bluuebunny/crossref_metadata_2025 huggingface dataset:
Processing ultrafine grained non-circular cross-section profiles via severe plastic deformation
Authors: Babaei A , Jafarzadeh H , Mazloumbashiri H
Published: November 2020

In this study, a new technique is presented for processing ultrafine-grained noncircular thin section profiles via severe plastic deformation. For the first time, a noncircular thin section profiles can be severe plastic deformation processed by this method entitled the noncircular thin section cyclic extrusion–compression (NCTS-CEC). In this technique, the whole length of the profile is passed through a neck zone while it is fully enclosed by the tools set. Therefore, the whole length of the specimen experiences a cyclic extrusion and compression, which accumulates a high level of strain in the material. The feasibility of the NCTS-CEC was successfully examined on aluminum profiles with L, U, and hollow square cross-sections. The microstructure evolution of the processed specimens was investigated by metallographic observations and X-ray diffraction analysis, which demonstrate the formation of a ultrafine-grained microstructure after processing by two cycles of the NCTS-CEC. Moreover, evaluations of the mechanical properties of the processed profiles show remarkable improvements in the yield and ultimate strengths. The microhardness of the processed specimens was also increased after the second cycle to ∼55 Hv from the initial value of 30 Hv. The deformation behavior of the material during processing by the NCTS-CEC method was also numerically simulated by the commercial finite element software DEFORM TM-3D V11.
Bricolage and MSEs in emerging economies
Authors: Simba Amon , Ojong Nathanael , Kuk George
Published: November 2020

This conceptual paper focuses on bricolage and it pays particular attention on the context of micro and small enterprises (MSEs) in resource-constrained environments – a common feature of most emerging economies. Knowledge about the underlying factors that determine bricolage as a common practice among MSEs operating in emerging economies is yet to advance and develop within the mainstream entrepreneurship literature. Much of this scholarship tends to focus on multi-national enterprises (MNEs) in advanced economies and it discusses bricolage as their strategic choice. Such an approach has led to a lack of meaningful theoretical paradigms for defining the business approaches MSEs adopt as a way of mitigating their perennial operational issues inherent in their environment. Thus, in this conceptual paper, which adopts a scoping review approach, we study the constructs of bricolage particularly their application in MSEs operating in emerging economies. From our analysis a fresh deterministic model mapping out the causal factors that give rise to bricolage behaviour in MSEs that operate in difficult conditions emerged. Thus, we contribute to entrepreneurial behaviour theories by identifying distinctive business methods MSEs adopt to withstand operational difficulties inherent in their environments.
Perinatal social work during the Covid-19 pandemic: Reflecting on concepts of time and liminality
Authors: Wilson Elaine , Jackson Kaylene , Shannon Aoife
Published: November 2020

This article reflects upon the experiences of two perinatal, hospital social workers during the unprecedented time of the Covid-19 in Ireland, as discussed with their academic colleague. This encounter revealed the complexity of service delivery that emerged, when managing the needs of vulnerable clients whilst being mindful of personal safety. One of the social workers was pregnant so was conscious of possible risks to her unborn child, as well as her young family at home. The second social worker, her line manager, discusses the dilemmas associated with the management of risk when allocating staff to contexts where they would be in direct contact with Covid-19. At the core of the analysis of these situations is the notion of liminal space and the realisation that time appears to have a new meaning; what we once knew as normal no longer exists, but we have yet to reach the ‘new normal’.
COVID en Español: Reflections of a trauma therapist serving Spanish-speaking Latinx survivors of violence
Authors: Lombana Yaneth
Published: November 2020

In this reflexive essay I share my experiences as a trauma-focused psychotherapist serving Spanish-speaking Latinx survivors of violence in New York City during the COVID-19 pandemic. Successes and challenges of working with this population during the pandemic are highlighted and connected to broader realities in the mental health field. Vicarious trauma is presented from the lens of a practitioner who shares a similar background to the population served.
COVID and Camus: Reflections on The Plague, collective experience, and qualitative inquiry during a pandemic
Authors: Stelson Elisabeth
Published: November 2020

As a social worker and qualitative researcher, I read Albert Camus’s The Plague as I lay recovering from COVID-19. The existential novella documents the experience of the citizens of Oran, Algeria during a fictional epidemic, and The Narrator’s documentation is explicitly based on qualitative “data” from participant observation, key informant accounts, and document analysis. Camus’s text forces the reader to reflect on what it means to qualitatively study an issue or an event when the researcher is also affected by it. Just as readers of The Plague must ponder the objectives and interpretation of The Narrator who is “closely involved in all that he proposed to narrate,” qualitative researchers must contemplate their own assumptions, aims, and subjectivity, which is both foundational and often overlooked in qualitative inquiry. While this is particularly critical when studying shared or collective experiences, like that of a pandemic, these assumptions and aims should always be made transparent in qualitative research. To this end, I suggest a series of reflective questions for researchers to iteratively grapple with throughout the research process.
Thermal and thermo-mechanical characterization of MWCNTs integrated E-glass/carbon fabric reinforced composites
Authors: Sezgin Hande , Mishra Rajesh , Militky Jiri , Berkalp Omer Berk
Published: November 2020

