bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness, Cost-Utility, and Safety of Neurofeedback Self-Regulating Training in Patients with Post-Traumatic Stress Disorder: A Randomized Controlled Trial
Authors: Leem Jungtae , Cheong Moon Joo , Lee Hyeryun , Cho Eun , Lee So Young , Kim Geun-Woo , Kang Hyung Won
Published: October 2021

Post-traumatic stress disorder (PTSD) is characterized by neurophysiological and psycho-emotional problems after exposure to trauma. Several pharmacological and psychotherapy limitations, such as adverse events and low adherence, increase the need for alternative therapeutic options. Neurofeedback is widely used for PTSD management. However, evidence of its clinical efficacy is lacking. We conducted a randomized, waitlist-controlled, assessor-blinded clinical trial to assess the effectiveness, cost-utility, and safety of 16 sessions of neurofeedback on people with PTSD for eight weeks. Eleven participants were allocated to each group. One and two subjects dropped out from the neurofeedback and control groups, respectively. The primary outcome was PTSD symptom change evaluated using the PTSD Checklist-5 (PCL-5-K). The PCL-5-K levels improved more in the neurofeedback group (44.3 ± 10.8 to 19.4 ± 7.75) than in the control group (35.1 ± 18.5 to 31.0 ± 14.92). The change value was significantly improved in the neurofeedback group (24.90 ± 13.13 vs. 4.11 ± 9.03). Secondary outcomes such as anxiety, depression, insomnia, and quality of life were also improved. In an economic analysis using EuroQol-5D, the incremental cost-per-quality-adjusted life-year was approximately $15,600, indicating acceptable cost-utility. There were no adverse events in either group. In conclusion, neurofeedback might be a useful, cost-effective, and safe intervention for PTSD management.
“It Is a Very Emotional Topic for Me”—Managing Breastfeeding Problems among German Mothers: A Qualitative Approach
Authors: Spannhake Mariz , Jansen Charlotte , Görig Tatiana , Diehl Katharina
Published: October 2021

Breastfeeding is associated with positive health outcomes for both child and mother. Nevertheless, some women experience breastfeeding problems which commonly lead to early cessation, or not starting breastfeeding at all. Our aim was to explore how women that have difficulties in breastfeeding perceive their situation and how they actively manage it. We conducted semi-structured interviews with 15 mothers living in Germany who had experienced breastfeeding problems. The interviews were audio-recorded, transcribed verbatim, and analyzed using qualitative content analysis. Breastfeeding problems occurred due to different reasons and had a huge impact, as evidenced in the four main themes of the findings: individual situation, managing the situation, perceived consequences for relations, feelings, and potential future pregnancies, and perceived health consequences for the mother. They frequently experienced negative emotions, including psychological distress and mental health problems, with perceived negative consequences for the mother–infant-bonding. Trying to actively manage the situation and availability of social support seemed to have a relieving effect, whereas confrontation and lack of understanding worsened the situation. Breastfeeding problems and the inability to breastfeed can have a great influence on maternal well-being. These can affect different aspects of a mother’s life, including the attachment to the child. Providing support for actively managing the situation and supporting the exchange of experience between mothers who perceive breastfeeding problems may help mothers to better deal with their situation. Our findings may help health professionals to understand what these mothers feel and how they can support these women in a sensitive way.
Things Always Come in Three: Non-Invasive Investigations of Alexander and Roxane’s Wedding Room in Villa Farnesina
Authors: Vagnini Manuela , Anselmi Chiara , Azzarelli Michela , Sgamellotti Antonio
Published: October 2021

Non-invasive optical spectroscopical analyses were conducted on the three main walls of Alexander and Roxane’s Wedding Room in Villa Farnesina, Rome. The north and the east walls were frescoed by Sodoma in 1519. The decoration of the third wall was subsequent and neither the author nor the period is known. The north and east walls underwent various restorations, some even very invasive. For these reasons, the supposed remaining original parts of the two walls by Sodoma were studied and compared with the third one, aiming to obtain more information about its author and epoch. The results show the use of the same pigments for the three walls. In particular, the same yellow pigments including lead antimonate, the use of enamel blue with Bi impurities whose use is time-limited, and the use of a certain kind of purple hematite. The commonality in the pictorial technique also emerged, especially in the yellow parts, painted in the same way on each wall. This information, and documentary sources, reinforce the hypothesis that the third wall was decorated shortly after the death of Agostino Chigi by someone who was well-acquainted with the materials and techniques used by Sodoma for the other two walls.
A Tale of Two Legacies: Byzantine and Egyptian Influences in the Manufacture and Supply of Glass Tesserae under the Umayyad Caliphate (661–750 AD)
Authors: Fiorentino Sara
Published: October 2021

