bluuebunny/crossref_metadata_2025 huggingface dataset:
Intervention with selution SLR™ Agent Balloon for Endovascular Latent Limus therapy for failing AV Fistulas (ISABELLA) Trial: Protocol for a pilot clinical study and pre-clinical results
Authors: Tang Tjun Yip , Chong Tze-Tec , Yap Charyl Jia Qi , Soon Shereen Xue Yun , Chan Sze Ling , Tan Ru Yu , Yap Hao Yun , Tay Hsien Ts’ung , Tan Chieh-Suai , Barnhill Scott , Hellinga David , DeGraw R Tyler , Finn Aloke V
Published: July 2021

Background:

The aim of this pilot clinical study is to evaluate the safety and efficacy of the Selution Sustained Limus Release (SLR)™ sirolimus-coated balloon (M.A. MedAlliance SA, Nyon, Switzerland) for improving the patency of failing arterio-venous fistulas (AVF) in hemodialysis patients. We also present herein a pre-clinical pharmacokinetic and safety evaluation of Selution™ to justify its first use in hemodialysis patients for endovascular access salvage.

Methods and results:

This is an investigator-initiated prospective single-center, non-blinded single-arm trial. Forty patients with clinically significant de novo or recurrent stenoses in a mature AVF circuit will be recruited. All stenotic lesions will be prepared with high pressure non-compliant conventional balloon angioplasty (CBA) prior to deployment of the Sustained-Release Selution™ sirolimus drug-eluting balloon. The primary efficacy endpoint is 6-month target lesion primary patency and the primary safety endpoint is freedom from localized or systemic serious adverse events through 30 days. Secondary endpoints of interest include technical and clinical success rates and circuit access patency at 3 and 6 months. Follow-up will occur for 2 years for those patients whose AVFs remain patent. Pharmacokinetic and histological animal safety studies performed with the Selution™ coating formulation showed prolonged arterial tissue retention of sirolimus with therapeutic levels up to 60 days and non-toxic and rapidly declining blood levels. Histological results in animal models demonstrated safety, freedom from intraluminal thrombus, reduction in restenosis by sirolimus elution compared to CBA, and no evidence of embolic phenomena indicative of adverse particulate effects.

Discussion:

Long release sirolimus coated balloons may serve as a promising novel alternative therapy to paclitaxel-based technology for treating conduit stenosis secondary to neointimal hyperplasia. Pre-clinical pharmacokinetic and histological animal data are encouraging and provide suggestion of safety and efficacy in this setting. This single-center trial will provide a first step toward demonstration of efficacy and safety of this device for treatment of stenotic fistulas.
In the service of secrecy: An enveloped history of priority, proof and patents
Authors: Hemmungs Wirtén Eva
Published: July 2021

This article is about an everyday paper object: an envelope. However, as opposed to most other flat paper containers, the enveloppe Soleau can only be bought from L’Institut national de la propriété industrielle (INPI) in Paris. At the cost of €15 you get a perforated, double-compartment envelope allowing you to constitute proof of creation and assign a precise date to your idea or project. But the enveloppe Soleau is something much more than just a simple and cheap way by which you can prove priority in any creative domain. It is a material footprint anchored to centuries of practices associated with disclosure and secrecy, a gateway into the infrastructure of the intellectual property system and its complicated relationship to the forms of knowledge it purports to hold. The purpose of this article is to consider the making of the enveloppe Soleau as a bureaucratic document, a material device performing a particular kind of legal paperwork. In four different vignettes, the article tracks the material becoming of the enveloppe Soleau as an evidentiary receptacle, beginning by going back to early modern practices of secrecy and priority, continuing with its consolidation in two patents (from 1910 and 1911) to the inventor Eugène Soleau (1852–1929), and ending up, in 2016, dematerialized in the e-Soleau. As a bureaucratic document, the enveloppe Soleau shows just how much work a mundane paper object can perform, navigating a particular materiality (a patented double envelope); formalized processes of proof (where perforations have legal significance); the practices of double archiving (in an institution and with the individual) and strict temporal limitations (a decade). Ultimately, the enveloppe Soleau travels between the material and immaterial, between private and public, between secrecy and disclosure, but also between what we perceive of as the outside and inside of the intellectual property system.
How much journalism is in brand journalism? How brand journalists perceive their roles and blur the boundaries between journalism and strategic communication
Authors: Koch Thomas , Viererbl Benno , Schulz-Knappe Charlotte
Published: July 2021

An increasing number of companies and other organizations publish their own news media that resemble journalistic media in terms of content, language and design. The production and distribution of these publications are often referred to as brand journalism. However, although these publications look a lot like journalistic media, they are used as strategic communication tools: They represent and legitimize an organization’s interests and aim to improve brand image, build relations with customers or increase sales. Thus, brand journalism blurs the boundaries between journalism and strategic communication. The present study focuses on brand journalists and analyses their work routines, professional role perceptions and possible role conflicts. To this end, we conducted qualitative semi-structured interviews with editors of corporate magazines. The interviewees described quite strong parallels to journalistic work routines and asserted their orientation toward journalistic norms (e.g. autonomy, unbiased reporting); however, these norms were regularly undermined when the topics covered centred on their own or their clients’ organizations. Most interviewees described large parts of their professional identity as journalistic, but were also aware that they were in a hybrid role between journalism and strategic communication. This hybrid role is associated with a range of expectations that can lead to role conflicts.
Facet Violation With Percutaneous Pedicle Screw Placement: Impact of 3D Navigation and Facet Orientation
Authors: Cong Ting , Sivaganesan Ahilan , Mikhail Christopher M. , Vaishnav Avani S. , Dowdell James , Barbera Joseph , Kumagai Hiroshi , Markowitz Jonathan , Sheha Evan , Qureshi Sheeraz A.
Published: July 2021

