bluuebunny/crossref_metadata_2025 huggingface dataset:
eWOM, destination preference and consumer involvement – a stimulus-organism-response (SOR) lens
Authors: Yadav Neha , Verma Sanjeev , Chikhalkar Rekha D.
Published: March 2022

Purpose

This study aims to examine the moderated-mediation impact of consumer involvement and destination preference on travel intentions. Stimulus-Organism-Response (SOR) and elaboration likelihood model (ELM) guided the conceptual framework of this study.

Design/methodology/approach

Churchill’s (1979) guidelines instrumentalize the scientific development and validation of measurement scales for data collection. The authors used higher-order multivariate analyzes such as structural equation modeling (SEM) and the Hayes process model for evaluating the hypotheses. The study uses Bauer et al. (2006) method to assess the conditional indirect effects of Electronic word of mouth (eWOM) on travel intention through destination preference at varying levels of consumer involvement.

Findings

SOR and ELM model successfully explained the moderated-mediation effect of eWOM, consumer involvement and destination preference in influencing the travel intentions. Results broaden the applicability of SOR and ELM in tourism marketing. Results indicate that consumer involvement moderated the direct and indirect influence of eWOM on travel intention via destination preference, such that the eWOM influence in shaping travel intention is stronger for highly involved consumers.

Research limitations/implications

The present study broadens the applicability of integrated SOR and ELM models to explain the moderated-mediation network between eWOM and travel intentions. Study findings offer new avenues to tourism marketers for the magnified effect of eWOM for promoting tourism. Tourism marketers may use customer journeys to build destination preference through organic information exchange with prospective travelers. Future researchers and practitioners can build prescriptive and predictive models based on altered levels of consumer involvement.

Originality/value

Present study pioneers in examining the interactive effect of moderated mediation network of consumer involvement and destination preference in shaping the travel intention. Grounded in SOR and ELM model, the present study is a trailblazer to offer the integrated moderated-mediation model between eWOM, destination preference, consumer involvement and travel intention.
Health tourism: behavioural intention and protection motivation theory
Authors: Seow Ai Na , Choong Yuen Onn , Choong Chee Keong , Moorthy Krishna
Published: March 2022

Purpose

Health tourism is recognised as a recent new pattern of taking a break while accessing health-care services overseas. Past studies have explored this research area, but few have focussed on the theoretical perspective. Applying an appropriate theoretical model to guide interventions in planning and programme development is crucial, particularly when the focus of the study is on the cognitive mediation processes of change in individual behaviour. This study aims to examine the effectiveness of the protection motivation theory with the influence of threat appraisal and coping appraisal. The purpose is to trigger the behavioural intention to engage in international health tourism.

Design/methodology/approach

A total of 299 international tourists participated in the survey. The partial least squares structural equation modelling technique was used to test the research framework. Both the measurement model and the structural model were assessed as adequate.

Findings

The empirical results demonstrate that tourists’ high risk perception must be complemented by coping ability to produce a motivational response. Further, the adaptive behaviours of international tourists are focussed more on perceived efficacy than on the perception of threats related to behavioural intentions towards health tourism.

Originality/value

The study presents an effective theoretical model intervention applicable to health tourism. Future studies should conduct a more comprehensive assessment to generate strong decision-making effectiveness from the theoretical model.
Who should provide expert opinion in emergency medicine‐related medical litigation?
Authors: Dalling Julie , Kelly Anne‐Maree , Madden Bill , Cockburn Tina
Published: March 2022

Expert evidence plays a central role in establishing the relevant standard of care in medical litigation. In Australia, little is known about the expert witnesses who provide evidence about the standard of care provided in ED. A sample of recent published case law suggests that a proportion of expert evidence about breach of the standard of reasonable care in ED is provided by medical practitioners who are not emergency physicians and/or have no recent practice experience in an ED. This may potentially distort the identification of the relevant standard of care. In the United States, the American College of Emergency Physicians has attempted to address this issue by developing and promulgating expert witness guidelines. Is there a case for the Australasian College for Emergency Medicine to assume an advocacy role and/or develop standards in this area?
Sticky Space: Toxicity and Time in a New England City
Authors: Potts Rebecca Lea
Published: March 2022

This article theorises stickiness in the built environment by narrating the surfaces, histories, and religious temporalities of one clock factory turned strip club building in New Haven, Connecticut. The factory‐club building demonstrates the ways in which sticky relationality counters the smooth nostalgia demanded by heritage preservation and urban revitalisation efforts. From the radium that clung to the bones of the women who painted watches in the clock factory, to the stigma that clings to sex workers, and to the label of blight that clings to neighbourhoods, histories and values accumulate and structure our surroundings. How might sticky spaces gum up the progressive temporalities of capital accumulation? Utilising stickiness as texture and concept, this article is an enquiry into the ways that the built environment helps create, maintain, and contest the boundaries of stigma, toxicity, and time.
A thorough QTc study to evaluate the effects of oral rilzabrutinib administered alone and with ritonavir in healthy subjects
Authors: Ucpinar Sibel , Darpo Borje , Neale Ann , Nunn Philip , Shu Jin , Chu Katherine A. , Kavanagh Marianne , Xue Hongqi , Phiasivongsa Pasit , Thomas Dolca , Smith Patrick F.
Published: March 2022

