bluuebunny/crossref_metadata_2025 huggingface dataset:
Caregivers' Perception of the Caring challenges in Coronavirus (COVID-19) Crisis: A Qualitative Study
Authors: Mohammadi Fateme , Farjam Mojtaba , Gholampour Yousef , Sohrabpour Mojtaba , Oshvandid Khodayar , Bijani Mostafa
Published: July 2020

Background

The medical personnel act as the guardians of people's health by preventing, controlling, and curing emerging diseases, including coronavirus, a highly infectious and contagious disease which has presented the caregivers in the Iranian healthcare system with many clinical challenges. The aim in present study was to describe the caregivers’ experiences of the caring challenges in patients with coronavirus (COVID-19).
Methods

The present study is a qualitative work with a phenomenological-descriptive design. Data were collected via semi-structured, in-depth, individual interviews. The collected data was analyzed according to Colaizzi's method. The participants were 23 members of the medical staff responsible for coronavirus patients in Iran who met the inclusion criteria. The participants were selected via purposeful sampling which was continued to the point of data saturation. The study lasted from February to May2020.
Results

The results yielded 3 main themes “invasion of psychological tension”, “inefficient management”, and “contextual factors” with 11 categories.
Conclusion

In dealing with coronavirus patients and providing quality care to them, medical personnel face a variety of clinical challenges which affect their performance. Administrators must, alongside giving instructions to people on how to prevent the coronavirus disease and taking effective security measures, make sure that clinical centers are managed efficiently in order for medical personnel to fulfill their caring objectives satisfactorily.
The Role of the Media on Parental Confidence in Provider HPV Recommendation
Authors: Walker Kimberly , Owens Heather , Zimet Gregory
Published: July 2020

Background
Despite a growing understanding of the importance of provider HPV recommendation on parental acceptance, US HPV vaccination rates remain suboptimal. Given the prevalence and use of the media for health decisions, this study examined the relationship between the media and provider HPV recommendation on parental HPV vaccine hesitancy.
Methods
Thirty individual interviews with vaccine accepting mothers in the Midwest were conducted to examine their experiences with initial hesitancy to accept HPV vaccination at point of provider recommendation and their suggestions for improving the HPV vaccine patient/provider recommendation experience.
Results
Results found that the media served as an antecedent to hesitancy for three main vaccination concerns: protection, efficacy and sexual stigma. A model for understanding the influence of the media as it relates to the three topical HPV vaccination concerns and its process on parental HPV vaccine decision making emerged.
Conclusions
Findings suggest that mothers experience hesitancies from passive and active HPV vaccination media information that prompt confusion and fear with accepting provider HPV vaccination recommendation. Providers’ approach to HPV vaccination recommendation must consider concerns reported in the media with delivery techniques modified to adjust to parental fears absorbed from adverse media information.
Urinary neutrophil gelatinase-associated lipocalin values alone and combined with Prognostic Index predict septic AKI, DIC, and shock: a pilot study
Authors: Shimoyama Yuichiro , Umegaki Osamu , Kadono Noriko , Minami Toshiaki
Published: July 2020

Objective: Sepsis is a syndrome involving life-threatening organ dysfunction. The present study aimed to determine whether septic AKI, ARDS, DIC, and shock can be predicted more readily by combining uNGAL values and inflammation-based prognostic scores, over the use of uNGAL values alone.Results: ROC curve analyses yielded the following cut-off values: AKI: 438.5 (ng/ml) for uNGAL at Day 1 (AUC, 0.8), 476.9 (ng/ml) for uNGAL at Day 2 (AUC, 0.86), 123.8 (ng/ml) for uNGAL at Day 3 (AUC, 0.81), 133.6 (ng/ml) for uNGAL at Day 4 (AUC, 0.78), 1.0 for iNS NGAL-NLR (AUC, 0.75), 2.0 for iNS NGAL-PI (AUC, 0.77), DIC; 648.5 (ng/ml) for uNGAL at Day 1 (AUC, 0.77); shock; 123.8 (ng/ml) for uNGAL at Day 3 (AUC, 0.71) and 9 for SOFA (AUC, 0.71). Multivariate logistic regression analyses revealed iNS NGAL-PI to be a significant independent predictor of AKI (OR, 20.62; 95%CI, 1.03-412.3; p=0.048).
­­­­­­Genomic analysis of worldwide sheep breeds reveals PDGFD as a major target of fat-tail selection in sheep
Authors: Dong Kunzhe , Yang Min , Han Jiangang , Ma Qing , Han Jilong , Song Ziyi , Luosang Cuicheng , Gorkhali Neena Amatya , Yang Bohui , He Xiaohong , Ma Yuehui , Jiang Lin
Published: July 2020