Background: The gold standard for percutaneous pedicle screw placement is 2-dimensional (2D) fluoroscopy. Data are sparse on the accuracy of 3-dimensional (3D) navigation percutaneous screw placement in minimally invasive spine procedures. Objective: We sought to compare a single surgeon’s percutaneous pedicle screw placement accuracy using 2D fluoroscopy versus 3D navigation, as well as to investigate the effect of facet orientation on facet violation when using 2D fluoroscopy. Methods: We conducted a retrospective radiographic study of consecutive cohort of patients who underwent percutaneous lumbar instrumentation using either 2D fluoroscopy or 3D navigation. All procedures were performed by a single surgeon at 2 academic institutions between 2011 and 2018. Radiographic measurement of screw accuracy was assessed using a postoperative computed tomographic scan. The primary outcome was facet violation, and secondary outcomes were endplate/tip breaches, the Gertzbein-Robbins classification for cortical breaches, and the Simplified Screw Accuracy grade. Statistical comparisons were made between screws placed using 2D fluoroscopy versus 3D navigation. Axial facet angles were also measured to correlate with facet violation rates. Results: In the 138 patients included, 376 screws were placed with fluoroscopy and 193 with navigation. Superior (unfused) level facet violation was higher with 2D fluoroscopy than with 3D navigation (9% vs 0.5%), which comprises the main cause for poor screw placement. Axial facet angles exceeding 45° at L4 and 60° at L5 were correlated with facet violations. Conclusion: This retrospective study found that 3D navigation is associated with lower facet violation rates in percutaneous lumbar pedicle screw placement when compared with 2D fluoroscopy. These findings suggest that 3D navigation may be of particular value when facet joints are coronally oriented.
Evaluation of PROMIS Outcomes for Surgical Treatment of Cubital Tunnel Syndrome With and Without Carpal Tunnel Syndrome
Authors: Phan Amy , Hammert Warren
Published: July 2021

Background:

Assessment of outcomes for cubital tunnel syndrome (CuTS) surgeries has been difficult due to heterogeneity in outcome reporting. Our objective was to evaluate the outcomes for 2 cohorts treated surgically for isolated CuTS and for combined CuTS and carpal tunnel syndrome (CTS) using Patient Reported Outcomes Measurement Information System (PROMIS).

Methods:

There were 29 patients in the isolated CuTS cohort and 30 patients in the combined CuTS and CTS cohort. PROMIS Physical Function (PF), Pain Interference (PI), Depression, and Upper Extremity (UE) were completed preoperatively and 1-week, 6-weeks, and 3-months postoperatively. Responsiveness was evaluated by standardized response means (SRM).

Results:

Significant improvements from the 1-week to 6-week postoperative period are shown in the isolated CuTS cohort for PROMIS PF ( P = .002), PI ( P = .0002), and UE ( P = .02), but scores plateau after 6-weeks postoperatively. A similar pattern for the same time points was seen for the combined CuTS and CTS group for PROMIS PF ( P = .001), PI ( P = .02), and UE ( P = .04), with a plateau of scores beyond 6 weeks postoperatively. PROMIS UE was more responsive (SRM range: 0.11-1.03) than the PF (SRM range: 0.02-0.52) and PI (SRM range: 0.11-0.40), which were both mildly responsive for both cohorts.

Conclusions:

PROMIS lacks the sensitivity to show improvement beyond 6-weeks postoperatively for both isolated CuTS and combined CuTS and CTS. Patients with combined nerve compressions follow similar trajectories in the postoperative period as those with isolated CuTS.

Level of Evidence:

Level IV.
The elderly IBD patient in the modern era: changing paradigms in risk stratification and therapeutic management
Authors: Hong Simon J. , Katz Seymour
Published: July 2021

The incidence and prevalence of inflammatory bowel disease (IBD) is rising in the elderly population. Compared with patients with onset during their younger years, patients with elderly onset IBD have a distinct clinical presentation, disease phenotype, and natural history. Genetics contribute less to pathogenesis of disease, whereas biological changes associated with aging including immunosenescence, dysbiosis, and frailty have a greater impact on disease outcomes. With the advent of an increasingly wider array of biologic and small-molecule therapeutic options, data regarding efficacy and safety of these agents in elderly IBD patients specifically are paramount, given the unique characteristics of this population.
An Integrated Mobile Platform for Automated Data Collection and Real-Time Patient Monitoring in Diabetes Clinical Trials
Authors: Cappon Giacomo , Cossu Luca , Boscari Federico , Bruttomesso Daniela , Sparacino Giovanni , Facchinetti Andrea
Published: July 2021

We present a new mobile platform to be used in clinical trials aimed at both collecting data and assessing new technologies and treatments for diabetes care. The main components of the platform are a mobile app, that automatically collects data from continuous glucose monitoring sensors and activity trackers, and also allows users to manually log daily events; a cloud database for safe data storage; a web interface, which allows clinicians to monitor patients’ status in real-time. The platform is modular and highly customizable for a multitude of purposes in clinical research. Preliminary tests performed for daily-life data gathering by both clinicians and users are extremely encouraging.
Are muscle weakness and stiffness risk factors of the development of rotator cuff tendinopathy in overhead athletes: a systematic review
Authors: Kwan Cheuk-Kin , Ko Man-Chi , Fu Sai-Chuen , Leong Hio-Teng , Ling Samuel Ka-Kin , Oh Joo-Han , Yung Patrick Shu-Hang
Published: July 2021

Background:

Underlying muscle weakness and stiffness may increase the risk of developing rotator cuff tendinopathy. This systematic review aims to assess existing prospective studies to summarize whether muscle weakness and stiffness are risk factors for the development of rotator cuff tendinopathy in overhead athletes.

