bluuebunny/crossref_metadata_2025 huggingface dataset:
Mobile health apps use among Jordanian outpatients: A descriptive study
Authors: Qan’ir Yousef , Khalifeh Anas Husam , Eid Moawia , Hammad Basmah , Al-Batran Mohammad
Published: May 2021

Our purpose in this descriptive cross-sectional study was to examine the prevalence of mobile health (mHealth) apps use, factors associated with downloading mHealth apps, and to describe characteristics of mHealth apps use among Jordanian patients in government-sponsored outpatient clinics. A total of 182 (41.6%) of the 438 outpatients who completed questionnaires downloaded mHealth apps. Common reasons for downloading mHealth apps included tracking physical activity, losing weight, learning exercises, as well as monitoring, and controlling diet. More than two thirds of the users (70%) stopped using the apps they downloaded due to loss of interest, lack of anticipated support, too time consuming, or better apps available. The most common personal reasons for never downloading mHealth apps were lack of interest, in good health, and the most common technical reasons included a limited data plan, lack of trust, cost, and complexity of the apps. We also found that gender, age, weight, and educational level influenced the decision whether to download mHealth apps or not. We have shown the potential in mHealth apps use among Jordanian patients is promising, and health care systems must adopt this technology as well as work through population needs and preferences to supply it.
Expression and Significance of HPV16 E6/E7 mRNAs in the Bronchial Brush and TBNA Cells of Patients With Small Cell Lung Cancer
Authors: Zou Di-Jia , Zhao Ya-Bin , Yang Jing-Hua , Xu Hong-Tao , Li Qing-Chang , Wu Guang-Ping
Published: May 2021

Background and Objective:

Small cell lung cancer (SCLC) is characterized by rapid growth, strong invasion, and early metastasis. However, the cause of its occurrence remains unclear. High-risk HPV infection is closely related to the occurrence of non-small cell lung cancer and cervical small cell neuroendocrine carcinoma.

Methods:

The expression levels of E6 mRNA and E7 mRNA in HPV16 were detected by qRT-PCR in the bronchial brushing and transbronchial needle aspiration (TBNA) of 310 patients with lung cancer and with benign lung diseases. To make the design of this experiment scientific and reasonable, the expression levels in lung squamous cell carcinoma were taken as positive controls, while those in benign cells were taken as negative controls.

Results:

The expression levels of E6 mRNA and E7 mRNA in SCLC group were significantly higher than those in benign cell group and slight higher than those in squamous cell carcinoma group. The expression levels of E6 mRNA and E7 mRNA in the central type of SCLC were significantly higher than those in the peripheral type of SCLC.

Conclusions:

We speculate that the occurrence of some small cell carcinoma is the same as that of some squamous cell carcinoma, which is closely related to HPV16 infection. The overexpression of E6 mRNA and E7 mRNA is in some benign lesion cells, which may be related to HPV transient infection.
Accuracy of Wearable Sensor Technology in Hand Goniometry: A Systematic Review
Authors: Avila Francisco R. , Carter Rickey E. , McLeod Christopher J. , Bruce Charles J. , Giardi Davide , Guliyeva Gunel , Forte Antonio J.
Published: May 2021

Background

Wearable devices and sensor technology provide objective, unbiased range of motion measurements that help health care professionals overcome the hindrances of protractor-based goniometry. This review aims to analyze the accuracy of existing wearable sensor technologies for hand range of motion measurement and identify the most accurate one.

Methods

We performed a systematic review by searching PubMed, CINAHL, and Embase for studies evaluating wearable sensor technology in hand range of motion assessment. Keywords used for the inquiry were related to wearable devices and hand goniometry.

Results

Of the 71 studies, 11 met the inclusion criteria. Ten studies evaluated gloves and 1 evaluated a wristband. The most common types of sensors used were bend sensors, followed by inertial sensors, Hall effect sensors, and magnetometers. Most studies compared wearable devices with manual goniometry, achieving optimal accuracy. Although most of the devices reached adequate levels of measurement error, accuracy evaluation in the reviewed studies might be subject to bias owing to the use of poorly reliable measurement techniques for comparison of the devices.

Conclusion

Gloves using inertial sensors were the most accurate. Future studies should use different comparison techniques, such as infrared camera–based goniometry or virtual motion tracking, to evaluate the performance of wearable devices.
Prolonged Grief Disorder: An Implementation Gone Awry and a Researcher Going Gonzo
Authors: Lund Peter Clement
Published: May 2021

In this article I discuss the muddled implementation of Prolonged Grief Disorder in a Danish context. I do this by drawing on my fieldwork, which has been ongoing during the last couple of years. I begin by describing how my initial research design suffered a breakdown that mirrored the breakdown in the implementation of the Prolonged Grief Disorder diagnoses. This breakdown became defining for my work and through the application of what I call gonzo sociology I was able to critically engage in the field of grief research in Denmark. I describe what gonzo research is, and then, following this, I tell the story of how I stumbled into the field of grief research in Denmark and the process of realization I went through. The article is thus structured as a narrative that relays both how I came to embrace gonzo research as a form of methodology, but also the story of what my encounters in the field showed me. I do this because I cannot separate the story of how I went about it from what I came to discover—methods, theory and results are intertwined. Gonzo research aims at going into the field and participating, co-creating the discoveries and pushing the boundaries for research, both in its way of doing research and in its way of reporting said research. Thus, the form of the article is alternative and balances between journalistic endeavor, academic research and autoethnography.
Post-allogeneic hematopoietic stem cell transplantation viral reactivations and viremias: a focused review on human herpesvirus-6, BK virus and adenovirus
Authors: Wang Xin , Patel Shyam A. , Haddadin Michael , Cerny Jan
Published: May 2021

