bluuebunny/crossref_metadata_2025 huggingface dataset:
Utilization, Patient Characteristics, and Longitudinal Improvements among Patients from a Provincially Funded Transdiagnostic Internet-delivered Cognitive Behavioural Therapy Program: Observational Study of Trends over 6 Years
Authors: Hadjistavropoulos Heather D. , Peynenburg Vanessa , Thiessen David L. , Nugent Marcie , Karin Eyal , Staples Lauren , Dear Blake F. , Titov Nickolai
Published: April 2021

Objective:

There is strong evidence supporting internet-delivered cognitive behaviour therapy (iCBT) and consequently growing demand for iCBT in Canada. Transdiagnostic iCBT that addresses both depression and anxiety is particularly promising as it represents an efficient method of delivering iCBT in routine care. The Online Therapy Unit, funded by the Saskatchewan government, has been offering transdiagnostic iCBT for depression and anxiety since 2013. In this article, to broadly inform implementation efforts, we examined trends in utilization, patient characteristics, and longitudinal improvements for patients receiving transdiagnostic iCBT over 6 years.

Methods:

Patients who completed telephone screening between November 2013 and December 2019 were included in this observational study. Patients provided demographics and mental health history at screening and completed measures at pre-treatment, post-treatment and at 3- to 4-month follow-up. Treatment engagement and satisfaction were assessed.

Results:

A total of 5,321 telephone screenings were completed and 4,283 of patients were accepted for treatment over the 6-year period (80.5% acceptance). The most common reason for referral to another service was high suicide risk/severe symptoms (47.1%). Examination of trends showed growing use of transdiagnostic iCBT over time (37% increase per year). There was remarkable stability in patient characteristics across years. Most patients were concurrently using medication (57.3%) with 11.9% reporting using iCBT while on a waiting list for face-to-face treatment highlighting the importance of integrating iCBT with other services. Consistent across years, large improvements in depression and anxiety symptoms were found and maintained at 3- to 4-month follow-up. There was strong patient engagement with iCBT and positive ratings of treatment experiences.

Conclusions:

As there is growing interest in iCBT in Canada, this large observational study provides valuable information for those implementing iCBT in terms of likely user characteristics, patterns of use, and improvements. This information has potential to assist with resource allocation and planning in Canada and elsewhere.
High Social Coping Self-Efficacy Associated With Lower Sweat Interleukin-6 in Older Adults With Chronic Illness
Authors: Hladek Melissa , Gill Jessica M. , Lai Chen , Bandeen-Roche Karen , Xue Qian-Li , Allen Jerilyn , Leyden Christine , Kanefsky Rebekah , Szanton Sarah L.
Published: April 2021

Inflammation, particularly interleukin-6 (IL-6), is associated with chronic disease in older adults, but not all older adults have the same progression of poor health outcomes. Self-efficacy may play a role in buffering the inflammatory burden in chronic disease. To evaluate associations between self-efficacy and IL-6, 159 community-dwelling older adults ( N = 159, Mage = 82 years, SD = 6.3 years) with one or more chronic illnesses were recruited for this cross-sectional study. Sweat IL-6 was collected using a noninvasive sweat patch worn for 72 hrs. Multiple linear regression with bootstrapping showed a significant association between social coping self-efficacy and IL-6 (β = −0.534, p = .010) after adjustment for age, sex, race, body mass index, financial strain, chronic conditions, and social support. Although preliminary, this study creates a rationale to explore the self-efficacy inflammatory biomarker association further. Enhancing self-efficacy might be a viable nonpharmacological treatment to lower or slow the inflammatory burden in older adults.
Evaluation of Anti-Xa Apixaban and Rivaroxaban Levels With Respect to Known Doses in Relation to Major Bleeding Events
Authors: Nguyen Steffany N. , Ruegger Melanie C. , Salazar Eric , Dreucean Diane , Tatara Alexandra W. , Donahue Kevin R.
Published: April 2021

Background:

Although not routinely recommended, anti-Xa level monitoring for apixaban or rivaroxaban may be useful in certain clinical scenarios. There are currently no laboratory standards, therapeutic ranges, or proven correlation between anti-Xa levels and clinical outcomes.

Objective:

This study describes the utilization, application, and association of anti-Xa levels with clinical outcomes in patients receiving apixaban or rivaroxaban.

Methods:

This retrospective, descriptive study included adult inpatients within the Houston Methodist System on apixaban or rivaroxaban with at least one anti-Xa level ordered subsequent to administered doses. The primary endpoint was major bleeding according to International Society on Thrombosis and Haemostasis criteria. Secondary endpoints included reasons for anti-Xa level ordering, anti-Xa levels at different time intervals post-dose, and thrombotic events. Pre-specified subgroup analyses were performed to further evaluate the primary endpoint.

Results:

The study population consisted of 169 patients and 234 anti-Xa levels. Twenty-nine levels were obtained in context of major bleeding. The majority of levels were not drawn as peak levels 2-4 hours post-dose, however remained quantifiable above typical observed levels within this timeframe and well beyond 24 hours post-dose. Patient characteristics with major bleeding included elderly age, acute renal impairment, and low body weight. At least 14 unique reasons for anti-Xa level ordering were identified. Twenty-nine levels were associated with thrombotic events.

