bluuebunny/crossref_metadata_2025 huggingface dataset:
Patients’ trust and associated factors among primary care institutions in China: a cross-sectional study
Authors: Li Liqing , Zhu Liyong , Zhou Xiaogang , Zeng Guohua , Huang Hongwei , Gan Yong , Lu Zuxun , Wang Xiaofang , Chen Zhensheng , Sun Ke , Yang Di , Zhang Qi , Wu Chunmei
Published: May 2022

Background

Empirical evidence on patients’ trust and the factors among primary care institutions (PCIs) in China is limited. This study aimed to investigate patients’ trust and explore some associated factors among PCIs in the central region of China.

Methods

The data was collected through a multistage stratified sampling method with a structured self-administered questionnaire, which was distributed from January to March 2021 among 2,287 Chinese patients ever involved in seeking healthcare among PCIs. Patients’ trust was measured with the Chinese version of the Wake Forest Physician Trust Scale (C-WFPTS). Differences in C-WFPTS scores among groups were estimated by t-tests or ANOVA analyses. Multiple linear regression analysis was used to analyze influencing factors for patients’ trust in primary care physicians.

Results

Based on the C-WFPTS with a full score of 50, the average score of patients’ trust was 34.19 (SD = 5.83). Multiple linear analyses indicated that the patients who were older aged, married, with education of higher level, living in urban regions, under better health status and with a family doctor contract reported a higher level of patients’ trust.

Conclusion

Patients’ trust in primary care physicians was at a medium but slightly improved level in the central region of China. Age, marital status, education, residential area, health status, and a family doctor contract were significant predictors of patients’ trust.
Percutaneous reduction with double screwdrivers versus limited open reduction in the treatment of irreducible extracapsular hip fractures
Authors: Huang Qiang , Xu YiBo , Xue HanZhong , Wang Qian , Li Ming , Ren Cheng , Lu Yao , Li Zhong , Zhang Kun , Ma Teng
Published: May 2022

Background

The reduction in irreducible extracapsular hip fractures has always been controversial. Here, we present a new minimally invasive reduction technique and compare it with limited open reduction (LOR) to treat irreducible extracapsular hip fractures.

Methods

From January 2016 to January 2018, our institution treated 653 patients with extracapsular hip fractures by intramedullary fixation. Among them, 525 cases got a successful closed reduction. The other 128 were irreducible and reduced by percutaneous reduction with double screwdrivers (PRDS) or LOR. There were 66 cases in the PRDS group while 62 in the LOR group. All fractures were classified using the Evans-Jensen classification. In addition, the differences in incision length, blood loss, fluoroscopic number, operation time, inpatient time, weight training time, Harris score, and complications were analyzed.

Results

The incision length was 8.4 ± 1.4 cm in the PRDS group and 15.3 ± 3.0 cm in the LOR group, respectively (p < 0.05); blood loss was equal to 151 ± 26 and 319 ± 33 ml, respectively (p < 0.05); fluoroscopic number was 14 ± 3 and 8 ± 2, respectively (p < 0.05); operation time was 44 ± 9 and 73 ± 11 min, respectively (p < 0.05); inpatient time was 6.2 ± 1.7 and 8.4 ± 2.2 days, respectively (p < 0.05); weight training time after the operation was 4.5 ± 1.5 and 10.7 ± 1.8 days, respectively (p < 0.05); and the excellent rate of Harris score was 92.4% and 88.7%, respectively (p > 0.05). There was no significant difference in complication incidence between the two groups (p > 0.05).

Conclusions

The PRDS group presented better clinical effects for managing irreducible extracapsular hip fractures than the LOR. Therefore, the PRDS technique could be the first reduction choice for patients with irreducible fractures.
Efficiency of biofilm removal by combination of water jet and cold plasma: an in-vitro study
Authors: Matthes Rutger , Jablonowski Lukasz , Pitchika Vinay , Holtfreter Birte , Eberhard Christian , Seifert Leo , Gerling Torsten , Vilardell Scholten Laura , Schlüter Rabea , Kocher Thomas
Published: May 2022

Background

Peri-implantitis therapy is a major problem in implantology. Because of challenging rough implant surface and implant geometry, microorganisms can hide and survive in implant microstructures and impede debridement. We developed a new water jet (WJ) device and a new cold atmospheric pressure plasma (CAP) device to overcome these problems and investigated aspects of efficacy in vitro and safety with the aim to create the prerequisites for a clinical pilot study with these medical devices.

Methods

We compared the efficiency of a single treatment with a WJ or curette and cotton swab (CC) without or with adjunctive use of CAP (WJ + CAP, CC + CAP) to remove biofilm in vitro from rough titanium discs. Treatment efficacy was evaluated by measuring turbidity up to 72 h for bacterial re-growth or spreading of osteoblast-like cells (MG-63) after 5 days with scanning electron microscopy. With respect to application safety, the WJ and CAP instruments were examined according to basic regulations for medical devices.

Results

After 96 h of incubation all WJ and CC treated disks were turbid but 67% of WJ + CAP and 46% CC + CAP treated specimens were still clear. The increase in turbidity after WJ treatment was delayed by about 20 h compared to CC treatment. In combination with CAP the cell coverage significantly increased to 82% (WJ + CAP) or 72% (CC + CAP), compared to single treatment 11% (WJ) or 10% (CC).

