bluuebunny/crossref_metadata_2025 huggingface dataset:
Experiences and Needs of Patients and Relatives During Hospitalization in an Intensive Care Unit in China: A Qualitative Study
Authors: Yahui Yang , Juan Wu , Huifen Xu , Xiaoqin Liu , Yinan Wang , Yang Gao , Chunmei Song
Published: September 2021

Introduction:

In comparison with Western cultures, the closed management system makes it difficult to implement family-centered nursing in many intensive care unit (ICU) in China. There are differences in cultural cognition and social environment between China and the West. The purpose of this study was to explore the experience and needs of critically ill patients and their relatives from a Chinese cultural perspective.

Method:

This was a qualitative study using semistructured interviews conducted in a 26-bed integrated ICU at a Tertiary Grade A comprehensive hospital in Nantong, China. The participants included patients admitted in the ICU and their relatives. We used Colaizzi’s seven-step procedure to analyze interview data.

Findings:

A total of 15 participants were recruited. Main categories within the patient perspective were variety of feelings, staff assistance required, and expectations for relatives. Patient opinions differed about the feelings of hospitalization and whether they needed the help of staff and relatives. The main categories from the relatives’ perspective were life is disrupted, information needs, and emotional needs. Relatives of patients in the ICU experienced a lot of physical and mental pressure. The lack of timely understanding of the patient’s condition and needs made them feel anxious.

Conclusion:

The closed management system currently used in China limits contact between ICU patients and their relatives, increasing their physical and emotional discomfort. Hospitals in China should consider updating to a more open visiting policy based on current guidelines for family-centered care. Such policies enable staff to continue providing quality care for their patients while addressing patient and family needs.
Prognostic Role of Matrix Metalloproteinases in Cervical Cancer: A Meta-Analysis
Authors: Chen Weiwei , Huang Shenjiao , Shi Kun , Yi Lisha , Liu Yaqiong , Liu Wenjie
Published: September 2021

Objective

Studies have published the association between the expression of matrix metalloproteinases (MMPs) and the outcome of cervical cancer. However, the prognostic value in cervical cancer remains controversial. This meta-analysis was conducted to evaluate the prognostic functions of MMP expression in cervical cancer.

Methods

A comprehensive search of PubMed, Embase, and Web of Science databases was conducted to identify the eligible studies according to defined selection and excluding criteria and analyzed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Fixed and random effects models were evaluated through the hazard ratios (HRs) and 95% confidence intervals (CIs) to estimate the overall survival (OS), recurrence-free survival (RFS), and progress-free survival (PFS).

Results

A total of 18 eligible studies including 1967 patients were analyzed for prognostic value. Totally 16 selected studies including 21 tests were relevant to the cervical cancer OS, 4 studies focused on RFS, and 1 study on PFS. The combined pooled HRs and 95% CIs of OS were calculated with random-effects models (HR = 1.64, 95% CI = 1.01–2.65, P = .000). In the subgroup analysis for OS, there was no heterogeneity in MMP-2 (I2 = .0%, P = .880), MMP-1 (I2 = .0%, P = .587), and MMP-14 (I2 = 28.3%, P = .248). In MMP-7 and MMP-9, the heterogeneities were obvious (I2 = 99.2% ( P = .000) and I2 = 77.9% ( P = .000), respectively). The pooled HRs and 95% CIs of RFS were calculated with fixed-effects models (HR = 2.22, 95% CI = 1.38–3.58, P = .001) and PFS (HR = 2.29, 95% CI = 1.14–4.58, P = .035).

Conclusions

The results indicated that MMP overexpression was associated with shorter OS and RFS in cervical cancer patients. It suggested that MMP overexpression might be a poor prognostic marker in cervical cancer. Research Registry Registration Number: reviewregistry 1159.
The Role of sGC Stimulators and Activators in Heart Failure With Reduced Ejection Fraction
Authors: Cordwin David J. , Berei Theodore J. , Pogue Kristen T.
Published: September 2021

Over the past decade, soluble guanylate cyclase (sGC) activators and stimulators have been developed and studied to improve outcomes in patients with heart failure with reduced ejection fraction (HFrEF). The sGC enzyme plays an important role in the nitric oxide (NO)-sGC-cyclic guanosine monophosphate (cGMP) pathway, that has been largely untargeted by current guideline directed medical therapy (GDMT) for HFrEF. Disruption of the NO-sCG-cGMP pathway can be widely observed in patients with HFrEF leading to endothelial dysfunction. The disruption is caused by an oxidized state resulting in low bioavailability of NO and cGMP. The increase in reactive oxygen species can also result in an oxidized, and subsequently heme free, sGC enzyme that NO is unable to activate, furthering the endothelial dysfunction. The novel sGC stimulators enhance the sensitivity of sGC to NO, and independently stimulate sGC, while the sGC activators target the oxidized and heme free sGC to stimulate cGMP production. This review will discuss the pathophysiologic basis for sGC stimulator and activator use in HFrEF, review the pre-clinical and clinical data, and propose a place in the HFrEF armamentarium for this novel pharmacotherapeutic class.
Simulation of projectile impact on steel plate-lined, reinforced concrete panels using the smooth particle hydrodynamics formulation
Authors: Terranova Brian , Schwer Len , Whittaker Andrew
Published: September 2021

