bluuebunny/crossref_metadata_2025 huggingface dataset:
Biomechanical Analysis of Conventional Partially Threaded Screws Versus Headless Compression Screws in Proximal Fifth Metatarsal (Jones) Fracture Fixation
Authors: Lam Kenrick , Bui Roger , Morris Randal , Panchbhavi Vinod
Published: June 2020

Background. Intramedullary screw fixation of Jones fractures using partially threaded screws is a common method of fixation for these injuries, but refracture continues to be a problem. Various other fixation strategies, such as headless compression screws, plantar plating, and tension-band wiring. have been developed to mitigate these issues. Biomechanical studies with regard to these other fixation strategies are limited. Herein, we investigate the compression strength and angular stiffness of Jones fractures fixed with Herbert-style headless compression screws. Methods. Jones fractures were created in 10 fresh-frozen pairs of cadaveric fifth metatarsals. A bone from each pair was instrumented with either a conventional, partially threaded screw 5.0 or 6.5 mm in diameter, or a headless compression screw 5.0 or 7.0 mm in diameter. Sizes were determined via sequential tapping until a snug fit was obtained. Each metatarsal was stressed via cantilever bending over 1000 cycles. We monitored compression and displacement throughout. Results. Headless compression screws achieved a significantly higher amount of stiffness than conventional, partially threaded screws (P = 0.005). There was no statistically significant difference with respect to compression. Conclusion. In a cadaveric model, headless compression screws achieved a greater amount of fracture stiffness versus conventional, partially threaded screws.

Levels of Evidence: Therapeutic, Level V: Biomechanical
Predicting Lodging Demand Trends in the U.S. Hotel Industry
Authors: O’Neill John W. , Ouyang Yuxia
Published: June 2020

Future economic trends in the U.S. hotel industry are often discussed and debated at hotel investment conferences and elsewhere, typically without discussion of the underlying economic indicators that lodging prognosticators should track to predict lodging demand growth and decline. This research endeavors to rank the predictive ability of various economic variables and determine which may be the strongest predictors of lodging demand trends. In addition, we seek to identify a relatively small group of economic variables, that is, a consideration set that may best serve lodging prognosticators with determining the future direction of lodging demand. In our analyses, we evaluate both economic indicators and quarterly change in those indicators. Furthermore, we analyze autoregressive and moving average features of lodging demand in recent years. We present models that prognosticators may use to project lodging demand trends. Although there are a variety of variables that serve to predict lodging demand trends, gross domestic private investment (GDPI) is noted as a particularly effective predictor of lodging demand trends, and it has been effective over all the recent time periods we studied. This information should be beneficial to lodging practitioners/analysts as well as academics.
Sex-Based Differences in Tensiomyography as Assessed in the Lower Erector Spinae of Healthy Participants: An Observational Study
Authors: Lohr Christine , Schmidt Tobias , Braumann Klaus-Michael , Reer Rüdiger , Medina-Porqueres Ivan
Published: June 2020

Background:

Although there is mounting evidence on sex-linked differences in paraspinal muscle function, it is unknown whether sex-based variations in mechanical and contractile characteristics of the lumbar erector spinae (LES) can be monitored noninvasively in healthy participants at rest using tensiomyography (TMG).

Hypothesis:

Sex-specific effects in muscle displacement (Dm) and velocity of muscle deformation (Vd) will be observed via TMG assessed in the LES.

Study Design:

Observational study.

Level of Evidence:

Level 3.

Methods:

LES response was measured in a relaxed state in 40 healthy adults (20 females). Possible differences between the conditions were investigated using mixed-model analyses of variance. Two-stage hierarchical linear regression analyses were performed to predict the outcome of TMG Dm and Vd based on participant sex.

Results:

There were significant main effects of sex with large effect sizes for both TMG parameters, resulting from lower mean values in women compared with men (Dm, P < 0.01; Vd, P < 0.01). In contrast, neither the main effect of side (left vs right LES) nor the interaction between the side and sex reached significance (all P > 0.3). Introducing the sex variable in stage 2 of the regression analyses significantly improved the prediction of the TMG parameters (all ∆R2 ≥ 0.18; all P < 0.01; all f2 ≥ 0.29).

Conclusion:

Sex-based differences in muscle stiffness and contractile characteristics could be observed by TMG on LES muscles in healthy individuals at rest. The data suggest that these disparities are not exclusively attributable to anthropometric measures but may be linked to intrinsic sex-based differences in skeletal muscle characteristics.

Clinical Relevance:

We recommend implementing TMG in a clinical setting using the obtained results as a basis to factor for the patient’s biological sex when assessing effects of therapeutic/exercise regimens aiming at the optimization of myofascial tissue regeneration and performance.
Women’s Foot Health–Related Quality of Life in Ballet Dancers and Nondancers
Authors: López-López Daniel , Fernández-Espiño Cristina , Losa-Iglesias Marta Elena , Calvo-Lobo César , Romero-Morales Carlos , Rodríguez-Sanz David , Navarro-Flores Emmanuel , Becerro-de-Bengoa-Vallejo Ricardo
Published: June 2020

Background:

Prevalence and severity of symptoms related to muscle and joint pain seem to be high in most dancers.