Methods:

A systematic search was performed using PRISMA guidelines. Prospective studies measuring muscle strength or stiffness and the incidence of rotator cuff tendinopathy were included. Quality assessment was performed with the Newcastle-Ottawa quality assessment scale.

Results:

The search yielded six studies, with a total of 523 trained overhead athletes followed up for one season. External rotation (ER) and internal rotation (IR) strength were described as protective factors against the development of rotator cuff tendinopathy. Athletes who did not sustain shoulder injuries had statistically stronger eccentric IR ( p < 0.01) and ER ( p < 0.05) strength in the pre-season assessment. Muscle stiffness indicated by limited range of motion of <106° for shoulder ER was described as a risk factor with an odds ratio of 1.12 ( p < 0.001). Imbalance between ER and IR strength was reported as risk factors for shoulder injuries in two studies, with a relative risk of 2.57 ( p < 0.05) reported in one study. Supraspinatus weakness was also reported as a risk factor for shoulder injuries in one study.

Conclusion:

Limited evidence support ER, IR weakness, limited ER range of motion, and very limited evidence support imbalance in ER/IR strength, and supraspinatus weakness as risk factors for rotator cuff tendinopathy in overhead athletes. No existing studies investigated the general population on this topic. Future cohort studies may improve on existing evidence with investigations on the general public, a longer follow-up time, clearly documented injury history, and a stringent diagnosis to rotator cuff tendinopathy.
Pre-Exposure Prophylaxis Training among Medical Schools in the United States
Authors: Cooper Robert L. , Tabatabai Mohammad , Juarez Paul D. , Ramesh Aramandla , Morris Matthew C. , Brown Katherine Y. , Arcury Thomas A. , Shinn Marybeth , Mena Leandro A. , Juarez Patricia-Matthews
Published: July 2021

Pre-Exposure Prophylaxis (PrEP) has been shown to be an effective method of HIV prevention for men who have sex with-men (MSM) and -transgender women (MSTGWs), serodiscordant couples, and injection drug users; however fewer than 50 000 individuals currently take this regimen. Knowledge of PrEP is low among healthcare providers and much of this lack of knowledge stems from the lack or exposure to PrEP in medical school. We conducted a cross sectional survey of medical schools in the United States to assess the degree to which PrEP for HIV prevention is taught. The survey consisted Likert scale questions assessing how well the students were prepared to perform each skill associated with PrEP delivery, as well as how PrEP education was delivered to students. We contacted 141 medical schools and 71 responded to the survey (50.4%). PrEP education was only reported to be offered at 38% of schools, and only 15.4% reported specific training for Lesbian, Gay, Bisexual, and Transgender (LGBT) patients. The most common delivery methods of PrEP content were didactic sessions with 11 schools reporting this method followed by problem-based learning, direct patient contact, workshops, and small group discussions. Students were more prepared to provide PrEP to MSM compared to other high-risk patients. Few medical schools are preparing their students to prescribe PrEP upon graduation. Further, there is a need to increase the number of direct patient contacts or simulations for students to be better prepared.
The Odyssey from Symptom to Diagnosis of Pulmonary Hypertension from the Patients and Spouses Perspective
Authors: Ivarsson Bodil , Johansson Anders , Kjellström Barbro
Published: July 2021

Introduction/objective:

Diagnostic delays in pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are related to increased morbidity and mortality. The risk of a delayed, or even a missed, diagnosis is high as the conditions are rare. The aim was to describe patients’ and spouses’ experiences of the journey from the first symptom to an established diagnosis.

Methods:

A secondary analysis of 31 transcripts, based on 2 primary datasets containing interviews with 17 patients and 14 spouses, was carried out and analyzed according to qualitative content analysis.

Results:

One overarching category was revealed from the content analysis; “The journey from doubt and hope to receive the diagnosis.” Five subcategories were identified as: overall experiences; ignoring symptoms; seeking primary care/hospital specialty care; blame and stigma; and finding a pulmonary hypertension specialist clinic. The main finding was that both patients and spouses experienced that waiting for a diagnosis and the deteriorating state of health led to anxiety and frustration. The knowledge about rare diseases among health professionals needs to be improved to enable a timelier diagnosis and initiation of treatment.