This study aimed to define the clinically relevant supratherapeutic dose of rilzabrutinib, an oral Bruton tyrosine kinase (BTK) inhibitor, and evaluate potential effects of therapeutic and supratherapeutic exposures on cardiac repolarization in healthy subjects. This was a two‐part phase I study (anzctr.org.au ACTRN12618001036202). Part A was a randomized, open‐label, three‐period, single‐dose crossover study (n = 12) with rilzabrutinib 100 mg ± ritonavir 100 mg or rilzabrutinib 1200 mg. Part B was a randomized, double‐blind, placebo‐controlled, four‐way, single‐dose crossover study (n = 39) with matched placebo, rilzabrutinib 400 mg ± ritonavir 100 mg, or moxifloxacin (positive control). Primary objectives: part A – pharmacokinetics (PK) of rilzabrutinib ± ritonavir, safety, and optimal dose for Part B; Part B – effect of rilzabrutinib therapeutic and supratherapeutic concentration on electrocardiogram (ECG) parameters. ECGs and PK samples were serially recorded before and post‐dose. In part A, rilzabrutinib 100 mg + ritonavir led to 17‐fold area under the concentration–time curve (AUC0–∞) and 7‐fold maximum plasma concentration (Cmax) increases over rilzabrutinib alone. Rilzabrutinib 1200 mg was discontinued due to mild‐to‐moderate gastrointestinal intolerance. In Part B, rilzabrutinib 400 mg + ritonavir increased rilzabrutinib mean AUC0–∞ from 454 to 3800 ng h/mL and Cmax from 144 to 712 ng/mL. The concentration–QTc relationship was slightly negative, shallow (−0.01 ms/ng/mL [90% CI −0.016 to −0.001]), and an effect >10 ms on QTcF could be excluded within the observed range of plasma concentrations, up to 2500 ng/mL. Safety was similar to other studies of rilzabrutinib. In conclusion, rilzabrutinib, even at supratherapeutic doses, had no clinically relevant effects on ECG parameters, including the QTc interval.
Cutaneous atypical fibroxanthoma with osteoclast‐like giant cell: A rare phenomenon
Authors: Anderson Jarett D. , Alhatem Albert , Li Yang , Hurley M. Yadira
Published: March 2022

Atypical fibroxanthoma (AFX) with osteoclast‐like giant cells is a rare entity. We present the case of an elderly woman who presented with a pink–purple dome‐shaped nodule with central hyperkeratotic crust. Biopsy revealed a cellular, dermal‐based tumor comprised of spindle, oval, and osteoclast‐like giant cells with pleomorphism. The immunohistochemistry profile supported a diagnosis of AFX with osteoclast‐like giant cells. We performed a literature review through PubMed and Google Scholar for AFX with osteoclast‐like giant cell formation and found 16 previously reported cases. We aim to provide a review and discuss features of these cases. We also discuss the pathogenesis of these osteoclast‐like cells as well as potential pitfalls in diagnosis.
Characteristics of fatal tapentadol‐related toxicity in Australia
Authors: Darke Shane , Duflou Johan , Peacock Amy , Farrell Michael , Lappin Julia
Published: March 2022

Introduction

Tapentadol is a centrally acting opioid analgesic prescribed for the treatment of moderate to severe pain. The study aimed to determine the characteristics of Australian toxicity deaths related to tapentadol.

Methods

All cases in which tapentadol use was coded contributory to death (n = 159) were retrieved from the National Coronial Information System (1 July 2000–31 December 2020).

Results

The mean age was 48.5 (18–81) and 56% were female. Documented histories of problems with chronic pain (66%), mental health (60.4%), substance use (44%) and injecting drug use (23.3%) were common. The majority of deaths were deemed unintentional (76.1%) and in 18.9% pre‐existing disease was co‐contributory. The median peripheral blood tapentadol concentration was 1.00 mg L−1 (0.02–47.00), and the median aortic concentration was 2.05 mg L−1 (0.10–30.00). In all cases, psychoactive drugs other than tapentadol were also detected, most commonly antidepressants (72.3%), opioids (66.7%), hypnosedatives (64.2%) and gabapentinoids (43.4%). Of cases where autopsies were conducted, 27.7% were diagnosed with cardiomegaly and 18.5% with severe coronary artery stenosis. Pulmonary oedema (68.1%), aspiration of vomitus (39.5%) and acute pneumonia (26.9%) were common.

Discussion and Conclusions

The typical tapentadol‐related toxicity death involved unintentional death in the presence of multiple drugs, although a notable minority were intentional self‐harm. Multiple morbidities were common. The identification and characteristics of these cases indicate that the adverse event profile of tapentadol needs to be considered in the setting of polypharmacy.
Do large termite mounds effect woody plant phylogenetic diversity and endemism across African savannas?
Authors: Muvengwi Justice , Fritz Herve , Witkowski Ed
Published: March 2022

Aim

Despite the importance of termite mounds in plant species’ taxonomic diversity, no study has quantified the effect of termite mounds on woody plant species’ phylogenetic diversity and phyloendemism. In order to understand how mounds influence phylogenetic diversity (PD), we had two objectives: (i) to determine the influence of termite mounds on PD and (ii) to determine how this varies with environmental and geographic factors.

Location

Africa.

Method

We performed a meta‐analysis on 21 studies that satisfied our selection criteria out of 369 that we initially identified. All these studies sampled woody plants that occurred on Macrotermes mounds and the surrounding savanna matrix.

