bluuebunny/crossref_metadata_2025 huggingface dataset:
“Men Are Scared That Others Will Know and Will Discriminate Against Them So They Would Rather Not Start Treatment.” Perceptions of Heterosexual Men on HIV-Related Stigma in HIV Services in Blantyre, Malawi
Authors: Kazuma-Matululu Thokozani , Nyondo-Mipando Alinane Linda
Published: December 2021

Background:

Although the concept of treatment as prevention has generated optimism that an AIDS-free generation is within reach, the success of this approach centers upon early diagnosis and linkages to care for people living with HIV. Unfortunately, people continue to present for HIV care at late stages of disease and HIV-related stigma has been recognized as the major impediment to HIV prevention and treatment efforts. Given the relevance of addressing stigma to improve access and utilization of HIV services among men, this secondary analysis assessed perceptions of heterosexual men in HIV-related stigma on HIV testing and ART services in Blantyre District.

Methods:

Purposive sampling was done with maximum variation which included men with unknown statuses, newly diagnosed with HIV infection and not yet on ARVs and those with HIV infection on ART. These participants were varied according to age and area of residency and included men from urban, semi urban and rural areas. Health care workers were included depending in the participation in the provision of HIV services. Eighteen (18 IDIs) and sixteen (16) KIIs were done at private facilities and a total of twenty (20) IDS and seventeen (17) KIIs interviews were conducted at public facilities and fourteen (14) FGD were conducted at public facilities as well. The data were collected from January to July 2017 and March to September 2018.

Results:

Men perceived that there are barriers and enablers that influence men from accessing HIV testing and ART services. These factors include individuals, family, community and workplace. The surroundings can be a person, community and a family and it plays an integral part in ones’ decision to get tested or initiate on ART. At all these levels, men would navigate the options of accessing the services while risking stigma and discrimination.

Conclusion:

HIV-related stigma exists and impedes access to HIV testing and ART services in men. Men preferred private hospitals to public facilities because of their ability to maintain respect to privacy and confidentiality to their client's. Imitating these policies into the public hospitals can help to improve the perception of HIV-related stigma in heterosexual men.
The Evolution of Arthroscopic Rotator Cuff Repair
Authors: Dey Hazra Rony-Orijit , Ernat Justin J. , Rakowski Dylan R. , Boykin Robert E. , Millett Peter J.
Published: December 2021

Over the past 30 years, arthroscopic rotator cuff repair (ARCR) has evolved to become the gold standard in treating rotator cuff pathology. As procedural concepts of ARCR continue to improve, it is also continually compared with the open rotator cuff repair as the historical standard of care. This review highlights the evolution of ARCR, including a historical perspective; the anatomic, clinical, and surgical implications of the development of an arthroscopic approach; how arthroscopy improved some of the problems of the open approach; adaptations in techniques and technologies associated with ARCR; future perspectives in orthobiologics as they pertain to ARCR; and lastly, the clinical improvements, or lack of improvements, with all of these adaptations.
Treatment With Glycogen Synthase Kinase 3β Inhibitor Decreases Apoptotic and Autophagic Reactions in Rat Rotator Cuff Tears
Authors: Kim Yang-Soo , Lee Yun-Gyoung , Kim Min-Tae , Lee Hyo-Jin
Published: December 2021

Background:

Apoptosis and autophagy are known to be correlated with the extent of damage in torn rotator cuffs, and there is no biological evidence for self-recovery or healing of the rotator cuff tear.

Purpose:

To establish in a rat model of partial- and full-thickness rotator cuff tears how a glycogen synthase kinase 3β (GSK-3β) inhibitor affects the expression of apoptotic and autophagic markers.

Study Design:

Controlled laboratory study.

Methods:

Twelve-week-old Sprague Dawley rats were divided into 3 groups (n = 16 per group). Group 1 acted as the control, with no treatment; group 2 received partial-thickness (right side) and full-thickness (left side) rotator cuff tears only; and group 3 received the same rotator cuff injuries, with GSK-3β inhibitor injected afterward. The tendons from each group were harvested 42 days after surgery. Evaluation of gene expression, immunohistochemistry, and TUNEL staining (terminal deoxynucleotidyl transferase–mediated dUTP nick end labeling) were performed for the following markers: caspases 3, 8, and 9 as well as Bcl-2 (B-cell lymphoma 2); BAX (Bcl-2-associated X protein); beclin 1; p53; and GSK-3β; which represented apoptotic and autophagic reactions. Statistical analysis was performed using 1-way analysis of variance.

Results:

In the group 2 rats with partial- and full-thickness tears, there were significant increases in the mRNA levels (fold changes) of all 8 markers as compared with group 1 (control). All these increased markers showed significant downregulation by the GSK-3β inhibitor in partial-thickness tears. However, the response to the GSK-3β inhibitor in full-thickness tears was not as prominent as in partial-thickness tears. The number of TUNEL-positive cells in group 2 (partial, 35.08% ± 1.625% [mean ± SE]; full, 46.92% ± 1.319%) was significantly higher than in group 1 (18.02% ± 1.036%; P < .01) and group 3 (partial, 28.04% ± 2.607% [ P < .01]; full, 38.97% ± 2.772% [ P < .01]), and immunohistochemistry revealed increased expression of all the markers in group 2 as compared with control.

