bluuebunny/crossref_metadata_2025 huggingface dataset:
Anatomically Fixed Posterior Malleolar Fractures in Syndesmosis Injuries without Transsyndesmotic Screw Fixation
Authors: Çağlar Ceyhun , Akçaalan Serhat , Akkaya Mustafa
Published: December 2021

Background:

The stability of the syndesmosis is extremely important in terms of syndesmosis injury, ankle instability, and posttraumatic osteoarthritis development following ankle fractures. The aim of this study is to evaluate 1-year radiographic outcomes after posterior malleolar fixation in lateral and posterior malleolar fractures and trimalleolar fractures without transsyndesmotic screw fixation.

Methods:

Ninety-four patients who underwent posterior malleolar fixation with posterolateral approach between January 2017 and June 2019 were evaluated retrospectively. The patients were evaluated with parameters such as demographic characteristics, fracture type, injury mechanism, physical examination, and radiographic measurements. The stability of the syndesmosis was evaluated by an intraoperative Cotton test and by measuring the tibiofibular overlap, tibiofibular clear space, and medial clear space parameters preoperatively on the immediate postoperative, first-year weightbearing ankle anteroposterior radiographs.

Results:

In immediate postoperative measurements on radiographs, although the mean tibiofibular overlap ( P < .001) increased, the mean tibiofibular clear space ( P < .001) and mean medial clear space ( P < .001) decreased compared with preoperative radiographs. Immediate postoperative mean tibiofibular overlap, tibiofibular clear space, and medial clear space compared with postoperative first-year mean tibiofibular overlap ( P = .39), tibiofibular clear space ( P = .23), and medial clear space ( P = .43) were not statistically significant. Bone union was completed radiographically at a median of 3.4 ± 1.8 months after surgery.

Conclusion:

After posterior malleolar fractures, anatomic reduction of the posterior malleolus and posterior inferior tibiofibular ligament complex provides strong syndesmosis stability as measured radiographically at 1 year. Patients may not need additional transsyndesmotic screw fixation.

Level of Evidence:

Level IV, case series.
Co-Creating the Real: A Transdisciplinary Dialogue
Authors: Glăveanu Vlad P. , de Miranda Luis
Published: December 2021

This article is the fruit of a written dialogue between a sociocultural psychologist and a philosopher invested in the study of the Creative Real, in a context that resonates with process philosophy and posthumanism. Each of the two authors come from a different tradition (or, rather, different traditions) to the topic of posthuman creativity and their approaches overlap considerably but include as well important points of difference, ranging from writing style to key concepts and areas of application.
The (in)credible fiscal prize: A critical examination of the discourse of evidence in early childhood intervention
Authors: Boyle Clionagh
Published: December 2021

In playing with the concept of ‘credibility’, this article presents a critical examination of the discourse of evidence and the programming of upbringing in early intervention policy and practice. The truth claims of the evidence discourse in policy are explored through a single complex case study of an early intervention city in Northern Ireland. The framework for the study discussed uses Bourdieu's thinking tools of habitus, capital and field alongside Foucauldian discourse analysis to explore the ways in which early intervention policy and practice impact on children, parents and communities. A key question is to consider how evidence is constructed within the discourse and how this can be considered as a Foucauldian regime of truth. Building from the emerging body of critique around scientism and parenting, the study extends this through a sociopolitical lens to the Northern Ireland context. Despite a strong tradition in Northern Ireland of community-based activism and political transition from direct rule to devolution, early intervention policy and programming have tended towards direct read across from Britain and the USA. The study documents that community-based practice struggles within the policy field for recognition, yet ‘home grown’ carries significant social capital within and across communities. The dominant policy discourse of the (in)credible ‘fiscal prize’, transformation through evidence-based interventions contrasts with the backdrop of worsening child poverty in communities. Contrary to the truth claims, this suggests the reproduction rather than transformation of social disadvantage.
Gender Differences in the Maltreatment-Youth Offending Relationship: A Scoping Review
Authors: Baidawi Susan , Papalia Nina , Featherston Rebecca
Published: December 2021

Maltreated and child welfare-involved youth are over-represented in juvenile justice systems. These youth are at a greater risk of serious offending and justice system entrenchment relative to their non-maltreated peers. Understanding gender differences in the pathways to justice involvement and the nature of offending among maltreated children is critical for informing policy and practice. Yet, this body of evidence is fragmented. This scoping review identified and narratively synthesized evidence from studies reporting on gender differences in the individual characteristics, maltreatment experiences, child protection involvement and offending profiles of maltreated youth who offend. A comprehensive search of four databases generated 11,568 publications, from which 180 met the review’s inclusion criteria. These primary studies included participants aged 8–21 years with a history of childhood maltreatment and youth offending and reported at least one gendered analysis. Some consistent findings were reported across studies. A greater level of child welfare involvement and maltreatment exposure (particularly sexual abuse and multi-type maltreatment) was found for justice involved girls, relative to boys. Maltreated and child welfare-involved boys appear more likely to offend than girls, but findings about how gender moderates the maltreatment-offending relationship were inconsistent. Child welfare systems involvement (particularly foster care and residential care) appeared to be an important moderator for girls, and school performance mediated outcomes for boys. Across this body of evidence, few studies accounted for under-reporting of abuse and neglect when using youth self-report measures of maltreatment. Future research is needed which explicitly explores how gender moderates the maltreatment-offending relationship.
Fabrication of carbon fibers from the cupric ion impregnated and thermally stabilized poly(hexamethylene adipamide) precursor
Authors: Erzurumluoglu Levent , Rahman Md. Mahbubor , Demirel Tuba , Karacan Ismail
Published: December 2021

