bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative profiling of prenatal cortisol and DHEA‐S among pregnant women with poor birth outcome and pregnant women with normal birth outcome
Authors: Sundararajan Aarthi , Vora Kranti , Saiyed Shahin , Natesan Senthilkumar
Published: August 2021

Context

Cortisol and dehydroepiandrosterone‐sulfate (DHEA‐S) are indispensable hormones for normal pregnancy. It is unclear if these hormones, specifically DHEA‐S can offer value for predicting poor birth outcome.

Objective

To compare prenatal cortisol and DHEA‐S levels among pregnant women with normal or poor birth outcome.

Methods

Plasma and saliva were collected prospectively from women in second‐third trimester of pregnancy. Women with normal birth outcome (NBO) (n = 501) included live birth, no pregnancy complications and ≥2.5 kg infant birth weight. Women with poor birth outcome included adverse birth outcome (ABO) (n = 50) or low birth weight outcome (LBW) (n = 147). Enzyme‐linked immunosorbent assay was performed to measure hormone concentrations in plasma and saliva.

Results

Circulatory‐DHEA‐S levels in pregnant women with ABO were higher than women with NBO (p = .043). Among ABO, only stillbirth cases demonstrated significant increase in circulatory‐DHEA‐S levels (p = .006). Circulatory and salivary cortisol/DHEA‐S ratio was lower among women with stillbirth (p = .004) and ABO outcome (p = .043) respectively compared with women with NBO. Consistently, increased odds of ABO were observed in pregnant women with highest circulatory‐DHEA‐S levels (odds ratio quartile score 1 vs. 4, 2.79, p = .027) and lowest salivary cortisol/DHEA‐S ratio (score 4 vs. 2, 2.83, p = .025). Increased odds of stillbirth outcome were observed in pregnant women with highest circulatory‐DHEA‐S levels (odds ratio quartile score 1 vs. 4, 8.47, p = .046) and lowest circulatory cortisol/DHEA‐S ratio (score 4 vs. 1, 4.803, p = .048). Associations remained significant after adjusting for confounders. Women with LBW did not demonstrate significant changes in cortisol or DHEA‐S levels.

Conclusion

Prenatal measurement of DHEA‐S or cortisol/DHEA‐S ratio may offer significant value for predicting adverse birth, specifically stillbirth outcome.
For whom (and for when) is the firm governed? The effect of changes in corporate fiduciary duties on tax strategies and earnings management
Authors: Cumming Douglas , Tingle QC Bryce C. , Zhan Feng
Published: August 2021

The proper object of the fiduciary duties of corporate directors and officers is frequently described as the central question in all corporate law. We use the adoption of constituency statutes, which shift the loci of corporate managers' duties from shareholders to a wide range of stakeholders, as a quasi‐natural experiment to determine the actual impact of fiduciary duties. We find that though the adoption of constituency statutes has no significant effect on measures of earnings management, it has a robust effect on firms' effective tax rate, which increases in a range between 0.570% and 1.903%. These results are robust in terms of various measures of the firm's effective tax rate. We provide explanations for why fiduciary duties apparently do not influence manager behaviours in relation to shareholders but do affect their behaviours in relation to the taxing authority. We argue that a change to fiduciary duties does not appear to alter the motivation of managers to maximize shareholder welfare outcomes, but rather it allows them to eschew short‐term strategies that often impair long‐term outcomes.
Medication overuse headache in patients with chronic migraine using cannabis: A case–referent study
Authors: Zhang Niushen , Woldeamanuel Yohannes W.
Published: August 2021

Objective

To examine whether cannabis use predicts medication overuse headache (MOH) in patients with chronic migraine (CM).

Methods

Electronic chart review was conducted by combining the terms “CM,” “medication overuse,” “cannabis,” “cannabidiol,” and “tetrahydrocannabinol” for patients seen at our headache clinics from 2015 to 2019. Of 729 charts consecutively screened, 368 met our inclusion criteria, that is, adult patients with CM with ≥1‐year CM duration. The following variables were extracted from the included patient charts: MOH diagnosis, age, sex, migraine frequency, current CM duration, current cannabis use duration, overused acute migraine medications, current MOH duration, and types of cannabis products used. Logistic regression was used to identify variables predicting MOH while controlling for remaining predictors. Agglomerative hierarchical clustering (AHC) was conducted to explore natural clusters using all predictor variables.

Results

There were 212 patients with CM and MOH (cases; median age 43 years, interquartile range [IQR] 33–54; 177 [83%] females) and 156 patients with CM without MOH (referents; median age 40 years, IQR 31–49; 130 [83%] females). MOH was present in 81% (122/150) of current cannabis users compared with 41% (90/218) in those without cannabis use—adjusted odds ratio 6.3 (95% CI: 3.56 to 11.1, p < 0.0001). Current cannabis use was significantly associated with opioid use (Spearman's rho 0.26, p < 0.0001). Both current cannabis use (rho 0.40, p < 0.0001) and opioid use (rho 0.36, p < 0.0001) were significantly associated with MOH. Similarly, AHC revealed two major natural clusters. Cluster I patients featured 9.3 times higher current cannabis use, 9.2 times higher current opioid use, and 1.8 times higher MOH burden than those in Cluster II (p < 0.0001).