Conclusion:

The apoptotic and autophagic activity induced in a rat model of an acute rotator cuff tear was downregulated after treatment with a GSK-3β inhibitor, particularly with partial-thickness rotator cuff tears.

Clinical Relevance:

A GSK-3β inhibitor may be able to modulate deterioration in a torn rotator cuff.
“I Live Here”: How Residents of Color Experience Racialized Surveillance and Diversity Ideology in a Liberal Predominantly White Neighborhood
Authors: Lowe Maria R. , Carrola Madeline , Cortez Dakota , Jalufka Mary
Published: December 2021

In many liberal predominantly white neighborhoods, white residents view their communities as inclusive yet they also engage in racialized surveillance to monitor individuals they perceive as outsiders. Some of these efforts center on people of color in neighborhood open spaces. We use a diversity ideology framework to analyze this contradiction, paying particular attention to how residents of color experience racialized surveillance of their neighborhood’s publicly accessible parks and swimming pools. This article draws on data from neighborhood documents, neighborhood digital platforms, and interviews with residents of a liberal, affluent, predominantly white community that was expressly designed with public spaces open to non-residents. We find that resident surveillance of neighborhood public spaces is racialized, occurs regularly, and happens in person and on neighborhood online platforms where diversity as liability rhetoric is conveyed using colorblind discourse. These monitoring efforts, which are at times supported by formal measures, impact residents of color to varying degrees. We expand on diversity ideology by identifying digital and in-person racialized surveillance as a key mechanism by which white residents attempt to enforce racialized boundaries and protect whiteness in multiracial spaces and by highlighting how Black and Latinx residents, in particular, navigate these practices.
Community Partnerships and Experiential Learning: Investing in the Next Generation of a Diverse, Qualified Public Health Workforce
Authors: Blenner Sarah R. , Roth Sarah E. , Manukyan Rita , Escutia-Calderon Yareli , Chan-Golston Alec M. , Owusu Elaine , Rice Lindsay N. , Prelip Michael L.
Published: December 2021

Annually, the University of California Los Angeles (UCLA) Public Health Scholars Training Program (Program) exposes and engages 35 to 40 undergraduate students, Public Health Scholars, through an 8-week intensive summer training program in public health. Experiential learning through internships is an integral part of the Program, allowing scholars to gain hands-on experience in the field of public health while providing pathways to enter the public health workforce and pursue graduate education. The Program leverages existing strong community partnerships developed through the school’s applied practice experiences as well as creates new partnerships. These relationships are mutually beneficial, improve community connections, expand relationships, and develop the school’s ability to work with undergraduate students. This article outlines an adapted, evidence-based experiential learning model and develops an evaluation framework to capture the program impact. In the program evaluation, scholars and professional mentors assess the impact of the Program on scholars’ intrapersonal, interpersonal, societal, strategic professional, and foundational public health skills. Mentor and peer relationships drive the experiential learning model, supporting the Program to train undergraduate scholars, prepare graduate students to be future mentors once established in the public health workforce, and build the capacity of partner organizations to train a diverse public health workforce. The Program provides a needed opportunity to scholars, most of whom are from underrepresented or underserved backgrounds, to receive in-depth exposure and engagement with public health.
Tailoring Recruitment and Outreach Strategies for Underrepresented Students in Public Health Pipeline Programs
Authors: Caldwell Cleopatra Howard , Thomas Dana , Hoelscher Hannah , Williams Hallie , Mason Zachary , Valerio-Shewmaker Melissa A. , Panapasa Sela V.
Published: December 2021

Studies have shown that racial and ethnic minority health professionals are more likely than those in the majority to work in predominantly underserved, largely minority communities. Increasing the pool of underrepresented racial and ethnic professionals could help reduce health disparities. Summer programs giving minority students public health training and experiences can increase the number who enter the health professions. This article describes recruitment strategies for obtaining a diverse pool of applicants for such a program as part of a Centers for Disease Control and Prevention funded multisite undergraduate training program intended to increase the diversity of the public health workforce. The recruitment strategies used included institutional linkages, collaborative partnerships, and interpersonal contacts. No one strategy was more effective; however, Hispanic/Latinas were more likely to be recruited through institutional linkages, but less likely to be recruited through interpersonal contacts than other female groups. Understanding successful recruitment strategies to achieve a diverse application pool for public health training programs is vital to achieve health equity.
Why Is Female Labour Force Participation So Low in India?
Authors: Chatterjee Deepaboli , Sircar Neelanjan
Published: December 2021

In this article, we analyse the reasons for low female labour force participation (FLFP) across approximately 14,000 households in the Indian urban clusters of Dhanbad, Indore, Patna and Varanasi. We argue that expectations placed upon women to carry out household duties generate incentives for them to largely seek part-time work near their homes, due to what we term as flexibility and proximity of work. While this characterises most agricultural employment, this is not true of urban employment. Using this framework, we argue that requirements to travel large distances for most jobs put prohibitive costs on women entering the labour market. To empirically test our claims, we conduct a survey experiment on the female respondents who are currently unemployed in our sample to elicit labour market preferences. Our results are striking—women are 12 to 23 percentage points less likely to express a preference for a suitable job if they have to travel one hour to work. The magnitude of these effects is far greater than the impact of the primary wage earner of the household losing their job or other family members assisting the woman in household duties. We conclude the article by discussing the implications for policy.
Partisan Disagreement: The Role of Media, Personal Networks and Gender in Forming Political Preferences
Authors: Badrinathan Sumitra , Chatterjee Deepaboli , Kapur Devesh , Sircar Neelanjan
Published: December 2021