Data from the Tsubota et al. (1993) experiments provided the basis for a numerical study that investigated the impact response of steel-plate lined, reinforced concrete panels using the SPH formulation in LS-DYNA. The simulated tests involved 50 mm (1.97 in), 70 mm (2.76 in), and 90 mm (3.54 in) thick reinforced concrete (RC) panels with steel liners and one 50-mm thick benchmark RC panel. Three of the five panels had a steel liner attached to the back face and one had a steel liner on both faces. The panels were normally impacted by a 39.6 mm (1.56 in) diameter projectile at a velocity of 170 m/s (6693 in/s). Reasonable predictions of observed damage, including perforation, liner fracture or bulging, and concrete scabbing were achieved using the MAT072R3 concrete material model. The effectiveness of adding steel liners to a concrete panel to prevent perforation and scabbing resulting from projectile impact was investigated using the numerical model and MAT072R3. Installing a steel liner on the back face of a panel, with a reinforcement ratio equal to that of the internal reinforcement, is an effective method to mitigate scabbing but has little effect on perforation resistance.
Educating Future Physicians in Artificial Intelligence (AI): An Integrative Review and Proposed Changes
Authors: Grunhut Joel , Wyatt Adam TM , Marques Oge
Published: September 2021

BACKGROUND

As medicine and the delivery of healthcare enters the age of Artificial Intelligence (AI), the need for competent human–machine interaction to aid clinical decisions will rise. Medical students need to be sufficiently proficient in AI, its advantages to improve healthcare's expenses, quality, and access. Similarly, students must be educated about the shortfalls of AI such as bias, transparency, and liability. Overlooking a technology that will be transformative for the foreseeable future would place medical students at a disadvantage. However, there has been little interest in researching a proper method to implement AI in the medical education curriculum. This study aims to review the current literature that covers the attitudes of medical students towards AI, implementation of AI in the medical curriculum, and describe the need for more research in this area.

METHODS

An integrative review was performed to combine data from various research designs and literature. Pubmed, Medline (Ovid), GoogleScholar, and Web of Science articles between 2010 and 2020 were all searched with particular inclusion and exclusion criteria. Full text of the selected articles was analyzed using the Extension of Technology Acceptance Model and the Diffusions of Innovations theory. Data were successively pooled together, recorded, and analyzed quantitatively using a modified Hawkings evaluation form. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses was utilized to help improve reporting.

RESULTS

A total of 39 articles meeting inclusion criteria were identified. Primary assessments of medical students attitudes were identified (n = 5). Plans to implement AI in the curriculum for the purpose of teaching students about AI (n = 6) and articles reporting actual implemented changes (n = 2) were assessed. Finally, 26 articles described the need for more research on this topic or calling for the need of change in medical curriculum to anticipate AI in healthcare.

CONCLUSIONS

There are few plans or implementations reported on how to incorporate AI in the medical curriculum. Medical schools must work together to create a longitudinal study and initiative on how to successfully equip medical students with knowledge in AI.
Reversible dysregulation of renal circadian rhythm in lupus nephritis
Authors: Mishra Rakesh , Bethunaickan Ramalingam , Berthier Celine C. , Yi Zhengzi , Strohl Joshua J. , Huerta Patricio T. , Zhang Weijia , Davidson Anne
Published: September 2021

Background

We have found disruption of expression of major transcriptional regulators of circadian rhythm in the kidneys of several mouse models of lupus nephritis. Here we define the consequence of this disturbance with respect to circadian gene expression and renal homeostatic function in a mouse model of lupus nephritis.

Methods

Molecular profiling of kidneys from 47 young and 41 nephritic female NZB/W F1 mice was performed at 4 hourly intervals over a 24 h period. Disruption of major circadian transcriptional regulators was confirmed by qPCR. Molecular data was normalized and analyzed for rhythmicity using RAIN analysis. Serum aldosterone and glucose and urine sodium and potassium were measured at 4 hourly intervals in pre-nephritic and nephritic mice and blood pressure was measured every 4 h. Analyses were repeated after induction of complete remission of nephritis using combination cyclophosphamide and costimulatory blockade.

Results

We show a profound alteration of renal circadian rhythms in mice with lupus nephritis affecting multiple renal pathways. Using Cosinor analysis we identified consequent alterations of renal homeostasis and metabolism as well as blood pressure dipper status. This circadian dysregulation was partially reversed by remission induction therapy.

Conclusions

Our studies indicate the role of inflammation in causing the circadian disruption and suggest that screening for loss of normal blood pressure dipping should be incorporated into LN management. The data also suggest a potential role for circadian agonists in the treatment of lupus nephritis.
MiR-100 overexpression attenuates high fat diet induced weight gain, liver steatosis, hypertriglyceridemia and development of metabolic syndrome in mice
Authors: Smolka Christian , Schlösser Delia , Hohnloser Catherine , Bemtgen Xavier , Jänich Caterina , Schneider Laura , Martin Julien , Pfeifer Dietmar , Moser Martin , Hasselblatt Peter , Bode Christoph , Grundmann Sebastian , Pankratz Franziska
Published: September 2021

Background

Diet-induced obesity can result in the development of a diverse spectrum of cardiovascular and metabolic diseases, including type 2 diabetes, dyslipidemia, non-alcoholic liver steatosis and atherosclerotic disease. MicroRNAs have been described to be important regulators of metabolism and disease development.