The prime objective of this work is to interpret the effects of different kinds of multi-walled carbon nanotubes (MWCNTs) on thermal and thermo-mechanical properties of E-glass/carbon fabric reinforced hybrid composites. MWCNTs enhanced composites are fabricated by vacuum-assisted resin transfer molding method. The thermal and thermo-mechanical characterizations are carried out using a differential scanning calorimeter, thermogravimetric analyzer and dynamic mechanical analyzer, while the morphological structure is examined by scanning electron microscope. The results show that the addition of MWCNTs and changing the fabric stacking sequences do not have effects on the phase changes of the materials but have reducing effects on the void ratio. Besides, it is observed that the added MWCNTs increase the degradation temperature of the composite material and the modulus values. The pristine MWCNT is found more effective on thermal and thermo-mechanical properties of composite structures than functionalized ones.
Critical Relational Community Building in Neoliberal Times
Authors: Roulston Kathryn
Published: November 2020

Scholars face a paradox: How to engage in critical community building when the nature of academic engagement in neoliberal times encourages academic entrepreneurship? Competition is encouraged among scholars as they vie for citations, resources, and recognition. This article considers how qualitative researchers might build and sustain critical community through engaging in research, teaching, and service in ways that inculcate humility and a spirit of generosity toward others’ work to build coalitions among scholars who may not agree. This work is imperative for qualitative scholars as they engage in collective action to address the inequities brought about by global crises.
Predictive Value of Midsagittal Tissue Bridges on Functional Recovery After Spinal Cord Injury
Authors: Pfyffer Dario , Vallotton Kevin , Curt Armin , Freund Patrick
Published: November 2020

Background

The majority of patients with spinal cord injury (SCI) have anatomically incomplete lesions and present with preserved tissue bridges, yet their outcomes vary.

Objective

To assess the predictive value of the anatomical location (ventral/dorsal) and width of preserved midsagittal tissue bridges for American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade conversion and SCI patient stratification into recovery-specific subgroups.

Methods

This retrospective longitudinal study includes 70 patients (56 men, age: 52.36 ± 18.58 years) with subacute (ie, 1 month) SCI (45 tetraplegics, 25 paraplegics), 1-month neuroimaging data, and 1-month and 12-month clinical data. One-month midsagittal T2-weighted scans were used to determine the location and width of tissue bridges. Their associations with functional outcomes were assessed using partial correlation and unbiased recursive partitioning conditional inference tree (URP-CTREE).

Results

Fifty-seven (81.4%) of 70 patients had tissue bridges (2.53 ± 2.04 mm) at 1-month post-SCI. Larger ventral ( P = .001, r = 0.511) and dorsal ( P < .001, r = 0.546) tissue bridges were associated with higher AIS conversion rates 12 months post-SCI (n = 39). URP-CTREE analysis identified 1-month ventral tissue bridges as predictors of 12-month total motor scores (0.4 mm cutoff, P = .008), recovery of upper extremity motor scores at 12 months (1.82 mm cutoff, P = .002), 12-month pin-prick scores (1.4 mm cutoff, P = .018), and dorsal tissue bridges at 1 month as predictors of 12-month Spinal Cord Independence Measure scores (0.5 mm cutoff, P = .003).

Conclusions

Midsagittal tissue bridges add predictive value to baseline clinical measures for post-SCI recovery. Based on tissue bridges’ width, patients can be classified into subgroups of clinical recovery profiles. Midsagittal tissue bridges provide means to optimize patient stratification in clinical trials.
A Minireview on Gastrointestinal Microbiota and Radiosusceptibility
Authors: Mao Aihong , Sun Chao , Katsube Takanori , Wang Bing
Published: November 2020

Gastrointestinal (GI) microbiota maintains a symbiotic relationship with the host and plays a key role in modulating many important biological processes and functions of the host, such as metabolism, inflammation, immune and stress response. It is becoming increasingly apparent that GI microbiota is susceptible to a wide range of environmental factors and insults, for examples, geographic location of birth, diet, use of antibiotics, and exposure to radiation. Alterations in GI microbiota link to various diseases, including radiation-induced disorders. In addition, GI microbiota composition could be used as a biomarker to estimate radiosusceptibility and radiation health risk in the host. In this minireview, we summarized the documented studies on radiation-induced alterations in GI microbiota and the relationship between GI microbiota and radiosusceptibility of the host, and mainly discussed the possible mechanisms underlying GI microbiota influencing the outcome of radiation response in humans and animal models. Furthermore, we proposed that GI microbiota manipulation may be used to reduce radiation injury and improve the health of the host.
Preparation physical, mechanical properties and biodegradable study of SAN/EOC/nanoclay/proteins nanocomposite
Authors: Goudarzian N , Esmaeli M , Mousavi SM , Hashemi SA , Zarei M , Gholami A , Yousefi Kh
Published: November 2020

In this paper, the mechanical and morphological properties of biodegradable SAN/EOC/Nanoclay/Proteins nanocomposite were investigated. The composites were first prepared by a laboratory-scale twin screw extruder. Morphology of the blend was determined by SEM images. Mechanical properties in terms of tensile tests were carried out by Testometric TS2000, stress at break, strain at break, and Young’s modulus was determined. Based on mechanical results, although the young’s modulus increases with increasing protein content but the strain at break of the composite decreases acutely because of the presence of protein. The blend indicated an improvement in mechanical and thermal properties. Today, according to the vast application of plastic in different fields, environmental issues were affected by these kinds of non-degradable materials, so that biodegradability of the plastics is just the remaining route to solve. In this research, biodegradable blends were prepared using whey protein as a biodegradable natural polymer. The results of the biological procedure-test after 3 months indicated sufficient weight loss and biodegradation of these blends.
Using process tracing to evaluate stakeholder disputes: The case of tender award dispute in Nepal’s forestry
Authors: Maskey Stuty
Published: November 2020