Conclusion

Cannabis use was significantly associated with increased prevalence of MOH in CM. Bidirectional cannabis–opioid association was observed—use of one was associated with use of the other. Advising patients with CM and MOH to reduce cannabis use may help treat MOH effectively.
“Whilst you are here…” Acceptability of providing advice about screening and early detection of other cancers as part of the breast cancer screening programme
Authors: Scott Suzanne E. , Rauf Betul , Waller Jo
Published: August 2021

Objectives

This research aimed to assess women's willingness to receive advice about cervical and bowel cancer screening participation and advice on cancer symptom awareness when attending breast cancer screening.

Methods

Women (n = 322) aged 60–64 years, living in the United Kingdom, who had previously taken part in breast cancer screening were recruited via a market research panel. They completed an online survey assessing willingness to receive advice, the potential impact of advice on breast screening participation, prospective acceptability and preferences for mode and timing of advice.

Results

Most women would be willing to receive information about cervical (86%) and bowel cancer screening (90%) and early symptoms of other cancers (92%) at a breast cancer screening appointment. Those who were not up to date with cervical cancer screening were less willing. Prospective acceptability was high for all three forms of advice and was associated with willingness to receive advice. Women would prefer to receive advice through a leaflet (41%) or discussion with the mammographer (30%) either before the appointment (27%), at the appointment (44%) or with their results (22%).

Conclusions

While there is high willingness and high acceptability towards using breast cancer screening as a teachable moment for advice about prevention and early detection of other cancers, some women find it unacceptable and this may reduce their likelihood of attending a breast screening appointment.

Patient or Public Contribution

This study focused on gaining women's insights into potential future initiatives to encourage screening and early diagnosis of cancer. Members of the public were also involved in piloting the questionnaire.
Nurses’ experiences of providing care during the COVID‐19 pandemic in Taiwan: A qualitative study
Authors: Liang Hwey‐Fang , Wu Yi‐Chen , Wu Chien‐Yu
Published: August 2021

In the event of a contagious disease outbreak that reaches the level of a pandemic, the responsibility of providing care for patients increases for front‐line nurses. However, being in a nursing role exposes professionals to a range of risks, including but not limited to contagion and mental health impacts. This qualitative study aimed to explore in‐depth nurses’ experiences of providing care in the time of the COVID‐19 global pandemic. The study followed the COREQ guidelines. Purposive sampling was applied to recruit participants. Semi‐structured face‐to‐face interviews were used to collect the data from 16 nurses across five hospitals in Taiwan in 2020. Contents were analysed using Colaizzi’s seven‐step method. The essential structure that was identified was ‘Providing care cautiously and being alert to the changing environment’, which reflects the progress of Taiwanese nurses in providing care during the global COVID‐19 pandemic. The essence of the phenomenon is presented through three themes: (i) facing the emerging challenge, (ii) struggling with uncertainty, fear, stigma, and workload, and (iii) adapting to changes in the environment: learning and innovation. The findings identified multi‐dimensional impacts of nursing experiences during the COVID‐19 pandemic, and the study yielded evidence and practices that can be used to guide and support adequate interventions to support nursing professionals. By understanding the various aspects of nurses’ experiences, policymakers and administrators can better address nursing care providers’ professional and mental health needs during a pandemic.
Mode of decision making's approach in surgical procedures at Jimma Medical Center, Jimma, Ethiopia
Authors: Biyazin Tsegaw , Yetwale Aynalem , Fenta Belete
Published: August 2021

Background

Perform sound decisions making while operating is crucial to the success of surgical procedures. The bewildering to choose the preferred mode of decision‐making during a surgical procedure is regularly observed. This study was aimed to assess the mode of decision‐making approach in surgical procedures among women who have undergone obstetrics and gynaecologic surgeries, Jimma, Ethiopia 2020.

Methods

Facility‐based cross‐sectional study was conducted from April 1 to May 30, 2020, at Jimma Medical Center. A total of 372 surgical patients were selected using a systematic sampling method. The collected data were coded, entered into Epi data version 3.1, and analysed using SPSS version 25. Multinomial logistic regression was carried out to determine the association between the outcome variable and independent variables.

Results

Three hundred seventy‐two respondents were interviewed and give a 92% response rate. The majority of 220 (59.1%) respondents reported that they decided on the surgical procedures through themselves without external coercion, followed by a shared 94 (25.3%) and paternalism 58 (15.6%). The multinomial logistic regression analysis in model‐1 shows that patient‐healthcare provider's relationship and practice of informed consent predictors were statistically significant with shared decision making. Moreover in model‐2 patient healthcare providers' relationship, marital status, and time spent on decision variables were statistically significant with the outcome variable.