Methods

In the current study, we investigated the effects of ubiquitous miR-100 overexpression on weight gain and the metabolic phenotype in a newly generated transgenic mouse strain under normal chow and high fat diet and used microarray expression analysis to identify new potential target genes of miR-100.

Results

While transgenic overexpression of miR-100 did not significantly affect weight and metabolism under a normal diet, miR-100 overexpressing mice showed a reduced weight gain under a high fat diet compared to wildtype mice, despite an equal calorie intake. This was accompanied by less visceral and subcutaneous fat development and lover serum LDL cholesterol. In addition, transgenic miR-100 mice were more glucose tolerant and insulin sensitive and demonstrated increased energy expenditure under high fat diet feeding. A comprehensive gene expression profiling revealed the differential expression of several genes involved in lipid storage- and metabolism, among them CD36 and Cyp4A14. Our data showed a direct regulation of CD36 by miR-100, leading to a reduced fatty acid uptake in primary hepatocytes overexpressing miR-100 and the downregulation of several downstream mediators of lipid metabolism such as ACC1, FABP4, FAS and PPARγ in the liver.

Conclusions

Our findings demonstrate a protective role of miR-100 in high fat diet induced metabolic syndrome and liver steatosis, partially mediated by the direct repression of CD36 and attenuation of hepatic lipid storage, implicating miR-100 as a possible therapeutic target in liver steatosis.
Associations of exposure to secondhand smoke with hypertension risk and blood pressure values in adults
Authors: Zhang Qi , Zeng Guowei , Wang Xiaowei , Wu Kai-Hong
Published: September 2021

Background

The effects of environmental chemical exposure on blood pressure (BP) have been confirmed, but the association between exposure to secondhand smoke (SHS) and hypertension risk and BP in the general population remains unknown.

Methods

Cross-sectional associations between SHS exposure and hypertension risk and BP values were evaluated using data for subjects who participated in the National Health and Nutrition Examination Survey (NHANES), 1999–2016. Logistic regression and linear regression were performed after adjusting for age, sex, race, alcohol consumption, poverty-to-income ratio (PIR), body mass index (BMI), estimated glomerular filtration rate, physical activity, diabetes, cardiovascular disease, and NHANES cycle. Restricted cubic spline models were created to display the potential nonlinear association between SHS and BP levels.

Results

Higher risk of hypertension was found at the highest SHS concentrations (OR = 1.13, 95% CI 1.04, 1.24, P for trend = 0.007). Additionally, SHS exposure had a strong positive association with systolic blood pressure (SBP) but was negatively associated with diastolic blood pressure (DBP). Furthermore, the nonlinear model result showed a significant association between SHS and SBP (P = 0.017); however, the nonlinear model result was not significant for SHS or DBP.

Conclusions

Our results suggest a potential association between high SHS exposure and the risk of hypertension. Further research is needed to elucidate the underlying mechanisms.
Multilevel responses of adult zebrafish to crude and chemically dispersed oil exposure
Authors: Esteban-Sánchez Ada , Johann Sarah , Bilbao Dennis , Prieto Ailette , Hollert Henner , Seiler Thomas-B. , Orbea Amaia
Published: September 2021

Background

The application of chemical dispersants is a common remediation strategy when accidental oil spills occur in aquatic environments. Breaking down the oil slick into small droplets, dispersants facilitate the increase of particulate and dissolved oil compounds, enhancing the bioavailability of toxic oil constituents. The aim of the present work was to explore the effects of water accommodated fractions (WAF) of a naphthenic North Sea crude oil produced with and without the addition of the chemical dispersant FINASOL OSR 52 to adult zebrafish exposed for 3 and 21 d. Fish were exposed to environmentally relevant concentrations of 5% and 25% WAFOIL(1:200) and to 5% WAFOIL+D(dispersant–oil ratio 1:10) in a semi-static exposure setup.

Results

The chemically dispersed WAF presented a 20-fold increase of target polycyclic aromatic hydrocarbons (PAHs) in the water phase compared to the corresponding treatment without dispersant and was the only treatment resulting in markedly bioaccumulation of PAHs in carcass after 21 d compared to the control. Furthermore, only 5% WAFOIL+Dcaused fish mortality. In general, the undispersed oil treatments did not lead to significant effects compared to control, while the dispersed oil induced significant alterations at gene transcription and enzyme activity levels. Significant up-regulation of biotransformation and oxidative stress response genes (cyp1a,gstp1,sod1andgpx1a) was recorded in the livers. For the same group, a significant increment in EROD activity was detected in liver along with significant increased GST and CAT activities in gills. The addition of the chemical dispersant also reduced brain AChE activity and showed a potential genotoxic effect as indicated by the increased frequency of micronuclei in erythrocytes after 21 d of exposure.