Hypothesis:

There will be a worse quality of life related to foot health for ballet dancers compared with nondancers.

Study Design:

Case-control study.

Level of Evidence:

Level 4.

Methods:

A sample of 156 women was recruited from a clinic of podiatric medicine and surgery. Self-reported data were measured by the Foot Health Status Questionnaire (FHSQ), which has 33 questions that assess 8 health domains of the feet and general health, namely, foot pain, foot function, general foot health, footwear, general health, physical activity, social capacity, and vigor.

Results:

Statistically significant differences ( P < 0.05) were shown for foot pain, foot function, foot health, and general health, which together revealed a worse foot health–related quality of life (lower FHSQ scores) but a better general health (higher FHSQ scores) for ballet dancers compared with nondancers. The remaining domains did not show statistically significant differences ( P > 0.05). According to multivariate linear regression models ( P < 0.05), the practice of ballet dance (group) was the only independent variable that predicted the dependent variables, such as foot pain ( R2 = 0.052;β = +8.349), foot function ( R2 = 0.108; β = +11.699), foot health ( R2 = 0.039; β = +10.769), and general health ( R2 = 0.019; β = −6.795).

Conclusion:

Ballet dancers showed a negative impact on quality of life related to foot health but better overall quality of life (general health) compared with nondancers.

Clinical Relevance:

Paying attention to a dancer’s foot health could provide important benefits for the dancer’s foot health and physical practice of dance.
Sexual Violence in Sport: American Medical Society for Sports Medicine Position Statement
Authors:   AMSSM Sexual Violence in Sport Task Force, Koontz Jennifer Scott , Mountjoy Margo , Abbott Kristin E. , Aron Cindy Miller , Basile Kathleen C. , Carlson Chad T. , Chang Cindy J. , Diamond Alex B. , Dugan Sheila A. , Hainline Brian , Herring Stanley A. , Hopkins B. Elliot , Joy Elizabeth A. , Judge Janet P. , LaBotz Michele , Matuszak Jason , McDavis Cody J. , Myers Rebecca A. , Nattiv Aurelia , Tanji Jeffrey L. , Wagner Jessica , Roberts William O.
Published: June 2020

The American Medical Society for Sports Medicine (AMSSM) convened a group of experts to develop a position statement addressing the problem of sexual violence in sport. The AMSSM Sexual Violence in Sport Task Force held a series of meetings over 7 months, beginning in July 2019. Following a literature review, the task force used an iterative process and expert consensus to finalize the position statement. The objective of this position statement is to raise awareness of this critical issue among sports medicine physicians and to declare a commitment to engage in collaborative, multidisciplinary solutions to reduce sexual violence in sport.
Pain and Functional Scores in Patients Affected by Knee OA after Treatment with Pulsed Electromagnetic and Magnetic Fields: A Meta-Analysis
Authors: Viganò Marco , Perucca Orfei Carlotta , Ragni Enrico , Colombini Alessandra , de Girolamo Laura
Published: June 2020

Objective

The purpose of this systematic review and meta-analysis was to evaluate the effect of electromagnetic field treatment on the symptoms of knee osteoarthritis (OA). In addition, the influence of the type of control group and other covariates have been investigated to identify the sources of heterogeneity in the results of the available clinical trials.

Methods

Randomized controlled trials reporting pulsed electromagnetic field–based therapies for the treatment of knee OA have been included. Main outcomes were self-reported pain and activity scores collected by Visual Analogue Scale (VAS) and/or Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) at short term after treatment.

Results

Thirteen studies comprising 914 unique patients were included in the analysis. Overall reduction in pain score was observed after treatment (standardized mean difference −0.4059, P = 0.0091), while improvement in the activity score was not significant (standardized mean difference −0.4452, P = 0.0859). Type of control (i.e., placebo or alternative therapies) and time of follow-up resulted as the two major elements influencing the outcomes. Indeed, the restriction of the analysis to placebo-controlled trials demonstrated higher standardized mean differences between treatment and control groups, with lower P value for pain, while statistical significance became evident also for the activity score. On the contrary, no differences were observed pooling only studies comparing pulsed electromagnetic or magnetic fields to alternative treatments. In addition, longer follow-up correlated with lower differences between treated and control patients.