In donor aid programs, the claims of causal links between inputs and outputs are crucial to establish the effectiveness of aid. As a result, there has been ample research on the degree and direction of correlation and causality between aid and poverty reduction. While evaluating end outcomes has its merits, this article aims to assess how some donor aid programs come under early criticism and/or are dropped or modified in order to ensure their continuation. This article examines a tender award dispute in a forestry program in Nepal, and traces the causal contribution of actors and actions that obstructed and changed the decisions related to the program implementation plan of this multi-million-dollar initiative. The article employs the process tracing method to search, collect, and assess evidence on the tender dispute case of the selected program. By tracing the logical sequence of evidence, this study establishes causality, linking the hypothesized causes and their effects to explain how the tender award decision that was announced by the lead donor and endorsed by the Government of Nepal was eventually nullified.
Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease Presenting as Recurrent and Migrating Focal Cortical Encephalitis
Authors: Xiang Xinran Maria , Evans Rachel , Lovera Jesus , Rao Rashmi
Published: November 2020

Although pediatric myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease is increasingly well-recognized, its full clinical spectrum is still being defined. Cortical encephalitis is emerging as a distinct clinico-radiologic syndrome of adult MOG antibody-associated disease. We describe a 12-year-old girl who presented with new onset seizures and left-sided hemiparesis. Brain MRI showed edema of the right temporal-parietal-occipital cortex with associated focal leptomeningeal enhancement. Patient received high-dose corticosteroids and 21 days of acyclovir despite negative infectious work-up due to the focal nature of encephalitis. Patient remained seizure-free for 20 months before presenting with new right hemiclonic seizures with right-sided hemiparesis and edema of the left temporal-parietal cortex with associated leptomeningeal enhancement. Patient’s MOG antibody titer was 1:40. She completed high-dose corticosteroids and intravenous immunoglobulin. Our patient highlights the importance of MOG antibody testing in pediatric focal cortical encephalitis to avoid unnecessary anti-viral agents and provide more appropriate immunotherapy and a more informed prognosis.
Towards a detailed comprehension of the inertisation processes of amphibole asbestos:in situhigh-temperature behaviour of fibrous tremolite
Authors: Ballirano Paolo , Pacella Alessandro
Published: November 2020

Thermal behaviour of fibrous tremolite from Maryland, USA has been investigatedin situup to breakdown temperature. Tremolite can be found both as primary constituent and as contaminant in Asbestos Containing Materials (ACMs). The products of breakdown are subcalcic diopside and calcium-rich clinoenstatite in a 2:1 ratio, traces of hematite plus minor silica-rich amorphous material. Thermal expansion follows a regular trend up to 723 K before the onset of Fe2+oxidation/OH–deprotonation which is completed at 1023 K. At 923 K the Fe3+migration starts towardsM(1) and the corresponding counter-migration of Mg toM(2) andM(3). AtTclose to structure breakdown,M(2) shows a significant site-scattering reduction possibly consistent with the occurrence of minor vacancies. In fully oxidised tremolite, Fe3+is allocated prevalently atM(1) and subordinately atM(3). As it is well-known thatM(1), along withM(2), is the most exposed octahedral site at the surface of amphiboles, most of the Fe3+is available for participating in the Fenton-like reactivity of oxidised tremolite, potentially making it dangerous for human health. This point should be properly taken into account in the evaluation of the safety of thermally decomposed tremolite-containing ACMs, in particular in the case of accidentally incomplete treatments.
How I manage cyclic thrombocytopenia
Authors: Kyrle Paul A. , Eichinger Sabine
Published: November 2020

Cyclic thrombocytopenia (CTP) is a rare disease, which is characterized by periodic fluctuation of the platelet count. The pathogenesis of CTP is unknown and most likely heterogeneous. Patients with CTP are almost always misdiagnosed as having primary immune thrombocytopenia (ITP). The interval between ITP and CTP diagnosis can be many years. CTP patients often receive ITP-specific therapies including corticosteroids, thrombopoietin receptor agonists, rituximab, and splenectomy, which are followed by a transient increase in platelet count that is wrongly attributed to treatment effect with inevitable “relapse.” CTP can be diagnosed by frequent platelet count monitoring, which reveals a typical pattern of periodic platelet cycling. An early diagnosis of CTP will prevent these patients from being exposed to possibly harmful therapies. The bleeding phenotype is usually mild and consists of mucocutaneous bleeding at the time when the platelet count is at its nadir. Severe bleeding from other sites can occur but is rare. Some patients respond to cyclosporine A or to danazol, but most patients do not respond to any therapy. CTP can be associated with hematological malignancies or disorders of the thyroid gland. Nevertheless, spontaneous remissions can occur, even after many years.
Sperm miRNAs— potential mediators of bull age and early embryo development
Authors: Wu Chongyang , Blondin Patrick , Vigneault Christian , Labrecque Rémi , Sirard Marc-André
Published: November 2020

Background

Sperm miRNAs were reported to regulate spermatogenesis and early embryonic development in some mammals including bovine. The dairy cattle breeding industry now tends to collect semen from younger bulls under high selection pressure at a time when semen quality may be suboptimal compared to adult bulls. Whether the patterns of spermatic miRNAs are affected by paternal age and/or impact early embryogenesis is not clear. Hence, we generated small non-coding RNA libraries of sperm collected from same bulls at 10, 12, and 16 months of age, using 16 months as control for differential expression and functional analysis.