Conclusion:

Anti-Xa levels may be useful for assessment of current drug concentrations, immediate safety of therapy, and guidance for possible clinical interventions. Dose titration and reversal therapies based on anti-Xa level results in major bleeding warrant further research.
Review of COVID-19 mRNA Vaccines: BNT162b2 and mRNA-1273
Authors: Teo Shyh Poh
Published: April 2021

The United States Food and Drug Administration recently issued emergency use authorization for 2 mRNA vaccines for preventing COVID-19 disease caused by SARS-CoV-2 virus infections. BNT162b2 from Pfizer-BioNTech and mRNA-1273 by Moderna are planned for use in mass-immunization programs to curb the pandemic. A brief overview of COVID-19 mRNA vaccines is provided, describing the SARS-CoV-2 RNA, how mRNA vaccines work and the advantages of mRNA over other vaccine platforms. The Pfizer-BioNTech collaboration journey to short-list mRNA vaccine candidates and finally selecting BNT162b2 based on safety data is outlined, followed by the Phase 3 study of BNT162b2 demonstrating 95% efficacy in preventing COVID-19 infections. Studies regarding mRNA-1273 (Moderna) are described, including extended immunogenicity data up to 119 days. The Phase 3 COVE study of mRNA-1273 eventually showed vaccine efficacy of 94.5%. Recommendations for future mRNA vaccine development are provided, including ongoing safety surveillance, evaluation in under-represented groups in previous studies and improving mRNA vaccine thermostability. Finally, further logistical considerations are required for manufacturing, storing, distribution and implementing mass vaccination programs to curb the pandemic.
Evaluation of mobbing perception levels of health employees
Authors: Hamzaoglu Nurcan , Yayak Asli , Turk Burcu
Published: April 2021

The objective of this study was to evaluate the mobbing perception levels of health workers, who were mobbed and to determine whether the socio-demographic characteristics of the employees made a significant difference in the perception of mobbing. Within the scope of the study, the mobbing perception levels of 516 healthcare personnel were evaluated by using relational screening model. In order to collect data, socio-demographic data form and Leymann Psychological Terrorist Scale developed by Heinz Leymann were used. As a result of the study, 70.0% of the participants who were exposed to mobbing reported that they were exposed to mobbing behaviors by their managers. The Leymann Psychological Terrorism Scale was found to be 1.49. Mobbing behaviors that affect self-disclosure and communication possibilities is the most common bullying behavior that the participants were exposed (x̄: 1.73). As a result, the data suggested that company policies rather than demographic characteristics of individuals are effective in the exposure to mobbing behaviors. It is thought that the cultural structures of the societies and the individuals’ knowledge about which behaviors can be evaluated as mobbing have an effect on the mobbing perception levels of the individuals. Accepting mobbing behaviors as a normal situation in hierarchical structure or interpersonal relationships is one of the important problems in prevention. For this reason, one of the most important steps in the prevention of mobbing is to ensure that both managers and employees are informed about mobbing.
Elastic vibration of rotationally ring-shaped periodic structure subjected to three-axis angular velocity components
Authors: Liu Jinlong , Wang Shiyu , Zhang Dongsheng
Published: April 2021

The elastic vibration of rotationally ring-shaped periodic structure (RRPS) subjected to angular velocities applied about three orthogonal directions are examined. An analytical model having in-plane radial and tangential displacements is developed by using Hamilton's principle. The modeling leads to a partial differential equation with revolution effect, based on which the eigenvalue splitting, mode contamination and vibration instability are examined by focusing on their evolutions with the support count, support strength and revolution speed. The eigensolutions are formulated by perturbation-superposition method. The results imply that the splitting, contamination and instability follow similar rules with those of stationary RRPS, which are heavily affected by the revolution speed. The dependence of parameters on eigensolutions and especially the relationships between eigenvalue splitting and principal instability, and those between mode contamination and combination instability are demonstrated based on a sample RRPS. The principal instability can occur at splitting eigenvalues, and the combination instability can arise in the presence of mode contamination. Main results are compared with the existing ones in the open literature.
Multi-response optimization of friction stir welding process of dissimilar AA3003-H12 and C12200-H01 alloys using full factorial method
Authors: Shinde Gurunath V , Arakerimath Rachayya R
Published: April 2021

In current research work, an attempt has been made to join dissimilar metals by employing friction stir welding (FSW), i.e., AA3003-H12 (aluminium alloy) and C12200-H01 (copper alloy). The experiments are designed as per full factorial design at different process parameters, namely tool pin profiles, rotational speed, welding speed, and shoulder diameter while the ultimate tensile strength (UTS), yield strength (YS), and percentage elongation (% E) are considered as a performance parameter. Moreover, a statistical tool, i.e., analysis of variance (ANOVA) is also utilized to check the adequacy of the results. It is observed that the higher UTS, % E and YS are obtained by employing a taper pin profile tool at a rotational speed of 1800 rpm, a welding speed of 16 mm/min, and a shoulder diameter of 22.5 mm. The ANOVA results showed that the rotational speed is the most significant factor for current research work. In addition, a scanning electron microscope is utilized for microstructural analysis of welded joints. It is witnessed that the minimum grain size, i.e., 4 microns, is obtained for highest strength specimen and the maximum grain size is obtained for the lowest strength specimen i.e., 31 microns. Besides this, the swirling of cu particle is also observed from advancing side (AS) to the retreating side (RS). Moreover, energy-dispersive X-ray spectroscopy (EDS) indicates the formation of intermetallic compounds i.e. Al2Cu, Al9Cu4 at nugget zone (NZ). The hardness is found to be higher at NZ due to the presence of Al-Cu intermetallic.
The disability employment gap in European countries: What is the role of labour market policy?
Authors: van der Zwan Roos , de Beer Paul
Published: April 2021