Human cytomegalovirus and Epstein–Barr virus have been recognized as potential drivers of morbidity and mortality of patients undergoing allogeneic stem cell transplantation for years. Specific protocols for monitoring, prophylaxis and pre-emptive therapy are in place in many transplant settings. In this review, we focus on the next three most frequent viruses, human herpesvirus-6, BK virus and adenovirus, causing reactivation and/or viremia after allogeneic transplant, which are increasingly detected in patients in the post-transplant period owing to emerging techniques of molecular biology, recipients’ characteristics, treatment modalities used for conditioning and factors related donors or stem cell source. Given the less frequent detection of an illness related to these viruses, there are often no specific protocols in place for the management of affected patients. While some patients develop significant morbidity (generally older), others may not need therapy at all (generally younger or children). Furthermore, some of the antiviral therapies used are potentially toxic. With the addition of increased risk of secondary infections, risk of graft failure or increased risk of graft- versus-host disease as well as the relationship with other post-transplant complications, the outcomes of patients with these viremias remain unsatisfactory and even long-term survivors experience increased morbidity.
Scaling Up Information Sharing on HIV-Associated Neurocognitive Disorder: Raising Awareness and Knowledge Among Key Stakeholders
Authors: Liboro Renato M. , Shuper Paul A. , Ross Lori E.
Published: May 2021

Although the majority of specialists and researchers in the field of HIV/AIDS are aware and knowledgeable about HIV-associated neurocognitive disorder (HAND) as a condition that affects as much as 50% of people living with HIV/AIDS (PLWH), research has documented that many health care and service providers who work directly with PLWH are either unaware of HAND or believe they do not know enough information about HAND to effectively support their clients experiencing neurocognitive challenges. Based on the findings of a qualitative study that interviewed 33 health care and service providers in HIV/AIDS services to identify and examine their awareness and knowledge on HAND, this article argues for utilizing a combination of Public Health Informatics principles; communication techniques, propagation strategies, and recognized approaches from Implementation and Dissemination Science; and social media and online discussion platforms, in addition to traditional Knowledge Mobilization strategies, to scale up information sharing on HAND among all relevant stakeholders. Increasing information sharing among stakeholders would be an important step to raising awareness and knowledge on HAND, and consequently, improving care, services, and support for PLWH and neurocognitive issues.
Cloud Computing Adoption for Healthcare: An Empirical Study Using SEM Approach
Authors: Baral Manish Mohan , Verma Amitabh
Published: May 2021

Cloud computing has been adopted by many healthcare firms throughout the world especially in developed countries to enhance their service levels. The main objective of this study was to find the constructs from the prior literature review which influence the adoption of cloud computing from the prospering nation’s perspective. The main pillars of the theoretical framework are technology, organizational, environmental and ethical factors. The responses were collected from the employees or staff who were working in this sector with the help of a structured questionnaire. The analysis was performed utilizing SPSS 20.0 and AMOS 22.0. The hypothesis developed was tested utilizing a structural equation modelling approach. The findings indicated that the assumed variables each under technology, organization, environment and ethics have an impact on the dependent variable that is cloud computing adoption in the healthcare segment, thereby increasing the efficiency. The study is unique when compared to past studies as it considered ethical factors, thereby extending the cloud computing literature. It also provides a base for future studies and cloud technology development for a prospering nation perspective.
Testicular Plasmablastic Lymphoma in an HIV-Negative Patient: A Rare Case Presentation
Authors: Nwanwene Kemnasom , Khan Noman Ahmed Jang , Alsharedi Mohamed
Published: May 2021

Plasmablastic lymphoma (PBL) is a very rare disease and it is usually considered a human immunodeficiency virus (HIV)–related B-cell lymphoma that carries a poor prognosis. It mostly involves the oral cavity, lungs, nasal cavity, gastrointestinal tract, lymph node, and skin. Therapeutic regimens like dose-adjusted etoposide, vincristine, doxorubicin, cyclophosphamide, and prednisone (DA-EPOCH) have shown better results in these aggressive lymphomas. We report a rare case of PBL in an HIV-negative patient who presented to the clinic with a complaint of left testicular swelling for 3 months. Ultrasound showed an enlarged left testicle. He underwent a left orchiectomy and the pathology showed PBL with involvement of the spermatic cord margin. Positron emission tomography scan showed hypermetabolic mediastinal and hilar lymph nodes. He was started on DA-EPOCH but showed no response. Accordingly, salvage therapy with bortezomib in addition to ifosfamide carboplatin and etoposide (B-ICE) chemotherapy was initiated with remarkable response. Several other regimens can be used in the refractory setting; however, the evidence is mostly based on retrospective analysis.
Minimum 10-Year Clinical Outcome of Lateral Collagen Meniscal Implants for the Replacement of Partial Lateral Meniscal Defects: Further Results From a Prospective Multicenter Study
Authors: Grassi Alberto , Lucidi Gian Andrea , Filardo Giuseppe , Agostinone Piero , Macchiarola Luca , Bulgheroni Paolo , Bulgheroni Erica , Zaffagnini Stefano
Published: May 2021

Background:

The collagen meniscal implant (CMI) is a biologic scaffold aimed at replacing partial meniscal defects. The long-term results of lateral meniscal replacement have never been investigated.