The connection between Umayyad and Byzantine mosaic manufacture is a debated issue: on the one hand, Arab sources report that Umayyad caliphs received craftspeople and materials to adorn religious buildings from the Byzantine emperor; on the other hand, the reliability of these texts has long been disputed among scholars, and other possible influences have been hypothesised. Was early Islamic mosaic manufacture related to Byzantine tradition and to what extent? Were materials and artisans gathered from Byzantium and/or territories under the Byzantine control? Based on a multi-analytical approach, glass tesserae from Khirbat al-Mafjar, the Great Mosque of Damascus, and the Dome of the Rock have been analysed. Results speak of a tale of two legacies, demonstrating that, parallel to a continuity with the manufacture of glass tesserae in the late antique Levant—pointing, more specifically, to a re-use of materials from abandoned buildings—legacies other than Byzantine occurred. It emerged that Egypt definitively played a role in mosaic making during the Umayyad caliphate, acting as a supplier of skilled artisans and materials.
A Multi-Analytical Study of Egyptian Funerary Artifacts from Three Portuguese Museum Collections
Authors: Schiavon Nick , Panganiban Patricia , Valadas Sara , Bottaini Carlo , Barrocas Dias Cristina , Manhita Ana , Candeias Antonio
Published: October 2021

A diachronic, multi-analytical approach combining EDXRF, µFTIR, µRaman, SEM-EDS, and Py-GC/MS has been adopted with the aim to study for the first time the painting materials used to decorate Egyptian funerary masks and sarcophagi ranging from the Late Period to the Roman Period and stored in the Archaeological National Museum (MNA) and the Carmo Archaeological Museum (MAC) of Lisbon and the Natural History Museum of the University in Oporto (MNH-FCUP). Results indicate that yellow and red ochres, realgar, cinnabar, Egyptian blue, and Egyptian green were used as pigments while chalk served as the preparatory layer. Over the 1000-year timeline of the studied artifacts, the palette remained remarkably consistent with previous findings as exemplified by cinnabar being used for red pigments in samples only dated after the Ptolemaic period. The presence of Sn in Egyptian blue and Egyptian green pigments used in one sample suggests the use of recycled bronze scraps during pigment production. Black pigments in two Late Period masks were found to be produced by mixing Egyptian blue with red ochre suggesting either a hitherto unknown method for production of purple pigments in the Egyptian palette or, alternatively, an attempt to create a specific hue or shade of dark brown or black. The results of this study contribute to further expand the database of Ancient Egyptian painting materials while at the same time helping to valorize three important Egyptian collections in Portugal.
The Seat of the Roman Governor at Carnuntum (Pannonia superior)
Authors: Gugl Christian , Wallner Mario , Hinterleitner Alois , Neubauer Wolfgang
Published: October 2021

The Roman site of Carnuntum was once a flourishing center on the frontiers of the Roman Empire. In its heyday as the capital of the province of Pannonia superior, Carnuntum probably covered an area of almost 9 km2. The whole site was divided into a military settlement (castra and canabae legionis) and a civil town (municipium/colonia). Through a large-scale archaeological prospection project, this huge area could be investigated and analyzed in great detail using a wide variety of nondestructive prospection methods. One of the main discoveries of the project was observed in the military settlement, where it was possible to identify a previously unknown military camp, interpreted as the garrison of the governor’s guard, the castra singularium. Through the topographic analysis of the immediate surroundings, the Roman fort was determined to be embedded in a large administrative complex related to the governor’s seat in Carnuntum. This article presents these new discoveries and shows what an important part they formed in the administration of the Roman province of Upper Pannonia.
Stille Nacht: COVID and the Ghost of Christmas 2020
Authors: Parker Murray , Spennemann Dirk H. R.
Published: October 2021

Annually, there are between 2500 and 3000 Christmas markets in Germany. While purported to be rooted in century-old tradition, the current concept of the markets, shaped in the 1930s, gradually transformed from primarily mercantile operations to experiential events. The experiential dimension is a collection of visual, auditory, and olfactory components that create a compound sensory response: the ‘Christmas atmosphere’. The prevalence of COVID-19 meant that traditional Christmas markets were largely absent from the festive calendar in Germany in 2020, disrupting the usual sensory experiences associated with these events. A review of the online presence showed that augmented markets and virtual reality were subsequently utilized in an attempt to re-create the experience and the ambience of the traditional markets, but had limited interactivity with many of the senses. We explore to what extent these multiple-sensory components may have been lost during the Christmas period of 2020 due to the COVID-19-induced transition from the traditional multisensory live market to a predominantly online experience, and highlight problems which arise through the documentation of such complex intangible heritage.
Archaeological Sites as Peripheral Destinations. Exploring Big Data on Fieldtrips for an Upcoming Response to the Tourism Crisis after the Pandemic
Authors: Martínez-Hernández Carlos , Mínguez Carmen , Yubero Claudia
Published: October 2021

Archaeological heritage sites constitute the most recent addition to the tourism supply of Madrid, one of the most visited regions of Spain. In 2003, the Plan de Yacimientos Visitables (Plan of Archaeological Visitable Sites) was implemented, museumising 21 sites. However, the peripheral nature of these sites and the lack of personnel prevent strict control being carried out of who visits them, the practices of these visitors and how they rate the sites. This study proposes a systematic procedure to analyse the data gathered from Twitter and Flickr, in order to determine the most shared archaeological spaces in the years immediately preceding the pandemic, and to assess the perception that the visitors had of them. The information provided is useful for learning about the real weight that these sites have in leisure experiences (school trips, guided tours, recreation, etc.). Now that travel has been restricted due to the pandemic, we should ask whether Spain’s minor heritage is able to structure new proximity tourism routes. This is based on the hypothesis that, until now, these types of heritage have had a very limited role in recreational practices, but offer potential as “outdoor museums” in the present climate.
An Efficient GPU Implementation of a Coupled Overland-Sewer Hydraulic Model with Pollutant Transport
Authors: Fernández-Pato Javier , García-Navarro Pilar
Published: October 2021