Conclusion:

Patients’ and spouses’ lives were negatively affected by having to search for a correct diagnosis. In order for health care to identify rare diseases earlier, a well-functioning and responsive health care system, in primary care as well as in specialist care, is needed. Symptoms like breathlessness and fatigue are often unspecific but should not be ignored. Keeping the patient and spouse in the loop, and providing information that the search for an answer might take time is essential for health care providers to create trust.
Disrupted Class, Undisrupted Learning: A Study on the Effect of Online Learning Among Primary and Middle School Students
Authors: Yuelin Li , Yujie Liu , Xiaohui Shu
Published: July 2021

In the first half of 2020, primary and secondary school teaching was transformed into online teaching in China, and the teaching effects have attracted considerable attention. This article collects relevant data on the effects of online learning among primary and middle school students through questionnaire surveys to study the impact of parents and teachers on learning effects, provide an experience for future online education and improve the quality of online education for primary and secondary school students in the future. Through empirical analysis, this article draws three main conclusions. First, parents improve students’ offline social presence, while teachers or classmates improve their online presence. Both changes have a significant positive impact on students’ subjective learning effects. Second, parents are more helpful with regard to the improvement of students’ objective learning effects. Third, in terms of age, parents have a greater influence on younger students. The innovation of this article is that the object of the study is primary and secondary school students. The article considers not only the role of teachers but also the role of parents, thereby filling gaps in the previous literature.

JEL Codes: I20, I21, I25
Individual socioeconomic and neighborhood factors predict changes in sports activity during the transition to retirement
Authors: Jürgens Dorothee , Schüz Benjamin
Published: July 2021

Background

There are substantial socioeconomic status (SES) differences in sports activity (SA) during the transition to retirement. In line with social-ecological models, the aim of this longitudinal study was to examine the association of perceptions of social and physical neighborhood factors with changes in SA across the retirement transition and to examine potential interactions with SES factors.

Methods

Data from 6 waves of the German Ageing Survey (DEAS) provided 710 participants (at baseline: mean age 61.1, 52.9% of men) who retired between baseline (1996, 2002, 2008, 2011) and their 6-year follow-up assessment. Associations between changes in SA (increases and decreases compared to retaining) and individual SES and neighborhood factors were estimated using multinomial logistic regression analysis.

Results

Increases were observed in 18.45% of participants, decreases in 10%. Occupational prestige was a risk factor for decreases, education a resource for increases in SA. Interactions between household income and several neighborhood factors were observed.

Conclusions

In line with social-ecological models, individual, neighborhood factors and interacting associations were found. In particular safety perceptions could be a resource for promotion SA in older adults who experience disadvantage.
Regulatory role of local tissue signal Del-1 in cancer and inflammation: a review
Authors: Li Meng , Zhong Di , Li Guozhong
Published: July 2021

Developmental endothelial locus-1 (Del-1) is a secretory, multifunctional domain protein. It can bind to integrins and phosphatidylserine. As a local tissue signal, it plays a regulatory role in the cancer microenvironment and inflammation. Del-1 has destructive effects in most cancers and is associated with the progression and invasion of some cancers. In contrast, Del-1 also plays a protective role in inflammation. Del-1 regulates inflammation by regulating the generation of neutrophils in bone marrow, inhibiting the recruitment and migration of neutrophils and accelerating the clearance of neutrophils by macrophages. Del-1 and IL-17 are reciprocally regulated, and their balance maintains immune system homeostasis. Del-1 is expected to become a new therapeutic target for inflammatory disorders such as multiple sclerosis.
Wide range detector of plasma induced charging effect for advanced CMOS BEOL processes
Authors: Chao Yi-Jie , Yang Kai-Wei , Su Chi , Lin Chrong-Jung , King Ya-Chin
Published: July 2021

This work proposed a modified plasma induced charging (PID) detector to widen the detection range, for monitoring the possible plasma damage across a wafer during advanced CMOS BEOL processes. New antenna designs for plasma induced damage patterns with extended capacitors are investigated. By adapting the novel PID detectors, the maximum charging levels of the detectors have been enhanced.
Exposure to Batrachochytrium dendrobatidis affects chemical defences in two anuran amphibians, Rana dalmatina and Bufo bufo
Authors: Ujszegi János , Ludányi Krisztina , Móricz Ágnes M. , Krüzselyi Dániel , Drahos László , Drexler Tamás , Németh Márk Z. , Vörös Judit , Garner Trenton W. J. , Hettyey Attila
Published: July 2021

Background

Batrachochytrium dendrobatidis (Bd) is the causative agent of chytridiomycosis, one of the major causes of worldwide amphibian biodiversity loss. Many amphibians exhibit skin-based chemical defences, which may play an important role against invading pathogens, but whether the synthesis of these chemical compounds is enhanced or suppressed in the presence of pathogens is largely unknown. Here we investigated direct and indirect effects of larval exposure to the globally distributed and highly virulent Bd-GPL strain on skin secreted chemical defences and life history traits during early ontogeny of agile frogs (Rana dalmatina) and common toads (Bufo bufo).

Results

Exposure to Bd during the larval stage did not result in enhanced synthesis of the antimicrobial peptide Brevinin-1 Da in R. dalmatina tadpoles or in increased production of bufadienolides in B. bufo tadpoles. However, exposure to Bd during the larval stage had a carry-over effect reaching beyond metamorphosis: both R. dalmatina and B. bufo froglets contained smaller quantities of defensive chemicals than their Bd-naïve conspecifics in the control treatment. Prevalence of Bd and infection intensities were very low in both larvae and metamorphs of R. dalmatina, while in B. bufo we observed high Bd prevalence and infection intensities, especially in metamorphs. At the same time, we did not find a significant effect of Bd-exposure on body mass or development rate in larvae or metamorphs in either species.