Results

We firstly excluded all miRNAs present in measurable quantity in oocytes according to the literature. Of the remaining miRNAs, ten sperm-borne miRNAs were significantly differentially expressed in younger bulls (four in the 10 vs 16 months contrast and six in the 12 vs 16 months contrast). Targets of miRNAs were identified and compared to the transcriptomic database of two-cell embryos, to genes related to two-cell competence, and to the transcriptomic database of blastocysts. Ingenuity pathway analysis of the targets of these miRNAs suggested potential influence on the developmental competence of two-cell embryos and on metabolism and protein synthesis in blastocysts.

Conclusions

The results showed that miRNA patterns in sperm are affected by the age of the bull and may mediate the effects of paternal age on early embryonic development.
Transcriptional response of Bacillus megaterium FDU301 to PEG200-mediated arid stress
Authors: Zhao Lei , Zhou Yanjun , Li Jianbei , Xia Yucheng , Wang Weiyun , Luo Xiuqi , Yin Juan , Zhong Jiang
Published: November 2020

Background

For microorganisms on a paper surface, the lack of water is one of the most important stress factors. A strain ofBacillus megateriumFDU301 was isolated from plaques on a paper surface using culture medium with polyethylene glycol 200 (PEG200) to simulate an arid condition. Global transcriptomic analysis ofB. megateriumFDU301 grown under normal and simulated arid conditions was performed via RNA-seq technology to identify genes involved in arid stress adaptation.

Results

The transcriptome ofB. megateriumFDU301 grown in LB medium under arid (15% PEG200 (w/w)) and normal conditions were compared. A total of 2941 genes were differentially expressed, including 1422 genes upregulated and 1519 genes downregulated under arid conditions. Oxidative stress-responsive regulatory genesperR,fur, andtipAwere significantly upregulated, along with DNA protecting protein (dps), and catalase (katE). Genes related to Fe2+uptake (feoB), sporulation stage II (spoIIB,spoIIE,spoIIGA), small acid-soluble spore protein (sspD), and biosynthesis of compatible solute ectoine (ectB,ectA) were also highly expressed to various degrees. Oxidative phosphorylation-related genes (atpB, atpE, atpF, atpH, atpA, atpG,atpD,atpC) and glycolysis-related genes (pgk,tpiA,frmA) were significantly downregulated.

Conclusion

This is the first report about transcriptomic analysis of aB. megateriumto explore the mechanism of arid resistance. Major changes in transcription were seen in the arid condition simulated by PEG200 (15%), with the most important one being genes related to oxidative stress. The results showed a complex mechanism for the bacteria to adapt to arid stress.
Characterization, validation, and cross-species transferability of EST-SSR markers developed from Lycoris aurea and their application in genetic evaluation of Lycoris species
Authors: Jiang Yumei , Xu Sheng , Wang Rong , Zhou Jiayu , Dou Jian , Yin Qian , Wang Ren
Published: November 2020

Background

TheLycorisgenus includes many ornamentally and medicinally important species. Polyploidization and hybridization are considered modes of speciation in this genus, implying great genetic diversity. However, the lack of effective molecular markers has limited the genetic analysis of this genus.

Results

In this study, mining of EST-SSR markers was performed using transcriptome sequences ofL. aurea, and 839 primer pairs for non-redundant EST-SSRs were successfully designed. A subset of 60 pairs was randomly selected for validation, of which 44 pairs could amplify products of the expected size. Cross-species transferability of the 60 primer pairs amongLycorisspecies were assessed inL. radiataHreb,L. sprengeriComes ex Baker,L. chinensisTraub andL. anhuiensis, of which between 38 to 77% of the primers were able to amplify products in theseLycorisspecies. Furthermore, 20 and 10 amplification products were selected for sequencing verification inL. aureaandL. radiatarespectively. All products were validated as expected SSRs. In addition, 15 SSRs, including 10 sequence-verified and 5 unverified SSRs were selected and used to evaluate the genetic diversity of sevenL. radiatalines. Among these, there were three sterile lines, three fertile lines and one line represented by the offspring of one fertile line. Unweighted pair group method with arithmetic mean analysis (UPGMA) demonstrated that the outgroup,L. aureawas separated fromL. radiatalines and that the sevenL. radiatalines were clustered into two groups, consistent with their fertility. Interestingly, even a dendrogram with 34 individuals representing the sevenL. radiatalines was almost consistent with fertility.

Conclusions

This study supplies a pool of potential 839 non-redundant SSR markers for genetic analysis ofLycorisgenus, that present high amplification rate, transferability and efficiency, which will facilitate genetic analysis and breeding program inLycoris.
A comparison between two different definitions of contrast-associated acute kidney injury for long-term mortality in patients with diabetes undergoing coronary angiography: a prospective cohort study
Authors: Lun Zhubin , Lei Li , Zhou Dianhua , Ying Ming , Liu Liwei , Chen Guanzhong , Liu Jin , He Yibo , Li Huanqiang , Huang Zhidong , Yang Yongquan , Ye Jianfeng , Liu Yong
Published: November 2020

Background

The definitions of contrast-associated acute kidney injury (CA-AKI) are diverse and have different predictive effects for prognosis, which are adverse for clinical practice. Few articles have discussed the relationship between these definitions and long-term prognosis in patients with diabetes.