Numerical simulation of flows that consider interaction between overland and drainage networks has become a practical tool to prevent and mitigate flood situations in urban environments, especially when dealing with intense storm events, where the limited capacity of the sewer systems can be a trigger for flooding. Additionally, in order to prevent any kind of pollutant dispersion through the drainage network, it is very interesting to have a certain monitorization or control over the quality of the water that flows in both domains. In this sense, the addition of a pollutant transport component to both surface and sewer hydraulic models would benefit the global analysis of the combined water flow. On the other hand, when considering a realistic large domain with complex topography or streets structure, a fine spatial discretization is mandatory. Hence the number of grid cells is usually very large and, therefore, it is necessary to use parallelization techniques for the calculation, the use of Graphic Processing Units (GPU) being one of the most efficient due to the leveraging of thousands of processors within a single device. In this work, an efficient GPU-based 2D shallow water flow solver (RiverFlow2D-GPU) is fully coupled with EPA’s Storm Water Management Model (SWMM). Both models are able to develop a transient water quality analysis taking into account several pollutants. The coupled model, referred to as RiverFlow2D-GPU UD (Urban Drainge) is applied to three real-world cases, covering the most common hydraulic situations in urban hydrology/hydraulics. A UK Environmental Agency test case is used as model validation, showing a good agreement between RiverFlow2D-GPU UD and the rest of the numerical models considered. The efficiency of the model is proven in two more complex domains, leading to a >100x faster simulations compared with the traditional CPU computation.
Effects of Hillslope Trenching on Surface Water Infiltration in Subalpine Forested Catchments
Authors: LaFevor Matthew C. , Ramos-Scharrón Carlos E.
Published: October 2021

Concerns over freshwater scarcity for agriculture, ecosystems, and human consumption are driving the construction of infiltration trenches in many mountain protected areas. This study examines the effectiveness of infiltration trenches in a subalpine forested catchment in central Mexico, where public and private organizations have been constructing trenches for ~60 years. We rely on empirical data to develop rainfall-runoff models for two scenarios: a baseline (no trenches) and a trenched scenario. Field measurements of infiltration capacities in forested and trenched soils (n = 56) and two years of meteorological data are integrated into a semi-distributed runoff model of 28 trenched sub-catchments. Sensitivity analysis and hydrographs are used to evaluate differences in total runoff and infiltration between the two scenarios. Multiple logistic regression is used to evaluate the effects of environmental and management variables on the likelihood of runoff response and trench overtopping. The findings show that soil infiltration capacity and rainfall intensity are primary drivers of runoff and trench overtopping. However, trenches provided only a 1.2% increase in total infiltration over the two-year period. This marginal benefit is discussed in relation to the potential adverse environmental impacts of trench construction. Overall, our study finds that as a means of runoff harvesting in these forested catchments, trenches provide negligible infiltration benefits. As a result, this study cautions against further construction of infiltration trenches in forested catchments without careful ex ante assessment of rainfall-runoff relationships. The results of this study have important implications for forest water management in Mexico and elsewhere, where similar earthworks are employed to enhance runoff harvesting and surface water infiltration.
Development of Predictive Models for Water Budget Simulations of Closed-Basin Lakes: Case Studies of Lakes Azuei and Enriquillo on the Island of Hispaniola
Authors: Moknatian Mahrokh , Piasecki Michael
Published: October 2021

The historical water level fluctuations of the two neighboring Caribbean lakes of Azuei (LA) and Enriquillo (LE) on Hispaniola have shown random periods of synchronous and asynchronous behaviors, with both lakes exhibiting independent dynamics despite being exposed to the same climatic forces and being directly next to each other. This paper examines their systems’ main drivers and constraints, which are used to develop numerical models for these two lakes. The water balance approach was employed to conceptually model the lakes on an interannual scale and examine the assumptions of surface and subsurface processes. These assumptions were made based on field observations and prior studies. The developed models were optimized and calibrated for 1984 to 2017 and then validated for the period 1972 to 1984 based on the lakes’ observational volume change and volume time series. The models yielded “good” performance, with NSE averaged at 0.7 and RE averaged at 13% for volume change. The performance improved to “very good” for volume simulations, with NSE averaging higher than 0.9 and RE averaging at 1%. The uncertainty analysis showed a p-factor of 0.73 and an r-factor of 1.7 on average, supporting the reliability and precision of the results. Analyzing the time series of the lakes and quantifying the main elements of the water balance, each lake’s shrinkage and expansion phases were explored, and the drivers of such behavior were identified for each lake. The main drivers of LE’s system are North Atlantic cyclone activities and uncontrolled inter-basin water transfer, and direct rainfall and evaporation to/from its surface. For LA, its system is controlled mainly by groundwater fluxes in and out of it, despite possessing small values in its water budget.
Numerical Simulation of Flow in Parshall Flume Using Selected Nonlinear Turbulence Models
Authors: Heyrani Mehdi , Mohammadian Abdolmajid , Nistor Ioan
Published: October 2021