Conclusions

Pulsed electromagnetic field therapy effectively relieves knee OA symptoms at short term, but it is not superior to other conservative therapies such as physiotherapy.
Diffuse subcortical white matter injury and bilateral basal ganglia neuronal loss after acute opioid overdose
Authors: Dinicu Andreea I , Chaudhari Amit , Kayyal Simon
Published: June 2020

Opiate intoxication has been associated with life-threatening effects of sympathetic suppression and respiratory depression, but current literature is limited in describing its neurotoxic effects on the central nervous system. Here, we present the case of an otherwise high-functioning adolescent male who was found unresponsive after ingestion of approximately 3–4 fake oxycodone 10–325 mg pills laced with fentanyl. Magnetic resonance imaging showed evidence of diffuse T2 hyperintensities in the corpus callosum and bilateral frontal, parietal, and cerebellum indicative of diffuse white matter injury. In addition, there were distinct areas of restricted diffusion in the bilateral basal ganglia concerning for oxidative stress-mediated neuronal loss. His neurological exam improved with supportive treatment over the course of his hospitalization. Although limited literature has shown leukoencephalopathy to be associated with opioid overdose, we present a case of additional involvement of subcortical gray matter.
BRD4 inhibitor nitroxoline enhances the sensitivity of multiple myeloma cells to bortezomib in vitro and in vivo by promoting mitochondrial pathway-mediated cell apoptosis
Authors: Li Guang , Zheng Yan-Hua , Xu Li , Feng Juan , Tang Hai-Long , Luo Cheng , Song Yan-Ping , Chen Xie-Qun
Published: June 2020

Background:

Multiple myeloma (MM) is the second most common hematological neoplasm. Wide administration of bortezomib significantly improves the survival of MM patients compared with conventional chemotherapy. Bromodomain-containing protein 4 (BRD4) inhibitors also have been demonstrated to retard cell proliferation and induce cellular apoptosis in various cancers. However, it is unclear whether the BRD4 inhibitor nitroxoline plus bortezomib has a synergistic anti-tumor effect on MM.

Methods:

Cell viability was determined via 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Cell cycle and cell apoptosis were assessed via flow cytometry. Protein expression levels were determined via western blotting. The expression of apoptosis-related proteins in xenograft tissue were detected by means of immunohistochemistry.

Results:

Treatment with nitroxoline or bortezomib suppressed cell proliferation, and caused G0/G1 phase arrest and apoptosis in H929 and RPMI8226 cells. Furthermore, nitroxoline intensified the retardation of cell proliferation, as well as further enhanced the G0/G1 phase arrest and apoptosis induced by bortezomib in H929 and RPMI8226 cells. The western blot analysis revealed that nitroxoline or bortezomib treatment markedly diminished the levels of Bcl-2 and cyclin D1, and increased the levels of p21, Bax, cleaved PARP and cleaved caspase-3. Combination of these two agents was observed to result in further marked changes on these levels compared with nitroxoline or bortezomib treatment alone. What is more, in the xenograft tumor model, combinative treatment markedly inhibited tumor growth compared with the single drug treatment.

Conclusion:

Combination of bortezomib with nitroxoline has a synergistic anti-tumor activity in MM cells and may be a novel treatment method for MM.
‘What they say peters down’: How non-profit leaders assess the trustworthiness of government – Elite discourse and distrust in post-conflict Northern Ireland
Authors: Rice Charis , Taylor Maureen
Published: June 2020

This article uses Northern Ireland as a research context to explore how elite discourse (from political and media actors/institutions) influences how Non-Profit Leaders (NPLs) assess the trustworthiness of government. We provide emergent themes which should aid theory development and practice in the area of political public relations by showing: (1) the value NPLs place on ‘soft’ trust qualities in trust assessments of government, namely benevolence; (2) the importance NPLs place on communicative acts which model trust (e.g. dialogue, compromise, mediation); and (3) the destructive role of divisive political elite discourse within a defective political system, amplified via the media, in NPLs’ distrust of government. The study thereby emphasises the crucial and constitutive role trust perceptions play in (in)effective political public relations, arguing that ‘trust’ must be defined by the perceiver and critically unpacked if public relations research is to fully appreciate its function. We propose that the nature of Northern Ireland’s post-conflict divided society, and political discourse in specific, makes certain trust antecedents most desirable to cross-community stakeholders. The findings contribute to further refining the concept of trust in public relations and they may also be instructive for other contexts.
Safety assessment and results of coronary spasm provocation testing in patients with myocardial infarction with unobstructed coronary arteries compared to patients with stable angina and unobstructed coronary arteries
Authors: Probst Sabine , Seitz Andreas , Martínez Pereyra Valeria , Hubert Astrid , Becker Alexander , Storm Klaus , Bekeredjian Raffi , Sechtem Udo , Ong Peter
Published: June 2020

Background

Coronary spasm is an established cause for myocardial infarction with unobstructed coronary arteries, and can be diagnosed using intracoronary acetylcholine testing. However, it has been questioned whether such testing is feasible and safe in the acute phase. The aim of this study was to assess the frequency of coronary spasm and the safety of the acetylcholine test in patients with myocardial infarction with unobstructed coronary arteries compared to patients with stable angina and unobstructed coronaries.