Conclusions

The results demonstrate that the addition of chemical dispersants accentuates the effect of toxic compounds present in oil as it increases PAH bioavailability resulting in diverse alterations on different levels of biological organization in zebrafish. Furthermore, the study emphasizes the importance to combine multilevel endpoints for a reliable risk assessment due to high variable biomarker responses. The present results of dispersant impact on oil toxicity can support decision making for oil spill response strategies.
Short-term associations of air pollution and meteorological variables on the incidence and severity of COVID-19 in Madrid (Spain): a time series study
Authors: Linares Cristina , Belda Fernando , López-Bueno José Antonio , Luna M. Yolanda , Sánchez-Martínez Gerardo , Hervella Beatriz , Culqui Dante , Díaz Julio
Published: September 2021

Background

There are studies that analyze the role of meteorological variables on the incidence and severity of COVID-19, and others that explore the role played by air pollutants, but currently there are very few studies that analyze the impact of both effects together. This is the aim of the current study. We analyzed data corresponding to the period from February 1 to May 31, 2020 for the City of Madrid. As meteorological variables, maximum daily temperature (Tmax) in ºC and mean daily absolute humidity (AH) in g/m3 were used corresponding to the mean values recorded by all Spanish Meteorological Agency (AEMET) observatories in the Madrid region. Atmospheric pollutant data for PM10 and NO2 in µg/m3 for the Madrid region were provided by the Spanish Environmental Ministry (MITECO). Daily incidence, daily hospital admissions per 100.000 inhabitants, daily ICU admissions and daily death rates per million inhabitants were used as dependent variables. These data were provided by the ISCIII Spanish National Epidemiology Center. Generalized linear models with Poisson link were performed between the dependent and independent variables, controlling for seasonality, trend and the autoregressive nature of the series.

Results

The results of the single-variable models showed a negative association between Tmax and all of the dependent variables considered, except in the case of deaths, in which lower temperatures were associated with higher rates. AH also showed the same behavior with the COVID-19 variables analyzed and with the lags, similar to those obtained with Tmax. In terms of atmospheric pollutants PM10 and NO2, both showed a positive association with the dependent variables. Only PM10 was associated with the death rate. Associations were established between lags 12 and 21 for PM10 and between 0 and 28 for NO2, indicating a short-term association of NO2 with the disease. In the two-variable models, the role of NO2 was predominant compared to PM10.

Conclusions

The results of this study indicate that the environmental variables analyzed are related to the incidence and severity of COVID-19 in the Community of Madrid. In general, low temperatures and low humidity in the atmosphere affect the spread of the virus. Air pollution, especially NO2, is associated with a higher incidence and severity of the disease. The impact that these environmental factors are small (in terms of relative risk) and by themselves cannot explain the behavior of the incidence and severity of COVID-19.
Spatial distribution of Gasterophilus pecorum (Diptera) eggs in the desert steppe of the Kalamaili Nature Reserve (Xinjiang, China)
Authors: Huang Heqing , Zhang Ke , Shao Changliang , Wang Chen , Ente Make , Wang Zhenbiao , Zhang Dong , Li Kai
Published: September 2021

Background

The dominant Gasterophilus species in the desert steppe (Xinjiang, China) Gasterophilus pecorum poses a serious threat to the reintroduced Przewalski’s horses. We investigated the distribution pattern of G. pecorum eggs in June 2017.

Methods

Two sampling methods, transect and grid, were used, and the results were analyzed via geostatistics by semivariance. The nest quadrat was used to determine the optimal quadrat size.

Results

Eggs were found in 99 quadrats (63.1%) and 187 clusters (1.5%) of Stipa caucasica on the steppe. The mean oviposition count of a cluster was 3.8 ± 1.6. Three-eggs is the mode of which females oviposit on each ovigerous S. caucasica (22.0%). Semivariogram analysis revealed that the distance of spatial dependence for eggs was 921 m, 1233 m and 1097 m for transect 1, transect 2 and grid methods, respectively, while spatial continuity was 62%, 77% and 57.0% for transect 1, transect 2 and grid, respectively. The eggs showed a patchy, aggregated distribution pattern. This suggested the spherical model is most applicable. The proportion of ovigerous S. caucasica was significantly correlated with the distance from water resources (r = − 0.382, p = 0).

Conclusion

Our findings indicated that diversification of G. pecorum oviposition was a new adaptative strategy for its survival in the desert steppe ecological niche. This made it more efficient at infecting hosts in the local environment. Areas surrounding water resources, especially around the drinking paths of equids (500 m radius surrounding the water), were concentrated epidemic areas. It is suggested that more attention to be paid to the ecological characteristics of G. pecorum in order to develop control measures that would reduce the infection risk for Przewalski’s horses.
Dynamic transcriptome profiles of postnatal porcine skeletal muscle growth and development
Authors: Wang Yanping , Wang Jiying , Hu Hongmei , Wang Huaizhong , Wang Cheng , Lin Haichao , Zhao Xueyan
Published: September 2021

Background

Skeletal muscle growth and development are closely associated with the quantity and quality of pork production. We performed a transcriptomic analysis of 12 Longissimus dorsi muscle samples from Tibetan piglets at four postnatal stages of 0, 14, 30, and 60 days using RNA sequencing.

Results

According to the pairwise comparisons between the libraries of the muscle samples at the four postnatal stages, a total of 4115 differentially expressed genes (DEGs) were identified in terms of |log2(fold change)| ≥ 1 and an adjusted P value < 0.01. Short-time series expression miner (STEM) analysis of the DEGs identified eight significantly different expression profiles, which were divided into two clusters based on the expression pattern. DEGs in cluster I displayed a pattern of decreasing to a nadir, and then a rise, and the significantly enriched gene ontology (GO) terms detected using them were involved in multiple processes, of which the cell cycle, immunocyte activation and proliferation, as well as actin cytoskeleton organization, were the top three overrepresented processes based on the GO terms functional classification. DEGs in cluster II displayed a pattern of increasing to a peak, then declining, which mainly contributed to protein metabolism. Furthermore, besides the pathways related to immune system, a few diseases, and protein metabolism, the DEGs in clusters I and II were significantly enriched in pathways related to muscle growth and development, such as the Rap1, PI3K-Akt, AMPK, and mTOR signaling pathways.