Across Europe, the labour market participation of persons with disabilities remains lower than that of persons without a disability. Our research examines this disability employment gap, looking specifically at its variation by country and gender. Additionally, we test the influence of labour market policies – testing both the social investment perspective and the welfare scepticism perspective – on the size of the gap, in an effort to determine whether a more generous welfare state raises or lowers the employment rate of people with disabilities. Using the European Union Statistics on Income and Living Conditions (EU-SILC), we show that Southern European countries have the smallest disability employment gap. Whereas stricter employment protection legislation is found to be beneficial for people with disabilities on the labour market, other labour market policies specifically intended to benefit this group do not strongly affect their chances on the labour market. These findings support the social investment perspective and show that social policies can have a positive effect on the employment of people with disabilities.
Attenuation of diethyl nitrosamine-induced hepatocellular carcinoma by taxifolin and/or alogliptin: The interplay between toll-like receptor 4, transforming growth factor beta-1, and apoptosis
Authors: Kabel AM , Arab HH , Abd Elmaaboud MA
Published: April 2021

Hepatocellular carcinoma (HCC) is the most common form of liver malignancies worldwide. Alogliptin is an anti-diabetic that may have effective anticancer properties against many types of malignancies. Taxifolin is a flavonoid that has potent antioxidant, and anti-inflammatory properties. The objective of this study was to explore the impact of alogliptin and/or taxifolin on diethyl nitrosamine-induced HCC in rats. One hundred male Wistar rats were divided into five equal groups as follows: Control; HCC; HCC + Alogliptin; HCC + Taxifolin; and HCC + Alogliptin + Taxifolin group. The survival rate, liver function tests, tissue antioxidant enzymes, malondialdehyde (MDA), nuclear factor (erythroid derived 2)-like 2 (Nrf2), transforming growth factor beta 1 (TGF-β1), interleukin 1 alpha (IL-1α), and toll-like receptor 4 (TLR4) were measured. Also, hepatic caspase 3, caspase 9, beclin-1, and c-Jun NH2-terminal kinase (JNK) in addition to serum alpha-fetoprotein (AFP) and α-L-Fucosidase (AFU) were assessed. Specimens of the liver were subjected to histopathological examination. Alogliptin and/or taxifolin induced significant improvement of liver function tests with significant increase in the survival rate, tissue antioxidant enzymes, Nrf2, caspase 3, caspase 9, Beclin-1 and JNK activities associated with significant decrease in serum AFP and AFU, tissue MDA, TGF-β1, IL-1α and TLR4 expression compared to HCC group. These results were significant with taxifolin/alogliptin combination when compared to the use of each of these agents alone. In conclusion, taxifolin/alogliptin combination might be used as adjuvant therapy for attenuation of HCC.
RAI14 Regulated by circNFATC3/miR-23b-3p axis Facilitates Cell Growth and Invasion in Gastric Cancer
Authors: Yan XinXin , Zhang MingZhi , Li BingBing , Ji Xia , Wu HongJin , Zhang QingYu
Published: April 2021

Circular RNAs (circRNAs) have been proved to act crucial roles in multiple malignancies including gastric cancer (GC). Retinoic acid induced 14 (RAI14) acts as an oncogene in human cancers, but the underlying mechanisms by which RAI14 is regulated by circRNA/miRNA axis remain elusive. The clinical value of RAI14, miR-23b-3p and circNFATC3 was estimated by The Cancer Genome Atlas and fluorescence in situ hybridization. The interplay between miR-23b-3p and RAI14 or circNFATC3 was determined by qRT-PCR, Western blot, luciferase gene report and RIP assays. Biological function assays and a subcutaneous xenograft model were executed to unveil the role of circNFATC3/miR-23b-3p/RAI14 axis in GC cells. As a consequence, upregulation of RAI14 and circNFATC3 or downregulation of miR-23b-3p was associated with poor prognosis in patients with GC. Restored miR-23b-3p depressed cell proliferation, colony formation, and cell invasion by targeting RAI14, whereas RAI14 facilitated cell progression and reversed the anti-tumor effects of miR-23b-3p in GC cells. Then, circNFATC3 had a co-localization with miR-23b-3p in the cytoplasm in GC tissue cells and could act as a sponge of miR-23b-3p in GC cell line. Silencing of circNFATC3 inhibited cell growth and in vivo tumorigenesis by upregulating miR-23b-3p and downregulating RAI14. In conclusion, our findings indicated that RAI14 facilitated cell growth and invasion and was regulated by circNFATC3/miR-23b-3p axis in GC.
Near infrared spectroscopy of Eucalyptus pellita for foliar nutrients and the potential for real-time monitoring of trees in fertiliser trial plots
Authors: Alwi Agustan , Meder Roger , Japarudin Yani , Hamid Hazandy A , Sanusi Ruzana , Yusoff Khairul H Mohd
Published: April 2021