Purpose:

To document the clinical outcomes and failures of lateral CMI implantation for partial lateral meniscal defect at a minimum 10-year follow-up.

Study Design:

Case series; Level of evidence, 4,

Methods:

This study included 24 consecutive patients who underwent lateral CMI implantation for partial lateral meniscal defects between April 2006 and September 2009 and who were part of a previous study with a 2-year follow-up. Outcome measures at the latest follow-up included the Lysholm score, Knee injury and Osteoarthritis Outcome Score, visual analog scale (VAS) for pain, Tegner activity level, and EuroQol 5-Dimensions score. Data regarding complications and failures were collected, and patients were asked about their satisfaction with the procedure.

Results:

Included in the final analysis were 19 patients (16 male, 3 female) with a mean age at surgery of 37.1 ± 12.6 years and a mean follow-up of 12.4 ± 1.5 years (range, 10-14 years). Five failures (26%) were reported: 1 CMI removal because of implant breakage and 4 joint replacements (2 unicompartmental knee arthroplasties and 2 total knee arthroplasties). The implant survival rate was 96% at 2 years, 85% at 5 years, 85% at 10 years, 77% at 12 years, and 64% at 14 years. Lysholm scores at the final follow-up were rated as “excellent” in 36% (5 of 14 nonfailures), “good” in 43% (6 of 14), and “fair” in 21% (3 of 14). The VAS score was 3.1 ± 3.1, with only 16% (3 of 19 patients) reporting that they were pain-free; the median Tegner score was 3 (interquartile range, 2-5). All clinical scores decreased from the 2-year follow-up; however, with the exception of the Tegner score, they remained significantly higher compared with the preoperative status. Overall, 79% of patients were willing to undergo the same procedure.

Conclusion:

Lateral CMI implantation for partial lateral meniscal defects provided good long-term results, with a 10-year survival rate of 85% and a 14-year survival rate of 64%. At the final follow-up, 58% of the patients had “good” or “excellent” Lysholm scores. However, there was a general decrease in outcome scores between the short- and the long-term follow-up.
Effects of Olfactory Stimulation on Swallowing Function in Taiwanese Older Adults
Authors: Chen Yea-Jyh , Chen Yea-Tzy , Lin Li-Chu , Chen Su-Chiu , Wang Chi-Te , Hsieh Chun-Man
Published: May 2021

This pretest-posttest pilot study was to examine the effects of how olfactory stimulation (OS) influenced swallowing function in older adults. Forty-four community-dwelling older residents (24 OS & 20 control) from southern Taiwan were recruited. Participants in the intervention group administered pre-meal OS using odor and flavor inhalation. The study found that physiological responses for different food textures significantly differed between groups at post-test ( p  ≤ .02). Within the experimental group, swallowing function, and individual satisfaction showed significant differences before and after the odor inhalation over time ( p < .01, [Formula: see text] = 0.16–0.33). An individual’s satisfaction to their own swallowing capacity was largely enhanced by the significant interaction between time and group ( F[1, 42] = 11.34, p = .002, [Formula: see text] = 0.21), but not for physiological response to OS and swallowing function. The results suggest OS may be advantageous to improving physiological response to OS, swallowing function and satisfaction with swallowing capacity in older adults.
Aging out of foster care: The experiences of former foster youth who successfully navigated this transition
Authors: Hedenstrom Margot
Published: May 2021

Foster youth face high risks and poor outcomes after aging out of care resulting in great economic and human costs to society. The purpose of the study was to describe life experiences of children aging out of the foster care system from the perspectives of adults who have successfully navigated this transition. Their life experiences during this period provided meaningful information for this study which helped to identify themes. Their perceptions of the periods during and after their transitions were explored to investigate supportive relationships, education, and workplace stability. Phenomenology was used to describe the experiences of nine young adults who had aged out of foster care. Participant ages ranged from 20 to 25 years old. Audiotaped semi-structured interviews were conducted for the study. Data analysis was ongoing throughout data collection. Four themes were identified: (1) “Facing a transition”; (2) “Depending on adults for help”; (3) “Making a difference for others”; and (4) “Moving forward with my life.” These four themes highlighted the participants’ experiences as they aged out of foster care. This study contributes to our understanding of the life experiences of former foster youth who are successful after the transition out of foster care. Recommendations for practice and research are identified.
Mitochondrial localization and moderated activity are key to murine erythroid enucleation
Authors: Liang Raymond , Menon Vijay , Qiu Jiajing , Arif Tasleem , Renuse Santosh , Lin Miao , Nowak Roberta , Hartmann Boris , Tzavaras Nikos , Benson Deanna L. , Chipuk Jerry E. , Fribourg Miguel , Pandey Akhilesh , Fowler Velia , Ghaffari Saghi
Published: May 2021