Conclusion

In the study, the shared decision‐making was inadequate and not in line with recent recommendation guidelines. The paternalism mode of decision‐making was still practice. Build patient‐health care providers' relationship is vital for promoting and advance the patients' autonomy on the decision‐making approach. The healthcare providers should be motive for collaborative decision‐making with the patient.
Recombinant soluble thrombomodulin accelerates epithelial stem cell proliferation in mouse intestinal organoids and promotes the mucosal healing in colitis
Authors: Gaowa Arong , Park Eun Jeong , Kawamoto Eiji , Qin Yan , Shimaoka Motomu
Published: August 2021

Background and Aim

Epithelial regeneration, a critical step for the mucosal healing in inflammatory bowel disease, is tightly regulated by stem cells. Therefore, identification of the specific factors that induce stem cell proliferation could contribute to the development of effective strategies for treating inflammatory bowel disease. Recombinant soluble thrombomodulin (rsTM) has previously been shown to promote cell proliferation in skin and corneal wound healing in murine models, but its effects on intestinal epithelial cell proliferation remains unclear.

Methods

Mouse intestinal organoids and dextran sulfate sodium (DSS)‐induced colitis mouse model were used to assess the effects of rsTM on proliferation of intestinal epithelial cells. The size and budding morphologies of organoids were studied by confocal microscopy. The gene expression levels were analyzed by quantitative real‐time polymerase chain reaction and immunofluorescence analysis. The effects of rsTM on DSS‐induced colitis were investigated by evaluating body weight changes, colon length, histological score, and survival rate.

Results

The rsTM markedly stimulated the growth of intestinal organoids, thereby increasing the surface areas and budding phenotypes of the organoids. rsTM also significantly upregulated the gene expression of intestinal stem cell‐specific and epithelial cell‐specific markers in a dose‐dependent manner. Furthermore, the treatment with high concentrations of rsTM significantly improved the recovery of body weight, histological outcomes, colon length shortening, and prolonged the survival of mice with colitis.

Conclusions

The rsTM promotes intestinal stem cell proliferation in intestinal organoids and enhances the mucosal healing during recovery phase in DSS‐induced colitis.
Exploring dietitians' practice and views of giving advice on dietary patterns to patients with type 2 diabetes mellitus: A qualitative study
Authors: Moutou Konstantina E. , England Clare , Gutteridge Callum , Toumpakari Zoi , McArdle Paul D. , Papadaki Angeliki
Published: August 2021

Background

Dietary guidelines for type 2 diabetes mellitus (T2DM) emphasise weight management and individualised total carbohydrate intake. Evidence on the most effective dietary patterns (DPs) for T2DM management is mixed, potentially leading to variations in the advice that dietitians provide. The present study aimed to explore dietitians' practice of DP advice provision to adults with T2DM, as well as understand their views when advising their patients on the DPs deemed effective for glycaemic management or recommended by current guidelines.

Methods

Semi‐structured interviews were conducted with 12 UK‐registered dietitians, with experience in consulting adults with T2DM. Dietitians were asked for their views on five DPs recommended for glycaemic management of T2DM. Interview transcripts were analysed using deductive and inductive thematic analysis.

Results

Nine themes were identified that draw attention to DP advice provision practices, the five DPs (low‐carbohydrate, low‐fat, low‐glycaemic index, Mediterranean diet and Dietary Approaches to Stop Hypertension diet), other DPs, the barriers and facilitators to DP advice provision and following this advice, and the factors affecting the provision of DP advice. Participants' current practice of DP advice provision to patients with T2DM was perceived to be individualised and patient‐centred. Participants discussed their current practice and perceptions of available evidence and how patients respond to advice on the DPs shown to be effective for glycaemic management. Several barriers to providing advice on specific DPs, including safety and compliance challenges, were identified. Participants also highlighted factors that would facilitate the provision of advice on specific DPs and would help patients to follow this advice, including social support, educational resources and more robust scientific evidence.

Conclusions

The findings of the present study provide important insights regarding dietitians' views of promoting whole DPs to patients with T2DM. Emerged barriers and facilitators should be considered when developing future guidance for dietetic practice to support patients with following whole DPs for T2DM management.
Calibration of local‐stochastic volatility models by optimal transport
Authors: Guo Ivan , Loeper Grégoire , Wang Shiyi
Published: August 2021

In this paper, we study a semi‐martingale optimal transport problem and its application to the calibration of local‐stochastic volatility (LSV) models. Rather than considering the classical constraints on marginal distributions at initial and final time, we optimize our cost function given the prices of a finite number of European options. We formulate the problem as a convex optimization problem, for which we provide a PDE formulation along with its dual counterpart. Then we solve numerically the dual problem, which involves a fully non‐linear Hamilton–Jacobi–Bellman equation. The method is tested by calibrating a Heston‐like LSV model with simulated data and foreign exchange market data.
Ordering Behavior and the Impact of Allocation Mechanisms in an Integrated Distribution System
Authors: Spiliotopoulou Eirini , Donohue Karen , Gürbüz Mustafa Çagri
Published: August 2021