Results

Part of our findings shows that termite mounds had higher PD compared with the surrounding savanna plots. We found that phyloendemism (PE) does not respond to the effects of Macrotermes mounds at small scales, that is between mounds and the savanna matrix. However, at continental scales, phyloendemism responded to environmental variables such as altitude, rainfall and temperature. Altitude and latitude acted negatively on both PD and phyloendemism, while temperature had a positive influence on both metrics.

Main conclusions

We provide the first quantification of the effect of termite mounds on woody plants’ PD in the savannas. Overall, termite mounds contribute, not only to taxonomic diversity in the savanna but also to PD of woody plants. Our analysis shows that termite mounds contribute strongly to overall savanna PD, hence the need to consider them in conservation planning.
Independent variation of avian sensitivity to climate change and trait‐based adaptive capacity along a tropical elevational gradient
Authors: Nowak Larissa , Schleuning Matthias , Bender Irene M. A. , Kissling W. Daniel , Fritz Susanne A.
Published: March 2022

Aim

How species respond to climate change is influenced by their sensitivity to climatic conditions (i.e. their climatic niche) and aspects of their adaptive capacity (e.g. their dispersal ability and ecological niche). To date, it is largely unknown whether and how species’ sensitivity to climate change and their adaptive capacity covary. However, understanding this relationship is important to predict the potential consequences of a changing climate for species assemblages. Here, we test how species’ sensitivity to climate change and trait‐based measures of their ecological adaptive capacity (i) vary along a broad elevational gradient and (ii) covary across a large number of bird species.

Location

A Neotropical elevational gradient (300–3600 m.a.s.l.) in the Manú Biosphere Reserve, south‐east Peru.

Methods

We focus on 215 frugivorous bird species along a Neotropical elevational gradient. We approximate species’ sensitivity to climate change by their climatic niche breadth, based on species occurrences across South America and bioclimatic variables. In addition, we use a trait‐based approach to estimate the dispersal ability of species (approximated by their wing pointedness), their dietary niche breadth (approximated by bill width) and their habitat niche breadth (the number of used habitat classes).

Results

We found that (i) species’ climatic niche breadth increased with elevation, while their trait‐based dispersal ability and dietary niche breadth decreased with elevation, and (ii) sensitivity to climate change and trait‐based adaptive capacity were not related across species.

Main conclusions

These results suggest different mechanisms of how species in lowland and highland assemblages might respond to climate change. The independent variation of species’ sensitivity to climate change and their trait‐based adaptive capacity suggests that accounting for both dimensions will improve assessments of species’ susceptibility to climate change and potential impacts of climate change on diverse species assemblages.
Property crime and private protection allocation within cities: Theory and evidence
Authors: Decreuse Bruno , Mongrain Steeve , van Ypersele Tanguy
Published: March 2022

Canada exhibits no correlation between income and victimization, rich neighborhoods are less exposed to property crime, rich households are more victimized than their neighbors, and rich households and neighborhoods invest more in protection. We provide a theory consistent with these facts. Criminals within city choose a neighborhood and pay a search cost to compare potential victims, whereas households invest in self‐protection. As criminals' return to search increases with neighborhood income, households in rich neighborhoods are likelier to enter a race to greater protection driving criminals toward poorer areas. A calibration reproduces the Canadian victimization and protection pattern by household/neighborhood income.
Macroglossia: A potentially severe complication of late‐onset Pompe disease
Authors: Dupé Charlotte , Lefeuvre Claire , Solé Guilhem , Behin Anthony , Pottier Corinne , Duval Fanny , Carlier Robert‐Yves , Prigent Hélène , Lacau St Guily Jean , Arrassi Azzeddine , Taouagh Nadjib , Hamroun Dalil , Nicolas Guillaume , Laforêt Pascal
Published: March 2022

Background

Pompe disease is a rare neuromuscular disorder caused by a deficiency of a lysosomal enzyme, acid α‐glucosidase. Macroglossia is a classic clinical sign of several inherited myopathies and has also been reported to occur progressively in late‐onset Pompe disease (LOPD).

Methods

We describe patients with LOPD and macroglossia included in the French national Pompe disease registry. Clinical, functional, and radiological data were collected during periodic follow‐up and analyzed retrospectively. These cases were compared with 15 previously reported cases.

Results

Five patients, three females and two males, aged 71–88 years, were included in this study. All but one of the patients suffered from symptoms related to macroglossia before the diagnosis of Pompe disease. Three had localized tongue atrophy and one had significant localized tongue hypertrophy which led to glossectomy 10 years before diagnosis. Two patients had severe dysphagia, one of whom underwent gastrostomy for enteral nutritional support. One patient experienced the persistence of numerous sleep apneas despite nocturnal bilevel positive airway pressure (BiPAP) ventilation. All our patients had dysarthria, and two required speech therapy. Four patients had a tongue hypersignal on magnetic resonance imaging (MRI) T1 sequences.

