bluuebunny/crossref_metadata_2025 huggingface dataset:
Exclusivity of breastfeeding and body composition: learnings from the Baby-bod study
Authors: Jayasinghe Sisitha , Herath Manoja P. , Beckett Jeffrey M. , Ahuja Kiran D. K. , Byrne Nuala M. , Hills Andrew P.
Published: May 2021

Background

This report evaluated the breastfeeding status in a Tasmanian cohort and its effects on infant and maternal anthropometry and body composition.

Methods

An observational-cohort analysis of self-reported feeding data from 175 Tasmanian mother-baby dyads (recruited via in-person contact between September 2017 and October 2019), was executed. Only mothers who were ≥ 18 years of age, who had a singleton pregnancy and were able to speak and understand English, were included in the study. Infants outside a gestational age range between 37+ 0 and 41+ 6 weeks were excluded. Infant (using Air Displacement Plethysmography) and maternal body composition was assessed at 0, 3 and 6 months. Analysis of variance with relevant statistical corrections were utilised for cross-sectional and longitudinal comparisons between non-exclusively breastfed (neBF) and exclusively breastfed (eBF) groups.

Results

Fat-free mass was significantly higher [t = 2.27, df = 98, P = 0.03, confidence interval (CI) 0.03, 0.48] in neBF infants at 6 months (5.59 ± 0.59 vs 5.33 ± 0.50 kg) despite a higher mean fat-free mass in eBF infants at birth (2.89 ± 0.34 vs 3.01 ± 0.35 kg). Weak evidence for different fat mass index trajectories was observed for eBF and neBF infants in the first 6 months of life (ANOVA, F = 2.42, df = 1.9, P = 0.09) with an inversion in fat mass index levels between 3 and 6 months. Body Mass Index (BMI) trajectories were significantly different in eBF and neBF mothers through pregnancy and the first 6 months postpartum (ANOVA, F = 5.56, df = 30.14, P = 0.01). Compared with eBF mothers, neBF mothers retained significantly less weight (t = − 2.754, df = 158, P = 0.02, CI -6.64, − 1.09) at 3 months (0.68 ± 11.69 vs 4.55 ± 6.08 kg) postpartum. Prevalence for neBF was incrementally higher in mothers with a normal BMI compared to mothers with obesity, and mothers who underwent surgical or medical intervention during birth were less likely to exclusively breastfeed.

Conclusions

Infants with different feeding patterns may display varying growth patterns in early life and sustained breastfeeding can contribute to greater postpartum maternal weight loss.
An optimized sporulation method for the wheat fungal pathogen Pyrenophora tritici-repentis
Authors: Jacques Silke , Lenzo Leon , Stevens Kofi , Lawrence Julie , Tan Kar-Chun
Published: May 2021

Background

The necrotrophic fungal pathogen Pyrenophora tritici-repentis (Ptr) causes tan (syn. yellow) spot of wheat and accounts for significant yield losses worldwide. Understanding the molecular mechanisms of this economically important crop disease is crucial to counteract the yield and quality losses of wheat globally. Substantial progress has been made to comprehend the race structure of this phytopathogen based on its production of necrotrophic effectors and genomic resources of Ptr. However, one limitation for studying Ptr in a laboratory environment is the difficulty to isolate high spore numbers from vegetative growth with mycelial contamination common. These limitations reduce the experimental tractability of Ptr.

Results

Here, we optimized a multitude of parameters and report a sporulation method for Ptr that yields robust, high quality and pure spores. Our methodology encompasses simple and reproducible plugging and harvesting techniques, resulting in spore yields up to 1500 fold more than the current sporulation methods and was tested on multiple isolates and races of Ptr as well as an additional seven modern Australian Ptr isolates. Moreover, this method also increased purity and spore harvest numbers for two closely related fungal pathogens (Pyrenophora teres f. maculata and f. teres) that cause net blotch diseases in barley (Hordeum vulgare), highlighting the usability of this optimized sporulation protocol for the wider research community.

Conclusions

Large-scale spore infection and virulence assays are essential for the screening of wheat and barley cultivars and combined with the genetic mapping of these populations allows pinpointing and exploiting sources of host genetic resistance. We anticipate that improvements in spore numbers and purity will further advance research to increase our understanding of the pathogenicity mechanisms of these important fungal pathogens.
Ultrasound-guided surgery for lateral snapping hip: a novel ultraminimally invasive surgical technique
Authors: Villanueva Manuel , Iborra Álvaro , Sanz-Ruiz Pablo , Noriega Concepción
Published: May 2021

Background

Greater trochanteric pain syndrome encompasses a range of causes of lateral hip pain including greater trochanteric bursitis, tendinopathy and tears of the gluteus minimus and medius, and lateral snapping hip (LSH).

Surgical options for LSH range from open surgery to endoscopic surgery, including a diamond-shaped cut or a simple transversal release to gluteus maximus tendon release.

Resection of an area of proximal iliotibial band (ITB) and step-cut or z-plasty lengthening have not proven superior to transverse release of the ITB. Therefore, making a complete and effective transverse cut guided by ultrasound may represent a potential advance over endoscopic surgery.

Purpose

In this case series study, we describe how to perform proximal release of the ITB guided by ultrasound.

Methods

The surgical technique—either z-plasty or transverse section of the ITB—was first validated on 10 cadaver specimens and then used in clinical practice. Fourteen patients (5 males and 9 females) were operated from 2014 to 2018. Mean age was 43 years (29–62).