In this article, we seek to understand the role of media and non-media personal networks in generating the opportunity for women to express political preferences that are different from men within the household—what we call partisan disagreement—using a survey of over 6,000 households in the Indian urban clusters of Patna and Dhanbad. We demonstrate a significant gender gap in both mobile phone ownership and media access among working age women. Due to low media access among women, we find that partisan disagreement is most likely when women have access to personal networks outside of the household, either due to employment or an opportunity to travel outside the home. For instance, women engaged in agricultural labour are 8 to 9 percentage points more likely to demonstrate partisan disagreement than unemployed women. While access is still low among women, men and women display similar patterns of social media usage. We suggest that this is due to the fact that social media can be consumed privately without family interference and highlight the potential of social media to reduce gender gaps in media access as mobile phone penetration and levels of education grow in India.
QTL and candidate gene identification of the node of the first fruiting branch (NFFB) by QTL-seq in upland cotton (Gossypium hirsutum L.)
Authors: Zhang Jingjing , Jia Xiaoyun , Guo Xiaohao , Wei Hengling , Zhang Meng , Wu Aimin , Cheng Shuaishuai , Cheng Xiaoqian , Yu Shuxun , Wang Hantao
Published: December 2021

Background

The node of the first fruiting branch (NFFB) is an important precocious trait in cotton. Many studies have been conducted on the localization of quantitative trait loci (QTLs) and genes related to fiber quality and yield, but there has been little attention to traits related to early maturity, especially the NFFB, in cotton.

Results

To identify the QTL associated with the NFFB in cotton, a BC4F2 population comprising 278 individual plants was constructed. The parents and two DNA bulks for high and low NFFB were whole genome sequenced, and 243.8 Gb of clean nucleotide data were generated. A total of 449,302 polymorphic SNPs and 135,353 Indels between two bulks were identified for QTL-seq. Seventeen QTLs were detected and localized on 11 chromosomes in the cotton genome, among which two QTLs (qNFFB-Dt2–1 and qNFFB-Dt3–3) were located in hotspots. Two candidate genes (GhAPL and GhHDA5) related to the NFFB were identified using quantitative real-time PCR (qRT-PCR) and virus-induced gene silencing (VIGS) experiments in this study. Both genes exhibited higher expression levels in the early-maturing cotton material RIL182 during flower bud differentiation, and the silencing of GhAPL and GhHDA5 delayed the flowering time and increased the NFFB compared to those of VA plants in cotton.

Conclusions

Our study preliminarily found that GhAPL and GhHDA5 are related to the early maturity in cotton. The findings provide a basis for the further functional verification of candidate genes related to the NFFB and contribute to the study of early maturity in cotton.
Role of exogenous-applied salicylic acid, zinc and glycine betaine to improve drought-tolerance in wheat during reproductive growth stages
Authors: Shemi Ramadan , Wang Rui , Gheith El-Sayed M. S. , Hussain Hafiz Athar , Cholidah Linna , Zhang Kangping , Zhang Sai , Wang Longchang
Published: December 2021

Background

Drought has become a dangerous threat to reduce crop productivity throughout the world. Exogenous applications of regulators, micronutrients, and/or osmoprotectants for inducing drought-tolerance in field crops have been effectively adopted. A controlled pot study was performed to investigate the relative efficacy of salicylic acid (SA), zinc (Zn), and glycine betaine (GB) as foliar applications on the growth, tissues pigments content, relative water content (RWC), leaf gas-exchange, antioxidant enzymes activity, reactive oxygen species (ROS) accumulation, osmolytes contents, and the yield parameters of wheat plants subjected to two soil water conditions (85% field capacity: well-watered, 50% field capacity: water-deficient) during reproductive growth stages.

Results

Water deficient conditions significantly decreased the growth, yield parameters, RWC, photosynthesis pigment, and gas-exchange attributes except for intercellular CO2 concentration. However, foliar applications remarkably improved the growth and yield parameters under water deficit conditions. Under drought condition, exogenous applications of SA, Zn, and GB increased the grain yield pot− 1 by 27.99, 15.23 and 37.36%, respectively, as compared to the control treatment. Drought stress statistically increased the contents of hydrogen peroxide (H2O2), superoxide anion radical (O2•−), and malonaldehyde (MDA), and elevated the harmful oxidation to cell lipids in plants, however, they were considerably reduced by foliar applications. Foliar applications of SA, Zn, and GB decreased MDA content by 29.09, 16.64 and 26.51% under drought stress, respectively, as compared to the control treatment. Activities of all antioxidant enzymes, proline content, and soluble sugar were increased in response to foliar applications under water deficit conditions.