Eucalyptus pellita F. Muell. has become an important tree species in the forest plantations of SE Asia, and in Malaysian Borneo in particular, to replace thousands of hectares of Acacia mangium Willd. which has suffered significant loss caused by Ceratocystis manginecans infection in Sabah, Malaysia. Since its first introduction at a commercial scale in 2012, E. pellita has been planted in many areas in the region. The species replacement requires new silvicultural practices to induce the adaptability of E. pellita to grow in the region and this includes relevant research to optimise such regimes as planting distance, pruning, weeding practices and nutrition regimes. In this present study, the nutritional status of the foliage was investigated with the aim to develop near infrared spectroscopic calibrations that can be used to monitor and quantify nutrient status, particularly total foliar nitrogen (N) and phosphorus (P) in the field. Spectra acquired on fresh foliage in situ on the tree could be used to predict N and P with accuracy suitable for operational decision-making regards fertiliser application. If greater accuracy is required, spectra acquired on dry, milled foliage could be used to predict N and P within a relative error of 10% (R2c, r2CV, RMSEP, RPD = 0.77, 0.71, 0.02 g 100 g-1, 1.9 for foliar P and = 0.90, 0.88, 0.21 g 100 g-1, 3.0 for foliar N on dry, milled foliage). The ultimate application of this is in situ nutrient monitoring, particularly to aid longitudinal studies in fertiliser trial plots and forest operations, as the non-destructive nature of NIR spectroscopy would enable regular monitoring of individual leaves over time without the need to destructively sample them. This would aid the temporal and spatial analysis of field data.
Knowledge and Practices About Sexual Health and Its Socioeconomic Correlates Among Adolescent Girls in Sikkim, India
Authors: Mukhopadhyay Susmita , Mishra Shailendra Kumar
Published: April 2021

Adolescents constitute a quarter of total Indian population. Many of them become sexually active despite being informed of the risks which they may encounter. The present study aims to address knowledge and perception on HIV/AIDS, STIs, and safe sex among adolescent girls (15 to 19years) in Sikkim, India. The study also evaluates their attitudes, and practices of sexual activities among their peer groups. The study is based on randomly selected 1031 unmarried adolescent girls residing in Gangtok, the capital town of Sikkim, and also in different blocks of the other three districts. The self-administered questionnaire was completed by participant girls to obtain data on socioeconomic characteristics, knowledge, awareness, and practices about sexual health issues such as HIV/AIDS, STIs, safe sex. Bivariate and multivariate analyses have been used for data analysis. Higher number of urban girls reported sexual activities among their peer group as compared to rural ones. However, unprotected sexual activity was reportedly higher among rural girls (10.26%). Results of multivariate analysis establishes role of media in raising sexual health awareness among girls in the study area. Role of socioeconomic characteristics of adolescents is important in raising awareness, building attitudes, and determining practices pertaining to sexual and reproductive health among them. Health care institutions along with media can raise awareness about sexuality and also can inculcate responsible sexual attitudes and practices among adolescents.
Family Nursing Practice Scale: Portuguese Language Translation, Cross-Cultural Adaptation, and Validation
Authors: Rodrigues Willian da Silva , Badagnan Heloísa França , Nobokuni Aila Cristina , Fendrich Lorena , Zanetti Ana Carolina Guidorizzi , Giacon Bianca Cristina Ciccone , Galera Sueli Aparecida Frari
Published: April 2021

Studies of family nursing interventions have shown positive results for the health of individuals and families. To increase the availability of instruments that evaluate the practice of family nursing, this research adapted and validated the Family Nursing Practice Scale (FNPS) for use in Brazil with a sample of 144 hospital nurses using a cross-sectional design. The adaptation process involved back-translation, validation by a committee of experts, and semantic analysis. Content validity was analyzed through the content validity coefficient (CVC); construct validity was analyzed by exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and convergent and discriminant validation through average variance extracted (AVE). The reliability of the measure was evaluated using Cronbach’s alpha index and composite reliability (CR). The results indicate that the adapted version of FNPS is recommended for family nursing research, education, or clinical practice with Brazilian nurses.
MRI measurement assessment on ischiofemoral impingement syndrome
Authors: Xing Qianchao , Feng Xuran , Wan Liye , Cao Hongwei , Bai Xuedong , Wang Shenglin
Published: April 2021

Background:

To explore the value of MRI upon diagnosis of ischiofemoral impingement syndrome (IFI) and to recognise deformation or oedema of the quadratus femoris muscle. MRI applied to measure the ischial femoral space (IFS), the average width of quadratus femoral space (QFS), and the ischial intertuberal diameter.

Methods:

A retrospective analysis was carried out of 213 hip joints MRI images of 58 cases diagnosed with IFI and 61 cases of normal subjects. IFS, QFS and ischial intertuberal diameter were measured by axial T1WI sequence. The morphological and signal changes of the quadratus femoris muscle were observed through proton density weighted image fat suppression sequence (PDWI-FS).