Results

The snap resolved in all patients, as verified actively during the surgical procedure as the patient has only local anesthesia. The VAS score for sports activity improved from 7 (5–9) before surgery to 0 (0–2) after 1 year. The HSS score improved from 58 points (47–72) to 96 at 1–2 years. There were no complications other than minor hematomas nor recurrences.

Conclusion

Ultrasound-guided release of the LSH is a novel surgical option with encouraging results in patients for whom conservative protocols have failed. It can be performed under local anesthesia in an outpatient setting with minimal aggressiveness. It is relatively easy, quick, and painless; no stitches are required. Weight bearing is immediate, and patients usually need crutches for only 2–3 days. Although complete recovery may take 3 months, the rehabilitation protocol is fast and painless.
Lymphoproliferative malignancies in patients with neurofibromatosis 1
Authors: Bergqvist Christina , Hemery François , Jannic Arnaud , Ferkal Salah , Wolkenstein Pierre
Published: May 2021

Neurofibromatosis 1 (NF1) is an inherited, autosomal-dominant, tumor predisposition syndrome with a birth incidence as high as 1:2000. A patient with NF1 is four to five times more likely to develop a malignancy as compared to the general population. The number of epidemiologic studies on lymphoproliferative malignancies in patients with NF1 is limited. The aim of this study was to determine the incidence rate of lymphoproliferative malignancies (lymphoma and leukemia) in NF1 patients followed in our referral center for neurofibromatoses. We used the Informatics for Integrated Biology and the Bedside (i2b2) platform to extract information from the hospital’s electronic health records. We performed a keyword search on clinical notes generated between Jan/01/2014 and May/11/2020 for patients aged 18 years or older. A total of 1507 patients with confirmed NF1 patients aged 18 years and above were identified (mean age 39.2 years; 57% women). The total number of person-years in follow-up was 57,736 (men, 24,327 years; women, 33,409 years). Mean length of follow-up was 38.3 years (median, 36 years). A total of 13 patients had a medical history of either lymphoma or leukemia, yielding an overall incidence rate of 22.5 per 100,000 (0.000225, 95% confidence interval (CI) 0.000223–0.000227). This incidence is similar to that of the general population in France (standardized incidence ratio 1.07, 95% CI 0.60–1.79). Four patients had a medical history leukemia and 9 patients had a medical history of lymphoma of which 7 had non-Hodgkin lymphoma, and 2 had Hodgkin lymphoma. Our results show that adults with NF1 do not have an increased tendency to develop lymphoproliferative malignancies, in contrast to the general increased risk of malignancy. While our results are consistent with the recent population-based study in Finland, they are in contrast with the larger population-based study in England whereby NF1 individuals were found to be 3 times more likely to develop both non-Hodgkin lymphoma and lymphocytic leukemia. Large-scale epidemiological studies based on nationwide data sets are thus needed to confirm our findings.
Cytogenetic and mutational analysis and outcome assessment of a cohort of 284 children with de novo acute myeloid leukemia reveal complex karyotype as an adverse risk factor for inferior survival
Authors: Chen Xi , Wang Xingjuan , Dou Hu , Yang Zhenzhen , Bi Junqin , Huang Yi , Lu Ling , Yu Jie , Bao Liming
Published: May 2021

Background

Acute myeloid leukemia (AML) is rare in children. Although complex karyotype (CK) defined as ≥ 3 cytogenetic abnormalities is an adverse risk factor in adult AML, its prognostic impact on childhood AML remains to be determined.

Results

We studied the prevalence, cytogenetic and mutational features, and outcome impact of CK in a cohort of 284 Chinese children with de novo AML. Thirty-four (12.0%) children met the criteria for CK-AML with atypical CK being more frequent than typical CK featured with -5/5q-, -7/7q-, and/or 17p aberration. Mutational prevalence was low and co-occurrence mutants were uncommon. Children with CK-AML showed shorter overall survival (OS) (5-year OS: 26.7 ± 10.6% vs. 37.5 ± 8.6%, p = 0.053) and event-free survival (EFS) (5-year EFS: 26.7 ± 10.6% vs. 38.8 ± 8.6%, p = 0.039) compared with those with intermediate-risk genetics. Typical CK tended to correlate with a decreased OS than atypical CK (5-year OS: 0 vs. 33 ± 12.7%.; p = 0.084), and CK with ≥ 5 cytogenetic aberrations was associated with an inferior survival compared with CK with ≤ 4 aberrations (5-year OS: 13.6 ± 11.7% vs. 50.0 ± 18.6%; p = 0.040; 5-year EFS: 13.6 ± 11.7% vs. 50.0 ± 18.6%; p = 0.048).

Conclusion

Our results demonstrate CK as an adverse risk factor for reduced survival in childhood AML. Our findings shed light on the cytogenetic and mutational profile of childhood CK-AML and would inform refinement of risk stratification in childhood AML to improve outcomes.
Intraoperative ultrasound-guided compared to stereotactic navigated ventriculoperitoneal shunt placement: study protocol for a randomised controlled study
Authors: Leu Severina , Halbeisen Florian , Mariani Luigi , Soleman Jehuda
Published: May 2021

Background

Ventriculoperitoneal shunt (VPS) placement is one of the most frequent neurosurgical procedures and the operation is performed in a highly standardised manner under maintenance of highest infection precautions. Short operation times are important since longer duration of surgery can increase the risk for VPS complications, especially infections. The position of the proximal ventricular catheter influences shunt functioning and survival. With freehand placement, rates of malpositioned VPS are still high. Several navigation techniques for improvement of shunt placement have been developed. Studies comparing these techniques are sparse. The aim of this study is to prospectively compare ultrasound (US) guided to stereotactic navigated shunt placement using optical tracking with the focus on operation time and efficiency.