This study uses a computational fluid dynamics (CFD) approach to simulate flows in Parshall flumes, which are used to measure flowrates in channels. The numerical results are compared with the experimental data, which show that choosing the right turbulence model, e.g., v2−f and LC, is the key element in accurately simulating Parshall flumes. The Standard Error of Estimate (SEE) values were very low, i.e., 0.76% and 1.00%, respectively, for the two models mentioned above. The Parshall flume used for this experiment is a good example of a hydraulic structure for which the design can be more improved by implementing a CFD approach compared with a laboratory (physical) modeling approach, which is often costly and time-consuming.
Clostridioides difficile Infection Rates after Ceftolozane–Tazobactam and Ceftazidime–Avibactam Treatment Compared to Carbapenem Treatment: A Retrospective Single-Center Study
Authors: Godefroy Nagisa , Junot Helga , Drieux-Rouzet Laurence , Méloni Cyril , Luyt Charles-Edouard , Robert Jérôme , Bleibtreu Alexandre
Published: October 2021

Introduction: Ceftolozane–tazobactam (CT) and ceftazidime–avibactam (CZA) are new beta-lactam/beta-lactamase inhibitors (BL/IBL) and antibiotics. There are few data regarding their impact on Clostridioides difficile infections (CDI). The objective of our study was, therefore, to determine and compare the number of CDI occurring after treatment with CT or CZA and carbapenem (CBP). Methods: All patients who received at least one dose of CT or CZA in our hospital between 1 January 2018 and 31 December 2019 were included. We compared, during the same period, the number of CDI after CT or CZA treatment and CBPs by using a chi-square test of Fischer’s exact test when required. p value < 0.05 was considered as significant. Results: Among the 53 patients receiving CZA and 42 patients receiving CT, two and one, respectively, developed a CDI within 90 days. Of the three (3%) patients who developed a CDI, one died 15 days after his second CDI (36 days after initiation of CZA). Of the 2291 patients receiving CBP, 37 (1.6%) developed a CDI within 90 days. There was no significant difference between the number of CDI occurring after CBP and CT or CZA treatment. CT or CZA use is not associated with an increased rate of CDI compared to CBP.
The COVID-19 Pandemic Seen from a Syndemic Perspective: The LGBTQIA2SP+ Community
Authors: Bragazzi Nicola Luigi
Published: October 2021

An adverse condition or a disease can (either directly or indirectly) interact in a synergistic fashion with other adverse conditions or diseases/maladies, and co-cluster together with them: this fundamental observation is at the basis of the term “syndemic” (a portmanteau for “synergistic epidemic”) [...]
Late Adolescents’ Attachment to Parents and Peers and Psychological Distress Resulting from COVID-19. A Study on the Mediation Role of Alexithymia
Authors: Tambelli Renata , Cimino Silvia , Marzilli Eleonora , Ballarotto Giulia , Cerniglia Luca
Published: October 2021

The scientific literature has shown the key role played by attachment to parents and peers and difficulties in recognizing, processing, and regulating emotions (i.e., alexithymia) in the (mal-)adaptive psychological response to the COVID-19 pandemic during late adolescence. No study has yet explored the complex interplay between these variables. We recruited a sample of 454 late adolescents (Mage = 22.79, SD = 2.27) and assessed attachment to parents and peers, alexithymia, and peritraumatic distress due to COVID-19 through self-report instruments. Attachment to fathers and peers, but not to mothers, and alexithymia significantly predicted levels of peritraumatic distress. Alexithymia fully and partially mediated the effect of, respectively, attachment to mothers and attachment to peers on peritraumatic distress due to COVID-19. These findings suggested that intervention programs focused on the promotion of peer social relationships, supportive parent–adolescent relationships, and the ability to recognize and discriminate one’s own and others’ emotions are needed in helping late adolescents to face the current health emergency and preventing short- and long-term psychopathological consequences related to the COVID-19 pandemic.
Trauma, Post-Traumatic Stress Disorder, and Mental Health Care of Asylum Seekers
Authors: Youngmann Rafael , Bachner-Melman Rachel , Lev-Ari Lilac , Tzur Hadar , Hileli Ravit , Lurie Ido
Published: October 2021

Asylum seekers in Israel from East Africa frequently experienced traumatic events along their journey, particularly in the Sinai Peninsula, where they were subjected to trafficking and torture. Exposure to trauma has implications for rights that are contingent on refugee status. This retrospective chart review aimed to characterize the types of traumas experienced by 219 asylum seekers (149 men) from Eritrea and Sudan who sought treatment at a specialized mental health clinic in Israel, and to compare the mental health of trauma victims (n = 168) with that of non-trauma victims (n = 53). About 76.7% of the asylum seekers had experienced at least one traumatic event, of whom 56.5% were diagnosed with post-traumatic stress disorder (PTSD). Most reported traumas were experienced en route in the Sinai, rather than in the country of origin or Israel. Few clinical differences were observed between trauma victims and non-trauma victims, or between trauma victims with and without a PTSD diagnosis. Our findings emphasize the importance of accessibility to mental and other health services for asylum seekers. Governmental policies and international conventions on the definition of human trafficking may need to be revised, as well as asylum seekers’ rights and access to health services related to visa status.
Outcomes of Scarf and Akin Osteotomy with Intra-Articular Stepwise Lateral Soft Tissue Release for Correcting Hallux Valgus Deformity in Rheumatoid Arthritis
Authors: Matsumoto Takumi , Maenohara Yuji , Chang Song Ho , Ono Kumiko , Omata Yasunori , Hirose Jun , Tanaka Sakae
Published: October 2021