Methods

A total of 1154 diabetic patients who were undergoing coronary angiography (CAG) were included in this study. Two definitions of CA-AKI were used: CA-AKIAwas defined as an increase ≥ 0.3 mg/dl or > 50% in serum creatinine (SCr) from baseline within 72 h after CAG, and CA-AKIBwas defined as an increase ≥ 0.5 mg/dl or > 25% in SCr from baseline within 72 h after CAG. We used Cox regression to evaluate the association of these two CA-AKI definitions with long-term mortality and calculate the population attributable risks (PARs) of different definitions for long-term prognosis.

Results

During the median follow-up period of 7.4 (6.2–8.2) years, the overall long-term mortality was 18.84%, and the long-term mortality in patients with CA-AKI according to both CA-AKIAand CA-AKIBcriteria were 36.73% and 28.86%, respectively. We found that CA-AKIA(HR: 2.349, 95% CI 1.570–3.517,p = 0.001) and CA-AKIB(HR: 1.608, 95% CI 1.106–2.339,p = 0.013) were associated with long-term mortality. The PARs were the highest for CA-AKIA(31.14%), followed by CA-AKIB(14.93%).

Conclusions

CA-AKI is a common complication in diabetic patients receiving CAG. The two CA-AKI definitions are significantly associated with a poor long-term prognosis, and CA-AKIA, with the highest PAR, needs more clinical attention.
Prevalence and incidence of cognitive impairment in an elder Portuguese population (65–85 years old)
Authors: Pais Ricardo , Ruano Luís , Moreira Carla , Carvalho Ofélia P. , Barros Henrique
Published: November 2020

Background

The increase in average life expectancy increases the risk of illness and frailty in the elderly, especially in the cognitive arena. This study has the objective to estimate the prevalence and incidence of cognitive impairment, in a representative sample of 65 to 85 years old followed for a mean period of 6-years.

Methods

Subjects aged 65–85 years (n = 586) were screened at baseline (1999–2004) to estimate the prevalence of cognitive impairment using the Mini-Mental State Examination. A total of 287 individuals with a normal MMSE at baseline were reassessed after 6.2 mean years (± 4.30 years) to evaluate the incidence of cognitive impairment, defined as scoring below the age and education-adjusted MMSE cut-off points adapted for the Portuguese population. We did not exclude Dementia.

Results

The baseline prevalence of cognitive impairment was 15.5% (95% CI: 12.7–18.7). Higher in women (18.9%; 95% CI: 14.9–23.3), that in men (10.4%; 95% CI: 6.7–15.1). Increased with age and was highest for participants without any schooling. The overall incidence rate was 26.97 per 1000 person-years; higher in women (33.8 per 1000 person-years) than in men (18.0 per 1000 person-years). Higher for the oldest participants and those with no schooling. Taking the standard European population, we estimated a prevalence of 16.5% and an incidence of 34.4 per 1000 person-years.

Conclusion

The prevalence of cognitive impairment in Portugal is within the estimated interval for the European population, and the incidence is lower than for the majority of the European countries. Women, senior and elders without education have a higher risk of cognitive impairment. In our sample, neither employment nor marital status has a significant effect on cognitive impairment.
Risk factors associated with death in infants <120 days old with severe pertussis: a case-control study
Authors: Liu Cong , Yang Lin , Cheng Yuwei , Xu Hongmei , Xu Feng
Published: November 2020

Background and purpose

Pertussis is a serious infectious disease in young infants, and severe cases frequently cause death. Our study explored risk factors for death from severe pertussis.

Method

A case-control study of infants with severe pertussis admitted to the paediatric intensive care unit (PICU) in the Children’s Hospital of Chongqing Medical University, China, from January 1, 2013, to June 30, 2019, was conducted. Pertussis was confirmed by clinical features and laboratory examinations. Severe pertussis was defined as patients with pertussis resulting in PICU admission or death. To understand the risk factors for death, we compared fatal and nonfatal cases of severe pertussis in infants aged < 120 days by collecting clinical and laboratory data.

Results

The participants included 63 infants < 120 days of age with severe pertussis. Fifteen fatal cases were confirmed and compared with 44 nonfatal severe pertussis cases, Four patients with termination of treatment were excluded. In the univariate analysis, the risk factors associated with death included apnoea (P = 0.001), leukocytosis (white blood cell (WBC) count≥30 × 109/L (P = 0.001) or ≥ 50 × 109/L (P = 0)), highest lymphocyte count (P = 0), pulmonary hypertension (P = 0.001), and length of PICU stay (P = 0.003). The multivariate analysis revealed that apnoea (OR 23.722, 95%CI 2.796–201.26,P = 0.004), leukocytosis (OR 63.708, 95%CI 3.574–1135.674,P = 0.005) and pulmonary hypertension (OR 26.109, 95%CI 1.800–378.809,P = 0.017) were significantly associated with death.