Methods

In this prospective randomised, single-centre, partially-blinded study, we will include all patients undergoing VPS placement in our clinic. The patients will be randomised into two groups, one group undergoing US-guided (US-G) and the other group stereotactic navigated VPS placement using optical tracking. The primary outcome will be the surgical intervention time. This time span consists of the surgical preparation time together with the operation time and is given in minutes. Secondary outcomes will be accuracy of catheter positioning, VPS dysfunction and need for revision surgery, total operation and anaesthesia times, and amount of intraoperative ventricular puncture attempts as well as complications, any morbidity and mortality.

Discussion

To date, there is no prospective data available comparing these two navigation techniques. A randomised controlled study is urgently needed in order to provide class I evidence for the best possible surgical technique of this frequent surgery.

Trial registration

Business Administration System for Ethical Committees (BASEC) 2019-02157, registered on 21 November 2019, https://www.kofam.ch/de/studienportal/suche/88135/studie/49552; clinicalTrials.gov: NCT04450797, registered on 30 June 2020.
Prevalence of human cystic echinococcosis in the towns of Ñorquinco and Ramos Mexia in Rio Negro Province, Argentina, and direct risk factors for infection
Authors: Uchiumi Leonardo , Mujica Guillermo , Araya Daniel , Salvitti Juan Carlos , Sobrino Mariano , Moguillansky Sergio , Solari Alejandro , Blanco Patricia , Barrera Fabiana , Lamunier Janete , Arezo Marcos , Seleiman Marcos , Yadon Zaida E. , Tamarozzi Francesca , Casulli Adriano , Larrieu Edmundo
Published: May 2021

Background

Cystic echinococcosis (CE) is a parasitic zoonosis caused by infection with the larval stage of Echinococcus granulosus (s.l.). This study investigated the prevalence and potential risk factors associated with human CE in the towns and rural areas of Ñorquinco and Ramos Mexia, Rio Negro province, Argentina.

Methods

To detect abdominal CE cysts, we screened 892 volunteers by ultrasound and investigated potential risk factors for CE using a standardized questionnaire. Prevalence ratio (PR) with 95% confidence intervals (CI) was used to measure the association between CE and the factors investigated, applying bivariate and multivariate analyses.

Results

Abdominal CE was detected in 42/892 screened volunteers (4.7%, 95% CI 3.2–6.1), only two of whom were under 15 years of age. Thirteen (30.9%) CE cases had 25 cysts in active stages (CE1, CE2, CE3a, according to the WHO Informal Working Group on Echinococcosis [WHO-IWGE] classification). The most relevant risk factors identified in the bivariate analysis included: living in rural areas (P = 0.003), age > 40 years (P = 0.000), always drinking water from natural sources (P = 0.007), residing in rural areas during the first 5 years of life (P = 0.000) and having lived more than 20 years at the current address (P = 0.013). In the multivariate final model, the statistically significant risk factors were: frequently touching dogs (P = 0.012), residing in rural areas during the first 5 years of life (P = 0.004), smoking (P = 0.000), age > 60 years (P = 0.002) and living in rural areas (P = 0.017).

Conclusions

Our results point toward infection with CE being acquired since childhood and with constant exposure throughout life, especially in rural areas with a general environmental contamination.

Graphical Abstract
Increased risk of impaired treatment satisfaction among girls/women and young people with suboptimal HbA1c: Results of a nationwide type 1 diabetes study
Authors: Stahl-Pehe Anna , Selinski Silvia , Bächle Christina , Rosenbauer Joachim
Published: May 2021

Background

This study aims to analyze the patient-reported outcome (PRO) of treatment satisfaction in a sample of children, adolescents and young adults with long-duration type 1 diabetes and to determine potential risk factors for poor treatment satisfaction and the intraindividual changes over a 3-year period.

Methods

This study used data from two population-based questionnaire surveys conducted in 2015–2016 and 2018–2019. The participants were 11 to 27 years old and had a type 1 diabetes duration of 10 years or longer in 2015–2016 (n = 575). Factors that were potentially associated with poor treatment satisfaction (moderate, poor or very poor) compared to the reference group (very good or good treatment satisfaction) were analyzed by log binomial regression adjusted for sex and age group.

Results

In 2015–2016 (2018–2019), 26% (33%) of the respondents rated their diabetes treatment/consultation as "very good", 53% (46%) as "good", and 20% (21%) as "poor". Based on the 2018–2019 data, girls/women had an increased risk of poor treatment satisfaction (RRgirls/women: 1.64 (1.10; 2.44), p = 0.016). In addition, people with hemoglobin A1c (HbA1c) values ≥ 7.5% had a more than twice the risk of poor treatment satisfaction than people with HbA1c values < 7.5% (RRHbA1c ≥7.5%: 2.43 (1.63; 3.63), p < 0.001). A total of 42% of people with poor treatment satisfaction in 2015–2016 also reported poor treatment satisfaction at follow-up.