Conclusions

The lack of detrimental effect of Bd-exposure on life history traits, even parallel with high infection intensities in the case of B. bufo individuals, is surprising and suggests high tolerance of local populations of these two species against Bd. However, the lowered quantity of defensive chemicals may compromise antimicrobial and antipredatory defences of froglets, which may ultimately contribute to population declines also in the absence of conspicuous mass-mortality events.
Transcriptome and metabolomic analysis to reveal the browning spot formation of ‘Huangguan’ pear
Authors: Wang Qi , Wu Xinyi , Liu Li , Yao Daozhi , Li Jinchao , Fang Jie , Chen Xiaonan , Zhu Liwu , Liu Pu , Ye Zhenfeng , Jia Bing , Heng Wei
Published: July 2021

Background

Browning spot (BS) disorders seriously affect the appearance quality of ‘Huangguan’ pear and cause economic losses. Many studies on BS have mainly focused on physiological and biochemical aspects, and the molecular mechanism remains unclear.

Results

In the present study, the structural characteristics of ‘Huangguan’ pear with BS were observed via scanning electron microscopy (SEM), the water loss and brown spots were evaluated, and transcriptomic and metabolomics analyses were conducted to reveal the molecular mechanism underlying ‘Huangguan’ pear skin browning disorder. The results showed that the occurrence of BS was accompanied by a decrease in the wax layer and an increase in lignified cells. Genes related to wax biosynthesis were downregulated in BS, resulting in a decrease in the wax layer in BS. Genes related to lignin were upregulated at the transcriptional level, resulting in upregulation of metabolites related to phenylpropanoid biosynthesis. Expression of calcium-related genes were upregulated in BS. Cold-induced genes may represent the key genes that induce the formation of BS. In addition, the results demonstrated that exogenous NaH2PO4·2H2O and ABA treatment could inhibit the incidence of BS during harvest and storage time by increasing wax-related genes and calcium-related genes expression and increasing plant resistance, whereas the transcriptomics results indicated that GA3 may accelerate the incidence and index of BS.

Conclusions

The results of this study indicate a molecular mechanism that could explain BS formation and elucidate the effects of different treatments on the incidence and molecular regulation of BS.
Stablization of ACOs by NatB mediated N-terminal acetylation is required for ethylene homeostasis
Authors: Liu Hai-qing , Zou Ya-jie , Li Xiao-feng , Wu Lei , Guo Guang-qin
Published: July 2021

N-terminal acetylation (NTA) is a highly abundant protein modification catalyzed by N-terminal acetyltransferases (NATs) in eukaryotes. However, the plant NATs and their biological functions have been poorly explored. Here we reveal that loss of function of CKRC3 and NBC-1, the auxiliary subunit (Naa25) and catalytic subunit (Naa20) of Arabidopsis NatB, respectively, led to defects in skotomorphogenesis and triple responses of ethylene. Proteome profiling and WB test revealed that the 1-amincyclopropane-1-carboxylate oxidase (ACO, catalyzing the last step of ethylene biosynthesis pathway) activity was significantly down-regulated in natb mutants, leading to reduced endogenous ethylene content. The defective phenotypes could be fully rescued by application of exogenous ethylene, but less by its precursor ACC. The present results reveal a previously unknown regulation mechanism at the co-translational protein level for ethylene homeostasis, in which the NatB-mediated NTA of ACOs render them an intracellular stability to maintain ethylene homeostasis for normal growth and responses.
Managerial challenges faced by Swedish nurse managers in perioperative settings– a qualitative study
Authors: Arakelian Erebouni , Rudolfsson Gudrun
Published: July 2021

Background

Nurse managers need to create cultures that are worthy, not only of the commitment of everyone who comes to work but also of the trust of everyone who comes to be served. The aim of our study was to describe the challenges faced by Swedish nurse managers in a perioperative setting.

Methods

A qualitative study was conducted. The participants were chosen by convenience sampling, and individual in-depth interviews were conducted. Data were analysed by Systematic Text Condensation. The COREQ checklist was consulted throughout the study to optimise the quality.

Results

Nineteen nurse managers (all women) participated. Six themes were identified: “striving to treat employees with consideration and solicitude”; “the obligation to take care of each employee’s individual needs”; “convincing others was an uphill battle”, “finding solutions when things seem impossible”; “staff recruitment, allocation, and management”; “working with constantly changing planning”.

Conclusions

The nurse managers faced challenges because of the overwhelming amount of work tasks, with almost no time for reflection. Having carefully chosen tasks and a realistic time schedule for each work task, plus time to find one’s own path to inner peace, are essential for nurse managers. Organisations that provide these prerequisites show that they care about their nurse managers. The results of this study indicate the need for time to reflect, as well as support from superior managers and from the human resources department.
Community health volunteers challenges and preferred income generating activities for sustainability: a qualitative case study of rural Kilifi, Kenya
Authors: Lusambili Adelaide M , Nyanja Njeri , Chabeda Sophie Vusha , Temmerman Marleen , Nyaga Lucy , Obure Jerim , Ngugi Anthony
Published: July 2021

Background

There is a global emphasis on engaging community health volunteers (CHVs) in low- to middle-income countries (LMICs) to reach to the vast underserved populations that live in rural areas. Retention of CHVs in most countries has however been difficult and turnover in many settings has been reported to be high with profound negative effects on continuity of community health services. In rural Kenya, high attrition among CHVs remains a concern. Understanding challenges faced by CHVs in rural settings and how to reduce attrition rates with sustainable income-generating activities (IGAs) is key to informing the implementation of contextual measures that can minimise high turnover. This paper presents findings on the challenges of volunteerism in community health and the preferred IGAs in rural Kilifi county, Kenya.