Conclusion

Leukocytosis and pulmonary hypertension exhibited the greatest associations with death in infants with severe pertussis admitted to the PICU. Vaccination is still the most effective protection method against pertussis.
High incidence and persistence of hepatitis B virus infection in individuals receiving HIV care in KwaZulu-Natal, South Africa
Authors: Msomi Nokukhanya , Naidoo Kogieleum , Yende-Zuma Nonhlanhla , Padayatchi Nesri , Govender Kerusha , Singh Jerome Amir , Abdool-Karim Salim , Abdool-Karim Quarraisha , Mlisana Koleka
Published: November 2020

Background

Hepatitis B virus (HBV), Human Immunodeficiency virus (HIV) and Tuberculosis (TB) are common infections in South Africa. We utilized the opportunity of care provision for HIV-TB co-infected patients to better understand the relationship between these coinfections, determine the magnitude of the problem, and identify risk factors for HBV infection in HIV infected patients with and without TB in KwaZulu-Natal, South Africa.

Methods

This retrospective cohort analysis was undertaken in 2018. In-care HIV infected patients were included in the analysis. Results from clinical records were analysed to determine the prevalence, incidence, persistence and factors associated with HBsAg positivity in HIV-infected patients with or without TB co-infection.

Results

A total of 4292 HIV-infected patients with a mean age of 34.7 years (SD: 8.8) were included. Based on HBsAg positivity, the prevalence of HBV was 8.5% (363/4292) [95% confidence interval (CI): 7.7–9.3] at baseline and 9.4% (95%CI: 8.6–10.3%) at end of follow-up. The HBV incidence rate was 2.1/100 person-years (p-y). Risk of incident HBV infection was two-fold higher among male patients (HR 2.11; 95% CI: 1.14–3.92), while severe immunosuppression was associated with a greater than two-fold higher risk of persistent infection (adjusted risk ratio (RR) 2.54; 95% CI 1.06–6.14; p = 0.004. Additionally, active TB at enrolment was associated with a two-fold higher risk of incident HBV infection (aHR 2.38; 95% CI: 0.77–7.35).

Conclusion

The provision of HIV care and treatment in high HBV burden settings provide a missed opportunity for HBV screening, immunization and care provision.
Comparison of different anticoagulation strategies for renal replacement therapy in critically ill patients with COVID-19: a cohort study
Authors: Arnold Frederic , Westermann Lukas , Rieg Siegbert , Neumann-Haefelin Elke , Biever Paul Marc , Walz Gerd , Kalbhenn Johannes , Tanriver Yakup
Published: November 2020

Background

Critically ill coronavirus disease 2019 (COVID-19) patients have a high risk of acute kidney injury (AKI) that requires renal replacement therapy (RRT). A state of hypercoagulability reduces circuit life spans. To maintain circuit patency and therapeutic efficiency, an optimized anticoagulation strategy is needed. This study investigates whether alternative anticoagulation strategies for RRT during COVID-19 are superior to administration of unfractionated heparin (UFH).

Methods

Retrospective cohort study on 71 critically ill COVID-19 patients (≥18 years), admitted to intensive care units at a tertiary health care facility in the southwestern part of Germany between February 26 and May 21, 2020. We collected data on the disease course, AKI, RRT, and thromboembolic events. Four different anticoagulatory regimens were administered. Anticoagulation during continuous veno-venous hemodialysis (CVVHD) was performed with UFH or citrate. Anticoagulation during sustained low-efficiency daily dialysis (SLEDD) was performed with UFH, argatroban, or low molecular weight heparin (LMWH). Primary outcome is the effect of the anticoagulation regimen on mean treatment times of RRT.

Results

In patients receiving CVVHD, mean treatment time in the UFH group was 21.3 h (SEM: ±5.6 h), in the citrate group 45.6 h (SEM: ±2.7 h). Citrate anticoagulation significantly prolonged treatment times by 24.4 h (P = .001). In patients receiving SLEDD, mean treatment time with UFH was 8.1 h (SEM: ±1.3 h), with argatroban 8.0 h (SEM: ±0.9 h), and with LMWH 11.8 h (SEM: ±0.5 h). LMWH significantly prolonged treatment times by 3.7 h (P = .008) and 3.8 h (P = .002), respectively.

Conclusions

UFH fails to prevent early clotting events in the dialysis circuit during COVID-19. For patients, who do not require effective systemic anticoagulation, regional citrate dialysis is the most effective strategy. For patients, who require effective systemic anticoagulation, the usage of LMWH results in the longest circuit life spans. The proposed anticoagulatory strategies are safe, can easily be monitored, and allow an individualized treatment.

Graphical abstract
Crossed versus conventional pseudophakic monovision for high myopic eyes: a prospective, randomized pilot study
Authors: Xun Yan , Wan Wenjuan , Jiang Lu , Hu Ke
Published: November 2020

Background

Aiming at spectacle independence, conventional pseudophakic monovision has been widely used in myopia patients with bilateral monofocal intraocular lens implantation. However, the crossed monovision, which is to correct the dominant eye for near vision and the non-dominant eye for distant vision, has been mentioned preferable for high myopic cataract patients by some studies.

We have conducted this study to compare clinical results to assess the feasibility of conventional and crossed monovision for high myopic pseudophakic patients by comparing patient satisfaction, visual function and spectacle independence.

Method

Forty-sixth high myopia patients were divided into two groups: 22 in crossed monovision group with patients whose refraction targeted to − 2.00 diopters (D) in the dominant eye and − 0.50D in the non-dominant eye; 24 in conventional monovision group with patients whose refraction targeted to − 0.50D in the dominant eye and − 2.00D in the non-dominant eye. Binocular uncorrected distance visual acuity (BUDVA), binocular uncorrected near visual acuity (BUNVA), binocular corrected distant visual acuity (BCDVA), binocular corrected near visual acuity (BCNVA), contrast visual acuity and stereoacuity were examined at postoperative 2 weeks, 1 month and 3 months. Questionnaires were completed by patients 3 months after binocular surgery to evaluate patients’ satisfaction and spectacle independence.