Conclusions

Detection of macroglossia should be part of the clinical diagnosis and follow‐up of patients with LOPD, with a careful evaluation of its main consequences. Macroglossia can have severe functional impacts on speech, swallowing, and sleep. Whole‐body MRI with facial sections may facilitate the early diagnosis of Pompe disease with the “bright tongue sign”.
Pairing structural reconstruction with catalytic competence to evaluate the mechanisms of key enzymes in the folate‐mediated one‐carbon pathway
Authors: Zhao Li Na , Kaldis Philipp
Published: March 2022

Mammalian metabolism comprises a series of interlinking pathways that include two major cycles: the folate and methionine cycles. The folate‐mediated metabolic cycle uses several oxidation states of tetrahydrofolate to carry activated one‐carbon units to be readily used and interconverted within the cell. They are required for nucleotide synthesis, methylation and metabolism, and particularly for proliferation of cancer cells. Based on the latest progress in genome‐wide CRISPR loss‐of‐function viability screening of 789 cell lines, we focus on the most cancer‐dependent enzymes in this pathway, especially those that are hyperactivated in cancer, to provide new insight into the chemical basis for cancer drug development. Since the complete 3D structure of several of these enzymes of the one‐carbon pathway in their active form are not available, we used homology modelling integrated with the interpretation of the reaction mechanism. In addition, have reconstructed the most likely scenario for the reactions taking place paired with their catalytic competence that provides a testable framework for this pathway.
Understanding recruitment and retention of doctors in rural Scotland: Stakeholder perspectives
Authors: Maclaren Andrew S. , Cleland Jennifer , Locock Louise , Skea Zoë , Denison Alan , Hollick Rosemary , Murchie Peter , Wilson Philip
Published: March 2022

Recruitment and retention of medical practitioners is a challenging contemporary policy issue for rural areas. In this paper we explore this issue in the context of doctors in rural and remote Scotland, drawing on findings from a service mapping exercise into the recruitment and retention of doctors in rural areas, conducted by interviewing key stakeholders in the delivery of healthcare in rural and remote Scotland, most of whom combine clinical and organisational responsibilities. The aim of this paper is to understand the key issues, drawing on what the stakeholders see across the day‐to‐day delivery of their clinical roles and within the varied levels of the organisational structure of Scottish healthcare to which they contribute. Our findings build on a review of key literature of contemporary issues in rural Scotland, healthcare delivery in rural areas and wider international literature on recruitment and retention of medical practitioners. Our findings focus around three key themes: power of place; how people make place; and place and policy. In our conclusion, we argue that the importance of this stakeholder research is three‐fold. First, that such insights from stakeholders are important in shaping and preparing for future research on the topic, particularly interviewing those currently working. Second, it adds to and echoes the growing body of literature globally focused on recruitment and retention by expanding on the Scottish context. Finally, it proposes that appropriate and effective rural proofing is important in the implementation of new policies where place‐based challenges or differences can emerge.
Acid‐thermal‐induced formation of rice bran protein nano‐particles: foaming properties and physicochemical characteristics
Authors: Diao Yunchun , Zhang Yanpeng , Zhang Weinong , Xu Wei , Hu Zhixiong , Yi Yang , Wang Yuehui
Published: March 2022

The purpose of this study was to expound on the correlation between foaming properties and physicochemical characteristics of rice bran protein (RBP) samples. RBP nano‐particles (RBPNs) were prepared by acidic–thermal treatment under different RBP solution concentrations and treated times at 90 °C, and then the foaming properties were measured at pH 7.0 and pH 2.0. Compared to RBP, the foaming properties of RBPNs were increased at pH 7.0, and RBPNs could have better foam capacity but have no obvious changes in foam stability at pH 2.0. The results of Pearson correlation showed that the foaming properties were closely correlated with ζ potential, contact angle, and surface hydrophobicity for RBP and RBPNs, and a strong correlation between foaming capacity and surface hydrophobicity was shown for RBPNs. Additionally, the result of TEM images confirmed that RBPNs were inclined to form associated aggregates which may affect the physicochemical characteristics of RBPNs.
In vitro digestion of whole chia seeds (Salvia hispanica L.): Nutrient bioaccessibility, structural and functional changes
Authors: Han Jieyu , Zhang Qiufang , Luo Wentao , Wang Ziyi , Pang Yuehong , Shen Xiaofang
Published: March 2022

Dietary chia seed (Salvia hispanica L.) has significant health‐related benefits due to its high nutrient contents. However, few studies reported the fate of whole seeds in the gastrointestinal tract. Herein, we explored the digestive characteristics in terms of hydrolysis of nutrients, structural and functional properties with a static in vitro digestion method. After gastrointestinal digestion, the digestibility of lipid and protein was 0.46% and 11.38%, respectively. The release rates of tryptophan, tyrosine and lysine were greater than 20%, whereas the glutamic acid and aspartic acid were less than 5%. The microscopic results (optical microscopy (OM), laser scanning confocal microscopy (LSCM) and scanning electron microscopy (SEM)) demonstrated that the seeds remained intact, and the mucilage adhered tightly to the seed coat during digestion. The water holding capacity and oil holding capacity of seeds accounted for 6.37 and 3.28 g/g after intestinal digestion, which were significantly lower than gastric digestion endpoints (P < 0.05). And there were no significant differences in Fourier transform infrared spectroscopy of G‐Mucilage and I‐Mucilage. In general, preprocessing before being consumed is necessary for chia seeds to take full advantage of rich polyunsaturated fatty acids and proteins.
How we say what we do and why it is important: An idiosyncratic analysis of mental health nursing identity on social media
Authors: McKenna Lawson Stephen
Published: March 2022