Conclusions

This study revealed GO terms and pathways that could affect the postnatal muscle growth and development in piglets. In addition, this study provides crucial information concerning the molecular mechanisms of muscle growth and development as well as an overview of the piglet transcriptome dynamics throughout the postnatal period in terms of growth and development.
Seroprevalence of Dengue and Chikungunya antibodies among blood donors in Dar es Salaam and Zanzibar, Tanzania: a cross-sectional study
Authors: Shauri Haliya S. , Ngadaya Esther , Senkoro Mbazi , Buza Joram J. , Mfinanga Sayoki
Published: September 2021

Background

The potential shift of major causes of febrile illnesses from malaria to non-malarial febrile illnesses, including arboviral diseases such as chikungunya and dengue, is of concern. The last outbreaks of these infections were reported in 2018 and 2019 for chikungunya in Zanzibar and dengue in Dar es Salaam. We conducted a cross-sectional study that involved serological testing of stored blood samples from the blood banks in Temeke Referral Hospital in Dar es Salaam and the National Blood Bank Unit in Zanzibar. The samples were collected from Zanzibar and Dar es Salaam donors in May and June 2020, respectively. A total of 281 samples were included in the study, and their demographic information extracted from the registers. The samples were then transported to Muhimbili University of Health and Allied Sciences at the Microbiology Laboratory. They were subjected to an indirect ELISA to detect IgG and IgM against dengue and chikungunya viruses.

Results

Seropositive IgM samples from Dar es Salaam were 3/101 (2.97%) for chikungunya and 1/101 (0.9%) for dengue, while samples from Zanzibar were all IgM negative for both viruses. Chikungunya IgG seropositivity was significantly higher (p ≤ 0.05) in Dar es Salaam 21/101 (21.2%) than Zanzibar 22/180 (12.2%). There was no difference in dengue IgG seropositivity between Dar es Salaam 44/101 (43.5%) and Zanzibar 68/180 (37.8%). Similarly, dual IgG seropositivity for both dengue and chikungunya viruses were not different between Dar es Salaam 13/101 (12.9%) and Zanzibar 11/180 (6.1%).

Conclusion

Detection of IgM for dengue and chikungunya in Dar es Salaam indicates recent or ongoing transmission of the two viruses in the absence of a reported outbreak. These findings suggest the possibility of transmission of the two infections through blood transfusion. Detection of IgG antibodies for dengue and chikungunya viruses might be contributed by both; the ongoing infections and residual responses caused by preceding infections in the country. Results from blood banks may represent the tip of the iceberg. Further studies are needed to gain insight into the actual burden of the two diseases in Tanzania.
Regional disparity of HIV incidence and prevalence among men who have sex with men
Authors: Vergara-Ortega D. N. , López-Gatell H. , Bautista-Arredondo S. , Colchero A. , Sosa-Rubí S. G. , Morales-Vazquez M. , Herrera-Ortiz A. , Olamendi-Portugal M. , García-Cisneros S. , Sevilla-Reyes E. E. , Hernández-Avila M. , Sánchez-Alemán M. A.
Published: September 2021

Background

HIV incidence can be estimated with cross-sectional studies using clinical, serological, and molecular data. Worldwide, HIV incidence data in only men who have sex with men (MSM) are scarce and principally focus on those with healthcare or under treatment. However, better estimates can be obtained through studies with national representativeness. The objective was to estimate the prevalence, incidence, and factors associated with acquiring HIV in a national sample of MSM who attend meeting places, considering geographical regions.

Methods

A nationally representative survey of MSM attending meeting places was performed in Mexico. Participants answered a questionnaire, and a dried blood spot (DBS) was collected. Samples were classified as recent infections using an algorithm with HIV status, antiretroviral therapy, and the result of BED-EIA assay. Parameters were analysed considering regions and demographic and sexual behaviour characteristics.

Results

The national HIV prevalence was 17.4% with regional differences; the highest prevalence (20.7%) was found in Mexico City, and the lowest prevalence was found in the West region (11.5%). The incidence was 9.4 per 100 p/y, with regional values from 6.2 to 13.2 for the Northeast and the Centre regions, respectively. Age, age at sexual debut, low wealth index, and rewarded sex were associated with HIV prevalence. Centre region, use of private clinics as health services, and having sex exclusively with men were associated with recent HIV infections.

Conclusions

The incidence and prevalence showed regional differences, suggesting a difference in the dynamics of HIV transmission; some regions have a greater case accumulation, and others have a greater rate of new infections. Understanding this dynamic will allow developing health programs focused on HIV prevention or treating people already living with HIV.
Investigation of SARS-CoV-2 in tear and conjunctival secretions of hospitalized patients with clinically-confirmed COVID-19 pneumonia
Authors: Karabela Yunus , Karabela Semsi Nur , Ozbas Mehmet , Kasikci Havva , Kart Yasar Kadriye
Published: September 2021

Background

The aim of this study was to demonstrate the presence of the virus in tear and conjunctival secretions of clinically-confirmed COVID-19 pneumonia patients.