Background. The effectiveness of scarf and Akin osteotomy with intra-articular lateral soft tissue release for the correction of hallux valgus (HV) in patients with rheumatoid arthritis (RA) has not been elucidated. Methods. A total of 36 feet in 28 patients with RA who had scarf and Akin osteotomy with intra-articular stepwise lateral soft tissue release between 2015 and 2020 at a single institute were investigated retrospectively, with a mean follow-up period of 32.0 ± 16.9 months. Radiographic evaluations including the HV angle, intermetatarsal angle, and sesamoid position were performed preoperatively and postoperatively. Clinical outcomes were assessed using the Japanese Society of Surgery of the Foot (JSSF) hallux scale and self-administered foot evaluation questionnaire (SAFE-Q). Results. The procedure resulted in significant HV correction, with a recurrence rate of 13.9%. The JSSF scale and all five SAFE-Q subscale scores significantly improved (p < 0.05), with no major complications. More than 90% of cases achieved adequate lateral soft tissue release without sacrificing the adductor tendon of the hallux. Conclusions. Intra-articular stepwise lateral soft tissue release in combination with scarf and Akin osteotomy provided satisfactory radiographic and patient-reported outcomes for the correction of HV in patients with RA with minimum lateral soft tissue release.
Measurement Invariance of the Sexual Orientation Microaggression Inventory across LGB Males and Females in Taiwan: Bifactor Structure Fits the Best
Authors: Hsieh Meng-Tsang , Chen Jung-Sheng , Lin Chung-Ying , Yen Cheng-Fang , Griffiths Mark D. , Huang Yu-Te
Published: October 2021

The present study examined the factor structure and concurrent validity of the traditional Chinese version of the Sexual Orientation Microaggression Inventory (SOMI) among lesbian, gay, and bisexual (LGB) individuals in Taiwan. In total, 1000 self-identified LGB individuals completed the SOMI, HIV and Homosexuality Related Stigma Scale (HHRSS), and Acceptance and Action Questionnaire-II (AAQ). Different factor structures (including one-factor, four-factor, bifactor, and higher-order factor structures) were evaluated using confirmatory factor analysis. The bifactor structure significantly outperformed all others on the SOMI. The bifactor structure with one general factor and four trait factors was found to be measurement invariant across biological sex with satisfactory fit indices. The SOMI general factor was significantly associated with HHRSS-Homosexuality score and AAQ score. The findings indicate that the SOMI is a psychometrically sound instrument for Taiwan sexual minority groups. More specifically, SOMI can be used to accurately assess microaggression among LGB individuals. The measure on microaggression may also provide insights for healthcare providers about LGB individuals’ sexuality-related stigma. Moreover, healthcare providers and relevant stakeholders can use the SOMI to understand how LGB individuals perceive and feel microaggression.
Long-Term Survival of Older Patients Hospitalized for COVID-19. Do Clinical Characteristics upon Admission Matter?
Authors: Chojnicki Michał , Neumann-Podczaska Agnieszka , Seostianin Mikołaj , Tomczak Zofia , Tariq Hamza , Chudek Jerzy , Tobis Sławomir , Mozer-Lisewska Iwona , Suwalska Aleksandra , Tykarski Andrzej , Merks Piotr , Kropińska Sylwia , Sobieszczańska Małgorzata , Romanelli Frank , Wieczorowska-Tobis Katarzyna
Published: October 2021

Older adults are particularly susceptible to COVID-19 in terms of both disease severity and risk of death. To compare clinical differences between older COVID-19 hospitalized survivors and non-survivors, we investigated variables influencing mortality in all older adults with COVID-19 hospitalized in Poznań, Poland, through the end of June 2020 (n = 322). In-hospital, post-discharge, and overall 180-day mortality were analyzed. Functional capacity prior to COVID-19 diagnosis was also documented. The mean age of subjects was 77.5 ± 10.0 years; among them, 191 were females. Ninety-five (29.5%) died during their hospitalization and an additional 30 (9.3%) during the post-discharge period (up to 180 days from the hospital admission). In our study, male sex, severe cognitive impairment, underlying heart disease, anemia, and elevated plasma levels of IL-6 were independently associated with greater mortality during hospitalization. During the overall 180-day observation period (from the hospital admission), similar characteristics, excluding male sex and additionally functional impairment, were associated with increased mortality. During the post-discharge period, severe functional impairment remained the only determinant. Therefore, functional capacity prior to diagnosis should be considered when formulating comprehensive prognoses as well as care plans for older patients infected with SARS-CoV-2.
The Usefulness of a Massive Open Online Course about Postural and Technological Adaptations to Enhance Academic Performance and Empathy in Health Sciences Undergraduates
Authors: Martín-Valero Rocío , Pastora-Bernal José-Manuel , Ortiz-Ortigosa Lucía , Casuso-Holgado María Jesús , Pérez-Cabezas Veronica , Ruiz-Párraga Gema Teresa
Published: October 2021