The conversion of poly (hexamethylene adipamide) or polyamide 66 precursor fiber to carbon fibers was accomplished through thermal stabilization and carbonization processes. Thermal stabilization was conducted of cupric chloride (CuCl2)–ethanol-impregnated polyamide 66 (PA66) fibers in the air. To determine the influence of heating rate on the fiber structure and properties of the resultant carbon fibers, carbonization experiments were performed at selected temperatures of 500, 700, 900, and 1100°C using 2.5 and 5 °C/min heating rates with no dwelling. The results conclusively revealed that the volume density and tensile properties of the PA66 fiber were higher at 2.5 °C/min heating rate. After fixing the heating rate as 2.5°C/min, further carbonization experiments were conducted at temperatures from 500 to 1100°C, using increments of 100°C with no dwelling time. Linear density, volume density, fiber diameter, carbon yield, elemental composition, tensile, and electrical properties exhibited a strong dependence on the carbonization temperature. After taking into account the effects of structural defects (i.e., microvoids), tensile strength, and tensile modulus of the carbon fibers increased to 794 MPa and 92.4 GPa, respectively, when carbonized at 1100°C. X-ray diffraction analysis of the carbon fibers further revealed the existence of a greatly disordered (i.e., amorphous) structure, which developed during the carbonization process. FT-IR analysis confirmed the formation of highly aromatic carbon clusters at temperatures of 500°C and higher. The outcomes of electrical conductivity in this study confirm that the PA66 precursor was converted into a semi-conducting state once it was carbonized.
Structural design and vertical wicking behavior of cotton roving-based materials for nutrient transport of indoor plant
Authors: Chu Changliu , Hu Chengwen , Sun Yanyan , Yan Hongqin , Zhang Yadong , Ning Fanggang
Published: December 2021

The liquid transport capacity in a fibrous textile is of great crucial in comprehensively assessing the final moisture management. In this work, several materials were prepared based on cotton rovings by regulating some technological parameters such as twist and ply number, and the effects of the above key parameters on vertical wicking behavior of cotton roving-based materials were investigated. To effectively improve the wicking rate of materials, three hydrophilic schemes were introduced. The experimental results indicated that the maximum vertical wicking height was obtained when samples treated with a mixed solution of 1.5% JFC and 3% NaOH. Subsequently, several cotton roving-based materials were fabricated based on the optimized hydrophilic treatment. It was found that, the as-prepared materials exhibit a twist-reduced wicking effect, and a ply number-strengthen effect. Furthermore, the underlying mechanisms in the above two cases were unraveled. Finally, our prepared cotton roving-based materials served as a nutrient absorbing medium were demonstrated. Such work provides certain support for an in-depth understanding of wicking behavior of microporous textile structures.
Systematic review and meta-analysis of randomized controlled trials of ketamine in the treatment of refractory anxiety spectrum disorders
Authors: Whittaker Elizabeth , Dadabayev Alisher R. , Joshi Sonalee A. , Glue Paul
Published: December 2021

Background:

Anxiety disorders are common, associated with significant burden of disease, and have high levels of treatment resistance. Low-dose ketamine has been extensively studied in treatment-resistant depression, with fewer reports in treatment-resistant anxiety disorders.

Aims:

This systematic review and meta-analysis collected efficacy, safety, and tolerability data for ketamine as a treatment for anxiety spectrum disorders.

Methods:

We conducted a systematic search for randomized controlled trials (RCTs) of acute ketamine treatment for patients with anxiety disorders. Open-label trials of ketamine maintenance therapy were also considered. Qualitative and, where possible, quantitative syntheses of findings were performed using Review Manager software (RevMan). Acute dose-response and maintenance treatment data were also collected.

Results:

There were six eligible acute RCTs – two in social anxiety disorder (SAD), three in post-traumatic stress disorder (PTSD), and one in obsessive-compulsive disorder (OCD). Four of the six showed significant improvement in anxiety rating scores in ketamine compared with control groups. Pooled analysis showed ketamine was associated with an increased likelihood of treatment response for SAD (odds ratio (OR): 28.94; 95% confidence interval [CI]: 3.45–242.57; p = 0.002) but not for PTSD (OR: 2.03; 95% CI: 0.67–6.15; p = 0.21). A dose-response profile was observed for ketamine and changes in SAD symptoms, with doses ⩾0.5 mg/kg associated with greater reduction in anxiety rating scores than lower doses. Ketamine maintenance therapy was associated with sustained anxiolytic effects and improved social and/or work functioning.