Methods

The study employed qualitative methods. We conducted 8 key informant interviews (KIIs) with a variety of stakeholders and 10 focus group discussions (FGDs) with CHVs. NVIVO software was used to organise and analyse our data thematically.

Results

Community Health Volunteers work is not remunerated and it conflicts with their economic activities, child care and other community expectations. In addition, lack of supervision, work plans and relevant training is a barrier to delivering CHVs’ work to the communities. There is a need to remunerate CHVs work as well as provide support in the form of basic training and capital on entrepreneurship to implement the identified income generating activities such as farming and events management.

Conclusions

Strategies to support the livelihoods of CHVs through context relevant income generating activities should be identified and co-developed by the ministry of health and other stakeholders in consultation with the CHVs.
Effectiveness of long-lasting insecticidal nets in prevention of malaria among individuals visiting health centres in Ziway-Dugda District, Ethiopia: matched case–control study
Authors: Wubishet Mesfin Kelkile , Berhe Gebretsadik , Adissu Alefech , Tafa Mesfin Segni
Published: July 2021

Background

Malaria is a major health problem in Ethiopia. Sleeping under long-lasting insecticidal nets (LLINs) is its major control strategy. Despite high LLINs use (84%) in Ziway-Dugda District, malaria remained a public health problem, raising concern on its effectiveness. Understanding the effectiveness of malaria control interventions is vital. This study evaluated the effectiveness of LLINs and determinants of malaria in Ziway-Dugda District, Arsi Zone Ethiopia.

Methods

A matched case–control study was conducted among 284 study participants (71 cases and 213 controls) in Ziway-Dugda District, Arsi Zone, Ethiopia from March to May, 2017. Three health centers were selected randomly, and enrolled individuals newly diagnosed for malaria proportionally. Cases and controls were individuals testing positive and negative for malaria using rapid diagnostic tests. Each case was matched to three controls using the age of (5 years), gender and village of residence. The information was collected using pre-tested structured questionnaires through face to face interviews and observation. Data were entered into Epi-Info version 3.5, and analysed using Stata version-12.Conditional logistic regression was performed, and odds of LLINs use were compared using matched Adjusted Odds Ratio (AOR), 95% confidence interval (CI) and p-value of < 0.05.

Results

One hundred twenty-three (61.2%) of the controls and 22 (32.8%) of cases had regularly slept under LLINs in the past two weeks. Using multivariate analysis, sleeping under LLINs for the past two weeks (AOR = 0.23, 95%CI = 0.11–0.45); living in houses sprayed with indoor residual spray (IRS) (AOR = 0.23, 95%CI: 0.10–0.52); and staying late outdoors at night in the past two-weeks (AOR = 2.99, 95%CI = 1.44–6.19) were determinant factors.

Conclusions

Sleeping under LLINs is effective for malaria prevention in the district. IRS and staying late outdoors at night were determinants of malaria. It is recommended to increase attention on strengthening LLINs use and IRS in the area.
Combined IFN-γ and IL-2 release assay for detect active pulmonary tuberculosis: a prospective multicentre diagnostic study in China
Authors: Tan Yaoju , Tan Yunhong , Li Junlian , Hu Pengnan , Guan Ping , Kuang Haobin , Liang Qide , Yu Yanyan , Chen Zhongnan , Wang Quan , Yang Zhenping , AiKeReMu DiLiNaZi , Pang Yu , Liu Jianxiong
Published: July 2021

Background

We performed a prospective multicentre diagnostic study to evaluate the combined interferon-γ (IFN-γ) and interleukin-2 (IL-2) release assay for detect active pulmonary tuberculosis (TB) in China.

Methods

Adult patients presenting symptoms suggestive of pulmonary TB were consecutively enrolled in three TB-specialized hospitals. Sputum specimens and blood sample and were collected from each participant at enrolment. The levels of Mycobacterium tuberculosis (MTB)-specific antigen-stimulated IFN-γ and IL-2 were determined using enzyme-linked immunosorbent assay (ELISA).

Results

Between July 2017 and December 2018, a total of 3245 patients with symptoms suggestive of pulmonary TB were included in final analysis. Of 3245 patients, 2536 were diagnosed as active TB, consisting of 1092 definite TB and 1444 clinically diagnosed TB. The overall sensitivity and specificity of IFN-γ were 83.8% and 81.5%, respectively. In addition, compared with IFN-γ, the specificity of IL-2 increased to 94.3%, while the sensitivity decreased to 72.6%. In addition, the highest sensitivity was achieved with parallel combination of IFN-γ/IL-2, with a sensitivity of 87.9%, and its overall specificity was 79.8%. The sensitivity of series combination test was 68.5%. Notably, the sensitivity of series combination test in definite TB (72.1%) was significantly higher than that in clinically diagnosed TB (65.8%).

Conclusion

In conclusion, we develop a new immunological method that can differentiate between active TB and other pulmonary diseases. Our data demonstrates that the various IFN-γ/IL-2 combinations provides promising alternatives for diagnosing active TB cases in different settings. Additionally, the diagnostic accuracy of series combination correlates with severity of disease in our cohort.
Width of pubic symphysis relating to age and sex in Koreans
Authors: Hwang Kun , Wu Xiajing , Park Chan Yong
Published: July 2021

Introduction

Diastasis of the pubic symphysis has been reported to occur in 13–16% of pelvic ring injuries. In Asians, there are only a few data showing the width of the pubic symphysis. The aim of this study is to see the width of pubic symphysis relating to age and sex in Koreans.