Massive open online courses (MOOCs) provide accessible and engaging information for Physical Therapy and Occupational Therapy students. The objective of this research was to determine the usefulness in improving academic performance and empathy in health sciences undergraduates, and to test a hypothetical model through structural equation analysis. This research was carried out using a descriptive and quasi-experimental design. It was conducted in a sample of 381 participants: 176 used a MOOC and 205 did not. The results of the Student’s t-test showed statistically significant differences in academic performance between the groups in favor of those students who had realized the MOOC. Participants carried out an evaluation rubric after taking MOOC. Statistically significant differences in empathy were also obtained between the pre (X = 62.06; SD = 4.41) and post (X = 73.77; SD = 9.93) tests. The hypothetical model tested via structural equation modeling was supported by the results. Motivation for the MOOC explained 50% of the variance. The MOOC (participation and realization) explained 58% of academic performance, 35% of cognitive empathy and 48% of affective empathy. The results suggest an association between higher realization and participation in a MOOC and higher levels of academic performance, and cognitive and affective empathy.
Impacts of the COVID-19 Pandemic and Self-Isolation on Students and Staff in Higher Education: A Qualitative Study
Authors: Knight Holly , Carlisle Sophie , O’Connor Mórna , Briggs Lydia , Fothergill Lauren , Al-Oraibi Amani , Yildirim Mehmet , Morling Joanne R. , Corner Jessica , Ball Jonathan , Denning Chris , Vedhara Kavita , Blake Holly
Published: October 2021

This qualitative study explored the impact of COVID-19 self-isolation and social restriction measures on university students, through the perspectives of both students and the staff supporting them. The study comprised 11 focus groups (students) and 26 individual interviews (staff) at a higher education institution in England during a period of national lockdown (January–March 2021). Participants were university students (n = 52) with self-isolation experiences and university staff (n = 26) with student-facing support roles. Focus group and interview data were combined and analysed using an inductive thematic approach. Four themes emerged: ‘Adaptation during the pandemic’, ‘Practical, environmental, and emotional challenges of self-isolating’, ‘Social factors and their impact on COVID-19 testing and self-isolation adherence’, and ‘Supporting self-isolation’. Students and staff struggled with the imposed restrictions and shift to online education. Students found it difficult to adapt to new expectations for university life and reported missing out on professional and social experiences. Students and staff noted concerns about the impact of online teaching on educational outcomes. Students endorsed varied emotional responses to self-isolation; some felt unaffected whilst others experienced lowered mood and loneliness. Students were motivated by pro-social attitudes; campaigns targeting these factors may encourage continued engagement in protective behaviours. Staff struggled to manage their increased workloads delivering support for self-isolating students. Universities must consider the support needs of students during self-isolation and prepare for the long-term impacts of the pandemic on student wellbeing and educational attainment. Greater support should be provided for staff during transitional periods, with ongoing monitoring of workforce stress levels warranted.
Exploring the Relationship between Window View Quantity, Quality, and Ratings of Care in the Hospital
Authors: Mihandoust Sahar , Joseph Anjali , Kennedy Sara , MacNaughton Piers , Woo May
Published: October 2021

Hospital ratings reflect patient satisfaction, consumer perception of care, and create the context for quality improvement in healthcare settings. Despite an abundance of studies on the health benefits of the presence and content of window views, there is a gap in research examining how these features may impact patient satisfaction and consumer perceptions of the quality of care received. A quantitative exploratory study collected data from 652 participants regarding their previous stay in the hospital, their perception of windows in their room, and their perception of their room, the hospital, and the quality of care received. On a scale of 0–10, participants with access to windows gave a 1-unit higher rating for the hospital. Access to window views from their bed provided a 1-unit increase, and having a view to green spaces resulted in a 2-unit increase in hospital ratings. Statistically significant results were also found for room ratings and care ratings. Windows in the patient rooms impact the key patient satisfaction measures and patient experience during the hospital stay. Patient room design, bed set up, and quantity and quality of window views may play an important role in shaping the patient’s experience.
Standardized Incidence Ratio and Standardized Mortality Ratio of Malignant Mesothelioma in a Worker Cohort Using Employment Insurance Database in Korea
Authors: Kim Eun-A
Published: October 2021

Malignant mesothelioma is one of the appropriate indicators for assessing the carcinogenic effects of asbestos. This study compared the risk ratio of mesothelioma according to the industry in the worker cohort. A cohort was constructed using the Korean employment insurance system during 1995–2017, enrolling 13,285,895 men and 10,452,705 women. The standardized mortality ratio (SMR) and standardized incidence ratio (SIR) were calculated using the indirect standardization method. There were 641 malignant mesotheliomas that occurred; the SIR was significantly higher than the general population (men 1.36, 95% confidence interval (CI) 1.24–1.48, women 1.44, 95% CI: 1.23–1.7). More than half (52.8%) of malignant mesothelioma cases occurred in the manufacturing (n = 240, 38.6%, SIR: men, 1.72, 95% CI: 1.37–2.15, women, 3.31, 95% CI: 1.71–5.79) and construction industries (n = 88, 14.2%, SIR: men, 1.54 95% CI: 1.33–1.78, women, 1.62 95% CI: 1.25–2.11). The accommodation and food service (men, 2.56 95% CI: 1.28–4.58, women 1.35, 95% CI: 0.65–2.48) and real estate (men 1.34, 95% CI: 0.98–1.83, women 1.95, 95% CI: 0.78–4.02) also showed a high SIR, indicating the risk of asbestos-containing materials in old buildings. The incidence of malignant mesothelioma is likely to increase in the future, given the long latency of this disease. Moreover, long-term follow-up studies will be needed.
A Critical Review of Symptom Management Nursing Science on HIV-Related Fatigue and Sleep Disturbance
Authors: Voss Joachim G. , Barroso Julie , Wang Tongyao
Published: October 2021