Conclusions

Overall, foliar application of GB, SA, and Zn compounds improved the drought-tolerance in wheat by decreasing the ROS accumulation, promoting enzymatic antioxidants, and increasing osmolytes accumulation. Finally, GB treatment was most effective in thoroughly assessed parameters of wheat followed by SA and Zn applications to alleviate the adverse effects of drought stress.
Lower testosterone levels predict increasing severity and worse outcomes of hepatitis B virus-related acute-on-chronic liver failure in males
Authors: Huang Yandi , Yan Dong , Zhang Huafen , Lou Bin , Yan Ren , Yao Yifan , Dong Minya , Yang Donglei , Lv Feifei , Chen Yu
Published: December 2021

Background

Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is a serious liver disease with pathogenesis remaining unclear. This study aims to investigate the association between testosterone levels, stage (early, middle, or late, categorized according to clinical manifestation), severity scores, and clinical outcomes of HBV-ACLF.

Methods

This single-center observational study involved 160 male patients with HBV-ACLF, 151 chronic hepatitis B patients without liver failure (CHB) and 106 healthy controls (HC). Morning blood samples were collected and androgen levels analyzed by chemi-bioluminescent immunoassay. Time to death or liver transplantation within 90 days comprised the primary composite outcome.

Results

Serum levels of total testosterone (TT), free testosterone index (FTI), dehydroepiandrosterone sulfate and cortisol were significantly lower among HBV-ACLF than CHB and HC, while androstenedione was higher. Low TT, sex hormone binding globulin and FTI were associated with increased stage (of HBV-ACLF, ascites, and hepatic encephalopathy) and severity scores (Model for End-stage Liver Disease and Chinese Group on the Study of Severe Hepatitis B-ACLF scores). Low TT (< 142.39 ng/dL) was a risk factor for both the composite outcome and for death alone within 90 days. Multivariate analysis revealed TT to be an independent predictor for the composite outcome (hazard ratio 2.57, 95% CI 1.09–6.02; P = 0.030).

Conclusion

Low serum testosterone is common among male patients with HBV-ACLF and predictive of increased severity and worse outcome of the disease and may play an important role in the progression of HBV-ACLF.
Evaluation of different platforms for the detection of anti-SARS coronavirus-2 antibodies, Thailand
Authors: Lerdsamran Hatairat , Mungaomklang Anek , Iamsirithaworn Sopon , Prasertsopon Jarunee , Prasert Kriengkrai , Intalapaporn Poj , Siriyakorn Nirada , Wiriyarat Witthawat , Thinpan Nattakan , Sawadpongpan Suteema , Sirikhetkon Somrak , Mongkalangoon Noparat , Petto Suwanna , Puthavathana Pilaipan
Published: December 2021

Background

Antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) help determine previous infection in individuals, regardless of whether they are asymptomatic or symptomatic. The detection of antibodies serves several purposes, including supporting other assays for disease diagnosis, conducting seroepidemiological studies, and evaluating vaccines. Many platforms of immunological methods for anti-SARS-CoV-2 antibody detection and their performance require validation.

Methods

This study evaluated the test performance of three autoanalyzer-based assays (Architect IgG, Vitros IgG, and Vitros total Ig) and one manual ELISA (Wantai total Ig) against a microneutralization (microNT) assay on the detection of SARS-CoV-2 antibodies. Furthermore, an indirect immunofluorescence assay verified the discordant results between the microNT and commercial assays. The test sensitivity, specificity, positive predictive value, and negative predictive value were determined based on four groups of 1005 serum samples: 102 COVID-19 prepandemic sera, 45 anti-SARS-CoV-2 positive sera, 366 sera of people at risk, and 492 sera of citizens returning from countries with a high prevalence of infection.

Results

The analyses as a whole showed that the performance of these commercial assays was comparable. Each group was also analysed separately to gain further insight into test performance. The Architect did not detect two positive sera of people at risk (prevalence of infection 0.55%). The other methods correctly identified these two positive sera but yielded varying false-positive results. The group of returning travellers with an infection rate of 28.3% (139 of 492) better differentiated the test performance of individual assays.

Conclusions

High-throughput Architect and Vitros autoanalyzers appear appropriate for working on large sample sizes in countries that can afford the cost. The Wantai ELISA, while requiring more individual time and technical skill, may provide reliable results at a lower cost. The selection of assays will depend on the laboratory facilities and feasibility.
Incidence and mortality of necrotizing fasciitis in The Netherlands: the impact of group A Streptococcus
Authors: Nawijn Femke , de Gier Brechje , Brandwagt Diederik A. H. , Groenwold Rolf H. H. , Keizer Jort , Hietbrink Falco
Published: December 2021

Background

Little is known about the exact incidence of necrotizing soft tissue infections. The few incidences reported in international literature are not directly relatable to the Netherlands, or other European countries, due to geographic heterogeneity in causative micro-organisms involved. This resulted in the aim of this study to map the incidence, mortality rate and hospital course of necrotizing fasciitis infections in the Netherlands to gain insight in the incidence of necrotizing fasciitis in the Netherlands and the associated mortality and health care burden.

Methods

This nationwide retrospective database study used three distinct data sources to map the incidence of necrotizing fasciitis in the Netherlands between 2014 and 2019, being data from the Dutch Hospital Data (DHD) foundation, data from Osiris-AIZ, which is a database of notifiable diseases managed by regional Public Health Services (GGD) and the National Institute for Public Health and the Environment (RIVM), and previously published studies on necrotizing fasciitis conducted in the Netherlands.