Results

The conventional monovision and the crossed monovision group showed no significant differences of mean BUDVA, BUNVA, BCDVA, BCNVA 2 weeks, 1 month or 3 months postoperatively (P > 0.05). There was no difference in the bilateral contrast sensitivity or stereoscopic function between the convention conventional and crossed monovision groups (P > 0.05). Patient satisfaction with near and distant vision, as well as spectacle dependence did not differ significantly between the two groups (P > 0.05).

Conclusion

Crossed pseudophakic monovision exhibited similar visual function when compared with conventional monovision technique, which indicates that it is an effective option to improve the visual functionality and quality of life for high myopic patients who considering bilateral cataract surgery.

Trial registration

The Institutional Review Board and Ethics committee of the First Affiliated Hospital of Chongqing Medical University, Chongqing, China. The trial registration was submitted in September 2018 and passed on March 18, 2020, and the registration number is: ChiCTR2000030935.
Extraperitoneal pediatric kidney transplantation of adult renal allograft using an en-bloc native liver and kidney mobilization technique
Authors: Alameddine Mahmoud , Jue Joshua S. , Morsi Mahmoud , Gonzalez Javier , Defreitas Marissa , Chandar Jayanthi J. , Gaynor Jeffrey J. , Ciancio Gaetano
Published: November 2020

Background

We describe the safety and efficacy of performing pediatric kidney transplantation with a modified extraperitoneal approach that includes mobilization of the native liver and kidney.

Methods

We retrospectively identified pediatric renal transplants performed using this technique between 2015 and 2019. Data on patient demographics, surgical technique, and intraoperative details were collected. Outcomes were measured by morbidity and re-operation at 90 days, as well as serum creatinine, allograft survival, and overall survival at 1 year.

Results

Twenty-one patients with a median age of 5 (IQR 3–9) years, weighing 17.5 (IQR 14.5–24) kg were included. Median donor age was 24 (IQR 19–31) years. No intraoperative complications occurred. One child required a right native nephrectomy to allow sufficient space. Postoperatively, all patients had immediate graft function without urine leak or allograft thrombosis. 90-day morbidity and re-operation rates were zero. Both 1-year allograft and overall survival were 100% (on follow-up of all 21 patients through 1 year post-transplant), with a median serum creatinine of 0.58 (IQR 0.47–0.70) mg/dl at 1 year post-transplant.

Conclusions

Pediatric kidney transplantation of adult renal allografts using an extraperitoneal approach with native liver and kidney mobilization has promising allograft and patient survival outcomes that eliminates peritoneal violation and may diminish the need for native nephrectomy.
Burden of prediabetes, undiagnosed, and poorly or potentially sub-controlled diabetes: Lolland-Falster health study
Authors: Bruun-Rasmussen Neda Esmailzadeh , Napolitano George , Kofoed-Enevoldsen Allan , Bojesen Stig Egil , Ellervik Christina , Rasmussen Knud , Jepsen Randi , Lynge Elsebeth
Published: November 2020

Background

This study aimed to investigate prevalence and risk factors for prediabetes, undiagnosed diabetes mellitus, poorly and potentially sub-controlled diabetes in a rural-provincial general adult population in Denmark.

Methods

Using cross-sectional data from the Lolland-Falster Health Study, we examined a total of 10,895 individuals aged 20 years and above.

Results

Prevalence of prediabetes was 5.8% (men: 6.1%; women: 5.5%); of undiagnosed diabetes 0.8% (men: 1.0%; women: 0.5%); of poorly controlled diabetes 1.2% (men: 1.5%; women: 0.8%); and of potentially sub-controlled diabetes 2% (men: 3.0%; women: 1.3%). In total, 9.8% of all participants had a diabetes-related condition in need of intervention; men at a higher risk than women; RR 1.41 (95% CI 1.26–1.58); person aged + 60 years more than younger; RR 2.66 (95% CI 2.34–3.01); obese more than normal weight person, RR 4.51 (95% CI 3.79–5.38); smokers more than non-smokers, RR 1.38 (95% CI 1.19–1.62); persons with self-reported poor health perception more than those with good, RR 2.59 (95% CI 2.13–3.15); low leisure time physical activity more than those with high, RR 2.64 (95% CI 2.17–3.22); and persons with self-reported hypertension more than those without, RR 3.28 (95% CI 2.93–3.68).

Conclusions

In the Lolland-Falster Health Study, nearly 10% of participants had prediabetes, undiagnosed diabetes, poorly controlled, or potentially sub-controlled diabetes. The risk of these conditions was more than doubled in persons with self-reported poor health perception, self-reported hypertension, low leisure time physical activity, or measured obesity, and a large proportion of people with diabetes-related conditions in need of intervention can therefore be identified relatively easily.
Impact of a theory-informed and user-centered stroke information campaign on the public’s behaviors, attitudes, and knowledge when facing acute stroke: a controlled before-and-after study
Authors: Haesebaert Julie , Laude Caroline , Termoz Anne , Bravant Estelle , Perreton Nathalie , Bony Thomas , Trehard Hélène , Porthault Sylvie , Derex Laurent , Nighoghossian Norbert , Schott Anne-Marie
Published: November 2020

Background

Public awareness of stroke symptoms is a key factor to ensure access to reperfusion strategies in due time. We designed and launched a regional theory-informed and user-centered information campaign and assessed its impact on emergency medical services (EMS) calls for stroke suspicion, time-to-call, and public attitudes and awareness concerning stroke.