We study the impact of three well‐known inventory allocation mechanisms, including proportional, linear, and uniform, on the ordering behavior of retailers serviced from a central distribution center. Based on the allocation mechanism, retailers may have an incentive to adjust (either inflate or deflate) their orders to gain a more favorable allocation, a behavior that may reduce allocation efficiency from a system perspective. We find that while all three mechanisms are centrally optimal under common knowledge of local demands, only the uniform allocation incentivizes retailers to set orders truthfully. Consistent with theory, our experimental results show that using proportional or linear allocation results in larger and more frequent order adjustments, with the degree of strategic ordering being largest under the linear mechanism. Across all mechanisms, order adjustments decrease both allocation efficiency and local retail profits. While uniform allocation results in smaller and less frequent adjustments overall, it may not be feasible to implement in more general settings. Hence, we propose and test a new mechanism, tailored uniform, that leverages the uniform principle while overcoming some practical limitations. It provides more flexibility by allowing for differences in the allocated quantities among retailers, while still providing no incentive for order manipulation. The tailored uniform mechanism performs similarly to uniform in terms of order adjustments, and further increases allocation efficiency when retailers have heterogeneous demands.
Effect of exogenous administration of oxytocin on postpartum follicular dynamics, oestrous rate and ovulation in Nili‐Ravi buffaloes
Authors: Murtaza Saeed , Sattar Abdul , Ahmad Nasim , Jamil Ahmad Muhammad , Akhtar Saleem , Ahmad Ejaz , Ahmad Tanveer , Omer Talha
Published: August 2021

Based on different surveys, dairy farmers are concerned about extensive use of exogenous oxytocin in buffaloes, which is being held responsible for reproductive problems including irregular oestrous cycle and delayed ovulation. For these concerns, effects of oxytocin injection on postpartum follicular dynamics, postpartum oestrous interval (PEI), oestrous length, the interval from onset of estrus to ovulation and blood progesterone (P4) were studied in Nili‐Ravi buffaloes. For this purpose, 23 animals within 1 week after calving were randomly divided into three groups: without oxytocin (CON; n = 7), 10 i.u. oxytocin (LOW; n = 8), 30 i.u. oxytocin – (HIGH; n = 8) and used to record the PEI for the study period of 154 days. At subsequent estrus, three buffaloes from each group (not served) were selected randomly to monitor two cycles for 6 weeks. Transrectal ultrasonography was performed to evaluate follicular and corpus luteum (CL) development, and blood sampling was done for progesterone (P4) analysis. These results revealed that postpartum oestrous interval (PEI) decreased significantly in oxytocin‐treated groups. The number of small, medium and total follicles on the left ovary was significantly higher in the HIGH group. However, an overall number of small and total follicles on both right and left ovaries was significantly higher in CON and HIGH groups. On the other hand, there was no difference in the number of follicles on the right ovary among all treatment groups. The same was true for the size of pre‐ovulatory follicles, CL, P4 concentrations and oestrous cycle length. The intervals from onset of estrus to ovulation and from standing estrus to ovulation were increased considerably in the HIGH group. It is concluded that exogenous oxytocin administration resulted in the shortening of PEI but triggered a delay in ovulation. Moreover, a higher dose of oxytocin could stimulate the growth of small, medium, and total follicles in postpartum Nili‐Ravi buffaloes.
Effects of long‐term contrasting lime and phosphorus applications on barley grain yield, root growth and abundance of mycorrhiza
Authors: Christensen Julie Therese , Azeez Musibau Oyeleke , Labouriau Rodrigo , Ravnskov Sabine , Kristensen Hanne Lakkenborg , Munkholm Lars Juhl , Rubæk Gitte Holton
Published: August 2021

Lime and phosphorus (P) applications are common agricultural management practices. Our aim was to quantify the effects of long‐term application practices on root growth and abundance of arbuscular mycorrhizal fungi (AMF) under field conditions. We assessed the effects of lime and P fertilizer applications on barley yield, root growth and AMF abundance in 2016. Treatments were no, low, medium and high liming rate corresponding to application of 0, 4, 8 and 12 Mg lime ha−1 every 5–9 years since 1942 combined with no or yearly application of 15.6 kg P ha−1 since 1944. At harvest, grain yield, root intensity (core‐break) and AMF abundance at different soil depths were estimated. Root development was monitored during early growth with minirhizotrons in treatments receiving low, medium and high liming rates and P fertilization. A quadratic model relating grain yield to liming rate estimated yields to peak at 6.4 Mg lime ha−1 with yields of 4.2 and 3.2 Mg grain ha−1 with and without P fertilization, respectively. Low and medium liming rates resulted in greater AMF abundance, especially in the no P treatments. During early growth in P‐fertilized treatments, 77% and 65% more roots developed in the soil profile when treated with medium and high liming rate, respectively, compared to low liming rate. We conclude that long‐term application of lime in soils receiving yearly P fertilization improved conditions for root growth in soil layers below 30 cm, but at the high liming rate, this did not translate into higher yield.
Collision‐related porphyry Cu deposits formed by input of ultrapotassic melts into the sulfide‐rich lower crust
Authors: Zheng Yuan‐Chuan , Shen Yang , Wang Lu , Griffin William L. , Hou Zeng‐Qian
Published: August 2021