Background: Fat tail is a special trait in sheep acquired during sheep domestication. Several genomic analyses have been conducted in sheep breeds from limited geographic origins to identify the genetic factors underlying this trait. Nevertheless, these studies obtained different candidates. The results of these regional studies were easily biased by the breed structures. Results: To minimize the bias and distinguish the true candidates, we used an extended data set of 968 sheep representing 18 fat-tailed breeds and 14 thin-tailed breeds from around the world, and integrated two statistic tests to detect selection signatures, including Genetic Fixation Index (FST) and difference of derived allele frequency (ΔDAF). The results showed that platelet derived growth factor D (PDGFD) exhibited the highest genetic differentiation between fat- and thin-tailed sheep breeds. Further analysis of sequence variation identified that a 6.8-kb region within the first intron of PDGFD is likely the target of positive selection and contains regulatory mutation(s) in fat-tailed sheep. Histological analysis and gene expression analysis demonstrated that PDGFD expression is associated with maturation and hemostasis of adipocytes. Luciferase reporter assays showed that a segment of conserved sequence surrounding the orthologous site of one mutation found in sheep is functional in regulating PDGFD expression. Conclusions: These results reveal that PDGFD is the predominant factor for the fat tail phenotype in sheep by contributing to adiopogenesis and maintaining the hemostasis of mature adipocytes. This study provides insights into the evolution of fat-tailed sheep and has important application to animal breeding, as well as obesity-related human diseases.
Transferability, development of simple sequence repeat (SSR) markers and application to the analysis of genetic diversity and population structure of the African fan palm (Borassus aethiopum Mart.) in Benin
Authors: Kpaténon Mariano Joly , Salako Valère Kolawolé , Santoni Sylvain , Zekraoui Leila , Latreille Muriel , Tollon-Cordet Christine , Mariac Cédric , Jaligot Estelle , Beulé Thierry , ADEOTI Kifouli
Published: July 2020

Background: In Sub-Saharan Africa, Borassus aethiopum Mart. (African fan palm) is an important non-timber forest product-providing palm that faces multiple anthropogenic threats to its genetic diversity. However, this species is so far under-studied, which prevents its sustainable development as a resource. The present work is a first attempt at characterizing the genetic diversity and population structure of B. aethiopum across nine collection sites spanning the three climatic regions of Benin, West Africa, through the use of microsatellite markers. Results: During a first phase we relied on the reported transferability of primers developed in other palm species. We find that, in disagreement with previously published results, only 22.5% of the markers tested enable amplification of B. aethiopum DNA and polymorphism detection is very low. We thus generated a B. aethiopum-specific genomic dataset through high-throughput sequencing and used it in a second phase for the de novo detection of microsatellite loci. Among the primer pairs designed to target these, 11 enabled polymorphism detection and were further used for analyzing genetic diversity. Across the nine collection sites, expected heterozygosity (He) ranges from 0.263 to 0.451 with an overall average value of 0.354, showing a low genetic diversity. Analysis of molecular variance (AMOVA) shows that within-site variation accounts for 53% of the genetic variation, and accordingly the low number of migrants and the positive values of the fixation index (F) in sites from both the Central (Sudano-Guinean) and the Southern (Guinean) climatic regions suggest limited gene flow between sites. While we globally observe a weak correlation between genetic and geographic distances, our clustering analyses indicate that B. aethiopum palms from Savè (Center) are genetically more similar to those from the Northern sites than to samples from the other Central sites. Conclusions: In the light of our results, we discuss the use of inter-species transfer vs. de novo development of microsatellite markers in genetic diversity analyses targeting under-studied species. We also suggest future applications for the molecular resources generated through the present study.
A biomechanical study comparing the mean load to failure of two different osteosynthesis techniques for the Step-Cut Olecranon Osteotomy
Authors: Hess Silvan , Bürki Alexander , Moor Beat Kaspar , Bolliger Lilianna , Zysset Philippe , Zumstein Matthias Alexander
Published: July 2020