Methods

One hundred and eighty selected patients (52% women, mean age 62 ± 13 years) with either myocardial infarction with unobstructed coronary arteries (n = 80) or stable angina and unobstructed coronaries (n = 100) were enrolled from 2007–2018. All patients underwent the acetylcholine test according to a standardised protocol immediately after diagnostic angiography. Apart from assessment of clinical, demographic and risk factor data, side effects and complications during the acetylcholine test were recorded.

Results

Overall, epicardial spasm was found in 26% with a higher prevalence among the myocardial infarction with unobstructed coronary arteries compared to the stable angina patients (35% vs 19%, p = 0.017). Microvascular spasm was found in 42% with a higher prevalence among the stable patients compared to the myocardial infarction with unobstructed coronary arteries cohort (53% vs 29%, p = 0.0014). There were no statistically significant differences in the rate of side effects (16% vs 14%, p = 0.674) or complications (1% vs 2.5%, p = 0.438) between the two groups. None of the patients experienced irreversible complications.

Conclusion

Coronary spasm is a frequent cause for myocardial infarction with unobstructed coronary arteries. Spasm provocation testing using acetylcholine is feasible in such patients in the acute phase. The complication rate during acetylcholine testing in myocardial infarction with unobstructed coronary arteries patients is low and comparable to patients with stable angina.
The Community Analytics Academy Pilot: A Community-Academic Partnership for Building Community Health Care Analytic Capacity
Authors: BeLue Rhonda , Wirth Lorinette , Steormer Amanda , Alexander Suzanne
Published: June 2020

The ability to analyze data to identify best practices is key to improving quality of care for community-based health care organizations (CBOs). Leading commercial statistical software remains too costly for many CBOs operating in underserved communities. The St Louis Integrated Health Network (IHN) collaborates with CBOs to increase access to health care. IHN and a local university developed the Community Analytics Academy (CAA), a training collaborative designed to meet the need for data-informed decision making among CBOs. Establishing analytics training collaboratives for CBOs empowers organizations to respond to the ever-growing amounts of health care data and the need for data-driven decision making.
Examining Students’ Responses to Teacher Translation Feedback: Insights From the Perspective of Student Engagement
Authors: Zheng Yao , Zhong Qiting , Yu Shulin , Li Xiaohui
Published: June 2020

This case study investigated students’ response to feedback in the lens of student engagement with teacher feedback on their translation work. Drawing upon data from multiple sources, including students’ translation assignments, classroom observations, semi-structured interviews, stimulated recalls, and other documents, it explored how three Chinese undergraduates engaged with the feedback affectively, behaviorally, and cognitively. The findings reveal that (a) the students went through varying mood swings, and their expectations and teacher-related beliefs impacted their judgments of the feedback; (b) their failure to undertake self-editing upon receiving feedback was attributable to both student individual factors and teacher practices; and (c) extensive cognitive and behavioral operations could contribute to students’ deeper understanding of the feedback. These indicate the complex and interrelated relationship among the three dimensions of student engagement and contribute to our limited knowledge on the interplay between teacher translation feedback and student responses. Pedagogical implications are put forward for translation teachers to provide feedback and improve translation students’ engagement.
Delivering Breast Reconstruction Information to Patients—Part 2: Women Report on Preferred Information Content
Authors: Jacox Natalie , Webb Carmen , Sharma Vishal , Temple-Oberle Claire
Published: June 2020

Purpose:

To determine the type of information women want to be provided in order to make an informed decision as to whether, when, and using what technique to proceed with breast reconstruction.

Method:

Using purposeful sampling, 19 patients who had recently undergone various breast reconstruction procedures were recruited to each participate in a 30- to 45-minute semi-structured interview. Participants shared their insights and beliefs regarding the type of breast reconstruction information they most valued prior to undergoing breast reconstruction surgery. Participants were also queried as to perceived information gaps. In some cases, the participants’ partners or support persons were also interviewed. Grounded theory and thematic analysis assisted in interview transcript analysis.

Results:

Eight topics were identified relating to women’s informational needs around breast reconstruction. Examples include how to weigh the pros and cons of various breast reconstruction options to decide between flap or implant reconstruction, whether there are safety concerns with immediate breast reconstruction or nipple-sparing reconstruction, and expectations and advice on how to manage possibly unexpected intimacy issues after breast reconstruction.

Conclusions:

Using mixed methods research methodology, 19 women reported on preoperative informational gaps relating to their recent breast reconstruction experiences. Patients report that adequate breast reconstruction information prior to breast reconstruction surgery helps them to manage their expectations, prepare for surgery and recovery, and improve postoperative satisfaction.
The Educational System and the Ethnic Skills Gap among the Working-Age Population: An Analysis of 16 Western Immigration Countries
Authors: Heisig Jan Paul , Schaeffer Merlin
Published: June 2020