Mammalian red blood cells (RBCs), which primarily contain hemoglobin, exemplify an elaborate maturation process, with the terminal steps of RBC generation involving extensive cellular remodeling. This encompasses alterations of cellular content through distinct stages of erythroblast maturation that result in the expulsion of the nucleus (enucleation) followed by the loss of mitochondria and all other organelles and a transition to anaerobic glycolysis. Whether there is any link between erythroid removal of the nucleus and the function of any other organelle, including mitochondria, remains unknown. Here we demonstrate that mitochondria are key to nuclear clearance. Using live and confocal microscopy and high-throughput single-cell imaging, we show that before nuclear polarization, mitochondria progressively move toward one side of maturing erythroblasts and aggregate near the nucleus as it extrudes from the cell, a prerequisite for enucleation to proceed. Although we found active mitochondrial respiration is required for nuclear expulsion, levels of mitochondrial activity identify distinct functional subpopulations, because terminally maturing erythroblasts with low relative to high mitochondrial membrane potential are at a later stage of maturation, contain greatly condensed nuclei with reduced open chromatin–associated acetylation histone marks, and exhibit higher enucleation rates. Lastly, to our surprise, we found that late-stage erythroblasts sustain mitochondrial metabolism and subsequent enucleation, primarily through pyruvate but independent of in situ glycolysis. These findings demonstrate the critical but unanticipated functions of mitochondria during the erythroblast enucleation process. They are also relevant to the in vitro production of RBCs as well as to disorders of the erythroid lineage.
Detectors Array for In Situ Electron Beam Imaging by 16-nm FinFET CMOS Technology
Authors: Wang Chien-Ping , Lin Burn Jeng , Shih Jiaw-Ren , Chih Yue-Der , Chang Jonathan , Lin Chrong Jung , King Ya-Chin
Published: May 2021

A novel in situ imaging solution and detectors array for the focused electron beam (e-beam) are the first time proposed and demonstrated. The proposed in-tool, on-wafer e-beam detectors array features full FinFET CMOS logic compatibility, compact 2 T pixel structure, fast response, high responsivity, and wide dynamic range. The e-beam imaging pattern and detection results can be further stored in the sensing/storage node without external power supply, enabling off-line electrical reading, which can be used to rapidly provide timely feedback of the key parameters of the e-beam on the projected wafers, including dosage, accelerating energy, and intensity distributions.
Playing with genetic and epigenetic concepts at the school: an Epigenetic Orchestra project
Authors: Alonso Conchita , Palomares Yolanda
Published: May 2021

A sound biological education at early schooling stages is highly desirable for individual understanding of the nature of science and comprehension of evolutionary theory. Making accessible the concepts to young minds is notwithstanding key and playful learning linked to artistic projects can be useful to reach this goal. Here, we propose a set of activities structured into three units that can be developed at school. They use music as a playful learning tool to support students’ motivation to discover the building blocks of genetic code, genetic variation and epigenetic regulation. Familiarity with these core molecular concepts will smooth their future understanding of the evolutionary process. A final activity programmed for a general audience can also contribute to better value scientific knowledge among the local population. And, it will potentially inspire some young girls and boys in orienting their future career development towards science.
De novo transcriptome sequencing and anthocyanin metabolite analysis reveals leaf color of Acer pseudosieboldianum in autumn
Authors: Gao Yu-Fu , Zhao Dong-Hui , Zhang Jia-Qi , Chen Jia-Shuo , Li Jia-Lin , Weng Zhuo , Rong Li-Ping
Published: May 2021

Background

Leaf color is an important ornamental trait of colored-leaf plants. The change of leaf color is closely related to the synthesis and accumulation of anthocyanins in leaves. Acer pseudosieboldianum is a colored-leaf tree native to Northeastern China, however, there was less knowledge in Acer about anthocyanins biosynthesis and many steps of the pathway remain unknown to date.

Results

Anthocyanins metabolite and transcript profiling were conducted using HPLC and ESI-MS/MS system and high-throughput RNA sequencing respectively. The results demonstrated that five anthocyanins were detected in this experiment. It is worth mentioning that Peonidin O-hexoside and Cyanidin 3, 5-O-diglucoside were abundant, especially Cyanidin 3, 5-O-diglucoside displayed significant differences in content change at two periods, meaning it may be play an important role for the final color. Transcriptome identification showed that a total of 67.47 Gb of clean data were obtained from our sequencing results. Functional annotation of unigenes, including comparison with COG and GO databases, yielded 35,316 unigene annotations. 16,521 differentially expressed genes were identified from a statistical analysis of differentially gene expression. The genes related to leaf color formation including PAL, ANS, DFR, F3H were selected. Also, we screened out the regulatory genes such as MYB, bHLH and WD40. Combined with the detection of metabolites, the gene pathways related to anthocyanin synthesis were analyzed.