Methods

This prospective study was conducted at Bakirkoy Dr. Sadi Konuk Training and Research Hospital (2020/190). Nasopharyngeal and ocular samples were obtained by swab technique and investigated by RT-PCR.

Results

A total of 83 patients were included. The mean age was 61.88 ± 16.04 years. 28.92% of the patients had mild, 65.06% moderate and 6.02% severe pneumonia radiologically. RT-PCR was positive in 31 (37.35%) patients in the first nasopharyngeal swabs and in 19 (22.89%) in the second swabs. 17 of 19 patients had positive both first and second nasopharyngeal swabs; only the second swabs of two patients were positive. The first conjunctival swabs RT-PCR were positive in 5 out of 83 clinically-confirmed patients or 33 laboratory-confirmed patients (rates: 6.02% and 15.15%). There were no positives detected in the second conjunctival swabs.

Conclusions

SARS-CoV-2 can be detected in the conjunctival swabs of patients with COVID-19 pneumonia.
Experiences of social stigma among patients tested positive for COVID-19 and their family members: a qualitative study
Authors: Chew Chii-Chii , Lim Xin-Jie , Chang Chee-Tao , Rajan Philip , Nasir Nordin , Low Wah-Yun
Published: September 2021

Background

Social stigma against persons infected with COVID-19 is not uncommon. This qualitative study aimed to explore the experience of social stigma among COVID-19 positive patients and their family members.

Method

This cross-sectional study was conducted between April to June 2020 in Malaysia. Patients who have recovered from COVID-19 for at least 1 month and their family members who were tested with negative results, Malaysian and aged 18–65 years old were purposively sampled. Cold call method was employed to recruit patients while their family members were recruited by their recommendations. Telephone interviews were conducted with the participants after obtaining their verbal consent.

Results

A total of 18 participants took part in this study. Three themes emerged from the interviews: (Ι) experience of stigmatization, (ΙΙ) perspective on disease disclosure, and (ΙΙΙ) suggestion on coping and reducing stigma. The participants expressed their experiences of being isolated, labelled, and blamed by the people surrounding them including the health care providers, neighbours, and staff at the service counters. Some respondents expressed their willingness to share their experience with others by emphasizing the importance of taking preventive measure in order to stop the chain of virus transmission and some of them chose to disclose this medical history for official purpose because of fear and lack of understanding among the public. As suggested by the respondents, the approaches in addressing social stigma require the involvement of the government, the public, health care provider, and religious leader.

Conclusion

Individuals recovered from COVID-19 and their families experienced social stigma. Fear and lack of public understanding of the COVID-19 disease were the key factors for non-disclosure. Some expressed their willingness to share their experience as they perceived it as method to increase public awareness and thereby reducing social stigma. Multifaceted approaches with the involvement of multiple parties including the government, non-governmental organization as well as the general public were recommended as important measures to address the issues of social stigma.
Modified F configuration in the treatment of Pauwels type III femoral neck fracture: a finite element analysis
Authors: Lin Shiyuan , Shang Jie , Xing Baizhou , Wu Biao , Peng Rong , Wang Gang , Lu Hua-Ding
Published: September 2021

Background

The optimal treatment of Pauwels type III femoral neck fracture (FNF) in young patients remains a worldwide challenge in orthopedic surgery.

Methods

Finite element models of four internal fixations were developed to treat Pauwels type III FNF: a: the traditional inverted triangular parallel cannulated screw (PCS) model, b: the F-technique cannulated screw model, c: the modified F-technique cannulated screw model using a fully threaded screw instead of a partially threaded distally, d: the dynamic hip screw coupled with derotational screw (DHS + DS) model. Under the same conditions, finite element analyses were carried out to compare the displacement and von Mises stress distribution of four internal fixations and femurs, the maximum crack distances of the fracture surfaces, Z axis displacements of four models as well as the stress distribution in the subtrochanteric region.

Results

The modified F-technique configuration resulted in a more stable fixation as compared to the other three configurations, with respect to the maximum displacement and stress peaks of femur and internal fixations, the maximum crack distances of the fracture surfaces, Z axis displacements of four configurations as well as the stress distribution in the subtrochanteric region.

Conclusions

Our results suggested that modified F-technique configuration show a better performance in resisting shearing and rotational forces in treating Pauwels type III FNF compared to those using traditional inverted triangular PCS, the F-technique configuration or DHS + DS, providing a new choice for the treatment of FNFs.
Nursing students’ experience with clinical placement in nursing homes: a focus group study
Authors: Laugaland Kristin , Kaldestad Kari , Espeland Elin , McCormack Brendan , Akerjordet Kristin , Aase Ingunn
Published: September 2021

Background

A renewed interest in nursing homes as clinical placement settings for nursing students has been prompted by the growing healthcare needs of an ageing population. However, if future nurses are to be enthusiastic about working in this healthcare context, it is essential that higher education institutions that educate nurses and nursing homes that provide placement experiences to students do so with a supportive, positive, and enriched approach.