This paper is the culmination of a qualitative research project into mental health nursing (MHN) identity via exploration of a social media campaign organized in 2018 by the UK Mental Health Nurses Association. Through engagement with this campaign and a multimethod approach, this paper proposes a new and novel heuristic framework for exploring MHN identity holistically, through what is termed the 6Ps of MHN identity. The 6Ps – encompassing the professional, personal, practical, proximal, philosophical, and political aspects of identity – were previously shared with members of the MHN research community at both the 2019 and 2020 proceedings of the International Mental Health Nursing Research Conference. To examine the identity expressed in the social media campaign, all contributions by nurses were amalgamated into one ‘text’ for analysis. When this text was examined, the focus was the particular language used by MHNs. This granular analysis concentrated on word choice, form, and frequency as the constituent aspects of meaning. Even when it was necessary to examine larger grammatical units, the key nouns – grammatical objects and subjects – were the primary focus of analysis. Following this, the author – a mental health nurse themselves – applied their personal understanding of the field of practice to the text to arrive at an understanding of its contents. This approach is the first in the field of MHN identity research to examine the profession’s identity as expressed by members on social media, as well as the linguistic form of that expression.
Effect of preoperative administration of atenolol to dogs with pulmonic stenosis undergoing interventional procedures
Authors: Gomart Samantha , MacFarlane Paul , Payne Jessie Rose , Hezzell Melanie J. , Borgeat Kieran
Published: March 2022

Background

Beta‐blockade is sometimes used in dogs with pulmonic stenosis with the intent of reducing frequency of ventricular arrhythmias during right heart catheterization.

Objectives

To evaluate if pretreatment with atenolol reduces frequency of ventricular arrhythmias, anesthetist interventions, or shortens procedure time.

Animals

Thirty dogs with pulmonic stenosis scheduled for interventional procedures.

Methods

Single center, prospective, randomized, open‐label study. Dogs were randomized to treatment with atenolol or no treatment preoperatively for a minimum of 10 days. Variables recorded included heart rate, arrhythmias and complexity, total procedure time and administration of antiarrhythmic treatment, vasopressors, positive chronotropes, or fluid boluses.

Results

Fifteen dogs were enrolled in each group. Dogs receiving atenolol had lower mean heart rates during the procedure (atenolol 100 ± 11 bpm vs untreated 115 ± 19 bpm, P = .01). There were no significant differences between the atenolol and untreated groups in the frequency of ventricular ectopic complexes (535 [6‐5296] vs 553 [79‐2863], P = .9), ventricular couplets (46 [0‐481] vs 29 [3‐121], P = .59), ventricular triplets (20 [0‐265] vs 16 [1‐82], P = .67), ventricular tachycardia (8 [0‐224] vs 8 [1‐118], P = .99), proportion exhibiting R‐on‐T phenomenon (11/15 vs 14/15, P = .33), proportion receiving intraoperative lidocaine (1/15 vs 3/15, P = .6), vasopressors/positive chronotropes (11/15 vs 5/15, P = .06), or fluid boluses (12/15 vs 7/15, P = .13). The procedure time was similar (atenolol 41 [23‐68] min vs untreated 35 [18‐98] min, P = .91).

Conclusions and Clinical Importance

No benefit of preoperative atenolol treatment was identified in this small group of dogs.
Molecular evolution and depth‐related adaptations of rhodopsin in the adaptive radiation of cichlid fishes in Lake Tanganyika
Authors: Ricci Virginie , Ronco Fabrizia , Musilova Zuzana , Salzburger Walter
Published: March 2022

The visual sensory system is essential for animals to perceive their environment and is thus under strong selection. In aquatic environments, light intensity and spectrum differ primarily along a depth gradient. Rhodopsin (RH1) is the only opsin responsible for dim‐light vision in vertebrates and has been shown to evolve in response to the respective light conditions, including along a water depth gradient in fishes. In this study, we examined the diversity and sequence evolution of RH1 in virtually the entire adaptive radiation of cichlid fishes in Lake Tanganyika, focusing on adaptations to the environmental light with respect to depth. We show that Tanganyikan cichlid genomes contain a single copy of RH1. The 76 variable amino acid sites detected in RH1 across the radiation were not uniformly distributed along the protein sequence, and 31 of these variable sites show signals of positive selection. Moreover, the amino acid substitutions at 15 positively selected sites appeared to be depth‐related, including three key tuning sites that directly mediate shifts in the peak spectral sensitivity, one site involved in protein stability and 11 sites that may be functionally important on the basis of their physicochemical properties. Among the strongest candidate sites for deep‐water adaptations are two known key tuning sites (positions 292 and 299) and three newly identified variable sites (37, 104 and 290). Our study, which is the first comprehensive analysis of RH1 evolution in a massive adaptive radiation of cichlid fishes, provides novel insights into the evolution of RH1 in a freshwater environment.
A conserved Plasmodium structural integrity maintenance protein (SIMP) is associated with sporozoite membrane and is essential for maintaining shape and infectivity
Authors: Singh Dipti , Patri Smita , Narahari Veeda , Segireddy Rameswara R. , Dey Sandeep , Saurabh Archi , Vijay Macha , Prabhu N. Prakash , Srivastava Anand , Kolli Surendra Kumar , Kumar Kota Arun
Published: March 2022