Conclusions

Cyanidin 3, 5-O-diglucoside played an important role for the final color. The genes related to leaf color formation including PAL, ANS, DFR, F3H and regulatory genes such as MYB, bHLH and WD40 were selected. This study enriched the available transcriptome information for A. pseudosieboldianum and identified a series of differentially expressed genes related to leaf color, which provides valuable information for further study on the genetic mechanism of leaf color expression in A. pseudosieboldianum.
Long -term persistence of antibodies against varicella in fully immunized healthcare workers: an Italian retrospective cohort study
Authors: Bianchi Francesco Paolo , Tafuri Silvio , Larocca Angela Maria Vittoria , Germinario Cinzia Annatea , Stefanizzi Pasquale
Published: May 2021

Background

Chickenpox is a highly contagious disease caused by the varicella zoster virus (VZV), and in infants, adolescents, adults, pregnant women, and the immunocompromised it can be serious. The best way to prevent chickenpox is immunization with the varicella vaccine. Protective levels of antibodies induced by the varicella vaccine decline over time, but there is currently no formal recommendation for testing anti-varicella zoster virus (VZV) IgG levels in immunized healthcare workers (HCWs).

Methods

The aims of this study were to evaluate the seroprevalence of circulating anti-VZV IgG in a sample a sample of students and residents of the medical school of the University of Bari, the long-term immunogenicity of the varicella vaccine, and the effectiveness of a strategy consisting of a third vaccine booster dose. The study population was screened as part of a biological risk assessment conducted between April 2014 and October 2020. A strategy for the management of non-responders was also examined.

Results

The 182 students and residents included in the study had a documented history of immunization (two doses of varicella vaccine). The absence of anti-VZV IgG was determined in 34% (62/182; 95%CI = 27.2–41.4%), with serosusceptibility more common among males than females (p < 0.05). After a third varicella dose, seroconversion was achieved in 100% of this previously seronegative group. No serious adverse events were recorded.

Conclusions

One-third of the study population immunized against VZV lacked a protective antibody titer, but a third dose of vaccine restored protection. Since it is highly unlikely that VZV will be eliminated in the immediate future, the loss of immunity in a substantial portion of the population implies a risk of varicella outbreaks in the coming years. Screening for varicella immunity in routine assessments of the biological risk of medical students and HCWs may help to prevent nosocomial VZV infections.
Who is the main caregiver of the mother during the doing-the-month: is there an association with postpartum depression?
Authors: Peng Ke , Zhou Lin , Liu Xiaoying , Ouyang Menglu , Gong Jessica , Wang Yuanyuan , Shi Yu , Chen Jiani , Li Yichong , Sun Mingfan , Wang Yueyun , Lin Wei , Yuan Shixin , Wu Bo , Si Lei
Published: May 2021

Background

To examine the relationship between the main caregiver during the “doing-the-month” (a traditional Chinese practice which a mother is confined at home for 1 month after giving birth) and the risk of postpartum depression (PPD) in postnatal women.

Methods

Participants were postnatal women stayed in hospital and women who attended the hospital for postpartum examination, at 14–60 days after delivery from November 1, 2013 to December 30, 2013. Postpartum depression status was assessed using the Edinburgh Postnatal Depression Scale. Univariate and multivariable logistic regressions were used to identify the associations between the main caregiver during “doing-the-month” and the risk of PPD in postnatal women.

Results

One thousand three hundred twenty-five postnatal women with a mean (SD) age of 28 (4.58) years were included in the analyses. The median score (IQR) of PPD was 6.0 (2, 10) and the prevalence of PPD was 27%. Of these postnatal women, 44.5% were cared by their mother-in-law in the first month after delivery, 36.3% cared by own mother, 11.1% by “yuesao” or “maternity matron” and 8.1% by other relatives. No association was found between the main caregivers and the risk of PPD after multiple adjustments.

Conclusions

Although no association between the main caregivers and the risk of PPD during doing-the-month was identified, considering the increasing prevalence of PPD in Chinese women, and the contradictions between traditional culture and latest scientific evidence for some of the doing-the-month practices, public health interventions aim to increase the awareness of PPD among caregivers and family members are warranted.
Bone Sclerostin and Dickkopf-related protein-1 are positively correlated with bone mineral density, bone microarchitecture, and bone strength in postmenopausal osteoporosis
Authors: Peng Jia , Dong Zhang , Hui Zhang , Aifei Wang , Lianfu Deng , Youjia Xu
Published: May 2021

Background

Wnt-catenin signaling antagonists sclerostin and dickkopf-related protein-1 (Dkk-1) inhibit bone formation and are involved in the pathogenesis of postmenopausal osteoporosis (PO). However, the association between sclerostin and Dkk-1 and bone mineral density (BMD) in women with PO remains unclear.

Objective

This study aimed to determine the association between sclerostin and Dkk-1 and BMD, bone microarchitecture, and bone strength in PO.

Methods

Trabecular bone specimens were obtained from the femoral heads of 76 Chinese women with PO who underwent hip arthroplasty for femoral neck fractures. Micro-computed tomography (Micro-CT) was used to assess the BMD and bone microarchitecture of the trabecular bone. Subsequently, a mechanical test was performed. Finally, sclerostin and Dkk-1 in the bone were measured by enzyme-linked immunosorbent (Elisa) assay. Serum ionized serum ionised calcium, propeptide of type 1 collagen, C-terminal β-telopeptide of type-1 collagen, sclerostin, and Dkk-1 were also detected.