Background: A tension band wiring technique is the current gold standard for osteosynthesis of olecranon osteotomies, although the technique has several practical disadvantages and its theoretical advantages have been questioned. The Step-Cut Olecranon osteotomy is an interesting new option for surgeons to access distal intra-articular humerus fractures, but its stability has only been assessed using the tension band wiring osteosynthesis. Therefore, the mean load to failure of this osteotomy with two different osteosynthesis techniques (tension band wiring and compression screws) was assessed. A higher load to failure was hypnotized for the tension-band-wiring osteosynthesis group. Methods: A Step-Cut Olecranon osteotomy was performed on 32 Sawbones. Half were secured by a tension band wiring and the other half by two compression screws. The humero-ulnar joint was simulated using an established test setup, which allows the application of triceps traction force through a tendon model to the ulna model, while the joint is in a fixed position. Eight models of each group were tested at one of two angles (20° and 70° of flexion) by isometrical loading until failure. A failure was defined as either complete fracture or gap formation of more than 2mm between osteotomy and the remaining model. Results: At 20° of flexion, the mean load to failure in the tension band wiring group was 1360 N (SD 238) and 1401 N (SD 261) in the compression screw group. At 70° of flexion, it was 1398 N (SD 215) and 1614 N (SD 427), respectively. Differences did not reach significance (p = 0.88 at 20°, p = 0.28 at 70°).Conclusions: A tension band wiring osteosynthesis does not provide higher stability than a compression screw osteosynthesis for the Step-Cut Olecranon osteotomy. A Step-Cut Olecranon osteotomy with screw osteosynthesis might be an interesting option for surgeons when treating intra-articular distal humeral fractures.
Ultra-High Performance Organic Thermoelectric Generators through Interfacial Doping Gradients
Authors: Petsagkourakis I. , Riera-Galindo S. , Ruoko Tero-Petri , Strakosas Xenofon , Pavlopoulou Eleni , Liu Xianjie , Braun Slawomir , Kim Nara , Lienemann S. , Gueskine V. , Hadziioannou Georges , Berggren Magnus , Fahlman Mats , Fabiano Simone , Tybrandt Klas , Crispin Xavier
Published: July 2020

The interfacial energetics are known to play a crucial role in organic electronic devices. However, their effects in organic thermoelectrics remain to be elucidated. In this work we optimize the output power density of an organic thermoelectric generator (OTEG) at ambient atmosphere to record high values, by varying the work function of the metal contacts. We find that the effect is linked to extended gradients of doping states, which are induced by humidity and reside inside the organic layer oriented perpendicular to the metal contacts. The thermovoltage, arising from this contact phenomenon alone, reaches a magnitude similar to that of the Seebeck voltage of the conducting polymer itself, thereby providing a major contribution to the resulting thermoelectric performance. With this work, we put a new emphasis on the importance of the metal-polymer interface in thermoelectrics. The overall output performance can be greatly improved by fine-tuning the interfacial energetics, which then provides an attractive complementing route for enhancing the performance of OTEGs.
Fast photothermal spatial light modulation for quantitative phase imaging at the nanoscale
Authors: Robert Hadrien , Bujak Łukasz , Holanová Kristýna , Vala Milan , Marek Piliarik
Published: July 2020

Spatial light modulators have become an essential tool for advanced microscopy enabling breakthroughs in 3D, phase, or super-resolution imaging. However, continuous spatial-light modulation without diffraction artifacts, polarization dependence, and able to capture sub-ms microscopic motion is challenging. Here we present a photothermal spatial light modulator (PT-SLM) enabling the fast wavefront shaping free of diffraction artifacts, having a high transmissivity and modulation efficiency independent of light polarization. It is based on the microscopic heating of a thin layer of thermo-optic material confined between the photothermal heat-source and a transparent heatsink. We achieve a phase-shift > π with a response time as short as 70 µs with a theoretical limit in the sub-µs range. The combination of the PT-SLM with an interferometric scattering microscope (iSCAT) allowed us to perform quantitative phase imaging of sub-diffractional scatterers and decipher the 3D nanoscopic displacement of microtubules matching closely with control data from atomic force microscopy.
Genome-wide Characterization and Functional Analysis of the Heat Shock Transcription Factor Family in Pumpkin
Authors: Shen Changwei , Yuan Jingping
Published: July 2020