Methods

Width of pubic symphysis was measured in pelvis AP and pelvic CT of 784 peoples (392 males, 392 females).

Results

In supine AP, the width at the upper end was 4.8±2.5 mm (males; 3.46±1.38 mm, females; 4.04±2.76 mm). The width at the midpoint was 4.7±2.0 mm (males; 4.64±1.58 mm, females; 4.75±2.29 mm). The width at the lower end was 4.8±2.5 mm (males; 4.58±2.19 mm, females; 5.08±2.76 mm). In abducted AP, the width at the upper end was 3.8±2.9 mm (males; 3.65±1.50 mm, females; 3.97±3.85 mm). The width at the midpoint was 4.6±2.3 mm (males; 4.45±2.16 mm, females; 5.18±3.79 mm). The width at the lower end was 4.8±3.1 mm (males; 4.55±1.30 mm, females; 4.74±3.06 mm). In axial CT, the width at the anterior border was 15.0±6.2 mm (males; 14.50±6.62 mm, females; 16.44±6.22 mm). The width at the narrowest point was 3.1±1.5 mm (males; 3.19±1.53 mm, females; 3.09±1.50 mm). The width at the widest point was 4.1±1.6 mm (males; 4.27±1.60 mm, females; 4.00±1.50 mm). The width at the posterior border was 2.3±1.3 mm (males: 2.20±1.30 mm, females; 2.44±1.40 mm). Axial thickness was 27.1±5.3 mm (males; 29.48±4.60 mm, females; 24.70±4.82 mm). In coronal CT, the width at the upper end was 3.1±4.1 mm (males; 2.28±1.26 mm, females; 3.83±5.48 mm). The width at beginning of widening was 3.6±4.5 mm (males; 2.68±1.63 mm, females; 4.54±6.08 mm). The width at the lower end was 20.5±8.2 mm (males; 17.49±4.53 mm, females; 23.60±9.86 mm). Coronal thickness was 20.4±7.1 mm (males; 24.50±5.98 mm, females; 16.23±5.61 mm). In supine film, width significantly increased with age at the upper end (p=0.022) and midpoint (p< 0.001); however, it decreased at the lower end (p< 0.001). In abduction film, width at midpoint increased with age (p=0.003).

Conclusion

Pelvic malunion should be defined according to the population and age. These results could be a reference in assessing the quality of reduction after internal fixation of the patients with traumatic diastasis of the pubic symphysis.
Modeling land use change and forest carbon stock changes in temperate forests in the United States
Authors: Fitts Lucia A. , Russell Matthew B. , Domke Grant M. , Knight Joseph K.
Published: July 2021

Background

Forests provide the largest terrestrial sink of carbon (C). However, these C stocks are threatened by forest land conversion. Land use change has global impacts and is a critical component when studying C fluxes, but it is not always fully considered in C accounting despite being a major contributor to emissions. An urgent need exists among decision-makers to identify the likelihood of forest conversion to other land uses and factors affecting C loss. To help address this issue, we conducted our research in California, Colorado, Georgia, New York, Texas, and Wisconsin. The objectives were to (1) model the probability of forest conversion and C stocks dynamics using USDA Forest Service Forest Inventory and Analysis (FIA) data and (2) create wall-to-wall maps showing estimates of the risk of areas to convert from forest to non-forest. We used two modeling approaches: a machine learning algorithm (random forest) and generalized mixed-effects models. Explanatory variables for the models included ecological attributes, topography, census data, forest disturbances, and forest conditions. Model predictions and Landsat spectral information were used to produce wall-to-wall probability maps of forest change using Google Earth Engine.

Results

During the study period (2000–2017), 3.4% of the analyzed FIA plots transitioned from forest to mixed or non-forested conditions. Results indicate that the change in land use from forests is more likely with increasing human population and housing growth rates. Furthermore, non-public forests showed a higher probability of forest change compared to public forests. Areas closer to cities and coastal areas showed a higher risk of transition to non-forests. Out of the six states analyzed, Colorado had the highest risk of conversion and the largest amount of aboveground C lost. Natural forest disturbances were not a major predictor of land use change.

Conclusions

Land use change is accelerating globally, causing a large increase in C emissions. Our results will help policy-makers prioritize forest management activities and land use planning by providing a quantitative framework that can enhance forest health and productivity. This work will also inform climate change mitigation strategies by understanding the role that land use change plays in C emissions.
Clinical relevance of targeted exome sequencing in patients with rare syndromic short stature
Authors: Kamil Gilyazetdinov , Yoon Ju Young , Yoo Sukdong , Cheon Chong Kun
Published: July 2021

Background

Large-scale genomic analyses have provided insight into the genetic complexity of short stature (SS); however, only a portion of genetic causes have been identified. In this study, we identified disease-causing mutations in a cohort of Korean patients with suspected syndromic SS by targeted exome sequencing (TES).

Methods

Thirty-four patients in South Korea with suspected syndromic disorders based on abnormal growth and dysmorphic facial features, developmental delay, or accompanying anomalies were enrolled in 2018–2020 and evaluated by TES.