Results

The incidence of necrotizing fasciitis in the Netherlands is estimated to be approximately 1.1 to 1.4 cases per 100,000 person years, which corresponds to 193–238 patients per year. Of all necrotizing fasciitis infections, 34 to 42% are caused by the group A Streptococcus. Annually, 56 patients die as a result of a necrotizing fasciitis infection (mortality of 23–29%) and 26 patients undergo an amputation for source control (11–14%). Patients stay a mean of 6 to 7 days at the intensive care unit and have a mean hospital length of stay of 24 to 30 days.

Conclusion

The combination of nationwide databases provides reliable insight in the epidemiology of low-incidence and heterogenic diseases. In the Netherlands, necrotizing fasciitis is a rare disease with group A Streptococcus being the most common causative micro-organism of necrotizing fasciitis. The prior Dutch cohort studies on necrotizing fasciitis report slightly higher sample mortality rates, compared to the population mortality. However, necrotizing fasciitis remain associated with substantial morbidity and mortality, risk at amputation and health care burden characterized by prolonged ICU and hospital stay.
CT Texture analysis and CT scores for characterization of fluid collections
Authors: Meyer Hans-Jonas , Schnarkowski Benedikt , Leonhardi Jakob , Mehdorn Matthias , Ebel Sebastian , Goessmann Holger , Denecke Timm
Published: December 2021

Background

Texture analysis derived from Computed tomography (CT) might be able to better characterize fluid collections undergoing CT-guided percutaneous drainage treatment. The present study tested, whether texture analysis can reflect microbiology results in fluid collections suspicious for septic focus.

Methods

Overall, 320 patients with 402 fluid collections were included into this retrospective study. All fluid collections underwent CT-guided drainage treatment and were microbiologically evaluated. Clinically, serologically parameters and conventional imaging findings as well as textures features were included into the analysis. A new CT score was calculated based upon imaging features alone. Established CT scores were used as a reference standard.

Results

The present score achieved a sensitivity of 0.78, a specificity of 0.69, area under curve (AUC 0.82). The present score and the score by Gnannt et al. (AUC 0.81) were both statistically better than the score by Radosa et al. (AUC 0.75). Several texture features were statistically significant between infected fluid collections and sterile fluid collections, but these features were not significantly better compared with conventional imaging findings.

Conclusions

Texture analysis is not superior to conventional imaging findings for characterizing fluid collections. A novel score was calculated based upon imaging parameters alone with similar diagnostic accuracy compared to established scores using imaging and clinical features.
Telework during the COVID-19 epidemic in Portugal and determinants of job satisfaction: a cross-sectional study
Authors: Sousa-Uva Mafalda , Sousa-Uva António , e Sampayo Marta Mello , Serranheira Florentino
Published: December 2021

Background

Telework satisfaction is a Public Health concern, intensified by the COVID-19 pandemic, and its determinant factors may be related with the negative health effects of teleworking. However, there is still little research exploring this issue. This study aimed to characterize telework during the first wave of the COVID-19 epidemic in Portugal and to identify the major predictors of telework satisfaction.

Methods

This is a cross-sectional study aimed at all teleworkers working in Portugal, during the first wave of the COVID-19 epidemic. Data were collected through a Google Forms platform online questionnaire distributed by a snowball method on social networks. Descriptive statistics included crude and relative frequency data. The associations between sociodemographic characteristics, self-perceived health, organization of working time, concentration at work, work-life balance, work disconnection, working conditions, and organizational demands (flexibility and organizational trust based on E-work Life Scale) with telework satisfaction were estimated through logistic regression.

Results

This study included 1004 participants. Teleworkers satisfaction levels were high (69%). Better concentration at work (OR = 1.54; 95%CI 1.01–2.34); the satisfaction with the balance between work life and extra work when teleworking (OR = 1.79; 95%CI 1.17–2.74); and higher work flexibility (OR = 2.26; 95%CI 1.46–3.49) were good predictors of greater levels of satisfaction with telework. However, its major predictors were the company’s trust in teleworkers (OR = 4.50; 95%CI 2.89–7.02) and feeling good in the workspace at home (OR = 3.72; 95%CI 1.46–9.49).

Conclusions

Our findings point that work environment and organizational culture play a crucial role in affecting telework satisfaction. More studies are needed to monitor telework satisfaction and its effects on physical and mental health, so that Public and Occupational Health (and Safety) can be able to identify and implement the best interventions that allow promoting individual health and foster a healthy work environment for teleworkers.
Predicting feeding-tube dependence in patients following endotracheal extubation: a two-item swallowing screen
Authors: Siao Shu-Fen , Tseng Wen-Hsuan , Wang Tyng-Guey , Wei Yu-Chung , Hsiao Tzu-Yu , Ku Shih-Chi , Chen Cheryl Chia-Hui
Published: December 2021

Background

To meet the surging demands for intubation and invasive ventilation as more COVID-19 patients begin their recovery, clinicians are challenged to find an ultra-brief and minimally invasive screen for postextubation dysphagia predicting feeding-tube dependence persisting for 72 h after extubation.

Methods

This study examined the predictive validity of a two-item swallowing screen on feeding-tube dependence over 72 h in patients following endotracheal extubation. Intensive-care-unit (ICU) patients (≥ 20 years) successfully extubated after ≥ 48 h endotracheal intubation were screened by trained nurses using the swallowing screen (comprising oral stereognosis and cough-reflex tests) 24 h postextubation. Feeding-tube dependence persisting for 72 h postextubation was abstracted from the medical record by an independent rater. To verify the results and cross-check whether the screen predicted penetration and/or aspiration during fiberoptic endoscopic evaluation of swallowing (FEES), participants agreeing to receive FEES were analyzed within 30 min of screening.