Conclusion

The newly developed water jet device effectively removes biofilm from rough titanium surfaces in vitro and, in combination with the new CAP device, biologically acceptable surfaces allow osteoblasts to grow. WJ in combination with CAP leads to cleaner surfaces than the usage of curette and cotton swabs with or without subsequent plasma treatment. Our next step will be a clinical pilot study with these new devices to assess the clinical healing process.
Survival analysis of three types of maxillary and mandibular bonded orthodontic retainers: a retrospective cohort
Authors: Rezaei Navid , Bagheri Zahra , Golshah Amin
Published: May 2022

Background

Retention is an important aspect of orthodontic treatment. This study aimed to analyze the survival of three types of maxillary and mandibular bonded orthodontic retainers.

Methods

This retrospective cohort study evaluated the records of 118 orthodontic patients (90 females, 28 males, mean age of 22.34 ± 6.44 years) retrieved from a private orthodontic office. Data regarding the retainer failure, dental caries, unwanted tooth movements, maximum pocket depth (PD), and bleeding on probing (BOP) recorded at the follow-up sessions were extracted from patient records. Three types of retainer wires namely Bond-A-Braid, Orthoflex, and Retainium were compared regarding the abovementioned parameters. Data were analyzed by ANOVA, Chi-square, Monte-Carlo Chi-square, and Kruskal Wallis tests, the log rank test, and the Cox regression model.

Results

The frequency of retainer failure was not significantly different between males and females, different age groups, or different treatment durations (P > 0.05). Wire fracture was the most common failure type in both the maxilla and mandible. Also, the frequency of failure was not significantly different between the maxillary and mandibular retainers (P > 0.05). The frequency of failure, and survival of the three types of retainer wires were not significantly different during a 5-year period (P > 0.05).

Conclusions

The three types of orthodontic retainers had comparable survival rates. Their failure rate was not correlated with the age or gender of patients or the treatment duration.
Pre-clerkship EPA assessments: a thematic analysis of rater cognition
Authors: Meyer Eric G. , Harvey Emily , Durning Steven J. , Uijtdehaage Sebastian
Published: May 2022

Background

Entrustable Professional Activities (EPAs) assessments measure learners’ competence with an entrustment or supervisory scale. Designed for workplace-based assessment EPA assessments have also been proposed for undergraduate medical education (UME), where assessments frequently occur outside the workplace and may be less intuitive, raising validity concerns. This study explored how assessors make entrustment determinations in UME, with additional specific comparison based on familiarity with prior performance in the context of longitudinal student-assessor relationships.

Methods

A qualitative approach using think-alouds was employed. Assessors assessed two students (familiar and unfamiliar) completing a history and physical examination using a supervisory scale and then thought-aloud after each assessment. We conducted a thematic analysis of assessors’ response processes and compared them based on their familiarity with a student.

Results

Four themes and fifteen subthemes were identified. The most prevalent theme related to “student performance.” The other three themes included “frame of reference,” “assessor uncertainty,” and “the patient.” “Previous student performance” and “affective reactions” were subthemes more likely to inform scoring when faculty were familiar with a student, while unfamiliar faculty were more likely to reference “self” and “lack confidence in their ability to assess.”

Conclusions

Student performance appears to be assessors’ main consideration for all students, providing some validity evidence for the response process in EPA assessments. Several problematic themes could be addressed with faculty development while others appear to be inherent to entrustment and may be more challenging to mitigate. Differences based on assessor familiarity with student merits further research on how trust develops over time.
Coping with personal care and stigma: experiences of persons living with schizophrenia
Authors: Commey Isaac Tetteh , Ninnoni Jerry Paul K. , Ampofo Evelyn Asamoah
Published: May 2022

Living with a chronic mental condition such as schizophrenia impacts significantly on the individual’s social functioning and activities of daily living. However, there is little data on the experiences of people living with schizophrenia, especially in Ghana regarding personal care and stigma. This study explored qualitatively the experiences of people living with schizophrenia in Southern Ghana. Nine people with schizophrenia were purposively recruited for this study. Data were collected using semi-structured interviews and analysed thematically following a descriptive phenomenological data analysis framework. The study revealed that people with schizophrenia are capable of performing some activities of daily living, such as maintenance of personal and environmental hygiene and medication management. However, some participants narrated their experiences of stigma and thus, resorted to certain strategies such as spirituality, medication adherence and mental fortitude to cope with schizophrenia. In conclusion, it was evident that people with schizophrenia, in their lucid intervals, can undertake various activities of daily living, including personal care, however, living with schizophrenia impacts on psychological well-being enormously, and thus, education, counselling, and client adherence to the treatment may improve quality of life.
Perceptions and experiences of maternity care workers during COVID-19 pandemic in Lagos State, Nigeria; a qualitative study
Authors: Leung Charlotte , Olufunlayo Tolulope , Olateju Zahra , MacArthur Christine , Taylor Beck
Published: May 2022

Background

The COVID-19 (coronavirus disease 2019) pandemic challenges provision and access to essential maternity care in low-resilience health systems. The aim of this study was to explore maternity healthcare workers’ experiences of, and perceptions about providing maternity care during the COVID-19 outbreak in Lagos State, Nigeria.