Conclusion:

These preliminary analyses suggest that acute ketamine may be broadly effective across treatment-resistant anxiety spectrum disorders. These effects can be prolonged with maintenance treatment. Future studies will be needed to provide critical knowledge gaps around off-label use, side effects, and potential risks for abuse in clinical settings.
A Framework for Evaluating Social Determinants of Health Screening and Referrals for Assistance
Authors: Chagin Kevin , Choate Franklin , Cook Karen , Fuehrer Susan , Misak James E. , Sehgal Ashwini R.
Published: December 2021

Introduction/Objectives:

Many health systems screen patients for social determinants of health and refer patients with social needs to community service organizations for assistance. We developed a framework based on sequential steps to evaluate this process.

Methods:

We reviewed efforts by The MetroHealth System in Cleveland, Ohio and identified 6 sequential steps: patient screened, has social needs, consents to referral to a service organization, referral placed, referral accepted, and referral outcome. Referral outcomes were categorized as resolved (organization provided requested service or patient self-resolved problem), or unresolved (patient unable to be contacted or declined assistance). We then determined the numbers of patients with food insecurity who completed each step, how completion differed by patient characteristics and service organization, and reasons for failure to complete specific steps.

Results:

We used the framework to evaluate screening and assistance steps among 5741 patients who attended a COVID-19 vaccine clinic from February 15-March 31, 2021 and were followed through April 30, 2021. The percentage of patients who completed each step ranged from 17-98%. Step completion differed by patient age, patient race, and clinic. Of 360 referrals accepted by community organizations, 98 (27%) were resolved. The most common reasons for unresolved referrals were inability of service organization to contact patients (151), no reason stated (71), and patients declined service (30).

Conclusions:

A framework based on sequential steps may be used to evaluate social determinants of health screening and assistance programs. Further work is needed to address reasons for failure to complete steps, to include patient perspectives, and to determine long-term outcomes.
Does Green Proactiveness Orientation Improve the Performance of Agricultural New Ventures in China? The Mediating Effect of Sustainable Opportunity Recognition
Authors: Zhang Xiu-e , Li Qing
Published: December 2021

It is still unclear whether the green proactiveness orientation (GPO) adopted by agricultural new ventures boost firm performance, and what is its internal mechanism, especially in the transition economies where agriculture accounts for a significant proportion. Therefore, drawing on the theory of green entrepreneurial orientation and natural-resource-based view, this study used the structural equation model combined with Bootstrapping to test the direct and indirect effects of GPO on firm performance. Results from 301 agricultural new ventures in China demonstrate that GPO has a positive influence on environmental performance, but its influence on financial performance is not significant. Sustainable opportunity recognition (SOR) partially mediates the relationship between GPO and environmental performance and fully mediates the relationship between GPO and financial performance. Besides, we find that environmental performance plays a mediating role between SOR and financial performance. This study, the first of its kind, focuses on green entrepreneurship of agricultural new ventures in the transition economy to enrich the literature on green entrepreneurial orientation through GPO. It also provides some valuable references for managers to recognize sustainable entrepreneurial opportunities through GPO to improve their environmental and financial performance. These could be important in terms of both management and policy implications.
Experimental and numerical study on the screw connection strength of bamboo-oriented strand board compared with wood-oriented strand board
Authors: Zhang Kaiting , Wang Fuli , Xu Runmin , Fan Xinhui , Yan Bin , Li Chuangye , Liu Shengquan , Guo Yong , Chen Yuxia
Published: December 2021

The utilization of resourceful bamboo can alleviate the wood shortage problem. Bamboo-oriented strand board (BOSB) with the highest utilization of bamboo ratio and excellent mechanical properties was considered as a good engineering and furniture material. The strength of joints affects the safety of BOSB structure. This study aims to investigate the effect of screw spacing on the tensile and compressive stiffness and strength of corner joints from BOSB by experimental method combined with finite element method (FEM) compared with wood-oriented strand board (WOSB). The results showed that (1) the strength and stiffness of the corner joint was significantly affected by the screw spacing, and it affected the compressive strength and stiffness of WOSB more significantly; (2) the bending moment and stiffness coefficient of BOSB compressed joint decreased with the increase of spacing, while that of tensile joint increased first and then decreased, and it reached the maximum value, when the spacing was 48 mm; (3) compared with WOSB joint, BOSB joint had higher strength and stiffness, and the failure of the joint was due to the yielding of self-drilling screws. This was also verified by numerical analysis results; (4) the bending moment of BOSB joints was about 2.5 times that of WOSB joints, while the difference between stiffness coefficient was small; (5) the elastic deformations resulted from experimental tests and FEM are similar. It was shown that when the screw spacing is 48 mm, the Von Mises stresses on the BOSB joint were smaller, and the bending strength and stiffness were larger, which was the most suitable screw spacing.
Transcriptomic analysis of resistance and short-term induction response to pyrethroids, in Anopheles coluzzii legs
Authors: Kefi M. , Charamis J. , Balabanidou V. , Ioannidis P. , Ranson H. , Ingham V. A. , Vontas J.
Published: December 2021

Background

Insecticide-treated bed nets and indoor residual spraying comprise the major control measures against Anopheles gambiae sl, the dominant vector in sub-Saharan Africa. The primary site of contact with insecticide is through the mosquitoes’ legs, which represents the first barrier insecticides have to bypass to reach their neuronal targets. Proteomic changes and leg cuticle modifications have been associated with insecticide resistance that may reduce the rate of penetration of insecticides. Here, we performed a multiple transcriptomic analyses focusing on An. coluzzii legs.