Results

The results showed that 95/123 participants (77.2%) failed the screen, which predicted ICU patients’ prolonged (> 72 h) feeding-tube dependence, yielding sensitivity of 0.83, specificity of 0.35, and accuracy of 0.68. Failed-screen participants had 2.96-fold higher odds of feeding-tube dependence (95% CI, 1.13–7.76). For the 38 participants receiving FEES, the swallowing screen had 0.89 sensitivity to detect feeding-tube dependence and 0.86 sensitivity to predict penetration/aspiration, although specificity had room for improvement (0.36 and 0.21, respectively).

Conclusion

This ultra-brief swallowing screen is sufficiently sensitive to identify high-risk patients for feeding-tube dependence persisting over 72 h after extubation. Once identified, a further assessment and care are indicated to ensure the prompt return of patients’ oral feeding.

Trial registration

NCT03284892, registered on September 15, 2017.
Spontaneous humeral torsion deformity correction after displaced supracondylar fractures in children
Authors: Hell Anna K. , Gadomski Claudia , Braunschweig Lena
Published: December 2021

Background

After displaced supracondylar humerus fractures (SCHF) in children, residual deformities are common with cubitus varus (CV) being the clinically most visible. Distal fragment malrotation may lead to instability, fragment tilt and subsequent CV. Detection and assessment of malrotation is difficult and the fate of post-traumatic humeral torsion deformity is unknown. The aim of this study was to evaluate the incidence of humeral torsion differences in children with surgically treated SCHF and to observe spontaneous changes over time.

Methods

A cohort of 27 children with displaced and surgically treated SCHF were followed prospectively from the diagnosis until twelve months after trauma. Clinical, photographic, sonographic and radiological data were obtained regularly. Differences in shoulder and elbow motion, elbow axis, sonographic humeral torsion measurement and radiological evaluation focusing on rotational spur were administered.

Results

Six weeks after trauma, 67% of SCHF children had a sonographically detected humeral torsion difference of > 5° (average 14.0 ± 7.6°). Of those, 44% showed a rotational spur, slight valgus or varus on radiographs. During follow-up, an average decrease of the difference from 14° (six weeks) to 7.8° (four months) to 6.5° (six months) and to 4.9° (twelve months) was observed. The most significant correction of posttraumatic humeral torsion occurred in children < 5 years and with internal malrotation > 20°.

Conclusion

After displaced and surgically treated SCHF, most children had humeral torsion differences of both arms. This difference decreased within one year after trauma due to changes on the healthy side or correction in younger children with severe deformity.

Level of Evidence/Clinical relevance

Therapeutic Level IV
Reliability and validity evaluation of the chinese version of the ethical sensitivity questionnaire for nursing students
Authors: Yu Haitao , Tong Tong , Gao Ye , Zhang Hui , Tong Huijuan , Liang Chunguang
Published: December 2021

Background

Advances in technology and the expansion of nursing roles have led to complex ethical issues in nursing. Nursing students are the future clinical nursing workers and practitioners. The ethical sensitivity of nursing students is very important to the professional development of nursing students, which can strengthen the ethical cognition of nursing students, improve the ethical decision-making ability of nursing students, and is beneficial to the development of nursing students in the process of clinical practice and nursing education. However, there are no instruments to evaluate the ethical sensitivity of nursing students in China. Therefore, the purpose of this study is to evaluate the validity and reliability of the Chinese version of the Ethical Sensitivity Questionnaire for Nursing Students (ESQ-NS).

Methods

After obtaining the authorization of the author of the original scale, the study used the Brislin back-translation method for translation. An exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA) were performed to examine the underlying factor structure of the translated questionnaire. The Cronbach alpha coefficient, the test-retest reliability, and the corrected item-total correlation were calculated to verify the internal consistency of the scale.

Results

The Chinese version of ESQ-NS retained 13 items. Exploratory factor analysis (EFA) extracts four common factors, and the cumulative variance contribution rate is 62.479%. The CFA reached the adaptive standard, and the discriminant validity of the scale was good. The Cronbach alpha coefficient of this scale was 0.821, and 4 dimensions were between 0.708 and 0.738. The results of the test-retest showed that Pearson’s correlation coefficient of the overall ESQ-NS was 0.814. Corrected item-total correlation ranged from 0.337 to 0.542.

Conclusions

The Chinese version of the ESQ-NS has good reliability and validity, which can be used to evaluate the level of ethical sensitivity of nursing students in China.
The impact of facilitation in a problem-based pedagogy on self-directed learning readiness among nursing students: a quasi-experimental study in Tanzania
Authors: Millanzi Walter C. , Herman Patricia Z. , Hussein Mahamudu R.
Published: December 2021

Background

Self-directed learning is important in nursing as it is associated with improved clinical and moral competencies in providing quality and cost-effective care among people. However, unethical professional conduct demonstrated by some graduate nurses is linked with the way they are developed in schools alongside the content and pedagogies prescribed in nursing curricula. Pedagogical transformations appear to be inevitable to develop enthusiastic nursing students who can work independently in delivering quality and cost-effective nursing services to people. This study intended to examine the impact of facilitation in a problem-based pedagogy on self-directed learning readiness among undergraduate nursing students in Tanzania.