Research shows that children of immigrants, the “second generation,” have comparatively high educational aspirations. This “immigrant optimism” translates into ambitious educational choices, given the second generation’s level of academic performance. Choice-driven (comprehensive) education systems, which allow the children of immigrants to follow their ambitions, are therefore regarded as facilitating their structural integration. The authors focus on an underappreciated consequence of these findings. If the second generation strives for higher qualifications than children of native-born parents with similar performance, working-age children of immigrants should have lower skills than children of native-born parents with comparable formal education. This could result in (statistical) employer discrimination and ultimately hamper integration. This pattern should be particularly pronounced in choice-driven education systems and in systems that emphasize vocational education. Two-step regression models using data on 16 countries support these expectations. The authors explore implications of these findings for comparative research on ethnic gaps in labor market attainment.
Overall mortality
Authors: Moore Duncan F , Steen Virginia D
Published: June 2020

Systemic sclerosis is a highly morbid, complex autoimmune disease that is variable both in its phenotype and the attendant mortality driven by such manifestations. This review article synthesizes mortality data from the best available meta-analyses, subgroup analyses of single cohorts, and subjective comparisons of individual cohort studies, which in aggregate suggest that mortality in systemic sclerosis has been gradually improving over the past several decades. This review also summarizes the literature describing various risk factors for mortality in systemic sclerosis.
Assessment of Patient Experiences in Otolaryngology Virtual Visits During the COVID‐19 Pandemic
Authors: Itamura Kyohei , Rimell Franklin L. , Illing Elisa A. , Higgins Thomas S. , Ting Jonathan Y. , Lee Matthew K. , Wu Arthur W.
Published: June 2020

This study evaluates the patient experience during virtual otolaryngology clinic visits implemented during the coronavirus disease 2019 (COVID‐19) pandemic. Patient satisfaction surveys were queried from January 1, 2020, to May 1, 2020, for both telehealth and in‐person visits. A descriptive analysis of the question responses was performed. There were 195 virtual and 4013 in‐person visits with surveys completed in this time period. Ratings related to provider‐patient communication were poor for virtual visits. Telehealth has become the new norm for most health care providers in the United States. This study demonstrates some of the initial shortcomings of telehealth in an otolaryngology practice and identifies challenges with interpersonal communication that may need to be addressed as telehealth becomes increasingly prevalent.
Protection for Otolaryngologic Surgery in the COVID‐19 Pandemic
Authors: Lagos Antonia E. , Ramos Phoebe H. , Andrade Tomás
Published: June 2020

Objective

The coronavirus disease 2019 (COVID‐19) has placed unprecedented challenges on the world and the medical community. It is transmitted through droplets, contact, the fecal‐oral route, and airborne transmission under certain conditions that allow droplets to combine with air particles to form an aerosol. Viral loads are higher in the nasal area and similar in symptomatic and asymptomatic patients. Medical situations have been classified into high and low risk of generating aerosols. Most procedures and surgery in otolaryngology correspond to high‐risk medical situations. This review aims to gather the vast amount of available information and generate recommendations for different surgical procedures according to aerosolization risk and COVID‐19 status, with use of specific personal protective equipment in each case.

Data Sources

PubMed, MEDLINE, and Embase. Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, and Food and Drug Administration.

Review Methods

We conducted a review on the literature on personal protective equipment for otolaryngologic surgery and surgical indication restrictions during the COVID‐19 pandemic.

Conclusions

SARS‐CoV‐2 is an easily transmitted virus. Asymptomatic and symptomatic patients with COVID‐19 present an upper airway high viral load, conferring otolaryngologic procedures a high risk of aerosolization. Surgical procedures must be categorized according to aerosolization risk and the possibility of COVID‐19 diagnosis, according to use of personal protective equipment.

Implications for Practice

This review contributes to scientific knowledge regarding the detailed description of protective personal equipment and, most important, surgical recommendations to reduce the risk of infection in the otolaryngology community during the COVID‐19 pandemic.
Effect of skew on the minimum support length requirements of single-span bridges with seat-type abutments
Authors: Wu Suiwen , Buckle Ian G
Published: June 2020

Skew bridges are known to be susceptible to girder unseating during earthquakes, and empirical equations for minimum support length are used in their design. To determine the degree of conservatism or un-conservatism in these equations, a rigorous model of a skewed bridge was developed in OpenSees and validated against a comprehensive dataset from shake table experiments. The validated model was then used to perform a parameter study on a series of single-span, simply supported, prototype bridges with seat-type abutments. Nonlinear response history analyses were performed that included impact and friction effects at the abutments and were repeated for both far-field and near-field motions. It was found that the additional support length required to prevent unseating is a linear function of skew angle over the range 0°–60° for both types of motions. This is contrary to common practice, which uses a quadratic function (American Association of State Highway and Transportation Officials, AASHTO) or the inverse of cosine of angle of skew (Federal Highway Administration (FHWA)). Consequently, common practice appears to be underestimating support length requirements by up to 50% at midrange skew angles of 30°–40°.
Impact of migraine on workplace productivity and monetary loss: a study of employees in banking sector in Malaysia
Authors: Wong Li Ping , Alias Haridah , Bhoo-Pathy Nirmala , Chung Ivy , Chong Yew Ching , Kalra Sonesh , Shah Zia U Bahkt Sultan
Published: June 2020

Background/objective

Productivity and monetary loss due to migraine in the workplace may be substantial. This study aimed to determine the impact of migraine on productivity and monetary lost among employees in the banking sectors, in a multiethnic middle income country.