Methods

This qualitative study conducted individual, remote, semi-structured interviews with midwives and traditional birth attendants (TBAs). Eligible participants spoke English, and provided maternity care during COVID-19 in Lagos, Nigeria. Participants were recruited via purposive and snowball sampling, from primary health facilities in seven Local Government Areas of Lagos State. Interview transcripts were analysed thematically following the framework method.

Results

Sixteen midwives (n = 11) and TBAs (n = 5) were interviewed from March to April 2021. Two overarching themes were identified from the data. ‘Maternity care workers’ willingness and ability to work during the COVID-19 pandemic’ outlined negative influences (fear and uncertainty, risk of infection, burnout, transport difficulties), and positive influences (professional duty, faith, family and employer support). Suggestions to improve ability to work included adequate protective equipment, training, financial support, and workplace flexibility. ‘Perceived impact of COVID-19 on women’s access and uptake of maternity care’ highlighted reduced access and uptake of antenatal and immunisation services by women. Challenges included overstretched health services, movement and cost barriers, and community fear of health facilities. Participants reported delayed healthcare seeking and unattended home births. Midwives and TBAs identified a need for community outreach to raise awareness for women to safely access maternity services. Participants highlighted the responsibility of the government to improve staff welfare, and to implement public health campaigns.

Conclusions

Despite disruption to maternity care access and delivery due to COVID-19, midwives and TBAs in Lagos remained committed to their role in caring for women and babies. Nevertheless, participants highlighted issues of understaffing and mistrust in Lagos’ underfunded maternity care system. Our findings suggest that future resilience during outbreaks depends on equipping maternity care workers with adequate working conditions and training, to rebuild public trust and improve access to maternity care.
Influence of different pretreatments and drying methods on the chemical compositions and bioactivities of Smilacis Glabrae Rhizoma
Authors: Qiao Juanjuan , Lu Gengyu , Wu Gang , Liu Hui , Wang Wanli , Zhang Tianmao , Xie Guoyong , Qin Minjian
Published: May 2022

Background

The processing of medicinal plant materials is one of the important factors influencing the components and biological activities of TCMs. Smilax glabra Roxb. is an herbal vine widely distributed in China, and its dried rhizome (Smilacis Glabrae Rhizoma, SGR) is often used in traditional medicines and functional foods. The processing methods of fresh cutting for SGR slices have been included in ancient Chinese herbal works, some local standards of TCMs, and the current Chinese Pharmacopoeia. Nevertheless, to date, the scientific basis for the processing of fresh medicinal materials for SGR slices has not been revealed.

Methods

To optimize the processing method for preparing SGR slices from the fresh rhizomes, the chemical compositions of the un-pretreated and pretreated (boiling, steaming) samples before and after drying (sun-drying, shade-drying, oven-drying), and the contents of astilbin isomers in dried SGR were analyzed by UHPLC-Q-TOF-MS/MS and UHPLC-DAD methods, respectively. Then, the antioxidant, anti-inflammatory, xanthine oxidase and α-glucosidase inhibitory activities of the prepared SGR slices were investigated by biological assays.

Results

A total of fifty-two compounds were identified from the un-pretreated and pretreated samples and a total of forty-nine compounds were identified from the subsequently dried samples. After pretreated by boiling and steaming, the contents of neoastilbin, neoisoastilbin, and isoastilbin in the prepared samples all increased. As a quality marker of SGR, the content of astilbin was unchanged or decreased slightly compared with that in the un-pretreated samples. During the drying process, the contents of the four astilbin stereoisomers in the un-pretreated samples increased significantly, while those in the pretreated samples had a slight increase or decrease. The effects of different processing methods were sorted according to the bioactivities of the prepared SGR. As a result, SGR slices prepared with no pretreatment followed by a sun-drying process have a higher astilbin content, better bioactivities and more energy savings, representing the optimum processing method for SGR slices.

Conclusions

This study reveals the scientific basis for the processing of fresh medicinal materials for SGR slices. The results provide scientific information for the quality control of SGR and its rational applications in herbal medicines and functional foods.

Graphical abstract
Pain catastrophising, body mass index and depressive symptoms are associated with pain severity in tertiary referral orthopaedic foot/ankle patients
Authors: Holt Matthew , Swalwell Caitlin L. , Silveira Gayle H. , Tippett Vivienne , Walsh Tom P. , Platt Simon R.
Published: May 2022

Introduction

Patients with chronic foot/ankle pain are often referred for orthopaedic assessment. Psychological vulnerabilities influence pain states (including foot and ankle), therefore this study aimed to establish the prevalence and relative importance of compromised psychological health to perceived foot/ankle pain severity in people referred to an orthopaedic foot and ankle clinic with non‐urgent presentations.

Methods

Patients with triaged non‐urgent foot/ankle referrals to the Department of Orthopaedics at Gold Coast University Hospital were recruited over a 12‐month period and completed the Manchester‐Oxford Foot and Ankle Questionnaire which was the primary measure. Participants also completed questionnaires assessing their anthropometric, demographic and health characteristics (Self‐Administered Comorbidity Questionnaire) as well as measures of health‐related quality of life (EuroQol‐5‐Dimensions‐5‐Level Questionnaire and EQ Visual Analogue Scale) and psychological health (Center for Epidemiological Studies‐Depression scale, Pain Catastrophizing Scale and Central Sensitization Inventory). Descriptive statistics were used to summarise participant characteristics and a hierarchical multiple linear regression was employed to establish the extent to which psychological variables explain additional variance in foot/ankle pain severity beyond the effects of participant characteristics (age, sex, body mass index (BMI)).