Conclusions

Most study participants were satisfied with their diabetes treatment. However, we identified risk groups that would benefit from targeted interventions to improve this important PRO.
Arylated gold nanoparticles have no effect on the adipogenic differentiation of MG-63 cells nor regulate any key signaling pathway during the differentiation
Authors: Abdulwahab Muhammad , Khan Amir Ali , Abdallah Sallam Hasan , Khattak Muhammad Nasir Khan , Workie Bizuneh , Chehimi Mohamed Mehdi , Mohamed Ahmed Ali
Published: May 2021

Objective

MG-63 cells that have osteoblastic and adipogenic differentiation potential were evaluated for internalization, and adipogenic differentiation in the presence and absence of the covalently functionalized aryl gold nanoparticles (AuNPs-C6H4-4-COOH).

Results

Inductively coupled plasma, flow cytometry and confocal microscopy analyses confirmed that gold nanoparticles were easily internalized by MG-63 cells. The MG-63 cells were differentiated into adipocytes without gold-aryl nanoparticles and with the gold-aryl nanoparticles at 5 µM concentration in both induction and maintenance media. The lipid content assay and the relative expressions of PPAR-γ, ADR1, GLUT1 and GLUT4 genes showed no significant variation with and without the gold nanoparticles treatment. Differential phosphorylation levels of 43 kinases phosphorylation sites were evaluated using the human phospho-kinase array to assess the effect of the gold nanoparticles on the signaling pathways during the differentiation. No kinase phosphorylation site was differentially phosphorylated with two or more folds after the nanoparticles treatment after the first day as well as at the end of MG-63 cells differentiation. The gold-aryl nanoparticles do not affect MG-63 cells differentiation into adipocytes neither do they affect any key signaling pathway. These properties make these gold nanoparticles suitable for future drug delivery and medical applications.
In vivo assessment of a single adenine mutation in 5′UTR of Endothelin-1 gene in paediatric cases with severe pulmonary hypertension: an observational study
Authors: Kumar Abhishek , Choudhury Minati , Batra Sakshi Dhingra , Sikri Kriti , Gupta Anushree
Published: May 2021

Objective

Endothelin-1 plays an important role in the pathogenesis of severe pulmonary hypertension. The + 139 ‘A’, adenine insertion variant in 5′UTR of edn1 gene has been reported to be associated with increased expression of Endothelin-1 in vitro. The aim of present study was to explore the association of this variant with the circulating levels of Endothelin-1 in vivo using archived DNA and plasma samples from 38 paediatric congenital heart disease (cyanotic and acyanotic) patients with severe pulmonary hypertension.

Results

The plasma Endothelin-1 levels were highly varied ranging from 1.63 to75.16 pg/ml. The + 139 ‘A’ insertion variant in 5′UTR of edn1 was seen in 8 out of 38 cases with only one acyanotic sample demonstrating homozygosity of inserted ‘A’ allele at + 139 site (4A/4A genotype). The plasma Endothelin-1 levels in children with homozygous variant 3A/3A genotype were comparable in cyanotic and acyanotic groups. Lone 4A/4A acyanotic sample had ET-1 levels similar to the median value of ET-1 associated with 3A/3A genotype and was absent in cyanotic group presumably due to deleterious higher ET-1 levels. The discussed observations, limited by the small sample size, are suggestive of homozygous adenine insertion variant posing a risk in cyanotic babies with Severe Pulmonary Hypertension.
Construction and application of a CRISPR/Cas9-assisted genomic editing system for Corynebacterium glutamicum
Authors: Yao Chengzhen , Hu Xiaoqing , Wang Xiaoyuan
Published: May 2021

Corynebacterium glutamicum is widely used as microbial cell factory for various bioproducts, but its genomic editing efficiency needs to be improved. In this study, a highly efficient CRISPR/Cas9-assisted genomic editing system for C. glutamicum was constructed. This system mainly involves a plasmid and can be used for both gene insertion and deletion in the chromosome of C. glutamicum. The recombinant plasmid for the target gene containing all the editing elements, and first constructed it in E. coli, then purified and transformed it into C. glutamicum. This temperature-sensitive plasmid was cured at high temperature after the genomic editing was completed in C. glutamicum. Using this genetic editing system, the genetic editing efficiency in C. glutamicum ATCC 13032 could reach 95%. The whole work of editing could be done in 8–9 days and showed most time-saving compared to the reported. Using this system, the native promoter of gdhA1 in ATCC 13032 has been replaced with the strong promoter PtacM, and more than 10 genes in ATCC 13032 have been deleted. The results demonstrate that this CRISPR/Cas9-assisted system is highly efficient and very suitable for genome editing in C. glutamicum.
Extinction and persistence of a stochastic SICA epidemic model with standard incidence rate for HIV transmission
Authors: Wang Xiaodong , Wang Chunxia , Wang Kai
Published: May 2021

In this paper, a stochastic SICA epidemic model with standard incidence rate for HIV transmission is proposed. The sufficient conditions of the extinction and persistence in mean for the disease are established. Numerical simulations show that random perturbations can suppress disease outbreaks and the risk of HIV transmission can be reduced by reducing the transmission coefficient of HIV while increasing the strength of the stochastic perturbation.
Generalizations of some contractions in b-metric-like spaces and applications to boundary value problems
Authors: Zoto Kastriot , Aydi Hassen , Alsamir Habes
Published: May 2021