Collision‐related porphyry Cu deposits (PCDs) are restricted to previous magmatic arcs, in which sulfide‐rich lower crust occurred. Fertile adakite‐like porphyries associated with PCDs have higher K2O contents and K2O/Na2O ratios than barren porphyries emplaced in the same arc. The elevated K2O/Na2O ratios of fertile porphyries reflect substantial inputs of coeval hydrous, oxidized ultrapotassic melts. Input of such melts could increase the water content and oxygen fugacity of the lower‐crust‐derived melts, which in turn would promote the breakdown of sulphides in the lower crust and increase the contents of Cu and S in the melts, making them favourable for the formation of large PCDs. The relatively low K2O contents and K2O/Na2O ratios of barren porphyries indicate limited input of ultrapotassic melts; these magmas have low potential to form PCDs. Thus, the input of ultrapotassic melts into the sulfide‐rich juvenile lower crust drives the formation of collision‐related PCDs.
Preliminary Design of Hybrid-Electric Propulsion Systems for Emerging Urban Air Mobility Rotorcraft Architectures
Authors: Saias Chana Anna , Goulos Ioannis , Roumeliotis Ioannis , Pachidis Vassilios , Bacic Marko
Published: August 2021

The increasing demands for air-taxi operations together with the ambitious targets for reduced environmental impact have driven significant interest in alternative rotorcraft architectures and propulsion systems. The design of hybrid-electric propulsion systems (HEPSs) for rotorcraft is seen as being able to contribute to those goals. This work aims to conduct a comprehensive design and tradeoff analysis of hybrid powerplants for rotorcraft, targeting enhanced payload-range capability and fuel economy. An integrated methodology for the design, performance assessment, and optimal implementation of HEPSs for conceptual rotorcraft has been developed. A multidisciplinary approach is devised comprising models for rotor aerodynamics, flight dynamics, HEPS performance, and weight estimation. All models are validated using experimental or flight test data. The methodology is deployed for the assessment of a hybrid-electric tilt-rotor, modeled after the NASA XV-15. This work targets to provide new insight into the preliminary design and sizing of optimally designed HEPSs for novel tilt-rotor aircraft. The paper demonstrates that at present, current battery energy densities (250 Wh/kg) severely limit the degree of hybridization if a fixed useful payload and range are to be achieved. However, it is also shown that if advancements in battery energy density to 500 Wh/kg are realized, a significant increase in the level of hybridization and hence reduction of fuel burned and carbon output relative to the conventional configuration can be attained. The methodology presented is flexible enough to be applied to alternative rotorcraft configurations and propulsion systems.
The Transition Out of Sport: A Case of College Athletics and Academic Support Services
Authors: Eicher Anya T. , Johnson James E. , Campbell Phoebe , Downs Benjamin J.
Published: August 2021

As the commercialization of intercollegiate sport continues to grow, it is critical to understand how transitioning away from college athletics may impact student-athletes. Sport administrators, coaches, academic support personnel, and players should be aware of how athletic identity, unpreparedness, and a lack of social connection can drastically impact student-athletes postsport. Understanding the adjustment issues associated with transition away from sport is crucial in developing policies and support services to effectively help struggling student-athletes. Sport management students are particularly important in the transition because they will be at the forefront of programming efforts. In addition, sport management students need to be exposed to the issue of athlete identity and adjustment in order to act in the best interests of student-athletes. The discussion questions provide an opportunity for sport management students to critically evaluate these issues from a multitude of perspectives.
Let Me Upgrade You: Impact of Mobile Genetic Elements on Enterococcal Adaptation and Evolution
Authors: Johnson Cydney N. , Sheriff Emma K. , Duerkop Breck A. , Chatterjee Anushila
Published: August 2021

Enterococci are Gram-positive bacteria that have evolved to thrive as both commensals and pathogens, largely due to their accumulation of mobile genetic elements via horizontal gene transfer. Common agents of horizontal gene transfer include plasmids, transposable elements, and temperate bacteriophages.
Severe acute inflammatory myositis and rhabdomyolysis in paediatric SARS-CoV-2-associated MIS-C (multisystem inflammatory syndrome in children)
Authors: Cassim Faeeza , Soni Abdullah Jalaluddin , Murphy Susan
Published: August 2021

We present the case of a 12-year-old African girl infected with SARS-CoV-2 who was admitted to a tertiary academic hospital in Johannesburg with severe acute inflammatory myositis complicated by rhabdomyolysis and acute kidney injury requiring renal replacement therapy and intensive care. She also fulfilled the diagnostic criteria for multisystem inflammatory syndrome in children.
Multiple abdominal artery dissections: how to distinguish two rare diseases
Authors: De Marchi Sara , Pianca Silvio , Ceriani Luca , Cippà Pietro E
Published: August 2021