Methods

A cross-sectional online survey was conducted among employees in two multinational banks in Malaysia between April and July 2019. Screening for migraine was conducted using the self-administered ID-Migraine™ questionnaire. Migraine-related disability (MIDAS) and headache frequency were recorded. Impact of migraine on work productivity and activities were evaluated using the Work Productivity and Activity Impairment (WPAI) questionnaire.

Results

Of the 1268 employees who submitted complete responses, 47.2% (n = 598) were screened positive for migraine. Strikingly, the mean percent productivity loss at work (presenteeism) was almost 20-fold higher than the mean percent work time missed due to migraine (absenteeism) (39.1% versus 1.9%). The mean percent productivity loss in regular activity (activity impairment) and overall work productivity loss (work impairment) was 38.4% and 39.9%, respectively. It was also found that the costs related to presenteeism (MYR 5392.6) (US$1296) was 3.5-fold higher than absenteeism (MYR1,548.3) (US$370). Highest monetary loss related to presenteeism was reported in migraineurs with frequency of headache of above 3 days (MYR 25,691.2) (US$6176), whereas highest monetary loss related to absenteeism was reported in migraineurs with MIDAS grade IV (MYR 12,369.1) (US$2973). Only 30% of migraineurs of MIDAS grade IV reported taking prescribed medication. Notably, a vast majority (96%) of migraineurs who had three or lower episodes of migraine per month did not seek treatment.

Conclusion

The significant impact of migraine on work productivity and regular activity, appears to lead to substantial monetary loss attributed to not only absenteeism, but more importantly to presenteeism. This study also highlights the unmet needs in migraine management among employees in the banking sector.
SAPK2 contributes to rice yield by modulating nitrogen metabolic processes under reproductive stage drought stress
Authors: Lou Dengji , Chen Zhen , Yu Diqiu , Yang Xiaoyan
Published: June 2020

Background

The sucrose non-fermenting 1-related kinases 2 (SnRK2s) play important roles in osmotic stress responses inA. thalianaand rice (Oryza sativaL.). Osmotic stress/ABA–activated protein kinase 2 (SAPK2) is a member of SnRK2s subclass II in rice, but its function in rice yield under drought stress is unclear.

Results

Compared with wild-type (Oryza.Sativa L.spp.japonica, WT) plants, thesapk2rice mutant lines were shorter and produced fewer grains per panicle, smaller grains and lower grain yield under reproductive stage drought stress (RDS). Subsequent analysis suggested that SAPK2 considerably influences the nitrogen, phosphorus, and potassium contents of rice grains. The examination of rice seedling growth and development under nutrient-deprived conditions (−N, −K, and − P) proved that SAPK2 can significantly affect rice seedling growth and root development in hydroponic cultures lacking N and K. Moreover, the NO3−influx rate and nitrate concentration analysis indicated that SAPK2 promotes nitrate uptake and assimilation by regulating nitrate-related transporters.

Conclusion

These results suggest thatSAPK2could enhance grain production by regulating nitrogen utilization efficiency under RDS. Our work provided insights to breeding drought tolerant rice with high nutrient uptake.
Perceived facilitators and predictors of positive change and posttraumatic growth following a first episode of psychosis: a mixed methods study using a convergent design
Authors: Jordan Gerald , Malla Ashok , Iyer Srividya N.
Published: June 2020

Background

This study aimed to identify predictors and perceived facilitators of positive change and posttraumatic growth in persons with a first episode of psychosis using a mixed methods convergent design.

Methods

In the quantitative component, 94 participants completed measures of posttraumatic growth and predictors of posttraumatic growth. The qualitative component involved in-depth interviews with 12 participants.

Results

Quantitative results revealed that being hospitalized for psychosis, spiritual coping, positive reframing and subjective recovery were significant predictors of posttraumatic growth. Qualitative findings revealed that positive change was perceived to be facilitated by the psychosis itself; receiving mental health services; drawing on personal and social resources and strategies; healing and recovering; a meaning-making and knowledge gaining process; and normative developmental processes.

Conclusions

Posttraumatic growth following a first episode of psychosis may therefore be facilitated by complex person-environment interactions.
The thermostability of the RTS,S/AS01 malaria vaccine can be increased by co-lyophilizing RTS,S and AS01
Authors: Fortpied Juliette , Collignon Sylvie , Moniotte Nicolas , Renaud Frédéric , Bayat Babak , Lemoine Dominique
Published: June 2020

Background

Developing thermostable vaccines is a challenge for pharmaceutical companies due to the inherent instability of biological molecules in aqueous solution. The problem is even more stringent in regions subjected to high temperatures in which protective cold chain is difficult to maintain due to a lack of infrastructure. Here, a simple, cost-effective solution to increase the thermostability of the malaria candidate vaccine RTS,S/AS01 is described. This vaccine currently needs to be stored between 2 and 8  °C due to the sensitivity of liquid AS01 to higher temperatures. The strategy was to increase thermostability by co-lyophilizing the RTS,S antigen and AS01.