Methods

To explore first-year nursing students’ placement experience in nursing homes, we conducted an exploratory qualitative study in three city-based nursing homes in western Norway. Thirteen first-year nursing students participated in the study. Three focus group interviews were conducted to explore the students’ placement experiences. Data were analysed using thematic analysis. The findings were reported using the Standards for Reporting Qualitative Research (SRQR).

Results

The analysis describes five themes relating to first-year students’ placement experience in nursing homes; (1) variations in utility of pre-placement orientation and welcome at placement site; (2) a challenging learning environment; (3) spending considerable placement time with non-registered nurses; (4) considerable variability in supervision practices; and (5) a vulnerable and demanding student role.

Conclusions

The research provides insight into the contextual characteristics encountered by first-year students that influence the quality of their placement experiences. Consequently, these characteristics impede access to important role models who lend support to a student’s growth and professional development, preventing full utilisation of the learning potential offered in nursing homes. Hence, we propose that targeted efforts are warranted to foster positive placement experiences and enhance students’ clinical education in nursing homes.
The impact of the Affordable Care Act on patient coverage and access to care: perspectives from FQHC administrators in Arizona, California and Texas
Authors: Ercia Angelo
Published: September 2021

Background

The Affordable Care Act (ACA) enabled millions of people to gain coverage that was expected to improve access to healthcare services. However, it is unclear the extent of the policy’s impact on Federally Qualified Health Centers (FQHC) and the patients they served. This study sought to understand FQHC administrators’ views on the ACA’s impact on their patient population and organization. It specifically explores FQHC administrators’ perspective on 1) patients’ experience with gaining coverage 2) their ability to meet patients’ healthcare needs.

Methods

Twenty-two semi-structured interviews were conducted with administrators from FQHCs in urban counties in 2 Medicaid-expanded states (Arizona and California) and 1 non-expanded state (Texas). An inductive thematic analysis approach was used to analyze the interview data.

Results

All FQHC administrators reported uninsured patients were more likely to gain coverage from Medicaid than from private health insurance. Insured patients generally experienced an improvement in accessing healthcare services but depended on their plan’s covered services, FQHCs’ capacity to meet demand, and specialist providers’ willingness to accept their coverage type.

Conclusion

Gaining coverage helped improved newly insured patients’ access to care, but limitations remained. Additional policies are required to better address the gaps in the depth of covered services in Medicaid and the most affordable PHI plans and capacity of providers to meet demand to ensure beneficiaries can fully access the health care services they need.
Prospective trial of different antimicrobial treatment durations for presumptive canine urinary tract infections
Authors: Allerton Fergus , Pouwels Koen B. , Bazelle Julien , Caddy Sarah , Cauvin Andria , De Risio Luisa , Swann James , Warland James , Kent Andrew
Published: September 2021

Background

Avoidance of unnecessary antimicrobial administration is a key tenet of antimicrobial stewardship; knowing the optimal duration of therapy obviates over-treatment. However, little research has been performed to establish course lengths for common canine infections. In clinical practice, antimicrobial therapy is frequently prescribed in dogs presenting lower urinary tract signs (haematuria, pollakiuria and dysuria/stranguria). The proposed length of treatment in International Consensus guidelines has decreased with each iteration, but these recommendations remain arbitrary and largely extrapolated from experience in people.

Methods

The objective of this prospective, multi-centre study is to find the shortest course duration that is non-inferior to the standard duration of 7 days of amoxicillin/clavulanate in terms of clinical outcomes for female dogs with lower urinary tract signs consistent with a urinary tract infection. An electronic data capture platform will be used by participating veterinarians working in clinical practice in the United Kingdom. Eligible dogs must be female, aged between 6 months and 10 years and have lower urinary tract signs of up to seven days’ duration. Enrolment will be offered in cases where the case clinician intends to prescribe antimicrobial therapy. Automatic pseudo-randomisation to treatment group will be based on the day of presentation (Monday-Friday); all antimicrobial courses will be completed on the Sunday after presentation generating different treatment durations. Follow-up data will be collected 1, 8 and 22–26 days after completion of the antimicrobial course to ensure effective safety netting, and to monitor short-term outcome and recurrence rates. Informed owner consent will be obtained in all cases. The study is approved by the Ethical Review Board of the University of Nottingham and has an Animal Test Certificate from the Veterinary Medicine’s Directorate.

Discussion

This study has been designed to mirror current standards of clinical management; conclusions should therefore, be widely applicable and guide practising veterinarians in their antimicrobial decision-making process. A duration-response curve will be created allowing determination of the optimal treatment duration for the management of female dogs with lower urinary tract signs. It is hoped that these results will contribute valuable information to improve future antimicrobial stewardship as part of a wider one-health perspective.
Novel pathogenic OCRL mutations and genotype–phenotype analysis of Chinese children affected by oculocerebrorenal syndrome: two cases and a literature review
Authors: Zhang Yu , Deng Linxia , Chen Xiaohong , Hu Yingjie , Chen Yaxian , Chen Kang , Zhou Jianhua
Published: September 2021

Background

Oculocerebrorenal syndrome of Lowe is a rare X-linked disorder characterized by congenital cataracts, mental retardation, and proximal tubulopathy. This condition is caused by a mutation ofOCRLgene (located at chromosome Xq26.1), which encodes an inositol polyphosphate 5-phosphatase.