Results:

The widths of IFS and QFS in the normal group were larger than those in the case group, while the ischial intertuberal diameter was significantly smaller ( p < 0.05). Pearson correlation analysis revealed that there was a positive correlation ( r = 0.824) between IFS and QFS in all hip joints and a negative correlation between the ischial intertuberal diameter and the widths of IFS and QFS ( r = −0.213, −0.222, p < 0.05) respectively. As the grade of oedema in quadratus femoris muscle increased, the corresponding IFS gradually decreased. The corresponding IFS width of grade 0 oedema of the quadratus femoris muscle oedema was significantly higher than that of grade 1, grade 2 and grade 3. The receiver operating characteristic curve (ROC) of the subjects was applied to determine the diagnostic boundary value of the IFS and QFS in IFI patients, which was 1.98 cm and 1.05 cm respectively. The area under the curve (AUC) was 0.948 and 0.953 respectively.

Conclusions:

MRI examination could provide a reliable basis for the diagnosis of ischiofemoral impingement syndrome. The narrowing of IFS and QFS with deformation and oedema in the quadratus femoris muscle may be the features of manifestation of IFI.
Identification and Analysis of Aux/IAA Family in Acer rubrum
Authors: Zhu Wenpeng , Zhang Manyu , Li Jianyi , Zhao Hewen , Ge Wei , Zhang Kezhong
Published: April 2021

The phytohormone auxin are important in all aspects of plant growth and development. The Auxin/Indole-3-Acetic Acid ( Aux/IAA) gene responds to auxin induction as auxin early response gene family. Despite the physiological importance of the Aux/IAA gene, a systematic analysis of the Aux/IAA gene in Acer rubrum has not been reported. This paper describes the characterization of Acer rubrum Aux/IAA genes at the transcriptomic level and Acer yangbiense Aux/IAA genes at the genomic level, with 17 Acer rubrum AUX/IAA genes (ArAux/IAA) and 23 Acer yangbiense Aux/IAA (AyAux/IAA) genes identified. Phylogenetic analysis shows that AyAux/IAA and ArAux/IAA family genes can be subdivided into 4 groups and show strong evolutionary conservatism. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to test the expression profile of ArAux/IAA genes in different tissues under indole-3-acetic acid (IAA) treatment. Most ArAux/IAA genes are responsive to exogenous auxin and have tissue-specific expression. Overall, these results will provide molecular-level insights into auxin metabolism, transport, and signaling in Acer species.
Exploring the feasibility of collecting multimodal multiperson assessment data via distance in families affected by fragile X syndrome
Authors: Bullard Lauren , Harvey Danielle , Abbeduto Leonard
Published: April 2021

Introduction

Telehealth is an important tool in helping to provide services for hard-to-reach populations. One population that might benefit from telehealth are individuals with fragile X syndrome (FXS). Although FXS is the leading inherited cause of intellectual disability, it is nonetheless a low incidence disorder. Individuals with FXS and their families are involved in research studies, clinical trials and receive interventions – many of which are only offered in a few locations in the United States and thus, not easily accessible to many families. The current project explored the feasibility of using telehealth procedures to collect multimodal behavioural and psychological assessment data from these families.

Methods

Participation in the current study involved online surveys, measures of physiological indices of stress, live interviews and observations of mother–child interactions conducted via distance videoconferencing using the family’s own technology when possible. Across all modes of data collection, we obtained information regarding the feasibility of participating entirely via distance by documenting missing data as well as each mother’s overall impression of participating via distance.

Results

Our telehealth procedures were successfully implemented across a wide range of technology platforms with limited difficulty, and we documented little missing data due to technology-related challenges. Perhaps most importantly, however, our sample of mothers reported high satisfaction with participating via distance.

Discussion

These findings suggest that a wide range of services and types of assessments may be amenable to telehealth procedures. Further, the findings have immediate applications as the field shifts towards telehealth due to the coronavirus disease 2019 (COVID-19) pandemic.
Sales of cigarettes to pseudo-underage mystery shoppers: Experiences from Stockholm County
Authors: Feltmann Kristin , Gripenberg Johanna , Elgán Tobias H.
Published: April 2021

Aims:

There is an 18 years age limit for cigarette purchase in Sweden and in order to implement this law outlets need to perform ID checks. This study investigates the rate of cigarette sales and ID checks when pseudo-underage mystery shoppers attempted to purchase cigarettes. It explores possible factors associated with sales outcomes.

Design:

Nine mystery shoppers (6 females and 3 males) attempted to purchase cigarettes without providing ID. The mystery shoppers were 18 years old but had a younger appearance as judged by an expert panel. During each attempt, the adolescents worked in pairs (shopper and observer). A total of 320 outlets in 13 municipalities in Stockholm County were randomly selected based on an outlet type stratum (i.e., gas station, convenience store, kiosk, grocery store). Effects of variables on sales outcomes were analysed using Pearson’s chi-square and binominal regression analysis.

Results:

In 25.4% of the purchase attempts (total n = 287), cigarettes were sold although the pseudo-underage mystery shopper did not provide a valid ID. In 82.6% of the attempts, the shopper was asked to provide ID, and cigarettes were sold in 9.7% of these cases. The rate of sales was significantly higher among female mystery shoppers (29.5%) compared to male (15.0%). Age limit signs were observed in 89.5% of the outlets but they were not significantly associated with the success rate in a regression analysis.