Results

Firstly, leg-specific enrichment analysis identified 359 genes including the pyrethroid-binder SAP2 and 2 other chemosensory proteins, along with 4 ABCG transporters previously shown to be leg enriched. Enrichment of gene families included those involved in detecting chemical stimuli, including gustatory and ionotropic receptors and genes implicated in hydrocarbon-synthesis.

Subsequently, we compared transcript expression in the legs of a highly resistant strain (VK7-HR) to both a strain with very similar genetic background which has reverted to susceptibility after several generations without insecticide pressure (VK7-LR) and a lab susceptible population (NG). Two hundred thirty-two differentially expressed genes (73 up-regulated and 159 down-regulated) were identified in the resistant strain when compared to the two susceptible counterparts, indicating an over-expression of phase I detoxification enzymes and cuticular proteins, with decrease in hormone-related metabolic processes in legs from the insecticide resistant population.

Finally, we analysed the short-term effect of pyrethroid exposure on An. coluzzii legs, comparing legs of 1 h-deltamethrin-exposed An. coluzzii (VK7-IN) to those of unexposed mosquitoes (VK7-HR) and identified 348 up-regulated genes including those encoding for GPCRs, ABC transporters, odorant-binding proteins and members of the divergent salivary gland protein family.

Conclusions

The data on An. coluzzii leg-specific transcriptome provides valuable insights into the first line of defense in pyrethroid resistant and short-term deltamethrin-exposed mosquitoes. Our results suggest that xenobiotic detoxification is likely occurring in legs, while the enrichment of sensory proteins, ABCG transporters and cuticular genes is also evident. Constitutive resistance is primarily associated with elevated levels of detoxification and cuticular genes, while short-term insecticide-induced tolerance is linked with overexpression of transporters, GPCRs and GPCR-related genes, sensory/binding and salivary gland proteins.
A high-continuity and annotated tomato reference genome
Authors: Su Xiao , Wang Baoan , Geng Xiaolin , Du Yuefan , Yang Qinqin , Liang Bin , Meng Ge , Gao Qiang , Yang Wencai , Zhu Yingfang , Lin Tao
Published: December 2021

Background

Genetic and functional genomics studies require a high-quality genome assembly. Tomato (Solanum lycopersicum), an important horticultural crop, is an ideal model species for the study of fruit development.

Results

Here, we assembled an updated reference genome of S. lycopersicum cv. Heinz 1706 that was 799.09 Mb in length, containing 34,384 predicted protein-coding genes and 65.66% repetitive sequences. By comparing the genomes of S. lycopersicum and S. pimpinellifolium LA2093, we found a large number of genomic fragments probably associated with human selection, which may have had crucial roles in the domestication of tomato. We also used a recombinant inbred line (RIL) population to generate a high-density genetic map with high resolution and accuracy. Using these resources, we identified a number of candidate genes that were likely to be related to important agronomic traits in tomato.

Conclusion

Our results offer opportunities for understanding the evolution of the tomato genome and will facilitate the study of genetic mechanisms in tomato biology.
Transcriptome comparative analysis of ovarian follicles reveals the key genes and signaling pathways implicated in hen egg production
Authors: Sun Xue , Chen Xiaoxia , Zhao Jinghua , Ma Chang , Yan Chunchi , Liswaniso Simushi , Xu Rifu , Qin Ning
Published: December 2021

Background

Ovarian follicle development plays an important role in determination of poultry egg production. The follicles at the various developmental stages possess their own distinct molecular genetic characteristics and have different biological roles in chicken ovary development and function. In the each stage, several genes of follicle-specific expression and biological pathways are involved in the vary-sized follicular development and physiological events. Identification of the pivotal genes and signaling pathways that control the follicular development is helpful for understanding their exact regulatory functions and molecular mechanisms underlying egg-laying traits of laying hens.

Results

The comparative mRNA transcriptomic analysis of ovarian follicles at three key developmental stages including slow growing white follicles (GWF), small yellow follicles (SYF) of recruitment into the hierarchy, and differentiated large yellow follicles (LYF), was accomplished in the layers with lower and higher egg production. Totally, 137, 447, and 229 of up-regulated differentially expressed genes (DEGs), and 99, 97, and 157 of down-regulated DEGs in the GWF, SYF and LYF follicles, including VIPR1, VIPR2, ADRB2, and HSD17B1 were identified, respectively. Moreover, NDUFAB1 and GABRA1 genes, two most promising candidates potentially associated with egg-laying performance were screened out from the 13 co-expressed DEGs in the GWF, SYF and LYF samples. We further investigated the biological effects of NDUFAB1 and GABRA1 on ovarian follicular development and found that NDUFAB1 promotes follicle development by stimulating granulosa cell (GC) proliferation and decreasing cell apoptosis, increases the expression of CCND1 and BCL-2 but attenuates the expression of caspase-3, and facilitates steroidogenesis by enhancing the expression of STAR and CYP11A1. In contrast, GABRA1 inhibits GC proliferation and stimulates cell apoptosis, decreases the expression of CCND1, BCL-2, STAR, and CYP11A1 but elevates the expression of caspase-3. Furthermore, the three crucial signaling pathways such as PPAR signaling pathway, cAMP signaling pathway and neuroactive ligand-receptor interaction were significantly enriched, which may play essential roles in ovarian follicle growth, differentiation, follicle selection, and maturation.