Results

One hundred and seventy‐two adults were recruited ((64.0% female), median (IQR) age 60.9 (17.7) years and BMI 27.6 (7.5) kg/m2). Specific psychological comorbidities were prevalent including depressive symptoms (48%), central sensitisation (38%) and pain catastrophising (24%). Age, sex and BMI accounted for 11.7% of the variance in MOXFQ‐index and psychological variables accounted for an additional 28.2%. Pain catastrophising was the most significant independent predictor of foot/ankle pain severity (accounting for 14.4% of variance), followed by BMI (10.7%) and depressive symptoms (2.3%).

Conclusions

This study demonstrated that specific psychological comorbidities and increased BMI are common in this cohort and that these factors are associated with the symptoms for which patients are seeking orthopaedic assessment. This knowledge should prompt clinicians to routinely consider the psychosocial components of patient presentations and develop non‐operative and pre‐operative treatment strategies which consider these factors with the goal of improving overall patient outcomes.
A mathematical model for the corneal transparency problem
Authors: Araújo Adérito , Barbeiro Sílvia , Bernardes Rui , Morgado Miguel , Sakić Sunčica
Published: May 2022

Understanding the physical basis of corneal transparency has been a subject of interest amongst physicists, basic scientists and ophthalmologists. Impairment of corneal clarity is a significant cause of visual morbidity worldwide. Thus, it is essential to understand the mechanisms behind corneal transparency and how the alterations due to corneal pathologies affect vision. We use Maxwell’s equations to model light propagation in ocular tissues and a nodal discontinuous Galerkin method combined with an explicit Runge-Kutta method to simulate light propagation in normal and pathological corneas. Our simulation results illustrate that an increase in the diameter of some fibres causes an increase in backscattering. Thus, these may represent some of the physical changes in the cornea that might result in loss of transparency and visual morbidity.
How much do government and households spend on an episode of hospitalisation in India? A comparison for public and private hospitals in Chhattisgarh state
Authors: Garg Samir , Tripathi Narayan , Ranjan Alok , Bebarta Kirtti Kumar
Published: May 2022

Background

Improvements in the financing of healthcare services are important for developing countries like India to make progress towards universal health coverage. Inpatient-care contributes to a big share of total health expenditure in India. India has a mixed health-system with a sizeable presence of private hospitals. Existing studies show that out-of-pocket expenditure (OOPE) incurred per hospitalisation in private hospitals was greater than public facilities. But, such comparisons have not taken into account the healthcare spending by government.

Methods

For a valid comparison between public and for-profit private providers, this study in Indian state of Chhattisgarh assessed the combined spending by government and households per episode of hospitalisation. The supply-side and demand-side spending from public and private sources was taken into account. The study used two datasets: a) household survey for data on hospital utilisation, OOPE, cash incentives received by patients and claims raised under publicly funded health insurance (PFHI) schemes (n = 903 hospitalisation episodes) b) survey of public facilities to find supply-side government spending per hospitalisation (n = 64 facilities).

Results

Taking into account all relevant demand and supply side expenditures, the average total spending per day of hospitalisation was INR 2833 for public hospitals and INR 6788 for private hospitals. Adjusted model for logarithmic transformation of OOPE while controlling for variables including case-mix showed that a hospitalisation in private hospitals was significantly more expensive than public hospitals (coefficient = 2.9,p < 0.001). Hospitalisations in private hospitals were more likely to result in a PFHI claim (adjusted-odds-ratio = 1.45,p = 0.02) and involve a greater amount than public hospitals (coefficient = 0.27,p < 0.001). Propensity-score matching models confirmed the above results.

Overall, supply-side public spending contributed to 16% of total spending, demand-side spending through PFHI to 16%, cash incentives to 1% and OOPE to 67%. OOPE constituted 31% of total spending per episode in public and 86% in private hospitals.

Conclusions

Government and households put together spent substantially more per hospitalisation in private hospitals than public hospitals in Chhattisgarh. This has important implications for the allocative efficiency and the desired public-private provider-mix. Using public resources for purchasing inpatient care services from private providers may not be a suitable strategy for such contexts.
Development and evaluation of the accuracy of an indicator of the appropriateness of interventional cardiology generated from a French registry
Authors: Francis-Oliviero Florence , Coste Pierre , Lesaine Emilie , Perez Corinne , Casteigt François , Clerc Jean-Marie , Delarche Nicolas , Hassan Akil , Larnaudie Bernard , Leymarie Jean-Louis , Salmi Louis-Rachid , Saillour-Glenisson Florence
Published: May 2022

Background

Development of appropriateness indicators of medical interventions has become a major quality-of-care issue, especially in the domain of interventional cardiology (IC). The objective of this study was to develop and evaluate the accuracy of an indicator of the appropriateness of interventional cardiology acts (invasive coronary angiographies (ICA) and percutaneous coronary interventions (PCI)) in patients with coronary stable disease and silent ischemia, automated from a French registry.