A 59-year-old woman was referred to the emergency room with acute abdominal pain. A CT scan revealed multiple dissections and microaneurysms of the superior mesenteric, the hepatic and the renal arteries. Stenting of the superior mesenteric artery was required. A non-invasive diagnostic procedure was instrumental to establish the diagnosis and guide appropriate treatment, which resulted in a rapid and sustained recovery.
Inverse correlates of COVID-19 mortality across European countries during the first versus subsequent waves
Authors: Villani Leonardo , Pastorino Roberta , Ricciardi Walter , Ioannidis John , Boccia Stefania
Published: August 2021

The objectives of the study were to calculate the standardised mortality rates (SMRs) for COVID-19 in European Union/European Economic Area countries plus the UK and Switzerland and to evaluate the correlation between SMRs and selected indicators in the first versus the subsequent waves until 23 June 2021. We used indirect standardisation (using Italy as the reference) to compute SMRs and considered 16 indicators of health and social well-being, health system capacity and COVID-19 response. The highest SMRs were in Belgium, the UK and Spain in the first wave (1.20–1.84) and in Hungary, Czechia and Slovakia in the subsequent waves (2.50–2.69). Human Development Index (HDI), life expectancy, urbanisation and healthcare expenditure had positive correlations with SMR in the first wave (rho=0.30–0.46), but negative correlations (rho=−0.67 to −0.47) in the subsequent waves. Retail/recreation mobility and transit mobility were negatively correlated with SMR in the first wave, while transit mobility was inversely correlated with SMR in the subsequent waves. The first wave hit most hard countries with high HDI, high life expectancy, high urbanisation, high health expenditures and high tourism. This pattern may reflect higher early community seeding and circulation of the virus. Conversely, in the subsequent waves, this pattern was completely inversed: countries with more resources and better health status did better than eastern European countries. While major SMR differences existed across countries in the first wave, these differences largely dissipated by 23 June 2021, with few exceptions.
Remote ultrasound diagnostics disrupting traditional military frontline healthcare delivery
Authors: Blenkinsop Georgina , Heller R A , Carter N J , Burkett A , Ballard M , Tai N
Published: August 2021

Accurate and reliable diagnostic capability is essential in deployed healthcare to aid decision-making and mitigate risk. This is important for both the patient and the deployed healthcare system, especially when considering the prioritisation of scarce aeromedical evacuation assets and frontline resources. Novel ultrasound tele-guidance technology presents a valuable diagnostic solution for remotely deployed military clinicians. This report discusses the first use of a consultant radiologist guiding a clinician, untrained in ultrasound, to perform an ultrasound scan via a live tele-guidance feed in the deployed environment using the Butterfly iQ+ tele-guidance system. Distance scanning provided a diagnostic quality report when compared with locally performed imaging to improve patient care and maintain operational output. This example demonstrates feasibility of remote point-of-care imaging systems in provision of location-agnostic high-quality diagnostic capability. Future opportunities to develop care pathways using bedside tele-diagnostics will democratise access, drive efficiency and improve patient care experience and outcomes.
Exploring managers’ response to a quality and safety leadership intervention: findings from a multiple case study in Norwegian nursing homes and homecare services
Authors: Johannessen Terese , Ree Eline , Aase Ingunn , Bal Roland , Wiig Siri
Published: August 2021

Background

Improvement interventions would be easier to treat if they were stable and uninfluenced by their environment, but in practice, contextual factors may create difficulties in implementing and sustaining changes. Managers of healthcare organisations play an important role in quality and safety improvement. We need more research in the nursing home and homecare settings to support managers in their quality and safety improvement work. The aim of this study was to explore managers’ response to a leadership intervention on quality and safety improvement.

Methods

This study reports findings from the SAFE-LEAD intervention undertaken from April 2018 to March 2019. The research design was a multiple case study of two nursing homes and two homecare services in four municipalities in Norway. We used a combination of qualitative methods including interviews, workshops, observations, site visits and document analysis in our data collection that took place over a 1-year period.

Results

Management continuity was key for the implementation process of the quality and safety leadership intervention. In the units where stable management teams were in place, the intervention was more rooted in the units, and changes in quality and safety practice occurred. The intervention served as an arena for managers to work with quality and safety improvement. We found that the workshops and use of the leadership guide contributed to a common understanding and commitment to quality and safety improvement among the managers.

Conclusions

This is a longitudinal study of managers’ response to a leadership intervention targeted to improve quality and safety work in nursing home and homecare settings. Our research demonstrates how the mechanisms of stable management and established structures are crucial for quality and safety improvement activities. Management continuity is key for participating in interventions and for using the leadership guide in quality and safety work.
Simple screening model for identifying the risk of sleep apnea in patients on opioids for chronic pain
Authors: Selvanathan Janannii , Waseem Rida , Peng Philip , Wong Jean , Ryan Clodagh M , Chung Frances
Published: August 2021

Background

There is an increased risk of sleep apnea in patients using opioids for chronic pain. We hypothesized that a simple model comprizing of: (1) STOP-Bang questionnaire and resting daytime oxyhemoglobin saturation (SpO2); and (2) overnight oximetry will identify those at risk of moderate-to-severe sleep apnea in patients with chronic pain.