Methods

A controlled quasi-experimental design was conducted in Tanzanian higher training institutions from January to April 2019. A 40-item Self-directed learning Readiness scale for nursing education adopted from previous studies measured self-directed learning and the Student A descriptive analysis via a Statistical Package for Social Sciences software program (version 23) was performed to establish nursing students’ socio-demographic characteristics profiles. Independent samples t-test determined mean scores difference of self-directed learning readiness among nursing students between groups while regression analysis was performed to discriminate the effect of an intervention controlled with other co-related factors.

Results

The post-test results of self-directed learning readiness showed that nursing students scored significantly higher [(M = 33.01 ± 13.17; t (399) = 2.335; 95%CI: 0.486,5.668)] in the intervention group than their counterparts in the control. Findings of SDL readiness subscales were significantly higher among students in the intervention including self-management [(M = 10.11 ± 4.09; t (399) = 1.354; 95%CI: 0.173,4.026)], interest learning [(M = 9.21 ± 2.39; t (399) = 1.189; 95%CI: 0.166,4.323)] and self-control [(M = 13.63 ± 5.05; t (399) = 2.335; 95%CI: 0.486,5.668)]. The probability of nursing students to demonstrate self-directed learning readiness was 1.291 more times higher when exposed to the intervention (AOR = 1.291,p < 0.05, 95%CI: 0.767, 2.173) than in the control.

Conclusion

Facilitation in a problem-based pedagogy promises to change the spectrum of nursing learning habits potentially to their academic and professional achievements. Nurse tutors need to be empowered with it to prepare nursing students to meet their academic and professional potentials.
Mutational and clinical spectrum of Japanese patients with hereditary hemorrhagic telangiectasia
Authors: Kitayama Kana , Ishiguro Tomoya , Komiyama Masaki , Morisaki Takayuki , Morisaki Hiroko , Minase Gaku , Hamanaka Kohei , Miyatake Satoko , Matsumoto Naomichi , Kato Masaru , Takahashi Toru , Yorifuji Tohru
Published: December 2021

Background

Hereditary hemorrhagic telangiectasia (HHT) is a dominantly inherited vascular disorder characterized by recurrent epistaxis, skin/mucocutaneous telangiectasia, and organ/visceral arteriovenous malformations (AVM). HHT is mostly caused by mutations either in the ENG or ACVRL1 genes, and there are regional differences in the breakdown of causative genes. The clinical presentation is also variable between populations suggesting the influence of environmental or genetic backgrounds. In this study, we report the largest series of mutational and clinical analyses for East Asians.

Methods

Using DNAs derived from peripheral blood leukocytes of 281 Japanese HHT patients from 150 families, all exons and exon–intron boundaries of the ENG, ACVRL1, and SMAD4 genes were sequenced either by Sanger sequencing or by the next-generation sequencing. Deletions/amplifications were analyzed by the multiplex ligation-dependent probe amplification analyses. Clinical information was obtained by chart review.

Results

In total, 80 and 59 pathogenic/likely pathogenic variants were identified in the ENG and ACVRL1 genes, respectively. No pathogenic variants were identified in the SMAD4 gene. In the ENG gene, the majority (60/80) of the pathogenic variants were private mutations unique to a single family, and the variants were widely distributed without any distinct hot spots. In the ACVRL1 gene, the variants were more commonly found in exons 5–10 which encompasses the serine/threonine kinase domain. Of these, 25/59 variants were unique to a single family while those in exons 8–10 tended to be shared by multiple (2–7) families. Pulmonary and cerebral AVMs were more commonly found in ENG-HHT (69.1 vs. 14.4%, 34.0 vs. 5.2%) while hepatic AVM was more common in ACVRL1-HHT (31.5 vs. 73.2%). Notable differences include an increased incidence of cerebral (34.0% in ENG-HHT and 5.2% in ACVRL1-HHT), spinal (2.5% in ENG-HHT and 1.0% in ACVL1-HHT), and gastric AVM (13.0% in ENG-HHT, 26.8% in ACVRL1-HHT) in our cohort. Intrafamilial phenotypic heterogeneity not related to the age of examination was observed in 71.4% and 24.1% of ENG- and ACVRL1-HHT, respectively.

Conclusions

In a large Japanese cohort, ENG-HHT was 1.35 times more common than ACVRL1-HHT. The phenotypic presentations were similar to the previous reports although the cerebral, spinal, and gastric AVMs were more common.
Angioedema associated with dipeptidyl peptidase-IV inhibitors
Authors: Cassano Nicoletta , Nettis Eustachio , Di Leo Elisabetta , Ambrogio Francesca , Vena Gino A. , Foti Caterina
Published: December 2021

Background

Dipeptidyl peptidase-IV (DPP-IV) inhibitors, also known as gliptins, are a class of oral antidiabetic agents. Postmarketing reports have documented the occurrence of angioedema in patients treated with gliptins and it was found that these drugs increased the risk of angioedema in patients concurrently treated with angiotensin-converting enzyme inhibitors (ACEIs). The aim of this manuscript is to provide an overview of the risk of angioedema associated with gliptins.