Results

For 17 of 34 patients with suspected syndromic SS, a genetic diagnosis was obtained by TES. The mean SDS values for height, IGF-1, and IGFBP-3 for these 17 patients were − 3.27 ± 1.25, − 0.42 ± 1.15, and 0.36 ± 1.31, respectively. Most patients displayed distinct facial features (16/17) and developmental delay or intellectual disability (12/17). In 17 patients, 19 genetic variants were identified, including 13 novel heterozygous variants, associated with 15 different genetic diseases, including many inherited rare skeletal disorders and connective tissue diseases (e.g., cleidocranial dysplasia, Hajdu–Cheney syndrome, Sheldon–Hall, acromesomelic dysplasia Maroteaux type, and microcephalic osteodysplastic primordial dwarfism type II). After re-classification by clinical reassessment, including family member testing and segregation studies, 42.1% of variants were pathogenic, 42.1% were likely pathogenic variant, and 15.7% were variants of uncertain significance. Ultra-rare diseases accounted for 12 out of 15 genetic diseases (80%).

Conclusions

A high positive result from genetic testing suggests that TES may be an effective diagnostic approach for patients with syndromic SS, with implications for genetic counseling. These results expand the mutation spectrum for rare genetic diseases related to SS in Korea.
A dual inhibitor overcomes drug-resistant FLT3-ITD acute myeloid leukemia
Authors: Wang Peihong , Xiao Xinhua , Zhang Yuyin , Zhang Baoyuan , Li Donghe , Liu Mingzhu , Xie Xi , Liu Chenxuan , Liu Ping , Ren Ruibao
Published: July 2021

FLT3 mutations are the most frequently identified genetic alterations in acute myeloid leukemia (AML) and are associated with poor prognosis. Multiple FLT3 inhibitors are in various stages of clinical evaluation. However, resistance to FLT3 inhibitors resulting from acquired point mutations in tyrosine kinase domain (TKD) have limited the sustained efficacy of treatments, and a “gatekeeper” mutation (F691L) is resistant to most available FLT3 inhibitors. Thus, new FLT3 inhibitors against both FLT3 internal tandem duplication (FLT3-ITD) and FLT3-TKD mutations (including F691L) are urgently sought. Herein, we identified KX2-391 as a dual FLT3 and tubulin inhibitor and investigated its efficacy and mechanisms in overcoming drug-resistant FLT3-ITD-TKD mutations in AML. KX2-391 exhibited potent growth inhibitory and apoptosis promoting effects on diverse AML cell lines harboring FLT3-ITD mutations and AC220-resistant mutations at the D835 and F691 residues in TKD and inhibited FLT3 phosphorylation and its downstream signaling targets. Orally administered KX2-391 significantly prolonged the survival of a murine leukemia model induced by FLT3-ITD-F691L. KX2-391 also significantly inhibited the growth of 4 primary AML cells expressing FLT3-ITD and 2 primary AML cells expressing FLT3-ITD-D835Y. Our preclinical data highlight KX2-391 as a promising FLT3 inhibitor for the treatment of AML patients harboring FLT3 mutations, especially refractory/relapsed patients with F691L and other FLT3-TKD mutations.
Sand fly identification and screening for Leishmania spp. in six provinces of Thailand
Authors: Phuphisut Orawan , Nitatsukprasert Chanyapat , Pathawong Nattaphol , Jaichapor Boonsong , Pongsiri Arissara , Adisakwattana Poom , Ponlawat Alongkot
Published: July 2021

Background

Phlebotomine sand flies are vectors ofLeishmaniaspp. At least 27 species of sand flies have been recorded in Thailand. Although human leishmaniasis cases in Thailand are mainly imported, autochthonous leishmaniasis has been increasingly reported in several regions of the country since 1999. Few studies have detectedLeishmaniainfection in wild-caught sand flies, although these studies were carried out only in those areas reporting human leishmaniasis cases. The aim of this study was therefore to identity sand fly species and to investigateLeishmaniainfection across six provinces of Thailand.

Methods

Species of wild-caught sand flies were initially identified based on morphological characters. However, problems identifying cryptic species complexes necessitated molecular identification using DNA barcoding in parallel with identification based on morphological characters. The wild-caught sand flies were pooled and the DNA isolated prior to the detection ofLeishmaniainfection by a TaqMan real-time PCR assay.

Results

A total of 4498 sand flies (1158 males and 3340 females) were caught by trapping in six provinces in four regions of Thailand. The sand flies were morphologically classified into eight species belonging to three genera (Sergentomyia,PhlebotomusandIdiophlebotomus).Sergentomyia iyengariwas found at all collection sites and was the dominant species at most of these, followed in frequency bySergentomyia barraudiandPhlebotomus stantoni, respectively. DNA barcodes generated from 68 sand flies allowed sorting into 14 distinct species with 25 operational taxonomic units, indicating a higher diversity (by 75%) than that based on morphological identification. Twelve barcoding sequences could not be assigned to any species for which cytochromecoxidase subunit I sequences are available. All tested sand flies were negative forLeishmaniaDNA.

Conclusions

Our results confirm the presence of several sand fly species in different provinces of Thailand, highlighting the importance of using DNA barcoding as a tool to study sand fly species diversity. While all female sand flies tested in this study were negative forLeishmania, the circulation ofLeishmaniaspp. in the investigated areas cannot be ruled out.

Graphical abstract