Results

Bone sclerostin was positively correlated with serum ionised calcium, serum sclerostin, BMD, bone volume/tissue volume (BV/TV), trabecular number (Tb.N), maximum compressive force, and yield strength (r = 0.32, 0.906, 0.355, 0.401, 0.329, 0.355, and 0.293, respectively, P < 0.05) and negatively correlated with age and trabecular separation (Tb.Sp) (r = − 0.755 and − 0.503, respectively, P < 0.05). Bone Dkk-1 was positively correlated with serum ionised calcium, serum Dkk-1, BMD, BV/TV, trabecular thickness, Tb.N, maximum compressive force, yield strength, and Young’s modulus (r = 0.38, 0.809, 0.293, 0.293, 0.228, 0.318, 0.352, 0.315, and 0.266, respectively, P < 0.05) and negatively correlated with age and Tb.Sp (r = − 0.56 and − 0.38, respectively, P < 0.05). Serum levels of sclerostin and Dkk-1 reflected the levels of sclerostin and Dkk-1 in the bone.

Conclusion

Bone sclerostin and Dkk-1 were positively correlated with BMD in women with PO, and higher levels of bone sclerostin and Dkk-1 might predict better BMD, bone microarchitecture, and bone strength. The potential molecular mechanisms still require further study.
How medical students cope with stress: a cross-sectional look at strategies and their sociodemographic antecedents
Authors: Neufeld Adam , Malin Greg
Published: May 2021

Background

Medical training can be highly stressful for students and negatively impact their mental health. Important to this matter are the types of coping strategies (and their antecedents) medical students use, which are only characterized to a limited extent. A better understanding of these phenomena can shed additional light on ways to support the health and well-being of medical students. Accordingly, we sought to determine medical students’ use of various coping reactions to stress and how their gender and year of study influence those behaviours.

Methods

A total of 400 University of Saskatchewan medical students were invited to complete an online survey. Using the Brief COPE inventory, we assessed students’ reported use of various adaptive and maladaptive coping strategies. Descriptive and comparative statistics were performed, including multivariate analysis of variance, to explore how gender and year influenced coping strategies.

Results

The participation rate was 49% (47% males and 53% females). Overall, the students’ coping strategies were mostly adaptive, albeit with a few exceptions. Females used more behavioural disengagement, while males used less emotional and instrumental support. Additionally, third years used more denial to cope with stress than students in any other year.

Conclusions

While few studies report significant sociodemographic effects on medical student coping, our findings raise the possibility that males and females do engage in different coping strategies in medical school, and that the clinical learning environment in third year may provoke more dysfunctional coping, compared to pre-clinical stages of training. Potential explanations and implications of these results are discussed.
Influence of national culture on mentoring relationship: a qualitative study of Japanese physician-scientists
Authors: Obara Haruo , Saiki Takuya , Imafuku Rintaro , Fujisaki Kazuhiko , Suzuki Yasuyuki
Published: May 2021

Background

Nurturing of physician-scientists is an important mission of academic medical institutes. Although the importance of mentorship in developing future physician-scientists internationally is well established, not much information is available about how they are mentored and how national cultures influence the mentoring relationship. This study explores the cultural characteristics of mentoring relationships between senior mentors and junior mentees of Japanese physician-scientists.

Method

A qualitative approach has been employed to explore mentoring relationships of Japanese physician-scientists from cultural viewpoints, through semi-structured interviews with 17 mentees who had the experience of working overseas as post-doctoral research fellow. The reflection of their experiences and the perception of mentoring relationships before going abroad were thematically analyzed by applying Hofstede’s model of six cultural dimensions as a theoretical framework.

Results

Twelve characteristic themes for mentoring were observed, including trustworthy dependency on mentor, embracing paternalistic mentoring, mentee’s initiative within expectations of mentor based on power distance, a sense of loyalty to mentor/organization/colleagues, family-like relationship with mentor based on collectivism, sense of security on being led by mentor through uncertainty avoidance, motivation by role modeling for the competitive academic world, and adaption of female mentee/mentor to a male-dominated academic structure based on masculinity, a long-term relationship between mentor and mentee, receiving advice for organizational continuity based on long-term orientation, putting work before leisure, and friendly relationship between mentor and mentee outside of work based on indulgence.

Conclusions

This study identified the characteristic mentoring relationships of postgraduate mentees of Japanese physician-scientists. Considering the importance of mentoring for physician-scientists in a globalized society, understanding the characteristics of national cultures would help in ensuring culture-sensitive mentoring and would contribute to the development of academic medicine.
Users’ experiences with an interactive Evidence to Decision (iEtD) framework: a qualitative analysis
Authors: Meneses-Echavez Jose Francisco , Rosenbaum Sarah , Rada Gabriel , Flottorp Signe , Moberg Jenny , Alonso-Coello Pablo
Published: May 2021

Background

Evidence to Decision (EtD) frameworks bring clarity, structure and transparency to health care decision making. The interactive Evidence to Decision (iEtD) tool, developed in the context of the DECIDE project and published by Epistemonikos, is a stand-alone online solution for producing and using EtD frameworks. Since its development, little is known about how organizations have been using the iEtD tool and what characterizes users’ experiences with it. This missing information is necessary for any teams planning future developments of the iEtD tool.