Conclusions

The current study provided new molecular data for insight into the regulatory mechanism underlying ovarian follicle development associated with egg production in chicken.
Regulation of CcpA on the growth and organic acid production characteristics of ruminal Streptococcus bovis at different pH
Authors: Jin Yaqian , Wang Chao , Fan Yaotian , Elmhadi Mawda , Zhang Ying , Wang Hongrong
Published: December 2021

Background

Catabolite control protein A (CcpA) regulates the transcription of lactate dehydrogenase and pyruvate formate-lyase in Streptococcus bovis, but knowledge of its role in response to different pH is still limited. In this study, a ccpA-knockout strain of S. bovis S1 was constructed and then used to examine the effects of ccpA gene deletion on the growth and fermentation characteristics of S. bovis S1 at pH 5.5 or 6.5.

Results

There was a significant interaction between strain and pH for the maximum specific growth rate (μmax) and growth lag period (λ), which caused a lowest μmax and a longest λ in ccpA-knockout strain at pH 5.5. Deletion of ccpA decreased the concentration and molar percentage of lactic acid, while increased those of formic acid. Strains at pH 5.5 had decreased concentrations of lactic acid and formic acid compared to pH 6.5. The significant interaction between strain and pH caused the highest production of total organic acids and acetic acid in ccpA-knockout strain at pH 6.5. The activities of α-amylase and lactate dehydrogenase decreased in ccpA-knockout strain compared to the wild-type strain, and increased at pH 5.5 compared to pH 6.5. There was a significant interaction between strain and pH for the activity of acetate kinase, which was the highest in the ccpA-knockout strain at pH 6.5. The expression of pyruvate formate-lyase and acetate kinase was higher in the ccpA-knockout strain compared to wild-type strain. The lower pH improved the relative expression of pyruvate formate-lyase, while had no effect on the relative expression of acetate kinase. The strain × pH interaction was significant for the relative expression of lactate dehydrogenase and α-amylase, both of which were highest in the wild-type strain at pH 5.5 and lowest in the ccpA-knockout strain at pH 6.5.

Conclusions

Overall, low pH inhibited the growth of S. bovis S1, but did not affect the fermentation pattern. CcpA regulated S. bovis S1 growth and organic acid fermentation pattern. Moreover, there seemed to be an interaction effect between pH and ccpA deletion on regulating the growth and organic acids production of S. bovis S1.
Factors associated with undertriage in patients classified by the need to visit a hospital by telephone triage: a retrospective cohort study
Authors: Inokuchi Ryota , Jin Xueying , Iwagami Masao , Abe Toshikazu , Ishikawa Masatoshi , Tamiya Nanako
Published: December 2021

Background

Prehospital telephone triage stratifies patients into five categories, “need immediate hospital visit by ambulance,” “need to visit a hospital within 1 hour,” “need to visit a hospital within 6 hours,” “need to visit a hospital within 24 hours,” and “do not need a hospital visit” in Japan. However, studies on whether present and past histories cause undertriage are limited in patients triaged as need an early hospital visit. We investigated factors associated with undertriage by comparing patient assessed to be appropriately triaged with those assessed undertriaged.

Methods

We included all patients classified by telephone triage as need to visit a hospital within 1 h and 6 h who used a single after-hours house call (AHHC) medical service in Tokyo, Japan, between November 1, 2019, and November 31, 2020. After home consultation, AHHC doctors classified patients as grade 1 (treatable with over-the-counter medications), 2 (requires hospital or clinic visit), or 3 (requires ambulance transportation). Patients classified as grade 2 and 3 were defined as appropriately triaged and undertriaged, respectively.

Results

We identified 10,742 eligible patients triaged as need to visit a hospital within 1 h and 6 h, including 10,479 (97.6%) appropriately triaged and 263 (2.4%) undertriaged patients. Multivariable logistic regression analyses revealed patients aged 16–64, 65–74, and ≥ 75 years (adjusted odds ratio [OR], 2.40 [95% confidence interval {CI} 1.71–3.36], 8.57 [95% CI 4.83–15.2], and 14.9 [95% CI 9.65–23.0], respectively; reference patients aged < 15 years); those with diabetes mellitus (2.31 [95% CI 1.25–4.26]); those with dementia (2.32 [95% CI 1.05–5.10]); and those with a history of cerebral infarction (1.98 [95% CI 1.01–3.87]) as more likely to be undertriaged.