Methods

A controlled before-and-after study was conducted during 3 sequential time-periods in 2 separate counties. Key messages of the campaign were underpinned by stroke representations and the theory of planned behavior, and focused on recognition of stroke warning signs and the need to call EMS urgently. The campaign included posters, leaflets, adverts and films displayed in bus and subway stations, internet, social networks, and local radio. Outcome measures on behavior, attitudes, and knowledge were assessed before the launch of the campaign, at 3 months, and 12 months.

Results

The number of EMS calls for stroke suspicion increased by 21% at 12 months in the intervention county and this change was significantly different to that observed in the control county (p = 0.02). No significant changes were observed regarding self-reported attitudes in case of stroke. An 8% significant increase in recognizing at least 2 stroke warning signs was observed in the intervention county (p = 0.04) at 3 months, while it did not change significantly in the control county (p = 0.6). However, there was no significant difference in warning sign recognition between both counties (p = 0.16).

Conclusion

The campaign significantly improved public’s behavior of calling EMS, although stroke knowledge was not improved as much as expected. Repeating these campaigns over time might further help improve timeliness and access to reperfusion strategies.

Trial registration

Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT02846363.
Effect of nutrition education on iodine deficiency disorders and iodized salt intake in south west Ethiopian women: a cluster randomized controlled trial
Authors: Asfaw Agize , Belachew Tefera , Gari Taye
Published: November 2020

Background

Although iodine nutrition status is improving globally, the progress is not uniform throughout the world due to several factors. Among these, poor knowledge, negative attitude and improper practice of iodized salt are the main risk factors for poor iodine nutrition in Ethiopia. This study was aimed to assess the effect of nutrition education intervention on knowledge, attitude and practice (KAP) of iodine deficiency and iodized salt utilization.

Methods

A cluster randomized controlled trial was carried out among 652 women of reproductive age group in southwest Ethiopia. A total of 24 clusters were selected and randomized in to an intervention and control villages. Women in the intervention village received iodine nutrition related education for 6 months; while those in the control village did not receive any education. Baseline and endline data were collected from both groups. Generalized Estimating Equations (GEE) was used to determine the effect of intervention.

Results

A total of 647 (99.2%) participants were successfully involved in the study. In the intervention group the median attendance was 10 out of 12 sessions. Women in the intervention group had shown statistically significant change in knowledge, attitude and practice scores as compared to control one. In multivariable GEE linear model, after adjusting for other background characteristics, the mean difference (95% CI) scores were 8.81 (8.46, 9.16) for knowledge, 3.35 (3.17, 3.54) for attitude and 2.90 (2.74, 3.05) for practice in the intervention arm.

Conclusions

Well designed and community-based iodine nutrition education is an effective strategy to improve the KAP of iodine deficiency disorders and iodized salt utilization.

Trial registration PACTR201809544276357 (Retrospectively registered on 14, Sept. 2018).

https://www.pactr.org.
Phone-based audience response system as an adjunct in orthodontic teaching of undergraduate dental students: a cross-over randomised controlled trial
Authors: Alharbi Fahad , Alazmi Khulud F. , El Momani Bashar R. , Al-Muzian Lubna , Wertheimer Mark , Almukhtar Anas , Almuzian Mohammed
Published: November 2020

Background

The advent of electronic teaching facilities improves tutor-student communication. This study aims to explore the effectiveness of Phone-Based Audience Response System (PB-ARS), as an adjunctive pedagogy tool to enhance the retention of orthodontic information by dental students; and to explore the students’ perception of PB-ARS.

Methods

This cross-over clustered randomised control trial included 34 males who were in the final year of their undergraduate dental training. Participants were allocated to one of two event groups (G1 and G2) using computer-generated randomisation. Both groups simultaneously attended two different traditional lectures (L 1 and L2) a week apart. During L1, PB-ARS was used as an adjunct to conventional presentation to teach G1 participants, (PB-ARS group) while G2’s participants acted as a control group (CG), and were taught using a traditional presentation. In the second week (L2), the interventions were crossed-over. Participants from both groups completed pre- and post-lecture multiple-choice questionnaires (MCQ) to assess their short-term retention of information. Their performance in the final MCQ exam (10 weeks following L2) was tracked to assess the long-term retention of the information. Participants also completed post-lecture questionnaires to evaluate their perceptions.

Results

Twenty-nine and 31 participants from the CG and PB-ARS group completed this trial, respectively. Although 87.5% of students in the PB-ARS group showed an improvement in their immediate post-lecture scores compared with 79.3% for the CG, it was statistically insignificant (p = 0.465). Similarly, the intervention showed an insignificant effect on the long-term retention of the knowledge (p = 0.560).

There was a mildly but favourable attitude of students towards the use of PB-ARS. However, the difference in the overall level of satisfaction between both groups was statistically insignificant (p = 0.183).

Conclusion

PB-ARS has a minimal and insignificant effect on the short- and long-term retention of orthodontic knowledge by male undergraduate dental students. PB-ARS was the preferred adjunct tool to conventional classroom teaching. Due to the limitations of this trial, a long-term randomised controlled trial with a larger sample size is recommended.