Methods

This study aimed to describe users’ experiences with the iEtD and identify main barriers and facilitators related to use. We contacted all users registered in the iEtD via email and invited people who identified themselves as having used the solution to a semi-structured interview. Audio recordings were transcribed, and one researcher conducted a directed content analysis of the interviews guided by a user experience framework. Two researchers checked the content independently for accuracy.

Results

Out of 860 people contacted, 81 people replied to our introductory email (response rate 9.4%). Twenty of these had used the tool in a real scenario and were invited to an interview. We interviewed all eight users that accepted this invitation (from six countries, four continents). ‘Guideline development’ was the iEtD use scenario they most commonly identified. Most participants reported an overall positive experience, without major difficulties navigating or using the different sections. They reported having used most of the EtD framework criteria. Participants reported tailoring their frameworks, for instance by adding or deleting criteria, translating to another language, or rewording headings. Several people preferred to produce a Word version rather than working online, due to the burden of completing the framework, or lack of experience with the tool. Some reported difficulties working with the exportable formats, as they needed considerable editing.

Conclusion

A very limited number of guideline developers have used the iEtD tool published by Epistemonikos since its development. Although users’ general experiences are positive, our work has identified some aspects of the tool that need improvement. Our findings could be also applied to development or improvement of other solutions for producing or using EtD frameworks.
Barriers, knowledge, and training related to pharmacists’ counselling on dietary and herbal supplements: a systematic review of qualitative studies
Authors: Ng Jeremy Y. , Tahir Umair , Dhaliwal Simran
Published: May 2021

Background

Pharmacists are recognized as one of the most accessible healthcare providers and are licensed to advise patients on drugs and health products including dietary and herbal supplements (DHSs). The objective of this study was to identify barriers, knowledge, and training that pharmacists report related to DHSs counselling.

Methods

MEDLINE, EMBASE, AMED and CINAHL were systematically searched from database inception to May 8th, 2020. Eligible articles contained qualitative data with a specific focus on pharmacists’ perceived knowledge, training, and barriers to DHSs counselling. Relevant data were extracted, and a thematic analysis was conducted.

Results

Nineteen articles met the inclusion criteria. The following three main themes were identified: challenges to pharmacists obtaining DHSs education, postgraduate workplace challenges surrounding DHSs, and pharmacists’ perceived role and importance on DHSs. Low knowledge of DHSs and the limited regulations surrounding DHSs acting as a barrier to counselling were common findings supported by the eligible articles.

Conclusions

A lack of pharmacists’ knowledge and awareness of DHSs stems from a variety of factors including a lack of education and training in the field, limited regulations surrounding DHSs, and inadequate availability of DHS information resources in the pharmacy. Pharmacists were unable to confidently counsel patients due to these aforementioned factors in addition to reporting that they lacked time. Further research that reviews pharmacy education and workplace training, and improving DHS regulations are warranted future directions.
Data utilisation and factors influencing the performance of the health management information system in Tanzania
Authors: Mboera Leonard E. G. , Rumisha Susan F. , Mbata Doris , Mremi Irene R. , Lyimo Emanuel P. , Joachim Catherine
Published: May 2021

Background

Health Management Information System (HMIS) is a set of data regularly collected at health care facilities to meet the needs of statistics on health services. This study aimed to determine the utilisation of HMIS data and factors influencing the health system’s performance at the district and primary health care facility levels in Tanzania.

Methods

This cross-sectional study was carried out in 11 districts and involved 115 health care facilities in Tanzania. Data were collected using a semi-structured questionnaire administered to health workers at facility and district levels and documented using an observational checklist. Thematic content analysis approach was used to synthesise and triangulate the responses and observations to extract essential information.

Results

A total of 93 healthcare facility workers and 13 district officials were interviewed. About two-thirds (60%) of the facility respondents reported using the HMIS data, while only five out of 13 district respondents (38.5%) reported analysing HMIS data routinely. The HMIS data were mainly used for comparing performance in terms of services coverage (53%), monitoring of disease trends over time (50%), and providing evidence for community health education and promotion programmes (55%). The majority (41.4%) of the facility’s personnel had not received any training on data management related to HMIS during the past 12 months prior to the survey. Less than half (42%) of the health facilities had received supervisory visits from the district office 3 months before this assessment. Nine district respondents (69.2%) reported systematically receiving feedback on the quality of their reports monthly and quarterly from higher authorities. Patient load was described to affect staff performance on data collection and management frequently.

Conclusion

Inadequate analysis and poor data utilisation practices were common in most districts and health facilities in Tanzania. Inadequate human and financial resources, lack of incentives and supervision, and lack of standard operating procedures on data management were the significant challenges affecting the HMIS performance in Tanzania.
Vitamin D receptor (VDR) expression in different molecular subtypes of canine mammary carcinoma
Authors: Sánchez-Céspedes R. , Fernández-Martínez M. D. , Raya A. I. , Pineda C. , López I. , Millán Y.
Published: May 2021

Background

The molecular-based classification of canine mammary carcinomas (CMCs) has been the focus of much current research. Both in canines and humans, the triple-negative (TN) molecular subtype of mammary cancer is defined by a lack of expression of progesterone receptor (PR), oestrogen receptor (ER) and HER2. It has a poor prognosis; no effective targeted therapy is available. Vitamin D displays anticarcinogenic properties, and the expression of its receptor (VDR) has been found in different molecular subtypes, being about 30–40 % of TN breast cancer (TNBC) positive to it. We assessed the VDR expression in the different molecular subtypes of 58 CMCs from 45 female dogs using an immunohistochemical panel for the molecular classification of included: PR, ER, HER2, cytokeratin (CK) 5, CK14, and Ki67. In addition, we studied the relationship among the molecular subtypes of CMCs and clinicopathologic parameters.