Conclusions

We found that older adults and patients with diabetes mellitus, dementia, or a history of cerebral infarction were at risk of undertriage in patients triaged as need to visit a hospital within 1 h and 6 h, but further studies are needed to validate these findings.
Nosocomial infections in an Iranian educational hospital: an evaluation study of the Iranian nosocomial infection surveillance system
Authors: Pezhman Bagheri , Fatemeh Rezaei , Amir Roodgari , Mahboobeh Rokhsari , Mohammad Fararouei
Published: December 2021

Background

Nosocomial infection (NI) or cross-infection is a major health problem in hospitals worldwide.

Aim

This study aimed to report the status of NIs and to evaluate the Iranian nosocomial infection surveillance system (INISS) in a teaching hospital in the south of Iran.

Methods

This is a comparative historical study on the records of hospital admitted patients from 2018 to 2019. Data on patients who were diagnosed with NI was extracted from the INISS database. The database includes data on the incidence of different types of NIs in each hospital ward, the patient’s infection outcome, the agents involved, and the site of infection.

Results

The results indicated that the rate of NI (cases of NI/ 100 admissions) in the hospital was %2.95. The highest rate of NIs was reported from ICUs. Of the infected patients, 45.61% were female, 98.95% had underlying diseases, and 30.88% died due to nosocomial infections. The median (IQR) of the duration of hospital stay among infected patients was 13 (7–18). The most common site of infection was VAE (ventilator-associated events) (39.40%) and the most common isolated agent, irrespective of the organ involved, wasAcinetobacter(spp.) (22.75%).

Conclusions

We reported ICU andAcinetobacter(spp.) as the most affected ward and most common agent involved in recorded NIs respectively. The rate of NI in the study hospital was exceptionally low when compared to its counterparts in a few other developed countries. The INISS needs to be further evaluated with regard to the completeness and representativeness of the surveillance system. Also, we need to evaluate the adherence to the INISS guidelines among staff and physicians in reporting the NIs.
Changes in mental health during three waves of the COVID-19 pandemic: a repeated cross-sectional study among Polish university students
Authors: Rogowska Aleksandra M. , Ochnik Dominika , Kuśnierz Cezary , Chilicka Karolina , Jakubiak Monika , Paradowska Maria , Głazowska Luiza , Bojarski Dawid , Fijołek Julia , Podolak Marcin , Tomasiewicz Maciej , Nowicka Dominika , Kawka Marek , Grabarczyk Maksymilian , Babińska Zuzanna
Published: December 2021

Background

Research indicates that mental health worsened during the Coronavirus crisis, in particular among women and university students. However, few longitudinal studies have so far investigated the changes in mental health outcomes across three subsequent waves of the COVID-19 pandemic. Therefore, this study aims to examine changes in mental health among university students.

Methods

A total of 1,961university students from Poland, at mean age 23.23 years (SD = 3.16, 57.47% of women) were included in this repeated cross-sectional study across three waves of the COVID-19 pandemic: W1 (n = 657), W2 (n = 654), and W3 (n = 650). They completed the online survey with the Generalized Anxiety Disorder (GAD-7), Perceived Stress Scale (PSS-10), General Self-Rated Health (GSRH), and Satisfaction with Life Scale (SWLS), as well as sociodemographic variables.

Results

The prevalence of people at high risk of anxiety and perceived stress, poorer physical health, and low life satisfaction changed significantly across three waves of the COVID-19 pandemic. The results of the two-way ANOVA showed that both the wave (W1<W2<W3) and gender (menW2, W1>W3), and genders (menW3, W2>W3), and was significantly worse in women than in men. The level of life satisfaction also decreased significantly in W3 (W1>W3, W2>W3), but did not differ between men and women. High GAD risk was presented two times more frequently among women and people who subjectively assessed their health as poor, three times more likely in participants dissatisfied with their lives, and seven times more probably in persons with high-stress levels.

Conclusions

The results of this study consistently indicate (using parametric and non-parametric statistical analysis) that there are significant differences in mental health problems across three waves of the COVID-19 pandemic. It suggests that pandemic waves should be considered in future review studies and meta-analyses. Furthermore, these findings indicate a potential role for prevention and intervention programs aimed at alleviating life satisfaction and subjective assessment of health and improving coping skills to reduce stress and anxiety.
Agenda-setting of tobacco control policy in Iran: a retrospective policy analysis study
Authors: Ravaghi Hamid , Tourani Sogand , Khodayari-Zarnaq Rahim , Aghapour Baharak , Pishgoo Azita , Arabloo Jalal
Published: December 2021

Background

The prevalence of tobacco use, especially hookah, has increased in Iran In recent years, particularly among young people and women, and the age of onset of use has decreased. Tobacco use is the fourth leading risk factor for non-communicable diseases in Iran. These issues cause concerns in the country and led to the present study on tobacco control agenda-setting in Iran over a 30-year timeframe.

Methods

We conducted this retrospective analytical study to investigate process analysis in Iran using Kingdon’s multiple-streams framework (MSF). We collected the data using semi-structured interviews with key informants (n = 36) and reviewing policy documents (n > 100). Then, we analyzed the policy documents and in-depth interviews using the document and framework analysis method. We used MAXQDA 11 software to classify and analyze the data.