Despite improved antiretroviral treatments, people living with HIV (PLWH) continue to suffer from HIV-related fatigue and sleep disturbances. We first reviewed the definition, etiology, and research breakthroughs of HIV-related fatigue and sleep disturbances, then analyzed nurse-led symptom management studies to describe their efficacy and make recommendations for future symptom research. We searched PubMed, CINAHL, PsycInfo, Psych and Behavioral Sciences Collection, and Scopus to identify nurse-led studies on symptom management for PLWH in the past 20 years. A total of 13 experimental or quasi-experimental studies were identified. The types of interventions included exercise, cognitive behavioral therapy, coaching, and symptom management manualized self-care activities. Currently, we cannot recommend with certainty any of the tested symptom management strategies to reduce fatigue or sleep disturbances. The current findings need to be confirmed and expanded to understand optimal dosing and sustainability.
Designing Acceptable Robots for Assisting Older Adults: A Pilot Study on the Willingness to Interact
Authors: Bevilacqua Roberta , Felici Elisa , Cavallo Filippo , Amabili Giulio , Maranesi Elvira
Published: October 2021

The aim of this paper was to explore the psychosocial determinants that lead to acceptability and willingness to interact with a service robot, starting with an analysis of older users’ behaviors toward the Robot-Era platform, in order to provide strategies for the promotion of social assistive robotics. A mixed-method approach was used to collect information on acceptability, usability, and human–robot interaction, by analyzing nonverbal behaviors, emotional expressions, and verbal communication. The study involved 35 older adults. Twenty-two were women and thirteen were men, aged 73.8 (±6) years old. Video interaction analysis was conducted to capture the users’ gestures, statements, and expressions. A coded scheme was designed on the basis of the literature in the field. Percentages of time and frequency of the selected events are reported. The statements of the users were collected and analyzed. The results of the behavioral analysis reveal a largely positive attitude, inferred from nonverbal clues and nonverbal emotional expressions. The results highlight the need to provide robotic solutions that respect the tasks they offer to the users It is necessary to give older consumers dedicated training in technological literacy to guarantee proper, long-lasting, and successful use.
Experience of Healthcare Access in Australia during the First Year of the COVID-19 Pandemic
Authors: Podubinski Tegan , Townsin Louise , Thompson Sandra C. , Tynan Anna , Argus Geoff
Published: October 2021

Changes in health-seeking behaviours and challenges in accessing care have been reported during the COVID-19 pandemic. This qualitative study examines Australian experiences related to healthcare access during the early months of the pandemic. The study aimed to identify key areas of concern as well as opportunities for services to prevent, manage and treat health concerns when normal access was disrupted. Fifty-nine semi-structured interviews were analysed. Participants were interviewed between August and December in 2020 over telephone or Zoom and were located across Australia. Rapid identification of themes with an audio recordings technique was used to generate themes from the data. Participants described a variety of influences on their health-seeking behaviours, resulting in decisions to delay care or being unable to reach care. Many individuals accessed health services via telehealth and offered a range of perceptions and views on its effectiveness and appropriateness. The findings illustrate that maintenance of health and access to healthcare and psychosocial support were compromised for some individuals, leading to negative impacts on both mental and physical health. This highlights the need to provide mechanisms to facilitate a person’s ability to access care in a timely manner during a pandemic.
Particulate Matter Exposure and Allergic Rhinitis: The Role of Plasmatic Extracellular Vesicles and Bacterial Nasal Microbiome
Authors: Mariani Jacopo , Iodice Simona , Cantone Laura , Solazzo Giulia , Marraccini Paolo , Conforti Emanuele , Bulsara Pallav A. , Lombardi Maria Stella , Howlin Robert P. , Bollati Valentina , Ferrari Luca
Published: October 2021

Particulate matter (PM) exposure is linked to the worsening of respiratory conditions, including allergic rhinitis (AR), as it can trigger nasal and systemic inflammation. To unveil the underlying molecular mechanisms, we investigated the effects of PM exposure on the release of plasmatic extracellular vesicles (EV) and on the complex cross-talk between the host and the nasal microbiome. To this aim, we evaluated the effects of PM10 and PM2.5 exposures on both the bacteria-derived-EV portion (bEV) and the host-derived EVs (hEV), as well as on bacterial nasal microbiome (bNM) features in 26 AR patients and 24 matched healthy subjects (HS). In addition, we assessed the role exerted by the bNM as a modifier of PM effects on the complex EV signaling network in the paradigmatic context of AR. We observed that PM exposure differently affected EV release and bNM composition in HS compared to AR, thus potentially contributing to the molecular mechanisms underlying AR. The obtained results represent the first step towards the understanding of the complex signaling network linking external stimuli, bNM composition, and the immune risponse.
Caregivers’ Knowledge and Food Accessibility Contributes to Childhood Malnutrition: A Case Study of Dora Nginza Hospital, South Africa
Authors: Clarke Pamela , Zuma Mthokozisi Kwazi , Tambe Ayuk Betrand , Steenkamp Liana , Mbhenyane Xikombiso Gertrude
Published: October 2021