Plasmodium sporozoites are extracellular forms introduced during mosquito bite that selectively invade mammalian hepatocytes. Sporozoites are delimited by a cell membrane that is linked to the underlying acto‐myosin molecular motor. While membrane proteins with roles in motility and invasion have been well studied, very little is known about proteins that maintain the sporozoite shape. We demonstrate that in Plasmodium berghei (Pb) a conserved hypothetical gene, PBANKA_1422900 specifies sporozoite structural integrity maintenance protein (SIMP) required for maintaining the sporozoite shape and motility. Sporozoites lacking SIMP exhibited loss of regular shape, extensive membrane blebbing at multiple foci, and membrane detachment. The mutant sporozoites failed to infect hepatocytes, though the altered shape did not affect the organization of cytoskeleton or inner membrane complex (IMC). Interestingly, the components of IMC failed to extend under the membrane blebs likely suggesting that SIMP may assist in anchoring the membrane to IMC. Endogenous C‐terminal HA tagging localized SIMP to membrane and revealed the C‐terminus of the protein to be extracellular. Since SIMP is highly conserved among Plasmodium species, these findings have important implications for utilizing it as a novel sporozoite‐specific vaccine candidate.
Irritable bowel syndrome patients who are not likely to respond to fecal microbiota transplantation
Authors: El‐Salhy Magdy , Mazzawi Tarek , Hausken Trygve , Hatlebakk Jan Gunnar
Published: March 2022

Background

Fecal microbiota transplantation (FMT) interventions have recently been advocated to not succeed in every irritable bowel syndrome (IBS) patient, since the outcome of FMT varies with the IBS subset. This study investigated the factors potentially affecting FMT response using the same patient cohort used in our previous study.

Methods

This study included 109 patients who received allogenic FMT. Patients completed five questionnaires that assessed their symptoms and quality of life at baseline and at 2 weeks, 1 month, and 3 months after FMT. Patients also provided fecal samples at baseline and 1 month after FMT. The fecal bacterial profile and dysbiosis index (DI) were determined using 16S rRNA gene PCR DNA amplification covering variable genes V3–V9. Response to FMT was defined as a decrease of ≥50 points in the total IBS‐SSS score after FMT.

Results

An IBS patient's response or nonresponse to FMT was not determined by age, IBS duration, IBS subtype, IBS symptoms, fatigue, quality of life, or DI. There were more male nonresponders than responders, and the fluorescence signals of Alistipes were lower in nonresponders than in responders.

Conclusions

We concluded that IBS patients who are male and/or have low fecal Alistipes levels are most likely to not respond to FMT treatment. Whether low fecal Alistipes levels could be used as a marker for predicting the outcome of FMT remains to be determined.

www.clinicaltrials.gov (NCT03822299).
Lean methodology in quality improvement
Authors: Ojo Bukola , Feldman Rachel , Rampersad Sally
Published: March 2022

Measurement of quality and improvement in medicine has existed since Florence Nightingale's time. In modern times, medicine has sought to learn from other high‐reliability industries such as aviation and nuclear power, where errors can result in catastrophic outcomes. Lean is a unique quality improvement strategy that seeks to improve both quality and safety by driving out waste and, where possible, standardizing work practices. It is a visual system with work aids and signals built into the workspace. An important tenet is that ideas come from the workers and that there is an iterative improvement. The improvement efforts are always viewed from the perspective of the customer, our patients, families, and coworkers. This paper describes the evolution of Lean in healthcare and highlights core principles of Lean. Examples are used to describe how various Lean tools can be applied by pediatric anesthesiologists to solve clinical problems.
Does extraversion increase following a three‐hour flirt training? Exploring two training routes
Authors: Allemand Mathias , Gmür Benjamin , Flückiger Christoph
Published: March 2022

Flirting situations are opportunities to behave in extraverted ways. However, it is not clear whether engaging in flirting behavior predicts extraversion. The current study explored whether extraversion increases following a 3‐h flirt training and compared two training routes to flirting. A two‐arm randomized pre‐post design with two active conditions were used. Ninety‐six adults between 18 and 49 years (67.7% women) were randomized to either: (1) a problem‐oriented training strategy that aims to compensate for problems and deficits related to flirting; or (2) a strengths‐oriented training strategy that capitalizes on individuals' strengths and resources. The outcome variables were assessed before and 30 days after the training. Participants in both conditions reported higher scores in flirting behavior as well as in extraversion following the trainings. The results suggest that flirt trainings are potentially interesting indirect intervention approaches to increase the expression of extraversion.
Constitucionalismo e Conceito de Constituição
Authors: Mello do Amaral Junior José Levi
Published: March 2022

O artigo tem a finalidade precipuamente didática de examinar o constitucionalismo, explorando os seus fundamentos e desdobramentos, inclusive no que se refere aos seus ciclos mais recentes. Também analisa o conceito de Constituição e a tipologia constitucional. Por fim, embasado nas premissas históricas e teóricas, destaca a importância de persistir na busca de mecanismos capazes de limitar o poder e prevenir o absolutismo.
Analysis of Turbomachinery Losses in sCO2 Brayton Power Blocks
Authors: Seshadri Lakshminarayanan , Kumar Pramod , Nassar Abdul , Giri Gaurav
Published: March 2022