Results

Iran’s accession to the Framework Convention on Tobacco Control (FCTC) opened a window of opportunity for tobacco control. The policy window opens when all three streams have already been developed. The adoption of the comprehensive law on the national control and campaign against tobacco in the Islamic Consultative Assembly in 2006 is a turning point in tobacco control activities in Iran.

Conclusions

The tobacco control agenda-setting process in Iran was broadly consistent with MSF. The FCTC strengthened the comprehensive plan for national control of tobacco as a policy stream. However, there are several challenges in developing effective policies for tobacco control in the Iranian setting.
Machine learning assisted Cameriere method for dental age estimation
Authors: Shen Shihui , Liu Zihao , Wang Jian , Fan Linfeng , Ji Fang , Tao Jiang
Published: December 2021

Background

Recently, the dental age estimation method developed by Cameriere has been widely recognized and accepted. Although machine learning (ML) methods can improve the accuracy of dental age estimation, no machine learning research exists on the use of the Cameriere dental age estimation method, making this research innovative and meaningful.

Aim

The purpose of this research is to use 7 lower left permanent teeth and three models [random forest (RF), support vector machine (SVM), and linear regression (LR)] based on the Cameriere method to predict children's dental age, and compare with the Cameriere age estimation.

Subjects and methods

This was a retrospective study that collected and analyzed orthopantomograms of 748 children (356 females and 392 males) aged 5–13 years. Data were randomly divided into training and test datasets in an 80–20% proportion for the ML algorithms. The procedure, starting with randomly creating new training and test datasets, was repeated 20 times. 7 permanent developing teeth on the left mandible (except wisdom teeth) were recorded using the Cameriere method. Then, the traditional Cameriere formula and three models (RF, SVM, and LR) were used to estimate the dental age. The age prediction accuracy was measured by five indicators: the coefficient of determination (R2), mean error (ME), root mean square error (RMSE), mean square error (MSE), and mean absolute error (MAE).

Results

The research showed that the ML models have better accuracy than the traditional Cameriere formula. The ME, MAE, MSE, and RMSE values of the SVM model (0.004, 0.489, 0.392, and 0.625, respectively) and the RF model (− 0.004, 0.495, 0.389, and 0.623, respectively) were lower with the highest accuracy. In contrast, the ME, MAE, MSE and RMSE of the European Cameriere formula were 0.592, 0.846, 0.755, and 0.869, respectively, and those of the Chinese Cameriere formula were 0.748, 0.812, 0.890 and 0.943, respectively.

Conclusions

Compared to the Cameriere formula, ML methods based on the Cameriere’s maturation stages were more accurate in estimating dental age. These results support the use of ML algorithms instead of the traditional Cameriere formula.
Patient-reported experiences and outcomes following two different approaches for non-surgical periodontal treatment: a randomized field study
Authors: Liss Anna , Wennström Jan L. , Welander Maria , Tomasi Cristiano , Petzold Max , Abrahamsson Kajsa H.
Published: December 2021

Context

The current report is part of a prospective, multi-center, two-arm, quasi-randomized field study focusing on the effectiveness in general praxis of evidence-based procedures in the non-surgical treatment of patients with periodontitis.

Objective

The specific aims were to (i) evaluate patient-reported experience and outcome measures of treatment following a guided approach to periodontal infection control (GPIC) compared to conventional non-surgical therapy (CNST) and to (ii) identify potential predictors of subjective treatment outcomes and patient’s adherence to self-performed infection control, i.e. adequate oral hygiene.

Methods

The study sample consisted of 494 patients treated per protocol with questionnaire- and clinical data at baseline and 6-months. The GPIC approach (test) comprised patient education for adequate oral hygiene prior to a single session of full-mouth ultra-sonic instrumentation, while the CNST approach (control) comprised education and instrumentation (scaling and root planing) integrated at required number of consecutive appointments. Clinical examinations and treatment were performed by Dental Hygienists, i.e. not blinded. Data were processed with bivariate statistics for comparison between treatment groups and with multiple regression models to identify potential predictors of subjective and clinical outcomes. The primary clinical outcome was gingival bleeding scores.

Results

No substantial differences were found between the two treatment approaches regarding patient-reported experiences or outcomes of therapy. Patients’ experiences of definitely being involved in therapy decisions was a significant predictor for a desirable subjective and clinical outcome in terms of; (i) that oral health was considered as much improved after therapy compared to how it was before, (ii) that the treatment definitively had been worth the cost and efforts, and (iii) adherence to self-performed periodontal infection control. In addition, to be a current smoker counteracted patients’ satisfaction with oral health outcome, while gingival bleeding scores at baseline predicted clinical outcome in terms of bleeding scores at 6-months.

Conclusions

The results suggest that there are no differences with regard to patient-reported experiences and outcomes of therapy following a GPIC approach to periodontal infection control versus CNST. Patients’ experiences of being involved in therapy decisions seem to be an important factor for satisfaction with care and for adherence to self-performed periodontal infection control.