Conclusions:

The results of the present study indicate that cigarettes could potentially and frequently be sold to underage adolescents by outlets within Stockholm County. Therefore, routines established for checking IDs clearly need to be improved. For example, strategies to improve adherence to the legal age limit on the purchase of cigarettes, such as compliance checks using mystery shopping with feedback to retailers, are needed.
Effect of microstructure and precipitate formation on mechanical and corrosion behavior of friction stir processed AA6061 alloy using different cooling media
Authors: Satyanarayana Marukurti VNV , Kumar Adepu , Thapliyal Shivraman
Published: April 2021

The present work studies the effect of microstructure and precipitate formation on mechanical and corrosion characteristics of friction stir processed AA6061 alloy using different cooling technologies (cryogenic and water cooling). The results revealed that recrystallized fine grains formed in all friction stir processing samples (grain size within a range of 2–6 µm) as a result of dynamic recovery and recrystallization, while samples processed in cooling-assisted friction stir processing resulted in better grain refinement in the stir zone than in air-cooled friction stir processing. Three kinds of precipitates (Fe-based needle-shaped precipitates, Si-based round-shaped precipitates, and chain of small round-shaped Si-based precipitates) were identified in base material and friction stir processing samples. Compared to air-cooled friction stir processing, in cooling-assisted friction stir processing, the hardness and tensile strength increased but remained lower than for the base alloy due to the presence of high density Fe-based needle-shaped precipitates. The ductility after friction stir processing greatly improved due to thermal softening and dissolution of precipitates. The corrosion results demonstrated that the corrosion resistance greatly enhanced after friction stir processing due to uniform distribution of grain structure and discontinuous chain of small round-shaped Si-based precipitates in stir zone. Moreover, cooling-assisted friction stir processing resulted in improved corrosion resistance compared to air-cooled friction stir processing due to the formation of fine precipitates.
Grieving Kairos Moments
Authors: Matson Viki
Published: April 2021

This article is a reflection on the loss of Kairos due to the COVID-19 pandemic. Kairos moments cannot be re-scheduled, they must be mourned.
Clergy Wholeness Study: How Occupational Distress, Depression, and Social Support Inform the Health of Clergy
Authors: Shaw Martin , Lukman Roy , Simmons Linda Wright , Reynolds Ramona
Published: April 2021

It has been shown that the rate of clergy occupational distress and depression is increasing. This study examines occupational distress, social support, mental health, and spiritual wholeness in Florida clergy. Clergy in our study sample exhibited higher rates of occupational distress than the national average. Significant connections were made between validated instruments used to assess mental health, clergy occupational distress, and social support. More research is needed to understand the potential causal effects.
Dear Unknown: A Letter to a Teenage Gunshot Victim
Authors: McCurry Ian J.
Published: April 2021

A medical student/adjunct clinical chaplain reflects on the significance of a young life lost to gun violence.
Vice-principals as leaders: Role ambiguity and role conflicts faced by vice-principals in Singapore
Authors: Ho Jeanne , Shaari Imran , Kang Trivina
Published: April 2021

This article examines what vice-principals in Singapore experience as constraints to their leadership practice, and how they deal with these constraints, cognisant that role misalignment for vice-principals presents barriers to schools achieving optimal effectiveness. This qualitative study seeks to hear the voices of vice-principals, to uncover the contextual richness of their experiences through interviews with 28 vice-principals. Coding involved a mix of codes from the literature and from the interviews, with member checking of the findings. Vice-principals in Singapore face two main constraints: role ambiguity and role conflicts. These are mainly a structural issue, given the dual expectations of vice-principals to support their principals and to lead. The problems are heightened when there are clashes of values, with vice-principals conflicted between two sources of authority: administrative and professional. Framing the constraints faced by vice-principals under role ambiguity and role conflicts raises these constraints to a theoretical and organisational level. The study proposes a link between the concepts of role ambiguity and role boundaries and illustrates how role ambiguity and conflicts can be disempowering. However, the study also shows that ambiguity need not always be a constraint but can be positive under some conditions.
Enhancing recovery: Joining the Improving Surgical Care and Recovery programme to decrease colorectal surgical site infections
Authors: Boalt-Watson Bernadette , Boutros Cherif
Published: April 2021

Aim

Surgical site infections after colorectal surgery are a clinical and financial challenge in healthcare. The purpose of this project was to decrease the rate of surgical site infections in colorectal surgical patients in a community hospital with an academic cancer centre in the United States of America.

Method

The Quality Improvement Department obtained data to measure the hospital’s performance with colorectal surgical patients. The data examined the surgical site infection rate and the length of stay. A multidisciplinary team was established to implement protocols to improve compliance.

Results

More than 200 patients received a colorectal surgical resection at the hospital. The implemented protocols decreased both the surgical site infection rate and the length of stay (9.1–0% and median 6–4 days respectively).

Discussion

Challenges with implementation of the Improving Surgical Care and Recovery programme, in a community setting, are discussed. The challenges were worked through collaboratively to achieve the best outcomes for the patients.