Methods

The keywords used for the literature search in the PubMed database included “angioedema” and “dipeptidyl peptidase”, “gliptins”, or the name of each DPP-IV inhibitor. Articles in English published up to December 2020 were taken into consideration.

Results

The available data appear to rule out a higher risk of angioedema associated with gliptin monotherapy and have revealed an increased susceptibility in patients simultaneously treated with gliptins and ACEIs. However, one single multicenter phase IV trial and case reports, even if very limited in number, have shown that angioedema can also occur during treatment with DPP-IV inhibitors without the concomitant use of ACEIs. The involvement of other drugs and drug interactions has occasionally been suggested. In a few patients, deficiency of enzymes involved in bradykinin catabolism was detected and this finding can constitute a risk factor for angioedema exacerbated by treatment with DPP-IV inhibitors.

Conclusions

This risk of angioedema associated with the use of gliptins has mostly been related to the concurrent administration of ACEIs, and has been considered rare, but it might be underestimated and underreported. The role of additional risk factors or drug interactions deserves further investigations. Caution should be taken when considering the use of DPP-IV inhibitors in patients treated with ACEIs or presenting with other known risk factors for angioedema.
Single cell sequencing analysis identifies genetics-modulated ORMDL3+ cholangiocytes having higher metabolic effects on primary biliary cholangitis
Authors: Xiang Bingyu , Deng Chunyu , Qiu Fei , Li Jingjing , Li Shanshan , Zhang Huifang , Lin Xiuli , Huang Yukuan , Zhou Yijun , Su Jianzhong , Lu Mingqin , Ma Yunlong
Published: December 2021

Background

Primary biliary cholangitis (PBC) is a classical autoimmune disease, which is highly influenced by genetic determinants. Many genome-wide association studies (GWAS) have reported that numerous genetic loci were significantly associated with PBC susceptibility. However, the effects of genetic determinants on liver cells and its immune microenvironment for PBC remain unclear.

Results

We constructed a powerful computational framework to integrate GWAS summary statistics with scRNA-seq data to uncover genetics-modulated liver cell subpopulations for PBC. Based on our multi-omics integrative analysis, 29 risk genes includingORMDL3,GSNK2B, andDDAH2were significantly associated with PBC susceptibility. By combining GWAS summary statistics with scRNA-seq data, we found that cholangiocytes exhibited a notable enrichment by PBC-related genetic association signals (Permuted P < 0.05). The risk gene ofORMDL3showed the highest expression proportion in cholangiocytes than other liver cells (22.38%). TheORMDL3+cholangiocytes have prominently higher metabolism activity score thanORMDL3−cholangiocytes (P = 1.38 × 10–15). Compared withORMDL3−cholangiocytes, there were 77 significantly differentially expressed genes amongORMDL3+cholangiocytes (FDR < 0.05), and these significant genes were associated with autoimmune diseases-related functional terms or pathways. TheORMDL3+cholangiocytes exhibited relatively high communications with macrophage and monocyte. Compared withORMDL3−cholangiocytes, the VEGF signaling pathway is specific forORMDL3+cholangiocytes to interact with other cell populations.

Conclusions

To the best of our knowledge, this is the first study to integrate genetic information with single cell sequencing data for parsing genetics-influenced liver cells for PBC risk. We identified thatORMDL3+cholangiocytes with higher metabolism activity play important immune-modulatory roles in the etiology of PBC.

Graphical Abstract
Application value of preoperative dual-source computed tomography in assessing the rupture site of thoracic aortic dissection
Authors: Huang Fang , Wu Hong , Lai Qing-Quan , Ke Xiao-Ting
Published: December 2021

Objective

To investigate the application value of dual-source computed tomography (DSCT) in preoperative assessment the rupture site of an thoracic aortic dissection (TAD).

Methods

A retrospective analysis of preoperative DSCT, multislice computed tomography (MSCT), and transthoracic echocardiography (TTE) results of 150 patients with suspected TAD in our hospital was conducted, and the intraoperative findings or interventional treatment results were used as the diagnostic gold standard.

Results

Of all 150 suspected TAD patients, 123 patients were confirmed to have TAD. The rupture site of TAD was in the ascending aorta in 46 patients, in the aortic arch in 13 patients, and in the descending aorta in 64 patients. The sensitivity of DSCT, MSCT, and TTE for locating the rupture site of the TAD was 100%, 93.5%, and 89.5%, respectively, and the specificity was 100%, 88.9%, and 81.5%. The differences were statistically significant. The distance between the actual rupture site and the one diagnosed by DSCT, MSCT, and TTE was 1.9 ± 1.2 mm, 5.1 ± 2.7 mm, and 7.8 ± 3.5 mm, respectively; the latter two were significantly worse than DSCT. The size of the rupture site diagnosed by DSCT, MSCT, and TTE was 1.5 ± 0.8 cm, 1.7 ± 0.9 cm, and 1.9 ± 1.0 cm, respectively. The size of the rupture site diagnosed by DSCT was not significantly different from the actual size of 1.4 ± 0.7 cm, while those by MSCT and TTE were.

Conclusion

DSCT has high sensitivity and specificity in diagnosing the rupture site of TAD and can clearly locate the rupture site. It can be a preferred imaging method for TAD.