Amongst the problems facing South Africa today are malnutrition and food insecurity, and there is a need for interventions and innovative strategies to address these. The aim of the study was to determine the contribution of caregivers’ knowledge of nutrition and household food security among children aged 0 to 60 months. A cross-sectional study design was applied using a quantitative approach. A convenience sample (n = 184) of caregiver–child pairs (for children 0 to 60 months) from the Dora Nginza Hospital Paediatric Outpatient Department was used. A structured questionnaire was applied to collect data on socio-economic factors, health status, household food security, and caregivers’ knowledge. In addition, interviews were conducted, and anthropometric measurements of children were taken to determine their nutritional status. The results indicate that most caregivers were female, and more than half completed high school, yet almost 75% were unemployed. Most of the caregivers (58.2%) were either overweight or obese. The results also show that only 33.2% of households were food secure, 29.3% were at risk of hunger, and 37.5% experienced hunger. The prevalence of stunting, underweight, and wasting among children in the study was high. A significant, slightly positive correlation was found between the body mass index of the caregiver and height for age. Poor socio-economic status and food inaccessibility were identified as possible underlying contributing factors to malnutrition, contributing to food insecurity and therefore poor dietary intake.
Disruption of Chromatin Dynamics by Hypotonic Stress Suppresses HR and Shifts DSB Processing to Error-Prone SSA
Authors: Krieger Lisa Marie , Mladenov Emil , Soni Aashish , Demond Marilen , Stuschke Martin , Iliakis George
Published: October 2021

The processing of DNA double-strand breaks (DSBs) depends on the dynamic characteristics of chromatin. To investigate how abrupt changes in chromatin compaction alter these dynamics and affect DSB processing and repair, we exposed irradiated cells to hypotonic stress (HypoS). Densitometric and chromosome-length analyses show that HypoS transiently decompacts chromatin without inducing histone modifications known from regulated local chromatin decondensation, or changes in Micrococcal Nuclease (MNase) sensitivity. HypoS leaves undisturbed initial stages of DNA-damage-response (DDR), such as radiation-induced ATM activation and H2AX-phosphorylation. However, detection of ATM-pS1981, γ-H2AX and 53BP1 foci is reduced in a protein, cell cycle phase and cell line dependent manner; likely secondary to chromatin decompaction that disrupts the focal organization of DDR proteins. While HypoS only exerts small effects on classical nonhomologous end-joining (c-NHEJ) and alternative end-joining (alt-EJ), it markedly suppresses homologous recombination (HR) without affecting DNA end-resection at DSBs, and clearly enhances single-strand annealing (SSA). These shifts in pathway engagement are accompanied by decreases in HR-dependent chromatid-break repair in the G2-phase, and by increases in alt-EJ and SSA-dependent chromosomal translocations. Consequently, HypoS sensitizes cells to ionizing radiation (IR)-induced killing. We conclude that HypoS-induced global chromatin decompaction compromises regulated chromatin dynamics and genomic stability by suppressing DSB-processing by HR, and allowing error-prone processing by alt-EJ and SSA.
Novel Synthesized N-Ethyl-Piperazinyl-Amides of C2-Substituted Oleanonic and Ursonic Acids Exhibit Cytotoxic Effects through Apoptotic Cell Death Regulation
Authors: Kazakova Oxana , Mioc Alexandra , Smirnova Irina , Baikova Irina , Voicu Adrian , Vlaia Lavinia , Macașoi Ioana , Mioc Marius , Drăghici George , Avram Ştefana , Dehelean Cristina , Şoica Codruța
Published: October 2021

A series of novel hybrid chalcone N-ethyl-piperazinyl amide derivatives of oleanonic and ursonic acids were synthesized, and their cytotoxic potential was evaluated in vitro against the NCI-60 cancer cell line panel. Compounds 4 and 6 exhibited the highest overall anticancer activity, with GI50 values in some cases reaching nanomolar values. Thus, the two compounds were further assessed in detail in order to identify a possible apoptosis- and antiangiogenic-based mechanism of action induced by the assessed compounds. DAPI staining revealed that both compounds induced nuclei condensation and overall cell morphological changes consistent with apoptotic cell death. rtPCR analysis showed that up-regulation of pro-apoptotic Bak gene combined with the down-regulation of the pro-survival Bcl-XL and Bcl-2 genes caused altered ratios between the pro-apoptotic and anti-apoptotic proteins’ levels, leading to overall induced apoptosis. Molecular docking analysis revealed that both compounds exhibited high scores for Bcl-XL inhibition, suggesting that compounds may induce apoptotic cell death through targeted anti-apoptotic protein inhibition, as well. Ex vivo determinations showed that both compounds did not significantly alter the angiogenesis process on the tested cell lines.