This paper analyzes the contribution of different turbomachinery loss mechanisms to the overall efficiency of a simple recuperated supercritical carbon dioxide (s-CO2) Brayton cycle for output capacities ranging from 100 kW to 1 GW. The optimum turbomachinery specifications suitable for the specified powers are retrieved using a standard design tool that provides information on various turbomachinery losses. The losses are influenced by operating pressures and mass flowrates, which are unknown a priori. An iterative approach is used to arrive at the turbomachinery efficiency and mass flowrate. Earlier studies have shown the dependence of optimal pressures on heat source and sink temperatures alone. This analysis reveals that design-point optimal cycle pressure ratios differ with varying power outputs due to differences in realizable turbomachinery efficiencies. The information on dominant loss mechanisms provides insights on a viable scale of power generation at which s-CO2 Brayton cycles become worthwhile. Poor turbomachinery efficiencies (less than 80%) render the s-CO2 technology commercially unviable at the sub-MW scale. For higher power scales (10 MW and above), axial machines are found to be appropriate, with corresponding turbomachinery efficiencies greater than 85%. The dominant loss mechanisms also help identify issues related to improving turbomachinery efficiencies at the sub-MW power levels, where the cycle efficiencies are not competitive.
Investigation of the Effect of Altitude on In-Cylinder Heat Transfer in Heavy-Duty Diesel Engines Based on an Empirical Model
Authors: Liu Zhentao , Liu Jinlong
Published: March 2022

Diesel engines are the predominant power source for the trucking industry. Heavy-duty trucks carry more than 70% of all goods transported across the United States. Atmospheric conditions vary with altitude but are critical to diesel engine performance, efficiency, and emissions. Existing studies have reported reduced thermal efficiency and increased emissions when truck engines were operated at high altitudes. Since heat loss is a key parameter related to engine efficiency, the goal of this paper was to investigate the altitude impacts on the in-cylinder heat transfer characteristics. Experiments on a single-cylinder four-stroke heavy-duty diesel engine were conducted at a constant speed and load, but with different intake pressures to simulate the varying atmospheric conditions at different altitudes. The quantity of diesel fuel injected into the cylinder per cycle was increased to maintain the same power output at decreased atmospheric pressure and to compensate for the combustion deterioration that occurred inside the cylinder. Experimental results showed that the bulk temperature was higher at high altitudes because of less mass of the mixture trapped in the cylinder. Such a large temperature difference between the hot products and the cold walls increased the in-cylinder heat transfer to the coolant, especially during combustion. Specifically, the 2000 m altitude rise led to an increase in heat loss to the atmosphere of ∼2% per cycle under full load conditions. As a result, the application of thermal coatings to improve fuel economy is even more necessary in high altitude states, such as Colorado and Wyoming.
Factors Influencing Long-Term Care Workers’ Self-Efficacy for Encouraging Residents to Engage in Physical Activity
Authors: Doran Kelly , Resnick Barbara
Published: March 2022

We aimed to assess work-related factors and their association with long-term care workers’ self-efficacy for encouraging and engaging residents in physical activity. Baseline data from a worksite wellness study with 98 workers were used. We used a linear regression model, to assess if job satisfaction, work ability, and social support for staff health behaviors from coworkers and supervisors were associated with staffs’ self-efficacy for Function-Focused Care (FFC) and Staffs’ Outcome Expectations for FFC. Staffs’ social support for healthy behaviors from coworkers was the only factor that was significantly associated with Staffs’ Outcome Expectations for FFC and staffs’ self-efficacy-FFC, respectively explaining 19% and 14% of the variance. Our findings show that staffs’ social support from coworkers is associated with higher self-efficacy for encouraging and engaging residents in physical activity suggests future worksite wellness studies with long-term care workers may wish to consider assessing program impacts on residents’ physical activity levels.
Kinesiophobia and Fear Avoidance in Older Adults: A Scoping Review on the State of Research Activity
Authors: Alpalhão Vanessa , Cordeiro Nuno , Pezarat-Correia Pedro
Published: March 2022

A scoping review was performed to examine the extent and nature of research activity on kinesiophobia and fear avoidance in older adults and summarize research findings. Four databases were searched from January 2006 to May 2021. Eleven papers were selected for inclusion, with a predominance of cross-sectional design (54.5%; n = 6). Most of the studies were associated with chronic pain (n = 9; 81.8%). Higher levels of kinesiophobia were found among frailer and older people, predominantly living in care homes. Kinesiophobia and fear avoidance have been related to other constructs of the fear avoidance model, and the conclusions partially support the assumptions derived from it in older adults. Nevertheless, kinesiophobia proved to be a more dominant factor in determining the level of physical activity than pain in this population. None of the studies aimed to test the effectiveness of interventions directly targeting kinesiophobia or fear avoidance.
Trust and experiences of National Health Service healthcare do not fully explain demographic disparities in coronavirus vaccination uptake in the UK: a cross-sectional study
Authors: Allington Daniel , McAndrew Siobhan , Duffy Bobby , Moxham-Hall Vivienne
Published: March 2022

Objective

To test whether demographic variation in vaccine hesitancy can be explained by trust and healthcare experiences.

Design

Cross-sectional study.

Setting

Data collected online in April 2021.

Participants

Data were collected from 4885 UK resident adults, of whom 3223 had received the invitation to be vaccinated against the novel coronavirus and could therefore be included in the study. 1629 included participants identified as female and 1594 as male. 234 identified as belonging to other than white ethnic groups, while 2967 identified as belonging to white ethnic groups.