This paper provides two wide classes of contractions, which are obtained by using notions of $\alpha _{s^{p}} $

α

s
p

-admissibility and the rich set of C-class functions in the setting of a complete b-metric-like space under more general contractive conditions. An application is provided and many known results in the literature can be derived.
Fixed point results for a pair of fuzzy mappings and related applications in b-metric like spaces
Authors: Rasham Tahair , Marino Giuseppe , Shahzad Aqeel , Park Choonkill , Shoaib Abdullah
Published: May 2021

This paper is devoted to finding out some realization of the concept of b-metric like space. First, we attain a fixed point for two fuzzy mappings satisfying a suitable requirement of contractiveness. Subsequently, we apply such a result to graphic contractions. Also, we attain a unique solution for a system of integral equations, and lastly we give an application to ensure that there exists a common bounded solution of a suitable functional equation in dynamic programming.
The method of upper and lower solutions for a class of fractional differential coupled systems
Authors: Quan Huan , Liu Xiping , Jia Mei
Published: May 2021

In this paper, we investigate a class of nonlocal boundary value problems of nonlinear fractional functional differential coupled systems with state dependent delays. The method of upper and lower solutions is established and some new results for the multiplicity of solutions of the boundary value problem are obtained. An example is also presented to illustrate our main results.
The nature of food promotions over one year in circulars from leading Belgian supermarket chains
Authors: Vandevijvere Stefanie , Van Dam Iris
Published: May 2021

Background

To examine the proportion of healthier and less healthy food promotions in circulars of major Belgian supermarket chains.

Methods

Food promotions were collected from all circulars over 1 year from the five largest Belgian supermarket chains. Foods promoted were classified according to the World Health Organization Europe nutrient profile model categories and the level and purpose of processing as per the NOVA classification. In addition, promotional characters (i.e. cartoons, licensed characters, celebrities) and premium offers within the promotions were analysed.

Results

In total, 15,271 food promotions were analyzed. The most frequently promoted foods in circulars were processed meat, poultry and fish (11.8%); fresh and frozen fruit, vegetables and legumes (9.5%); soft drinks and sweetened beverages (9.0%); fresh and frozen meat, poultry, fish and eggs (8.6%); cakes, sweet biscuits and pastries (8.1%); ready-made and convenience foods (8.0%); chocolate and sugar confectionery; energy bars and sweet toppings (7.7%) and cheeses (5.7%). About 52.2% of food promotions across all circulars were for ultra-processed foods, with considerable variation across chains (42.9–61.6%).

Promotional characters and premium offers were found within 5.3 and 19.5% of promotions respectively. For all chains, circular covers were healthier compared to entire circulars, with a lower proportion of ultra-processed foods and a higher proportion of fresh fruit and vegetables promoted.

Conclusions

Food promotions in circulars were most frequently for ultra-processed foods, with considerable variation across chains. Circular covers were healthier than entire circulars. Policies to reduce less healthy food promotions could contribute to improving the healthiness of supermarket food purchases.
Health insurance coverage and maternal healthcare services utilization in Jordan: evidence from the 2017–18 Jordan demographic and health survey
Authors: Fernandes Petula , Odusina Emmanuel Kolawole , Ahinkorah Bright Opoku , Kota Komlan , Yaya Sanni
Published: May 2021

Background

Despite the relationship between health insurance coverage and maternal healthcare services utilization, previous studies in Jordan on the use of maternal healthcare services have mainly focused on patterns and determinants of maternal healthcare services utilization in Jordan. Therefore, this study investigated the relationship between health insurance coverage and maternal healthcare services utilization in Jordan.

Methods

This study used secondary data published in 2017-18 Jordan Demographic and Health Survey on 4656 women of reproductive age (15–49 years). The independent variable was health insurance coverage and the outcome variable was maternal healthcare services utilization, measured through timing of first antenatal visit, four or more antenatal care visits, and skilled birth attendance. The data were analyzed using descriptive statistics and binary logistic regression.

Results

Out of the total number of women who participated in the study, 38.2% were not covered by health insurance. With maternal healthcare utilization, 12.5%, 23.2%, and 10.1% respectively, failed to make early first antenatal care visit, complete four or more antenatal care visits and have their delivery attended by a skilled worker. After controlling for the socio-demographic factors, health insurance coverage was associated with increased odds of early timing of first antenatal care visits and completion of four or more antenatal care visits (aOR = 1.33,p < 0.05, aOR = 1.25,p < 0.01, respectively). However, women who were covered by health insurance were less likely to use skilled birth attendance during delivery (aOR = 0.72p < 0.001).

Conclusions

Jordanian women with health insurance coverage were more likely to have early first antenatal care visits and complete four or more antenatal care visits. However, they were less likely to have their delivery attended by a skilled professional. This study provides evidence that health insurance coverage has contributed to increased maternal healthcare services utilization, only in terms of number and timing of antenatal care visits in Jordan. It is recommended that policy makers in Jordan should strengthen the coverage of health insurance in the country, especially among women of reproductive age in order to enhance the use of maternal healthcare services in the country.
Analyzing German consumers’ willingness to pay for green electricity tariff attributes: a discrete choice experiment
Authors: Danne M. , Meier-Sauthoff S. , Musshoff O.
Published: May 2021

Background

In order to achieve an environmentally friendly and sustainable energy supply, it is necessary that this goal is supported by society. In different countries worldwide it has been shown that one way consumers want to support the energy transition is by switching to green electricity. However, few people make the leap from their intention to a buying decision. This study explores parameters that influence whether German consumers would hypothetically decide to switch to a green electricity tariff.