Registered at: ClinicalTrials.gov (NCT02168621).
Assessing the quality of deliberative stakeholder consultations involving allied health professionals in pediatric palliative care and hematology/oncology in Canada
Authors: Rahimzadeh Vasiliki , Longo Cristina , Gagnon Justin , Fernandez Conrad , Bartlett Gillian
Published: December 2021

Background

In this paper we assess the quality of six deliberative stakeholder consultations regarding the implementation of a precision diagnostic for life-threatening pediatric brain tumors. Decision makers who base policy recommendations on the outputs of consultative exercises can presuppose that all deliberants are well informed of the policy issue, that participation in the deliberative process was fair, and that overcoming implementation barriers will necessarily result in practice change. Additional evidence is therefore needed to substantiate the informational quality of the deliberation, measure the equality of participation and study the effects on stakeholder reasoning to appropriately guide uptake of proposed recommendation(s).

Methods

Using the DeVries framework for assessing the deliberative quality, we analyzed data from 44 post-consultation evaluation surveys completed by pediatric oncology and palliative care teams at two tertiary pediatric healthcare centers in Canada. We also conducted turn-taking and word-contribution analyses from the text transcriptions of each deliberation to assessequality of participationusing descriptive statistics.

Results

Deliberants agreed the quality of the deliberativeprocesswas fair (median ratings ranging from 9–10 out of 10) and the opportunities to receive expert information and discuss with others about the implementation of a new LDT were helpful (9.5 out of 10). While the session improved understanding of the implementation barriers and opportunities, it had marginal effects on deliberants’ reasoning about whether LDTs would change their own clinical practice (3–10 out of 10). Participation was proportionate in at least four of the six deliberations, where no deliberant took more than 20% of total turns and contributed equal to, or less than 20% of total words.

Conclusion

The quality assessment we performed demonstrates high informational value and perceived fairness of two deliberative stakeholder consultations involving pediatric palliative care and oncology teams in Canada. Quality assessments can reveal how the process of deliberation unfolds, whether deliberative outputs are the result of equitable participation among deliberants and what, if any, stakeholder voices may be missing. Such assessments should be routinely reported as a condition of methodological rigor and trustworthiness of deliberative stakeholder engagement research.
The impact of medical tourism on cervical cancer screening among immigrant women in the U.S.
Authors: Jang Sou Hyun , Meischke Hendrika , Ko Linda K.
Published: December 2021

Background

Research on the relationship between medical tourism—traveling abroad for healthcare and cervical cancer screening is lacking. This study examines (1) the association between medical tourism and cervical cancer screening among immigrant women and (2) whether the association varies across years in the U.S.

Methods

We analyzed the New Immigrant Survey data of immigrant women aged 21–65 (n = 999). The outcome was having had a Pap smear since becoming a permanent resident, and the main predictor was medical tourism. Logistic regressions were conducted.

Results

Immigrant women who engaged in medical tourism had higher cervical cancer screening rates compared to those who did not engage in medical tourism (84.09% vs. 71.68%). This relationship was statistically significant only among women who have recently immigrated, after controlling for covariates.

Conclusions

Immigrant women who engaged in medical tourism had 2.18 higher odds of receiving a Pap smear than immigrant women who did not, after controlling for other covariates. Health educators should be aware of the practice of medical tourism and consider providing education on adherence to cancer screening guidelines and follow up abnormal results to ensure that immigrant women receive continuous cancer care.
Causal role of high body mass index in multiple chronic diseases: a systematic review and meta-analysis of Mendelian randomization studies
Authors: Larsson Susanna C. , Burgess Stephen
Published: December 2021

Background

Obesity is a worldwide epidemic that has been associated with a plurality of diseases in observational studies. The aim of this study was to summarize the evidence from Mendelian randomization (MR) studies of the association between body mass index (BMI) and chronic diseases.

Methods

PubMed and Embase were searched for MR studies on adult BMI in relation to major chronic diseases, including diabetes mellitus; diseases of the circulatory, respiratory, digestive, musculoskeletal, and nervous systems; and neoplasms. A meta-analysis was performed for each disease by using results from published MR studies and corresponding de novo analyses based on summary-level genetic data from the FinnGen consortium (n = 218,792 individuals).

Results

In a meta-analysis of results from published MR studies and de novo analyses of the FinnGen consortium, genetically predicted higher BMI was associated with increased risk of type 2 diabetes mellitus, 14 circulatory disease outcomes, asthma, chronic obstructive pulmonary disease, five digestive system diseases, three musculoskeletal system diseases, and multiple sclerosis as well as cancers of the digestive system (six cancer sites), uterus, kidney, and bladder. In contrast, genetically predicted higher adult BMI was associated with a decreased risk of Dupuytren’s disease, osteoporosis, and breast, prostate, and non-melanoma cancer, and not associated with Alzheimer’s disease, amyotrophic lateral sclerosis, or Parkinson’s disease.

Conclusions

The totality of the evidence from MR studies supports a causal role of excess adiposity in a plurality of chronic diseases. Hence, continued efforts to reduce the prevalence of overweight and obesity are a major public health goal.