Methods

All ICA and PCI recorded in a Regional IC Registry (ACIRA) and operated for a stable coronary artery disease or silent ischemia from January 1st to December 31th 2013 in eight IC hospitals of Aquitaine, southwestern France, were included.

The indicator was developed to reflect European guidelines. Classification of appropriateness by the indicator, measured on the registry database, was compared to the classification of a reference standard (expert judgment applied through complete record review) on a random sample of 300 interventions.

Accuracy parameters were estimated. A second version of the indicator was defined, based on the analysis of false negative and positive results, and its accuracy estimated.

Results

The second indicator accuracy was: sensitivity 63.5% (95% confidence interval CI [51.7–75.3]), specificity 76.0% (95%CI [70.4–81.6]), PPV 43.0% (95% CI [33.0–53.0]) and NPV 88.0% (95% CI [83.4–92.6]). When stratified on the type of act, parameters were better for ICA alone than for PCI.

Conclusions

Accuracy of the indicator should raise with improvement of database quality. Despite its average accuracy, it is already used as a benchmark indicator for cardiologists. It is sent annually to each IC center with value of the indicator at the region level to allow a comparison.
Laparoscopic complete excision of an enormous simple hepatic cyst occupying the entire abdomen in a child: a case report and literature review
Authors: Matsushita Nozomi , Kaneko Kenitiro , Kato Shoko , Odashima Takayuki , Kondo Remi , Fukuyama Takahiro , Saito Takuya , Fukami Yasuyuki , Komatsu Shunichiro , Sano Tsuyoshi
Published: May 2022

Background

Simple hepatic cysts are common lesions in adults, but rare in children. Because of their benign nature, simple hepatic cysts may not be detected until they grow too large to be diagnosed and resected in a minimally invasive manner.

Case presentation

An 18-month-old girl presented with an enormous cyst occupying the entire abdomen. The beak sign on computed tomography revealed the hepatic origin of the cyst. The cyst was decompressed through the umbilicus, which was opened by the three-triangular-skin-flap technique, thus creating a working space that enabled laparoscopic surgery. The cyst was excised en bloc together with the attached hepatic parenchyma.

Conclusions

Giant simple hepatic cysts occupying the entire abdomen are rare in children. Of 14 reported cases, only 1 underwent laparoscopic treatment. We have herein reported another case of a giant simple hepatic cyst in which the beak sign on imaging and the three-triangular-skin-flap umbilical opening technique were useful for its diagnosis and laparoscopic excision, respectively. Complete excision is desirable because there is a possibility of recurrence or other diseases that require total removal, including hydatid cysts and mesenchymal hamartomas.
A parallel methodology of adaptive Cartesian grid for compressible flow simulations
Authors: Qi Xinyu , Yang Yuchen , Tian Linlin , Wang Zhenming , Zhao Ning
Published: May 2022

The combination of Cartesian grid and the adaptive mesh refinement (AMR) technology is an effective way to handle complex geometry and solve complex flow problems. Some high-efficiency Cartesian-based AMR libraries have been developed to handle dynamic changes of the grid in parallel but still can not meet the unique requirements of simulating flow around objects. In this paper, we propose an efficient Cartesian grid generation method and an information transmission approach for the wall boundary to parallelize the implementation of ghost-cell method (GCM). Also, the multi-valued ghost-cell method to handle multi-value points is improved to adapt to the parallel framework. Combining the mentioned methodologies with the open-source library p4est, an automatic and efficient simulation of compressible flow is achieved. The overall performance of the methodology is tested through a wide range of inviscid/viscous flow cases. The results indicate that the capability and parallel scalability of the present numerical methodology for solving multiple types of flows, involving shock and vortices, multi-body flow and unsteady flows are agreeable as compared with related reference data.
Maternal-derived antibodies hinder the antibody response to H9N2 AIV inactivated vaccine in the field
Authors: Pan Xue , Su Xin , Ding Pingyun , Zhao Jinhua , Cui Hongrui , Yan Dawei , Teng Qiaoyang , Li Xuesong , Beerens Nancy , Zhang Haitao , Liu Qinfang , de Jong Mart C. M. , Li Zejun
Published: May 2022