Methods

A quota-representative online survey including a discrete choice experiment with 371 German private households was conducted in 2016. For the econometric analysis, a generalized multinomial logit model in willingness-to-pay space was employed, enabling the estimation of WTP values to be as realistic as possible.

Results

The results show that consumers’ decision whether or not to make the switch to green energy is mainly influenced by the source of green energy, whether a person can outsource the switching process, and a person’s attitude towards the renewable energy sources levy that currently exist in Germany.

Conclusions

The findings indicate that politics should focus on supporting wind and solar energy as German consumers prefer these sources over biogas. As the results suggest, the EEG levy is a reason why consumers have lower WTP for switching to a green tariff. Therefore, a switching bonus with a specifically “framed” bonus in the amount of the current EEG levy could be a promising strategy for the increase of green energy tariff acceptance. Furthermore, attention should be given to psychological and behavioral aspects, as the results indicate that these factors influence the consumer’s choice for a green electricity tariff.
Inhibition of glycolysis and mitochondrial respiration promotes radiosensitisation of neuroblastoma and glioma cells
Authors: Nile Donna L. , Rae Colin , Walker David J. , Waddington Joe Canning , Vincent Isabel , Burgess Karl , Gaze Mark N. , Mairs Robert J. , Chalmers Anthony J.
Published: May 2021

Background

Neuroblastoma accounts for 7% of paediatric malignancies but is responsible for 15% of all childhood cancer deaths. Despite rigorous treatment involving chemotherapy, surgery, radiotherapy and immunotherapy, the 5-year overall survival rate of high-risk disease remains < 40%, highlighting the need for improved therapy. Since neuroblastoma cells exhibit aberrant metabolism, we determined whether their sensitivity to radiotherapy could be enhanced by drugs affecting cancer cell metabolism.

Methods

Using a panel of neuroblastoma and glioma cells, we determined the radiosensitising effects of inhibitors of glycolysis (2-DG) and mitochondrial function (metformin). Mechanisms underlying radiosensitisation were determined by metabolomic and bioenergetic profiling, flow cytometry and live cell imaging and by evaluating different treatment schedules.

Results

The radiosensitising effects of 2-DG were greatly enhanced by combination with the antidiabetic biguanide, metformin. Metabolomic analysis and cellular bioenergetic profiling revealed this combination to elicit severe disruption of key glycolytic and mitochondrial metabolites, causing significant reductions in ATP generation and enhancing radiosensitivity. Combination treatment induced G2/M arrest that persisted for at least 24 h post-irradiation, promoting apoptotic cell death in a large proportion of cells.

Conclusion

Our findings demonstrate that the radiosensitising effect of 2-DG was significantly enhanced by its combination with metformin. This clearly demonstrates that dual metabolic targeting has potential to improve clinical outcomes in children with high-risk neuroblastoma by overcoming radioresistance.
Specialized post-inpatient psychotherapy for sustained recovery in anorexia nervosa via videoconference – study protocol of the randomized controlled SUSTAIN trial
Authors: Giel Katrin Elisabeth , Martus Peter , Schag Kathrin , Herpertz Stephan , Hofmann Tobias , Schneider Antonius , Teufel Martin , Voderholzer Ulrich , von Wietersheim Jörn , Wild Beate , Zeeck Almut , Bethge Wolfgang , Schmidt Ulrike , Zipfel Stephan , Junne Florian
Published: May 2021

Background

A major barrier to long-term recovery from anorexia nervosa (AN) are early and frequent relapses after inpatient treatment. There is an urgent need for enhanced continuity of specialized care involving effective aftercare interventions and relapse prevention strategies in order to improve the long-term outcome for patients with AN.

Methods

SUSTAIN is a multi-center, prospective, randomized-controlled trial investigating the efficacy of a novel post-inpatient aftercare intervention for patients with AN as compared to optimized treatment-as-usual (TAU-O). The SUSTAIN aftercare intervention is based on the cognitive-interpersonal maintenance model of AN and specifically tailored to achieve sustained recovery in AN following inpatient treatment. The SUSTAIN aftercare intervention comprises 20 treatment sessions over eight months and will be predominantly delivered via videoconference to overcome discontinuity of care. TAU-O refers to routine outpatient psychotherapy as generally offered in the German health care system. A total number of 190 patients receiving inpatient or day-hospital treatment for AN will be randomized and assessed over a 14-month period following randomization including a 6 months follow-up. Minimum Body Mass Index (BMI) is 15 kg/m2 at trial inclusion. The primary efficacy endpoint is the change in BMI between baseline (T0) and end of treatment (T2) adjusted for baseline BMI. Key secondary outcomes comprise eating disorder and general psychopathology, quality of life, proportion of relapse and of weight restoration, and cost-effectiveness.

Discussion

The results of the present trial will provide evidence if the novel aftercare intervention fosters sustained recovery in patients affected by severe courses of AN.

Trial registration

The SUSTAIN trial was prospectively registered on November 18, 2020, under the registration number DRKS00023372 at the German Clinical Trials Register (https://www.drks.de/drks_web/) which is an acknowledged primary register of the World Health Organization (http://apps.who.int/trialsearch/).