Methods

Co-lyophilization was achieved in a solution containing 5% sucrose, 10 mM potassium phosphate and 0.0312% polysorbate 80 at pH 6.1. The physicho-chemical characteristics and immunogenic properties of the resulting solid product, called CL-vac, fresh or stored at high temperature, were compared to those of the candidate RTS,S/AS01.

Results

CL-vac proved to be acceptable in terms of visual appearance and physico-chemical characteristics. The structural integrity of both RTS,S and AS01 within CL-vac and its equivalence to the RTS,S/AS01 candidate vaccine were shown. Further, the stability of CL-vac was demonstrated for storage periods including 1 year at 4  °C, 1 year at 30  °C, and up to 6 months at 37  °C. In addition, CL-vac could withstand a heat excursion consisting of 1 month at 45  °C after storage for 1 year at 30  °C. Equivalence and stability were demonstrated by the various analytical tools and the immunogenicity of the samples after storage was also demonstrated in mice.

Conclusions

In conclusion, the co-lyophilization process appeared as a promising approach to increase RTS/AS01 vaccine thermostability.
Is the allocation of medical and health resources effective? Characteristic facts from regional heterogeneity in China
Authors: Yi Ming , Peng Jiachao , Zhang Lian , Zhang Yao
Published: June 2020

Background

Over the last decade, the expenditure on public medical and health has increased greatly in China, however, problems as low efficiency and unfairness still exist. How to accurately describe the effectiveness of existing medical and health resources in combination with regional heterogeneity is of great significance to China’s medical and health reform.

Methods

Based on provincial panel data for the period of 2005 to 2017, combining expected output and unexpected output, this paper constructs a super-efficiency three-stage SBM-DEA model, to measure and analyze the spatial-temporal heterogeneity characteristics and influencing factors of public medical and health efficiency (PMHE).

Results

(1) After the impacts of random error and external environmental factors are removed, the mean value of overall PMHE is 0.9274, failing to reach DEA efficiency, and PMHE shows a fluctuated downward trend. (2) The adjusted PMHE level shows a prominent spatial imbalance at the stage 3. The average efficiency level is ranked by the East > the West > the Central > the Northeast. (3) The increases of GDP per capita and population density are beneficial to the improvement of PMHE, while income level and education level are disadvantageous to PMHE, and last, the urbanization level, an uncertain effect. (4) There is no σ convergence of the PMHE in the East, the Central and the West, that is, the internal differences may gradually expand in the future, while the Northeast shows a significant σ convergence trending of PMHE. (5) The state’s allocation of medical and health resources has undergone major changes during “The Twelfth Five-Year Plan”.

Conclusion

This study innovatively incorporates undesired outputs of health care into the efficiency evaluation framework by constructing the main efficiency evaluation indicators. The results of the robust evaluation conclude that China’s existing investment in medical and health resources is generally not effective. Therefore, although China’s health care reform has made certain achievement, it is still necessary to expand the investment in health care resources.
Who is going to pay the price of Covid-19? Reflections about an unequal Brazil
Authors: Ribeiro Fabiana , Leist Anja
Published: June 2020

The COVID-19 pandemic has caused high mortality rates among older people, and in order to avoid a healthcare system crisis, almost all countries worldwide have adopted social isolation measures to prevent the spread of the disease. However, in Brazil, a country demarcated by economic inequalities, in which approximately 25% of the population live below the poverty line, these measures will cost severe economic losses and accentuated starvation. For this reason, the underprivileged population should be immediately prioritized and well informed through good practice to avoid the virus. Since, government discrepancies in dealing with the COVID-19 outbreak leaves the population without congruent guidelines on how to react or what to believe, allowing the spread of fake news and political crises. Here, we discuss who will pay the price of the Brazilian government denying the impact of COVID-19 pandemic and suggest some measures to ensure that clear information and protection reach this population.
Prenatal exposure to pesticides and risk for holoprosencephaly: a case-control study
Authors: Addissie Yonit A. , Kruszka Paul , Troia Angela , Wong Zoë C. , Everson Joshua L. , Kozel Beth A. , Lipinski Robert J. , Malecki Kristen M. C. , Muenke Maximilian
Published: June 2020

Background

Pesticide exposure during susceptible windows and at certain doses are linked to numerous birth defects. Early experimental evidence suggests an association between active ingredients in pesticides and holoprosencephaly (HPE), the most common malformation of the forebrain in humans (1 in 250 embryos). No human studies to date have examined the association. This study investigated pesticides during multiple windows of exposure and fetal risk for HPE. It is hypothesized that pre-conception and early pregnancy, the time of brain development in utero, are the most critical windows of exposure.