The H9N2 subtype avian influenza virus (AIV) inactivated vaccine has been used extensively in poultry farms, but it often fails to stimulate a sufficiently high immune response in poultry in the field, although it works well in laboratory experiments; hence, the virus still causes economic damage every year and poses a potential threat to public health. Based on surveillance data collected in the field, we found that broilers with high levels of maternal-derived antibodies (MDAs) against H9N2 virus did not produce high levels of antibodies after vaccination with a commercial H9N2 inactivated vaccine. In contrast, specific pathogen-free (SPF) chickens without MDAs responded efficiently to that vaccination. When MDAs were mimicked by administering passively transferred antibodies (PTAs) into SPF chickens in the laboratory, similar results were observed: H9N2-specific PTAs inhibited humoral immunity against the H9N2 inactivated vaccine, suggesting that H9N2-specific MDAs might hinder the generation of antibodies when H9N2 inactivated vaccine was used. After challenge with homologous H9N2 virus, the virus was detected in oropharyngeal swabs of the vaccinated and unvaccinated chickens with PTAs but not in the vaccinated chickens without PTAs, indicating that H9N2-specific MDAs were indeed one of the reasons for H9N2 inactivated vaccine failure in the field. When different titers of PTAs were used to mimic MDAs in SPF chickens, high (HI = 12 log2) and medium (HI = log 9 log2) titers of PTAs reduced the generation of H9N2-specific antibodies after the first vaccination, but a booster dose would induce a high and faster humoral immune response even of PTA interference. This study strongly suggested that high or medium titers of MDAs might explain H9N2 inactivated vaccine failure in the field.
Platelet Transfusion and Outcomes After Massive Transfusion Protocol Activation for Major Trauma: A Retrospective Cohort Study
Authors: Aichholz Pudkrong K. , Lee Sarah A. , Farr Carly K. , Tsang Hamilton C. , Vavilala Monica S. , Stansbury Lynn G. , Hess John R.
Published: May 2022

BACKGROUND:

Incorporation of massive transfusion protocols (MTPs) into acute major trauma care has reduced hemorrhagic mortality, but the threshold and timing of platelet transfusion in MTP are controversial. This study aimed to describe early (first 4 hours) platelet transfusion practice in a setting where platelet counts are available within 15 minutes and the effect of early platelet deployment on in-hospital mortality. Our hypothesis in this work was that platelet transfusion in resuscitation of severe trauma can be guided by rapid turnaround platelet counts without excess mortality.

METHODS:

We examined MTP activations for all admissions from October 2016 to September 2018 to a Level 1 regional trauma center with a full trauma team activation. We characterized platelet transfusion practice by demographics, injury severity, and admission vital signs (as shock index: heart rate/systolic blood pressure) and laboratory results. A multivariable model assessed association between early platelet transfusion and mortality at 4 hours, 24 hours, and overall in-hospital, with P <.001.

RESULTS:

Of the 11,474 new trauma patients admitted over the study period, 469 (4.0%) were massively transfused (defined as ≥10 units of red blood cells [RBCs] in 24 hours, ≥5 units of RBC in 6 hour, ≥3 units of RBC in 1 hour, or ≥4 units of total products in 30 minutes). 250 patients (53.0%) received platelets in the first 4 hours, and most early platelet transfusions occurred in the first hour after admission (175, 70.0%). Platelet recipients had higher injury severity scores (mean ± standard deviation [SD], 35 ± 16 vs 28 ± 14), lower admission platelet counts (189 ± 80 × 109/L vs 234 ± 80 × 109/L; P < .001), higher admission shock index (heart rate/systolic blood pressure; 1.15 ± 0.46 vs 0.98 ± 0.36; P < .001), and received more units of red cells in the first 4 hours (8.7 ± 7.7 vs 3.3 ± 1.6 units), 24 hours (9 ± 9 vs 3 ± 2 units), and in-hospital (9 ± 8 vs 3 ± 2 units) than nonrecipients (all P < .001). We saw no difference in 4-hour (8% vs 7.8%; P = .4), 24-hour (16.4% vs 10.5%; P = .06), or in-hospital mortality (30.4% vs 23.7%; P = .1) between platelet recipients and nonrecipients. After adjustment for age, injury severity, head injury, and admission physiology/laboratory results, early platelet transfusion was not associated with 4-hour, 24-hour, or in-hospital mortality.

CONCLUSIONS:

In an advanced trauma care setting where platelet counts are available within 15 minutes, approximately half of massively transfused patients received early platelet transfusion. Early platelet transfusion guided by protocol-based clinical judgment and rapid-turnaround platelet counts was not associated with increased mortality.
What Is New in Obstetric Anesthesia: The 2021 Gerard W. Ostheimer Lecture
Authors: Lim Grace
Published: May 2022

The Gerard W. Ostheimer lecture is given annually to members of the Society for Obstetric Anesthesia and Perinatology. This lecture summarizes new and emerging literature that informs the clinical practice of obstetric anesthesiologists. In this review, some of the most influential articles discussed in the 2021 virtual lecture are highlighted. Themes include maternal mortality; disparities and social determinants of health; cognitive function, mental health, and recovery; quality and safety; operations, value, and economics; clinical controversies and dogmas; epidemics and pandemics; fetal-neonatal and child health; general clinical care; basic and translational science; and the future of peripartum anesthetic care. Practice-changing evidence is presented and evaluated. A priority list for clinical updates, systems, and quality improvement initiatives is presented.
The Whiteness of Birds
Authors: Mirzoeff Nicholas
Published: May 2022

This essay frames the 2020 Central Park bird-watching incident, in which a white financial analyst called police on a Black bird-watcher, in the context of histories of settler colonialism, extraction, and white supremacy. Situating ornithology as a white way of seeing, it considers the extermination and extinction of birds in terms of fugitivity, necrography, and eugenics, engaging the work of Audubon and the collection and display of birds at the American Museum of Natural History. It closes with a reflection on the Assembly of Birds in Aotearoa New Zealand, as depicted by painter Bill Hammond, and the work of decolonizing extinction.
Loss of slc39a14 causes simultaneous manganese hypersensitivity and deficiency in zebrafish
Authors: Tuschl Karin , White Richard J. , Trivedi Chintan , Valdivia Leonardo E. , Niklaus Stephanie , Bianco Isaac H. , Dadswell Chris , González-Méndez Ramón , Sealy Ian M. , Neuhauss Stephan C. F. , Houart Corinne , Rihel Jason , Wilson Stephen W. , Busch-Nentwich Elisabeth M.
Published: May 2022