Protocol version: 1.2.
Australian mental health care practitioners’ construing of non-White and White people: implications for cultural competence and therapeutic alliance
Authors: Dune Tinashe , Caputi Peter , Walker Beverly M. , Olcon Katarzyna , MacPhail Catherine , Firdaus Rubab , Thepsourinthone Jack
Published: May 2021

Background

The development of cultural competence is central to the therapeutic alliance with clients from diverse backgrounds. Given that the majority of Australia’s population growth is due to migration, mental health practitioner construing of non-White and White people has a significant role and impact on client engagement.

Method

To examine the impact of mental health practitioner construing on their strategies for cultural competence and the therapeutic alliance, 20 White and non-White mental health practitioners and trainees providing mental health services were purposively sampled and interviewed face-to-face or via videoconferencing. Data was analysed thematically and the impact of construing on practitioner cultural competence and the therapeutic alliance were interpreted using Personal Construct Psychology.

Results

Practitioners demonstrated cultural competence in their acknowledgement of the impact of negative construing of ethnic, cultural, religious, social, racial and linguistic diversity on client wellbeing. Practitioners sought to address these negative impacts on clients by drawing on the client-practitioner relationship to improve the therapeutic alliance.

Conclusions

The results reinforce the need for mental health care workers to develop cultural competence with a focus on developing awareness of the impact of frameworks of Whiteness on the experiences of non-White people. This is central to the development of a therapeutic alliance where clients feel understood and assured that their mental health concerns will not be constructed (and treated) through a framework that constrains both White and non-White people’s opportunities for improved mental health and wellbeing.
A novel approach to earlobe reconstruction using the V to Y advancement flap
Authors: Allen Laura , Munroe Kelti , Taylor S. Mark
Published: May 2021

Background

The V to Y advancement flap offers an excellent option for reconstructing defects of the lobule and adjacent structures of the external ear. We demonstrate its utility for small defects of the earlobe including those extending to the antitragal and conchal bowl regions. To our knowledge use of this technique for earlobe reconstruction has not been reported.

Methods

A review of the literature was performed on the use of the V to Y flap for earlobe reconstruction. We then described its use in reconstructing lobular defects in 6 patients. All patients had a non-melanoma skin cancer involving the earlobe. All surgeries were performed under local anesthetic at a tertiary care centre in Halifax, Canada. Defects ranged in size from 1.0 to 1.4 cm. All defects were reconstructed with only a V to Y advancement flap. Patient photographs were taken intra-operatively and post-operatively. For all patients, satisfaction of the final aesthetic result was assessed on a 10 point scale in follow-up at 6 months.

Results

A review of the literature did not reveal any reports of the V to Y flap used in isolation for lobular reconstruction. At our centre from 2018 to 2020, this method was well tolerated under local anesthetic in 6 patients with non-melanoma skin cancers of the earlobe. All patients reported an aesthetically satisfying result at 6 months with scores ranging between 8 and 10. Scarring in all cases was minimal.

Conclusion

The V to Y advancement flap is a simple technique for reconstructing small defects of the lobule. This method is technically straight-forward, poses minimal risk to the patient, and in our experience, yields a favourable cosmetic outcome.

Graphical Abstract
Modelling customers credit card behaviour using bidirectional LSTM neural networks
Authors: Ala’raj Maher , Abbod Maysam F. , Majdalawieh Munir
Published: May 2021

With the rapid growth of consumer credit and the huge amount of financial data developing effective credit scoring models is very crucial. Researchers have developed complex credit scoring models using statistical and artificial intelligence (AI) techniques to help banks and financial institutions to support their financial decisions. Neural networks are considered as a mostly wide used technique in finance and business applications. Thus, the main aim of this paper is to help bank management in scoring credit card clients using machine learning by modelling and predicting the consumer behaviour with respect to two aspects: the probability of single and consecutive missed payments for credit card customers. The proposed model is based on the bidirectional Long-Short Term Memory (LSTM) model to give the probability of a missed payment during the next month for each customer. The model was trained on a real credit card dataset and the customer behavioural scores are analysed using classical measures such as accuracy, Area Under the Curve, Brier score, Kolmogorov–Smirnov test, and H-measure. Calibration analysis of the LSTM model scores showed that they can be considered as probabilities of missed payments.The LSTM model was compared to four traditional machine learning algorithms: support vector machine, random forest, multi-layer perceptron neural network, and logistic regression. Experimental results show that, compared with traditional methods, the consumer credit scoring method based on the LSTM neural network has significantly improved consumer credit scoring.
Metachronous port site, muscular and subcutaneous metastases from a gastric adenocarcinoma: a case report and review of articles
Authors: Fukui Yasuhiro , Kubo Naoshi , Sakurai Katsunobu , Tamamori Yutaka , Maeda Kiyoshi , Ohira Masaichi
Published: May 2021

Background

Port site metastasis (PSM) after curative gastrectomy for gastric cancer and muscular metastasis from gastric cancer are rare manifestations. Similarly, subcutaneous metastasis from gastric cancer is rare, and muscular and subcutaneous metastases are associated with poor prognosis. We report a case of long-term survival in a patient who underwent curative resection of gastric cancer and repeated recurrence of port site, muscular and subcutaneous metastases from gastric cancer, treated by resection.