Conclusion

The interdisciplinary committee used evidence-based practices to enhance the care of the colorectal patients. Some of the protocols that emerged were: patient education, pain medication, mechanical bowel preparation and antibiotics, as well as early alimentation. The protocols are discussed in Tables 1 to 4.
Comment: Emotions as Relational Orientations: Accounting for Culture and Social Structure
Authors: von Scheve Christian
Published: April 2021

The present contribution provides a constructive criticism of Brian Parkinson’s “Heart to Heart: A Relation-Alignment Approach to Emotion’s Social Effects.” I outline a number of points in Parkinson’s approach that I find particularly useful from a sociological perspective on emotions and provide suggestions for further extending his account. In doing so, I concentrate on issues regarding the social ontology of emotion, the proposition of emotional adjacency pairs in verbal and facial communication, the importance of social appraisals in intergroup contexts, and the relevance of social institutions for understanding how some emotions come to dominate certain social relations.
How could patient navigation help promote health equity in sub-Saharan Africa? A qualitative study among public health experts
Authors: Louart Sarah , Bonnet Emmanuel , Kadio Kadidiatou , Ridde Valéry
Published: April 2021

The indigents have long been excluded from health policies in sub-Saharan Africa. Despite recent efforts by some countries to allow them free access to health services, they face a multitude of non-financial barriers that prevent them from accessing care. Interventions to address the multiple patient-level barriers to care, such as patient navigation interventions, could help reverse this trend. However, our scoping review showed that no navigation interventions in low-income countries targeted the indigents. The objective of this qualitative study is, therefore, to go beyond the lack of evidence and discuss relevant approaches to act in favor of health care equity. We interviewed 22 public health experts with the objective of finding out which actions related to patient navigation programs (identified in the scoping review for other target groups) could be relevant and/or adapted for the indigents. For each ability to access care described by Levesque and colleagues, we were thus able to list the potential opportunities and challenges of implementing each type of action for the indigents in sub-Saharan Africa. Overall, the experts all felt that patient navigation programs were very relevant to implement for the indigents. They emphasized the need for personalized follow-up and for holistic actions to consider the whole context of the situation of indigence. The recommendations made by the experts are valuable in guiding political decision-making, while leaving room for adaptation of the proposed guidelines according to different contexts.
Tetralone Derivatives From a Deep-Sea-Derived Fungus Cladosporium Sp. HDN17-58
Authors: Fan Cheng , Zhou Guoliang , Wang Wenxue , Zhang Guojian , Zhu Tianjiao , Che Qian , Li Dehai
Published: April 2021

One new tetralone derivative, named aladothalen (1), and one known biogenetically related compound, (3 S,4 S)−3,4,8-trihydroxy-3,4-dihydronaphthalen-1(2 hours)-one (2), were isolated from a deep-sea-derived-fungal Cladosporium sp. HDN17-58. Their structures, including absolute configurations, were elucidated by extensive NMR, MS, and ECD analyses. Compound 1 exhibited potent bacteriostatic activity against Bacillus cereus, Mycobacterium phlei and methicillin-resistant coagulase-negative Staphylococci, with a MIC value of 25 µM.
Endoscopic Haglund’s Resection and Percutaneous Double-Row Insertional Achilles Repair
Authors: Miller Christopher P. , McWilliam James R. , Michalski Max P. , Acevedo Jorge
Published: April 2021

Insertional Achilles tendinopathy can be a debilitating condition that often fails to improve with nonsurgical management such as bracing and physical therapy. Traditional surgical techniques include an open debridement of the diseased tendon and resection of calcaneal spurs. This is followed by repair of the tendon. Suture anchors are often used to secure the tendon, but recent advances in tendon fixation, including the advent of double-row repairs, has allowed better biomechanical repairs and faster rehabilitation. Additionally, minimally invasive surgery and endoscopic techniques have advanced to allow successful treatment of all aspects of the condition while minimizing wound complications and infection. The authors present a technique to treat insertional Achilles tendinopathy and calcaneal bone spurs using minimally invasive surgery techniques while also incorporating a percutaneous double-row suture anchor repair. The technique utilizes 4 portals to access 2 endoscopic working planes. The burr is inserted deep to the tendon and the calcaneoplasty is performed. Subsequently, the endoscope is inserted alongside a shaver to remove bony debris and debulk the anterior aspect of the Achilles areas of tendinopathy. Following this, the portals are used to place a double-row suture anchor repair.

Levels of Evidence: Level V
Mechanical thrombectomy in acute ischaemic stroke patients with pre-interventional intracranial haemorrhage following intravenous thrombolysis
Authors: Styczen Hanna , Gawlitza Matthias , Abdullayev Nuran , Brehm Alex , Serna-Candel Carmen , Fischer Sebastian , Gerber Johannes , Kabbasch Christoph , Psychogios Marios-Nikos , Forsting Michael , Henkes Hans , Maus Volker
Published: April 2021

Background

Data on outcome of endovascular treatment in patients with acute ischaemic stroke due to large vessel occlusion suffering from intravenous thrombolysis-associated intracranial haemorrhage prior to mechanical thrombectomy remain scarce. Addressing this subject, we report our multicentre experience.

Methods

A retrospective analysis of consecutive acute ischaemic stroke patients treated with mechanical thrombectomy due to large vessel occlusion despite the pre-interventional occurrence of intravenous thrombolysis-associated intracranial haemorrhage was performed at five tertiary care centres between January 2010–September 2020. Baseline demographics, aetiology of stroke and intracranial haemorrhage, angiographic outcome assessed by the Thrombolysis in Cerebral Infarction score and clinical outcome evaluated by the modified Rankin Scale at 90 days were recorded.