Case presentation

We identified two novelOCRLmutations in two unrelated Chinese boys, each with a severe phenotype of Lowe syndrome. A novel de novo deletion (hemizygous c.659_662delAGGG, p.E220Vfs*29) was present in patient 1 and a novel splicing mutation (hemizygous c.2257-2A > T) that was maternally inherited was present in patient 2. A renal biopsy in patient 2 indicated mild mesangial proliferative glomerulonephritis, mild focal mononuclear cells infiltration, and interstitial focal fibrosis. Moreover, renal expression of OCRL-1 protein in patient 2 was significantly reduced compared to a control patient with thin basement membrane disease.

Conclusions

This study reports two novelOCRLvariants associated with severe ocular and neurologic deficiency, despite only mild renal dysfunction. Based on our two patients and a literature review, the genotype–phenotype correlation ofOCRLmutations with this severe phenotype of Lowe syndrome suggest a possible clustering of missense, deletion, and nonsense mutations in the 5-phosphatase domain and Rho-GAP domain in the Chinese population.
Cost-effectiveness of physical activity intervention in children – results based on the Physical Activity and Nutrition in Children (PANIC) study
Authors: Kuvaja-Köllner Virpi , Lintu Niina , Lindi Virpi , Rissanen Elisa , Eloranta Aino-Maija , Kiiskinen Sanna , Martikainen Janne , Kankaanpää Eila , Valtonen Hannu , Lakka Timo A.
Published: September 2021

Background

We assessed the cost-effectiveness of a 2-year physical activity (PA) intervention combining family-based PA counselling and after-school exercise clubs in primary-school children compared to no intervention from an extended service payer’s perspective.

Methods

The participants included 506 children (245 girls, 261 boys) allocated to an intervention group (306 children, 60 %) and a control group (200 children, 40 %). The children and their parents in the intervention group had six PA counselling visits, and the children also had the opportunity to participate in after-school exercise clubs. The control group received verbal and written advice on health-improving PA at baseline. A change in total PA over two years was used as the outcome measure. Intervention costs included those related to the family-based PA counselling, the after-school exercise clubs, and the parents’ taking time off to travel to and participate in the counselling. The cost-effectiveness analyses were performed using the intention-to-treat principle. The costs per increased PA hour (incremental cost-effectiveness ratio, ICER) were based on net monetary benefit (NMB) regression adjusted for baseline PA and background variables. The results are presented with NMB and cost-effectiveness acceptability curves.

Results

Over two years, total PA increased on average by 108 h in the intervention group (95 % confidence interval [CI] from 95 to 121, p < 0.001) and decreased by 65.5 h (95 % CI from 81.7 to 48.3, p < 0.001) in the control group, the difference being 173.7 h. the incremental effectiveness was 87 (173/2) hours. For two years, the intervention costs were €619 without parents’ time use costs and €860 with these costs. The costs per increased PA hour were €6.21 without and €8.62 with these costs. The willingness to pay required for 95 % probability of cost-effectiveness was €14 and €19 with these costs. The sensitivity analyses revealed that the ICER without assuming this linear change in PA were €3.10 and €4.31.

Conclusions

The PA intervention would be cost-effective compared to no intervention among children if the service payer’s willingness-to-pay for a 1-hour increase in PA is €8.62 with parents’ time costs.

Trial registration

ClinicalTrials.gov: NCT01803776. Registered 4 March 2013 - Retrospectively registered, https://clinicaltrials.gov/ct2/results?cond=&term=01803776&cntry=&state=&city=&dist=.
Multi-parametric MRI phenotype with trustworthy machine learning for differentiating CNS demyelinating diseases
Authors: Huang Jing , Xin Bowen , Wang Xiuying , Qi Zhigang , Dong Huiqing , Li Kuncheng , Zhou Yun , Lu Jie
Published: September 2021

Background

Misdiagnosis of multiple sclerosis (MS) and neuromyelitis optica (NMO) may delay the treatment, resulting in poor prognosis. However, the precise identification of these two diseases is still challenging in clinical practice. We aimed to evaluate the value of quantitative radiomic features extracted from the brain white matter lesions for differential diagnosis of MS and NMO.

Methods

We recruited 116 CNS demyelinating patients including 78 MS, and 38 NMO. Three neuroradiologists performed visual differential diagnosis based on brain MRI for comparison purpose. A multi-level scheme was designed to harness the selection of discriminative and stable radiomics features extracted from brain while mater lesions in T1-MPRAGE, T2 sequences and clinical factors. Based on the imaging phenotype composed of the selected radiomic and clinical features, Multi-parametric Multivariate Random Forest (MM-RF) model was constructed and verified with both 10-fold cross-validation and independent testing. Result interpretation was provided to build trust in diagnostic decisions.

Results

Eighty-six patients were randomly selected to form the training set while the rest 30 patients for independent testing. On the training set, our MM-RF model achieved accuracy 0.849 and AUC 0.826 in 10-fold cross-validation, which were significantly higher than clinical visual analysis (0.709 and 0.683, p < 0.05). In the independent testing, the MM-RF model achieved AUC 0.902, accuracy 0.871, sensitivity 0.873, specificity 0.869, respectively. Furthermore, age, sex and EDSS were found mildly correlated with the radiomic features (p of all < 0.05).

Conclusions

Multi-parametric radiomic features have potential as practical quantitative imaging biomarkers for differentiating MS from NMO.