Case presentation

A 75-year-old man was diagnosed with gastric cancer and referred to our department. Upper endoscopy demonstrated a 5-cm circumferential ulcerated lesion at the cardia. Biopsy findings showed a poorly differentiated tubular adenocarcinoma. He underwent laparoscopic total gastrectomy with lymph node dissection, and pathologic examination revealed a moderately differentiated tubular adenocarcinoma stage T4aN1M0 and IIIA according to the UICC (Union for International Cancer Control) classification. He refused adjuvant chemotherapy and was only carefully observed. Twenty-three months after the primary gastrectomy, computed tomography (CT) revealed an irregular mass near the port site wounds. Then the patient underwent mass resection, and the pathological diagnosis was consistent with metastatic adenocarcinoma, located in the subcutaneous tissue at the port site wounds. Thirteen months after the second surgery, CT revealed an enhanced mass in the abdominal wall. Positron emission tomography (PET) CT showed an elevated uptake in the rectus abdominis muscle and a standardized uptake value (SUV) of 3.1. The patient underwent another mass resection, and the pathological diagnosis was consistent with metastatic adenocarcinoma in the rectus abdominis muscle. Thirty-five months after the third surgery, CT revealed a mass in the left gluteal subcutaneous region. Furthermore, PET-CT revealed a 35-mm mass with an elevated SUV of 9.6. Another mass resection procedure was performed, and the pathological diagnosis was consistent with metastatic adenocarcinoma in the subcutaneous tissue. Since tumor cells were present at the resection margin, additional radiation therapy was performed. The patient has survived 78 months after primary gastrectomy.

Conclusion

The prognosis of muscular and subcutaneous metastases from gastric cancer is poor. However, if the metastatic tumor is solitary, surgical excision could be a feasible treatment option and might prolong survival.
Serial computed tomography findings of Coronavirus disease 2019 (COVID-19) pneumonia treated with favipiravir and steroid therapy: report of 11 cases
Authors: Irizato Naoki , Matsuura Hiroshi , Okada Atsuya , Ueda Ken , Yamamura Hitoshi
Published: May 2021

Background

This study evaluated the time course of computed tomography (CT) findings of patients with COVID-19 pneumonia who required mechanical ventilation and were treated with favipiravir and steroid therapy.

Results

Eleven patients with severe COVID-19 pneumonia were included. CT findings assessed at the three time points showed that all patients had ground-glass opacities (GGO) and consolidation and mixed pattern at intubation. Consolidation and mixed pattern disappeared in most of the patients whereas GGO persisted in all patients at 1-month follow-up. In addition to GGO, a subpleural line and bronchus distortion and bronchial dilatation were frequent findings. The degree of resolution of GGO varied depending on each patient. The GGO score correlated significantly with the time from symptoms onset to initiation of steroid therapy (ρ = 0.707, p = 0.015).

Conclusions

At 1-month follow-up after discharge, non-GGO lesions were absorbed almost completely, and GGO were a predominant CT manifestation. Starting steroid therapy earlier after onset of symptoms in severe COVID-19 pneumonia may reduce the extent of GGO at 1-month follow-up.
k-Zumkeller labeling of super subdivision of some graphs
Authors: Basher M.
Published: May 2021

A simple graph $$G=(V,E)$$

G
=
(
V
,
E
)

is said to be k-Zumkeller graph if there is an injective function f from the vertices of G to the natural numbers N such that when each edge $$xy\in E$$

x
y
∈
E

is assigned the label f(x)f(y), the resulting edge labels are k distinct Zumkeller numbers. In this paper, we show that the super subdivision of path, cycle, comb, ladder, crown, circular ladder, planar grid and prism are k-Zumkeller graphs.
Butterfly optimizer-assisted optimal integration of REDG units in hybrid AC/DC distribution micro-grids based on minimum operational area
Authors: Injeti Satish Kumar
Published: May 2021

This paper presents the impact of optimal location and sizing of renewable and non-renewable-based distributed generators in the AC/DC micro-grid system using the latest optimizer called butterfly optimization algorithm with an aim to minimize power loss. Generally, hybrid AC/DC micro-grids systems are modeled by separating AC and DC feeders with the help of high-power converters (HPC).AC grids sustained by substation and DC grids are maintained by their individual DG units. While planning of DGs in the hybrid AC/DC systems, the power loss incurred by HPCs is not considered avoiding complexity by many authors. In this paper, the sizing of DGs is determined by the operational area required by the type of DG technology as one variable and all possible candidate buses in the respective zones of AC/DC micro-grid system are another variable with due consideration of HPC losses in AC/DC micro-grid system. A hybrid AC/DC MG system is developed by classifying the existing benchmark 33-bus and 69-bus radial distribution systems into various AC/DC zones. To evaluate the proposed approach, it is implemented on aforementioned micro-grid systems and the obtained results are verified with other existing approaches in the literature. The results proved that the proposed approach is better than the other approaches in technical aspects.
The psychology of climate anxiety
Authors: Dodds Joseph
Published: May 2021

This paper focuses on climate anxiety and its role in the psychology of climate change, compared with responses to the COVID-19 global pandemic. Four psychological hypotheses for why we do not act on climate change will be reviewed, and the role of anxiety for each, as well as potential solutions. Different types of climate anxiety both inside and outside the clinic will be explored, along with associated defence mechanisms and treatment.