Primary and secondary outcome measures

Uptake of coronavirus vaccination.

Results

Membership of an other than white ethnic group (adjusted OR (AOR)=0.53, 95% CI 0.35 to 0.84, p=0.005) and age (AOR=1.61, 95% CI 1.39 to 1.87, p<0.001 for a 1 SD change from the mean) were the only statistically significant demographic predictors of vaccine uptake. After controls for National Health Service (NHS) healthcare experiences and trust in government, scientists and medical professionals, the effect associated with membership of an other than white ethnic group appears more marginal (AOR=0.61, 95% CI 0.38 to 1.01, p=0.046), while the effect associated with age remains virtually unchanged. Exploratory analysis suggests that NHS healthcare experiences mediate 24% (95% CI 8% to 100%, p=0.024) of the association between ethnicity and uptake, while trust mediates 94% (95% CI 56% to 100%, p=0.001) of the association between NHS healthcare experiences and uptake.

Conclusions

Members of other than white ethnic groups report inferior NHS healthcare experiences, potentially explaining their lower reported trust in government, scientists and medical professionals. However, this does not fully explain the ethnic gap in coronavirus vaccination uptake.
Prevalence of reproductive tract infections including sexually transmitted infections among married women in urban and peri-urban mid to low socioeconomic neighbourhoods of Delhi, North India: an observational study protocol
Authors: Dhabhai Neeta , Chaudhary Ritu , Wi Teodora , Mburu Gitau , Chowdhury Ranadip , More Deepak , Chatterjee Leena , De Devjani , Kabra Rita , Kiarie James , Habib Ndema , Dang Arjun , Dang Manvi , Mazumder Sarmila
Published: March 2022

Introduction

The Global Health Sector Strategy on sexually transmitted infections (STIs), endorsed by the World Health Assembly in 2016 aims to end STIs as public health threat by 2030. WHO conducts global estimates of prevalence to monitor progress towards achieving the same. However, limited laboratory confirmed data exist of STIs and reproductive tract infections (RTIs) apart from few prevalence surveys among key populations and clinic-based reports, including in India. Syndromic approach is the cornerstone of RTI/STI management and to maximise the diagnostic accuracy, there is a need to determine the main aetiologies of vaginal discharge. This study aims to estimate the prevalence of common STIs and RTIs and their aetiological organisms in symptomatic and asymptomatic women living in the urban and peri-urban, mid to low socioeconomic neighbourhoods of Delhi, North India.

Methods and analysis

A cross-sectional study will be conducted among 440 married women who participated in the ‘Women and Infants Integrated Interventions for Growth Study (WINGS)’. Information on sociodemographic profile, sexual and reproductive health will be collected, followed by examination and collection of vaginal swabs for nucleic acid amplification tests to diagnoseNeisseria gonorrhoeae,Chlamydia trachomatisandTrichomonas vaginalisand microscopy to identify bacterial vaginosis andCandida albicans. Treatment will be as per the syndromic approach recommendations in the Indian National Guidelines. Data will be analysed to estimate prevalence, presence of symptoms and signs associated with laboratory confirmed RTIs/STIs using STATA V.16.0 (StataCorp).

Ethics and dissemination

This study protocol has been approved by the ethics review committees of the WHO and Society for Applied Studies (SAS/ERC/RHR-RTI/STI/2020). Approval has been obtained by the WINGS investigators from SAS ethics research committee to share the contact details of the participants with the investigators. The findings will be published in peer-reviewed journals and disseminated through scientific conferences.

Trial registration number

CTRI/2020/03/023954.
Improving the care of patients with COVID-19 with a medical student-run telemedicine clinic
Authors: Wees Isabel , Murtuza Mohammad Imran , Mathisen Danielle , Zhang Helena , Roy Mathews , Phelps Eleanor , Reed Gary
Published: March 2022

Introduction

In March 2020, the Dallas Fort Worth Metroplex experienced a surge in acute COVID-19 infections. At that time, no consistent protocols existed for follow-up of discharged patients with COVID-19 from the William P Clements Jr University Hospital at the University of Texas Southwestern Medical Center. Simultaneously, medical students were suspended from in-person clinical activities to limit viral spread. In response to these events, a telemedicine elective was created to provide timely and high-quality telehealth follow-up for recently discharged patients with COVID-19.

Methods

The pilot team, consisting of several second-year through fourth-year medical students, developed a call script that included warning signs and symptoms, Centers for Disease Control and Prevention (CDC) guidelines for isolation and primary care physician referral information. Patients with COVID-19 discharged from the emergency department (ED) and inpatient services were identified and assigned to student callers. All patients were discussed with an attending physician, who was available if an acute issue arose. The elective also included education on the SBAR (situation, background, assessment, and recommendation) handover technique, telehealth education, updated COVID-19 literature and CDC guidelines.

Results

Improvement was noted in students’ ability to identify patients who required escalation of care, as seen by over 60% of patients who were advised to return to ED required hospital admission. Statistically significant improvement was observed in the students’ degree of feeling informed about the current state of COVID-19 and their degree of comfort with interviewing patients over the phone.

Discussion

This elective provided quality virtual healthcare to patients with COVID-19 while allowing medical students to progress in their medical education and participate in patient care.