Manganese neurotoxicity is a hallmark of hypermanganesemia with dystonia 2, an inherited manganese transporter defect caused by mutations in SLC39A14. To identify novel potential targets of manganese neurotoxicity, we performed transcriptome analysis of slc39a14−/− mutant zebrafish that were exposed to MnCl2. Differentially expressed genes mapped to the central nervous system and eye, and pathway analysis suggested that Ca2+ dyshomeostasis and activation of the unfolded protein response are key features of manganese neurotoxicity. Consistent with this interpretation, MnCl2 exposure led to decreased whole-animal Ca2+ levels, locomotor defects and changes in neuronal activity within the telencephalon and optic tectum. In accordance with reduced tectal activity, slc39a14−/− zebrafish showed changes in visual phototransduction gene expression, absence of visual background adaptation and a diminished optokinetic reflex. Finally, numerous differentially expressed genes in mutant larvae normalised upon MnCl2 treatment indicating that, in addition to neurotoxicity, manganese deficiency is present either subcellularly or in specific cells or tissues. Overall, we assembled a comprehensive set of genes that mediate manganese-systemic responses and found a highly correlated and modulated network associated with Ca2+ dyshomeostasis and cellular stress.

This article has an associated First Person interview with the first author of the paper.
International eHealth ecosystems and the quest for the winning value proposition: findings from a survey study
Authors: Oberschmidt Kira , van Velsen Lex , Grünloh Christiane , Fiorini Laura , Rovini Erika , Melero Muñoz Francisco José
Published: May 2022

Background: eHealth ecosystems are becoming increasingly important for national and international healthcare. In such ecosystems, different actors are connected and work together to create mutual value. However, it is important to be aware of the goals that each actor pursues within the ecosystem.

Method: This study describes the outcomes of a workshop (30 participants) and two surveys (completed by 54 and 100 participants), which investigated how different types of industry stakeholders, namely social services, healthcare, technology developers and researchers, rated potential value propositions for an eHealth ecosystem. Both the feasibility and the importance of each proposition was taken into account.

Results: Interoperability between services was highly valued across industry types but there were also vast differences concerning other propositions.

Conclusion: Jointly reflecting on the different perceived values of an ehealth ecosystem can help actors working together to form an ecosystem.
Comparative study on scenarios for rotating gantry mechanical structures
Authors: Piacentini Luca , Dassa Luca , Perini Diego , Ratkus Andris , Torims Toms , Uberti Stefano , Vilcans Janis , Vretenar Maurizio
Published: May 2022

Background: This paper outlines a comparative study on scenarios of gantries mechanical design for ion-therapy of cancer, which is a crucial step toward the development of the next ion medical machine.

Methods: Multiple scenarios were considered based on robustness of the design, size, weight and complexity, deformation and precision performances and costs, as well as environmental impact. Four prospective scenarios were identified, each of them capable of providing beam to at least 220° around the patient. One scenario is capable of providing treatment angles of 360°. This report will describe the unified methodology performed during the study in order to achieve unbiased results in a comprehensive manner.

Results: Results show that in statically balanced scenarios, considerable improvements can be reached in terms of safety, deformation, precision performances, complexity and costs of implementation.

Conclusions: All scenarios are deemed suitable for further gantry design development.
Potential for positive biodiversity outcomes under diet-driven land use change in Great Britain
Authors: Ferguson-Gow Henry , Nicholas Owen , Outhwaite Charlotte , Green Rosie , Scheelbeek Pauline , Eustachio Colombo Patricia , Wheeler Amber , Taylor Anna , Dangour Alan D , Mace Georgina , Pearson Richard G
Published: May 2022

Background: A shift toward human diets that include more fruit and vegetables, and less meat is a potential pathway to improve public health and reduce food system-related greenhouse gas emissions. Associated changes in land use could include conversion of grazing land into horticulture, which makes more efficient use of land per unit of dietary energy and frees-up land for other uses.

Methods: Here we use Great Britain as a case study to estimate potential impacts on biodiversity from converting grazing land to a mixture of horticulture and natural land covers by fitting species distribution models for over 800 species, including pollinating insects and species of conservation priority.

Results: Across several land use scenarios that consider the current ratio of domestic fruit and vegetable production to imports, our statistical models suggest a potential for gains to biodiversity, including a tendency for more species to gain habitable area than to lose habitable area. Moreover, the models suggest that climate change impacts on biodiversity could be mitigated to a degree by land use changes associated with dietary shifts.

