C, Wang X, Sun W, Li J. Analysis of the effect of Lyophilized Recombinant Human Brain Natriuretic Peptide on Endothelial Function in patients with acute myocardial infarction. Pak J Med Sci. 2021;37(1):99-103. doi: https://doi.org/10.12669/pjms.37.1.2706

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.