Results

Investigation showed VDR positivity in 45.0 % of the triple-negative CMCs (TNCMCs), 27.3 % of luminal B and 19.0 % of luminal A. Luminal A was the most molecular subtype represented of the total tumours (36.2 %), followed of TNCMCs (34.5 %), luminal B (20.7 %) and HER2-overexpression (10.3 %). Both HER2-overexpression and TNCMC subtypes were positively related to lymphatic invasion (P = 0.028), simple histologic subtype (P = 0.007), a higher histological grade (P = 0.045) and a trend to higher proliferation index (P = 0.09).

Conclusions

The highest VDR expression was observed in TNCMC, being almost half of them (45 %) positive to this receptor. VDR expression was absent in HER2-overexpression tumours and low in luminal A and B molecular subtypes.
Clinical significance of circulating tumour cells and Ki-67 in renal cell carcinoma
Authors: Song Jinbo , Yu Zhe , Dong Bingqi , Zhu Mingkai , Guo Xiaofeng , Ma Yongkang , Zhao Shiming , Yang Tiejun
Published: May 2021

Background

Renal cell carcinoma (RCC) is a common malignant tumour of the genitourinary system. We aimed to analyse the potential value of metastasis-related biomarkers, circulating tumour cells (CTCs) and the proliferative marker Ki-67 in the diagnosis of RCC.

Methods

Data from 24 laparoscopic radical nephrectomies (RNs) and 17 laparoscopic partial nephrectomies (PNs) were collected in 2018. The numbers and positive rates of CTCs and circulating tumour microemboli (CTM) in the peripheral blood were obtained at three different time points: just before surgery, immediately after surgery and 1 week after surgery. Ki-67 protein expression was evaluated in the RCC tissue by immunohistochemistry.

Results

Except for the statistically significant association between the preoperative CTC counts and tumour size, no association between the number and positive rate of perioperative CTCs and clinicopathological features was found. The CTC counts gradually decreased during the perioperative period, and at 1 week after surgery, they were significantly lower than those before surgery. High Ki-67 expression was significantly positively correlated with preoperative CTC counts. In addition, Ki-67 expression was higher in the high CTC group (≥ 5 CTCs).

Conclusion

Our results suggest that surgical nephrectomy is associated with a decrease in CTC counts in RCC patients. CTCs can act as a potential biomarker for the diagnosis and prognosis of RCC. A careful and sufficient long-term follow-up is needed for patients with high preoperative CTC counts.
The global end-ranges of neck flexion and extension do not represent the maximum rotational ranges of the cervical intervertebral joints in healthy adults - an observational study
Authors: Andersen Victoria , Wang Xu , de Zee Mark , Østergaard Lasse Riis , Plocharski Maciej , Lindstroem René
Published: May 2021

Background

In clinical diagnosis, the maximum motion of a cervical joint is thought to be found at the joint’s end-range and it is this perception that forms the basis for the interpretation of flexion/extension imaging studies.

There have however, been representative cases of joints producing their maximum motion before end-range, but this phenomenon is yet to be quantified.

Purpose

To provide a quantitative assessment of the difference between maximum joint motion and joint end-range in healthy subjects. Secondarily to classify joints into type based on their motion and to assess the proportions of these joint types.

Study design

This is an observational study.

Subject sample

Thirty-three healthy subjects participated in the study.

Outcome measures

Maximum motion, end-range motion and surplus motion (the difference between maximum motion and end-range) in degrees were extracted from each cervical joint.

Methods

Thirty-three subjects performed one flexion and one extension motion excursion under video fluoroscopy. The motion excursions were divided into 10% epochs, from which maximum motion, end-range and surplus motion were extracted. Surplus motion was then assessed in quartiles and joints were classified into type according to end-range.

Results

For flexion 48.9% and for extension 47.2% of joints produced maximum motion before joint end-range (type S). For flexion 45.9% and for extension 46.8% of joints produced maximum motion at joint end-range (type C). For flexion 5.2% of joints and for extension 6.1% of joints concluded their motion anti-directionally (type A).

Significant differences were found for C2/C3 (P = 0.000), C3/C4 (P = 0.001) and C4/C5 (P = 0.005) in flexion and C1/C2 (P = 0.004), C3/C4 (P = 0.013) and C6/C7 (P = 0.013) in extension when comparing the joint end- range of type C and type S.

The average pro-directional (motion in the direction of neck motion) surplus motion was 2.41° ± 2.12° with a range of (0.07° -14.23°) for flexion and 2.02° ± 1.70° with a range of (0.04°-6.97°) for extension.

Conclusion

This is the first study to categorise joints by type of motion. It cannot be assumed that end-range is a demonstration of a joint’s maximum motion, as type S constituted approximately half of the joints analysed in this study.