Method

Adults on opioids for chronic pain were recruited from pain clinics. Participants completed the STOP-Bang questionnaire, resting daytime SpO2, and in-laboratory polysomnography. Overnight oximetry was performed at home to derive the Oxygen Desaturation Index. A STOP-Bang score ≥3 or resting daytime SpO2 ≤95% were used as thresholds for the first step, and for those identified at risk, overnight oximetry was used for further screening. The Oxygen Desaturation Index from overnight oximetry was validated against the Apnea-Hypopnea Index (≥15 events/hour) from polysomnography.

Results

Of 199 participants (52.5±12.8 years, 58% women), 159 (79.9%) had a STOP-Bang score ≥3 or resting SpO2 ≤95% and entered the second step (overnight oximetry). Using an Oxygen Desaturation Index ≥5 events/hour, the model had a sensitivity of 86.4% and specificity of 52% for identifying moderate-to-severe sleep apnea. The number of participants who would require diagnostic sleep studies was decreased by 38% from Step 1 to Step 2 of the model.

Conclusion

A simple model using STOP-Bang questionnaire and resting daytime SpO2, followed by overnight oximetry, can identify those at high risk of moderate-to-severe sleep apnea in patients using opioids for chronic pain.

Trial registration number

NCT02513836.
Winter nest trees of sympatric northern (Glaucomys sabrinus) and southern (Glaucomys volans) flying squirrels: a test of reinforcement in a hybrid zone
Authors: O’Brien Paul P. , Bowman Jeff , Coombs Andrea B. , Newar Sasha L. , Garroway Colin J.
Published: August 2021

Shifting range boundaries can lead to secondary contact of closely related species, which might in turn lead to hybridization when the evolution of reproductive isolation is incomplete. We examined winter nest use of northern (Glaucomys sabrinus (Shaw, 1801)) and southern (Glaucomys volans (Linnaeus, 1758)) flying squirrels in an area of recent secondary contact and known hybridization in Ontario, Canada, to test for evidence of reinforcement due to different and diverging nesting behaviours. We radio-collared 26 flying squirrels (12 G. sabrinus and 14 G. volans) between two survey periods (winters of 2008–2009 and 2019–2020) and identified all nest trees used by individuals throughout each winter. For each nest tree, we identified the nest type and collected tree classification information to compare differences in nest use between species. We also present a novel application of habitat suitability modelling to test for evidence of divergence in nest use through time, which would suggest reinforcement. We found southern flying squirrels used a higher proportion of cavities in large, hardwood trees, whereas northern flying squirrels used more external nests and softwood trees. Conditional probabilities provided some evidence for increased differentiation in nest use by flying squirrels through time. Overall, we found relatively little overlap in winter nest use between flying squirrel species, despite evidence for hybridization at this site, and some weak evidence for increased divergence between species in nest use over 11 years.
Disperse Solid-Phase Extraction Cleanup for the Determination of 1-Deoxynojirimycin in Mulberry Leaves with Ultraperformance Liquid Chromatography-Tandem Mass Spectrometry
Authors: Zhang Lei , Zhou Yiran , Meng Jing , Li Jia
Published: August 2021

A new determination method of 1-deoxynojirimycin (1-DNJ) in mulberry leaves based on ultraperformance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) has been developed. Dried and crushed mulberry leaves’ sample was extracted by MeCN-water solvent, purified by graphitized carbon black (GCB) and primary secondary amine (PSA) to remove organic acids and pigments, and then analyzed after attenuation and filtration. The calibration curve showed linearity in the concentration range of 10–500 ng/mL, with the correlation coefficient of 0.998. Recoveries of spiked 1-DNJ at three fortification levels ranged from 94.6% to 96.4%, with relative standard derivation below 1.2%. Additionally, the matrix effect was assessed as negligible. Compared with methods by gas chromatography (GC) and liquid chromatography (LC) via real sample detection, the proposed method acquired better stability and detection efficiency. These results proved that this method has advantages of simple operation, complete purification, small pretreatment loss, good precision and accuracy, and high determination specificity, which is suitable for massive monitoring and precise quantitation of 1-DNJ in mulberry leaves.
Proposed Geometrical Tool for Cases of Laterally Adapted Tibial Tubercle during Total Knee Replacement
Authors: Khairy Umaima R. , Hamandi Sadiq J. , Abid Ali Ahmed S.
Published: August 2021