Methods

A questionnaire was developed for this retrospective case-control study to estimate household, occupational, and environmental pesticide exposures. Four windows of exposure were considered: preconception, early, mid and late pregnancy. Cases were identified through the National Human Genome Research Institute’s ongoing clinical studies of HPE. Similarly, controls were identified as children with Williams-Beuren syndrome, a genetic syndrome also characterized by congenital malformations, but etiologically unrelated to HPE. We assessed for differences in odds of exposures to pesticides between cases and controls.

Results

Findings from 91 cases and 56 controls showed an increased risk for HPE with reports of maternal exposure during pregnancy to select pesticides including personal insect repellants (adjusted odds ratio (aOR) 2.89, confidence interval (CI): 0.96–9.50) and insecticides and acaricides for pets (aOR 3.84, CI:1.04–16.32). Exposure to household pest control products during the preconception period or during pregnancy was associated with increased risk for HPE (aOR 2.60, OR: 0.84–8.68). No associations were found for occupational exposures to pesticides during pregnancy (aOR: 1.15, CI: 0.11–11.42), although exposure rates were low. Higher likelihood for HPE was also observed with residency next to an agricultural field (aOR 3.24, CI: 0.94–12.31).

Conclusions

Observational findings are consistent with experimental evidence and suggest that exposure to personal, household, and agricultural pesticides during pregnancy may increase risk for HPE. Further investigations of gene by environment interactions are warranted.
From COVID-19 research to vaccine application: why might it take 17 months not 17 years and what are the wider lessons?
Authors: Hanney Stephen R. , Wooding Steven , Sussex Jon , Grant Jonathan
Published: June 2020

It is often said that it takes 17 years to move medical research from bench to bedside. In a coronavirus disease (COVID-19) world, such time-lags feel intolerable. In these extraordinary circumstances could years be made into months? If so, could those lessons be used to accelerate medical research when the crisis eases?

To measure time-lags in health and biomedical research as well as to identify ways of reducing them, we developed and published (in 2015) a matrix consisting of overlapping tracks (or stages/phases) in the translation from discovery research to developed products, policies and practice. The matrix aids analysis by highlighting the time and actions required to develop research (and its translation) both (1) along each track and (2) from one track to another, e.g. from the discovery track to the research-in-humans track. We noted four main approaches to reducing time-lags, namely increasing resources, working in parallel, starting or working at risk, and improving processes.

Examining these approaches alongside the matrix helps interpret the enormous global effort to develop a vaccine for the 2019 novel coronavirus SARS-CoV-2, the causative agent of COVID-19. Rapid progress in the discovery/basic and human research tracks is being made through a combination of large-scale funding, work being conducted in parallel (between different teams globally and through working in overlapping tracks), working at greater (but proportionate) risk to safety than usual, and adopting various new processes. The overlapping work of some of the teams involves continuing animal research whilst entering vaccine candidates into Phase I trials alongside planning their Phase II trials. The additional funding available helps to reduce some of the usual financial risks in moving so quickly. Going forward through the increasingly large human trials for safety, dosage and efficacy, it will be vital to overlap work in parallel in the often challenging public policy and clinical tracks. Thus, regulatory and reimbursement bodies are beginning and preparing rapid action to pull vaccines proving to be safe and effective through to extraordinarily rapid application to the general population. Monitoring the development of a COVID-19 vaccine using the matrix (modified as necessary) could help identify which of the approaches speeding development and deployment could be usefully applied more widely in the future.
The clinical application of electrical impedance technology in the detection of malignant neoplasms: a systematic review
Authors: Pathiraja Angela A. , Weerakkody Ruwan A. , von Roon Alexander C. , Ziprin Paul , Bayford Richard
Published: June 2020

Background

Electrical impedance technology has been well established for the last 20 years. Recently research has begun to emerge into its potential uses in the detection and diagnosis of pre-malignant and malignant conditions. The aim of this study was to systematically review the clinical application of electrical impedance technology in the detection of malignant neoplasms.

Methods

A search of Embase Classic, Embase and Medline databases was conducted from 1980 to 22/02/2018 to identify studies reporting on the use of bioimpedance technology in the detection of pre-malignant and malignant conditions. The ability to distinguish between tissue types was defined as the primary endpoint, and other points of interest were also reported.

Results

731 articles were identified, of which 51 reported sufficient data for analysis. These studies covered 16 different cancer subtypes in a total of 7035 patients. As the studies took various formats, a qualitative analysis of each cancer subtype’s data was undertaken. All the studies were able to show differences in electrical impedance and/or related metrics between malignant and normal tissue.

Conclusions

Electrical impedance technology provides a novel method for the detection of malignant tissue, with large studies of cervical, prostate, skin and breast cancers showing encouraging results. Whilst these studies provide promising insights into the potential of this technology as an adjunct in screening, diagnosis and intra-operative margin assessment, customised development as well as multi-centre clinical trials need to be conducted before it can be reliably employed in the clinical detection of malignant tissue.