Results

In total, six patients were included in the study. Five individuals demonstrated cerebral intraparenchymal haemorrhage on pre-interventional imaging; in one patient additional subdural haematoma was observed and one patient suffered from isolated subarachnoid haemorrhage. All patients except one were treated by the ‘drip-and-ship’ paradigm. Successful reperfusion was achieved in 4/6 (67%) individuals. In 5/6 (83%) patients, the pre-interventional intracranial haemorrhage had aggravated in post-interventional computed tomography with space-occupying effect. Overall, five patients had died during the hospital stay. The clinical outcome of the survivor was modified Rankin Scale=4 at 90 days follow-up.

Conclusion

Mechanical thrombectomy in patients with intravenous thrombolysis-associated intracranial haemorrhage is technically feasible. The clinical outcome of this subgroup of stroke patients, however, appears to be devastating with high mortality and only carefully selected patients might benefit from endovascular treatment.
Pulmonary echinococcosis: A rare pseudotumour of the lung
Authors: Greimelmaier Kristina , Hager Thomas , Moskalenko Vasily , Mueller-Huelsbeck Stefan , Feist Henning , Schmid Kurt Werner , Seidel Alice , Jonigk Danny , Wohlschlaeger Jeremias
Published: April 2021

Cystic echinococcosis is a widely endemic helminthic disease worldwide but occurs only rarely in Central Europe. Humans are infected as ‘aberrant’ hosts by Echinococcus granulosus and develop cysts in numerous different organs. 20%–30% of the affected individuals develop hydatid disease in the lungs with associated complications including pleuritis, lung abscess and pneumothorax. Radiologically, the pulmonary lesions of cystic echinococcosis occasionally pose difficulties in the differential diagnosis of primary lung carcinoma or metastatic disease and vice versa. Herein we report on a case of pulmonary hydatid disease in a 25-year-old Iraqi male presenting with a cystic lesion of the lung associated with thoracic pain and involuntary weight loss. Despite of its rare occurrence in Central Europe, clinicians, radiologists and pathologists should be aware of this entity and its pulmonary manifestations. During frozen section examination, imprint cytology specimens may facilitate the detection of the pathogens.
Passport to the future: Boosting academic outcomes and citizenship through urban debate
Authors: Patten Joseph N , Chapman Stephen J
Published: April 2021

This study examines the impact of a university-high school debate mentoring program on educational outcomes of high school graduates attending a racially segregated school in New Jersey, USA. Evidence shows that from 2011 to 2018, participants had stronger grade point average growth, higher cumulative grade point averages, and higher SAT scores relative to non-debating graduates. The sample ( N = 275) consists of 55 high school graduates who competed on the debate team and a control group of 220 non-debating graduates. Findings indicate debate graduates experienced a 0.81 GPA growth (2.5–3.31) from 9th grade to 12th grade while non-debate graduates exhibited a markedly lower 0.10 GPA growth (2.2–2.3). Debaters scored higher on particular sections of the SAT exam and overall SAT scores. The study provides evidence of the potential efficacy of debate team membership on student outcomes.
Evidence for the BUAS-test ability to diagnose lumbar radicular pain
Authors: Samolsky Dekel Boaz Gedaliahu , Sorella Maria Cristina , Vasarri Alessio , Melotti Rita Maria
Published: April 2021

Background:

Differential diagnosis of low back pain (LBP) is complex and a prominent issue at all health-care levels; guidance may come from patients’ history cues and clinical examination signs. Human and animal studies report that diagnosis of lumbar radicular pain (LRP) may come from evaluating subjective responses of injured lumbar nerves to a strain applied at the buttock. The Buttock Applied Strain (BUAS-test) test may guide the differential diagnosis of LBP. Following an ex-adiuvantibus criterion, clinical improvement of LRP, diagnosed with the BUAS-test and congruently treated, may support this test diagnostic ability.

Methods:

Among 258 LRP patients, who, upon first visit (V1), tested positive on the BUAS-test (with/without positive Straight Leg Raising Test, SLRT), the effect of gabapentin prescription on painDETECT (PD) questionnaire and Brief Pain Inventory (BPI) outcomes was quantified in the follow-up visit (V2). To support BUAS-test diagnostic ability, we hypothesized that, at V2, >50% of the sample would present negative PD outcome, significant ( t-test) and ⩾2 points V2-V1 differences for each of the BPI-item’s score. We used multinomial logistic regression (MLR) and χ2 analyses to evaluate the PD-V2 outcomes’ dependence upon independent variables.

Results:

Of the sample, 77% reported a negative PD-V2 outcome. V2-V1 differences of all BPI items were significant and >2 points. PD-V2 outcomes showed significant associations with SLRT-V1 and PD-V1, respectively, but not with gender, age group or pain site. MLR showed a significant relationship between SLRT-V1 and PD-V2 outcomes.

Conclusion:

Among LRP patients, diagnosed by the BUAS-test and treated with gabapentin, all prespecified endpoints were reached. These results may be considered a piece of ex-adiuvantibus evidence for the BUAS-test ability to diagnose LRP. While positive BUAS-test implies potential LRP, the co-presence with positive SLRT may imply a severer LRP condition. Further prospective research, in different settings and direct clinical measures, is needed.