Conclusions: Our analysis demonstrates that options exist for changing agricultural land uses in a way that can generate win-win-win outcomes for biodiversity, adaptation to climate change and public health.
The prevalence of comorbidity in rheumatoid arthritis: a systematic review and meta-analysis
Authors: Hill James , Harrison Joanna , Christian Danielle , Reed Janet , Clegg Andrew , Duffield Stephen J , Goodson Nicola , Marson Tony
Published: May 2022

This systematic review and meta-analysis estimates the prevalence of common comorbid health disorders in adults with rheumatoid arthritis (RA). A multi-database search strategy was undertaken. Screening, data extraction and quality assessment were carried out by two independent reviewers. A meta-analysis and meta-regression were used to generate a pooled prevalence estimate and identify relevant moderators. After study selection, 33 studies (74633 participants) were included in the meta-analysis. Some 31 studies were judged to be of low risk of bias, and two studies were judged to be at moderate risk of bias. The three most common comorbidities in RA were anxiety disorders (62.1%, 95% Cl: 43.6%; 80.6%), hypertension (37.7%, 95% Cl: 29.2%; 46.2%) and depression (32.1%, 95% Cl: 21.6%; 42.7%). There was substantial statistically significant heterogeneity for all comorbidities (I2 ≥77%). Meta-regression identified that the covariate of mean age (unit increase) had a statistically significant effect on the prevalence of hypertension (+2.3%, 95% Cl: 0.4%; 4.2%), depression (−0.5%, 95% Cl: −0.6%; −0.4%) and cancer (0.5%, 95% Cl: 0.2%; 0.8%) in adults with RA. A country's income was identified to have a statistically significant effect on the prevalence of depression, with low-to moderate-income countries having 40% (95% Cl: 14.0%; 66.6%) higher prevalence than high-income countries. No studies consider health inequalities. It is concluded that comorbidities are prevalent among people with RA, particularly those associated with mental health and circulatory conditions. Provision of health services should reflect the importance of such multimorbidity and the consequences for quality and length of life.
Managing chronic wounds in the community: should we be promoting self-care?
Authors: Brown Annemarie
Published: May 2022

Annemarie Brown considers patient factors affecting the appropriateness of self-care for chronic wounds.
Long-term outcomes after ulna shortening osteotomy: a mean follow-up of six years
Authors: Teunissen Joris S. , van der Oest Mark J. W. , Selles Ruud W. , Ulrich Dietmar J. O. , Hovius Steven E. R. , van der Heijden Brigitte ,   On behalf of Hand Wrist Study Group contributors
Published: May 2022

Aims

The primary aim of this study was to describe long-term patient-reported outcomes after ulna shortening osteotomy for ulna impaction syndrome.

Methods

Overall, 89 patients treated between July 2011 and November 2017 who had previously taken part in a routine outcome evaluation up to 12 months postoperatively were sent an additional questionnaire in February 2021. The primary outcome was the Patient-Rated Wrist and Hand Evaluation (PRWHE) total score. Secondary outcomes included patient satisfaction with treatment results, complications, and subsequent treatment for ulnar-sided wrist pain. Linear mixed models were used to compare preoperative, 12 months, and late follow-up (ranging from four to nine years) PRWHE scores.

Results

Long-term outcomes were available in 66 patients (74%) after a mean follow-up of six years (SD 1). The mean PRWHE total score improved from 63 before surgery to 19 at late follow-up (difference in means (Δ) 44; 95% confidence interval (CI) 39 to 50; p = <0.001). Between 12 months and late follow-up, the PRWHE total score also improved (Δ 12; 95% CI 6 to 18; p = < 0.001). At late follow-up, 14/66 of patients (21%) reported a PRWHE total score of zero, whereas this was 3/51 patients (6%) at 12 months (p = 0.039). In all, 58/66 patients (88%) would undergo the same treatment again under similar circumstances. Subsequent treatment (total n = 66; surgical n = 57) for complications or recurrent symptoms were performed in 50/66 patients (76%). The most prevalent type of reoperation was hardware removal in 42/66 (64%), and nonunion occurred in 8/66 (12%).

Conclusion

Ulna shortening osteotomy improves patient-reported pain and function that seems to sustain at late follow-up. While satisfaction levels are generally high, reoperations such as hardware removal are common. Cite this article: Bone Jt Open 2022;3(5):375–382.
Integrated refractive index sensor based on an AlN-PSiO2 hybrid plasmonic microdisk resonator
Authors: Guo Caixia , Wang Chenghao , Ma Tao , Zhang Linqing , Wang Fang
Published: May 2022

In this paper, a microdisk resonator (MDR) based on an

A
l
N

−

P
S
i
O

2

hybrid plasmonic waveguide (HPW) and its refractive index (RI) sensing characteristics are investigated. The plasmonic characteristics of the MDR based on the

A
l
N

−

P
S
i
O

2

HPW (APHPW-MDR) in near-infrared wavelengths are studied by using the finite element method. Through the structure parameter optimizations, the propagation length (

L

p
r
o
p

) of the APHPW-MDR is

∼

165

µ

m

, which is

∼

2.5

times as long as that of the MDR based on the AlN HPW (AHPW-MDR). The simulation results show that the quality factor (

Q

) and extinction rate (ER) of the APHPW-MDR are

∼

621.3

and

∼

30

d
B

, respectively. The RI sensing sensitivity (

S

) of the RI sensor based on the APHPW-MDR is

∼

276.6

n
m

/

R
I
U

. The RI sensor based on the APHPW-MDR has wide application prospects in high-performance biochemical sensing, and it can also be used in integrated optical filters, modulators, switches, routers, and delay circuits.