The alignment of tibial component in total knee replacement operation must be achieved in three planes to ensure optimum results. In coronal plane, the alignment depends on three anatomical landmarks. These landmarks are tibial tuberosity, leg shin, and midtalar point. In eastern community, people get used to sit cross-legged which causes additional tension in the quadriceps muscle which is attached distally to the tibial tuberosity. This tension causes adaptation of the tuberosity laterally. Tuberosity adaptation causes the three anatomical landmarks being not collinear. In this work, eight cases of lateral adapted tubercle were diagnosed of this condition before the surgery and their X-ray images after the surgery were checked regarding tibial alignment. Tibial alignment has been checked by measuring the medial proximal tibial angle (MPTA) which is the angle between the mechanical tibial axis and the tibial component plateau. MPTAs for the eight cases were (86.9°–93.6°). Three cases had MPTA less than 90° indicating varus alignment and five of them had MPTA more than 90° indicating valgus alignment. A geometrical tool was designed using the DesignSpark Mechanical software as a proposed solution to solve the adaptation problem. The tool can give a method for fixing the tibial component precisely without any varus\valgus malalignment.
Dynamic Patterns of N6‐Methyladenosine Profiles of Messenger RNA Correlated with the Cardiomyocyte Regenerability during the Early Heart Development in Mice
Authors: Yang Yuhui , Shen Siman , Cai Yin , Zeng Kejun , Liu Keyu , Li Simeng , Zeng Lanfen , Chen Linming , Tang Jing , Hu Zhe , Xia Zhengyuan , Zhang Liangqing
Published: August 2021

N6‐Methyladenosine (m6A) plays important roles in regulating mRNA processing. Despite rapid progress in this field, little is known about the role and mechanism of m6A modification in myocardial development and cardiomyocyte regeneration. Existing studies have shown that the heart tissues of newborn mice have the capability of proliferation and regeneration, but its mechanism, particularly its relation to m6A methylation, remains unknown. Methods. To systematically profile the mRNA m6A modification pattern in the heart tissues of mice at different developmental stages, we jointly performed methylated RNA immunoprecipitation sequencing (MeRIP‐seq) and RNA sequencing (RNA‐seq) of heart tissues of mice, respectively, aged 1 day old, 7 days old, and 28 days old. Results. We identified the linkages and association between differentially expressed mRNA transcripts and hyper or hypomethylated m6A peaks in C57BL/6J mice at different heart developmental stages. Results showed that the amount of m6A peaks and the level of m6A modification were the lowest in the heart of mice at 1 day old. By contrast, heart tissues from 7‐day‐old mice tended to possess the most m6A peaks and the highest global m6A level. However, the m6A characteristics of myocardial tissue changed little after 7 days old as compared to that of 1 day old. Specifically, we found 1269 downmethylated genes of 1434 methylated genes in 7‐day‐old mouse heart tissues as compared to those in 1‐day‐old mice. Hypermethylation of some specific genes may correlate with the heart’s strong proliferative and regenerative capability at the first day after birth. In terms of m6A density, the tendency shifted from coding sequences (CDS) to 3 ′‐untranslated regions (3 ′UTR) and stop codon with the progression of heart development. In addition, some genes demonstrated remarkable changes both in methylation and expression, like kiss1, plekha6, and megf6, which may play important roles in proliferation. Furthermore, signaling pathways highly related to proliferation such as “Wnt signaling pathway,” “ECM‐receptor interaction,” and “cardiac chamber formation” were significantly enriched in 1‐day‐old methylated genes. Conclusions. Our results reveal a pattern that different m6A modifications are distributed in C57BL/6J heart tissue at different developmental stages, which provides new insights into a novel function of m6A methylation of mRNA in myocardial development and regeneration.
Robust Blood Cell Image Segmentation Method Based on Neural Ordinary Differential Equations
Authors: Li Dongming , Tang Peng , Zhang Run , Sun Changming , Li Yong , Qian Jingning , Liang Yan , Yang Jinhua , Zhang Lijuan
Published: August 2021

For the analysis of medical images, one of the most basic methods is to diagnose diseases by examining blood smears through a microscope to check the morphology, number, and ratio of red blood cells and white blood cells. Therefore, accurate segmentation of blood cell images is essential for cell counting and identification. The aim of this paper is to perform blood smear image segmentation by combining neural ordinary differential equations (NODEs) with U-Net networks to improve the accuracy of image segmentation. In order to study the effect of ODE-solve on the speed and accuracy of the network, the ODE-block module was added to the nine convolutional layers in the U-Net network. Firstly, blood cell images are preprocessed to enhance the contrast between the regions to be segmented; secondly, the same dataset was used for the training set and testing set to test segmentation results. According to the experimental results, we select the location where the ordinary differential equation block (ODE-block) module is added, select the appropriate error tolerance, and balance the calculation time and the segmentation accuracy, in order to exert the best performance; finally, the error tolerance of the ODE-block is adjusted to increase the network depth, and the training NODEs-UNet network model is used for cell image segmentation. Using our proposed network model to segment blood cell images in the testing set, it can achieve 95.3% pixel accuracy and 90.61% mean intersection over union. By comparing the U-Net and ResNet networks, the pixel accuracy of our network model is increased by 0.88% and 0.46%, respectively, and the mean intersection over union is increased by 2.18% and 1.13%, respectively. Our proposed network model improves the accuracy of blood cell image segmentation and reduces the computational cost of the network.