Background: Crop quality and yield are affected by abiotic and biotic stresses, and heat shock transcription factors (Hsfs) are considered to play important roles in regulating plant tolerance under various stresses. To investigate the response of pumpkin to abiotic stress, we analysed the genome of pumpkin. Results:In this research, a total of 36 Cucurbita moschata Hsf (CmHsf) members were identified and classified into three subfamilies (I, II, and III) according to their amino acid sequence identity. The Hsfs of the same subfamily usually exhibit a similar gene structure (intron-exon distribution) and conserved domains (DNA-binding and other functional domains). Chromosome localization analysis showed that the 36 CmHsfs were unevenly distributed on 18 of the 21 chromosomes (except for Cm_Chr00, Cm_Chr08 and Cm_Chr20), among which 18 genes formed 9 duplicated gene pairs that have undergone segmental duplication events. The Ka/Ks ratio showed that the duplicated CmHsfs have mainly experienced strong purifying selection. High-level synteny was observed between Cucurbita moschata and other Cucurbitaceae species. Conclusions: The expression profile of CmHsfs in the roots, stems, cotyledons and true leaves revealed that the CmHsfs exhibit tissue specificity. The analysis of cis-acting elements and quantitative real-time polymerase chain reaction (qRT-PCR) revealed that some key CmHsf genes were activated by cold stress, heat stress, hormones and salicylic acid. This study lays the foundation for revealing the role of CmHsfs in resistance to various stresses, which is of great significance for the selection of stress-tolerant pumpkin varieties.
Tele-ECG consulting and outcomes on primary care patients in a low-to-middle income population: The first experience from Makassar Telemedicine Program, Indonesia
Authors: Mappangara Idar , Qanitha Andriany , Uiterwaal Cuno S. P. M. , Henriques Jose P. S. , de Mol Bastianus A. J. M.
Published: July 2020

Background: Telemedicine has been a popular tool to overcome the lack access to healthcare facilities, primarily in underprevilaged populations. We aimed to describe and assess the implementation of tele-electrocardiography (ECG) program in primary care settings in Indonesia, and subsequently examine the short- and mid-term outcomes of patients those received tele-ECG consultation.Methods: A total of 505 ECG recordings from thirty primary care centers were transmitted to Makassar Cardiac Center, Indonesia from January to July 2017. We prospectively collected data by sending a detailed questionnaire to general practitioners (GPs). Follow-up was performed at 30 days and at the end of follow-up on October 2018.Results: Of 505 recordings, all (100%) ECGs were qualified for analysis, and about a half showed normal findings. Ischemia presented in 15.6%, arrhythmia in 23.6%, and abnormalities compatible with structural changes in 5.1%. The mean age of participants was 53.3 ± 13.6 years, and 40.2% were male. Most (73.9%) of these primary care patients turned up with a manifasted CVD symptom with at least one risk factor. More men had an ischemic ECG compare to women (p<0.01), while aged >55 years was associated with ischemic or arrhythmic ECG (p<0.05). Factors significantly associated with a normal ECG were younger age, female gender, lower blood pressure and heart rate, and no history of previous cardiovascular disease (CVD) or medication. More patients with an abnormal ECG had a history of hypertension, known diabetes, and were current smokers (p<0.05). Majority (95%) of GPs were satisfied with each tele-ECG consultation, and 58.6% used tele-ECG for an expert opinion. Over the total follow-up (14 ± 6.6 months), seven (1.4%) patients died and 96 (19.0%) were hospitalized for CVD. Of 88 patients for whom hospital admission was advised, 72 (81.8%) were immediately referred within 48 hours following the tele-ECG consultation. Conclusions: Tele-ECG can be implemented in Indonesian primary care settings with limited resources and may assist the GPs for immediate triage, results in higher rate of early hospitalization for indicated patients.
Relationship between Sleep Duration and Sociodemographic Characteristics, Mental Health and Chronic Diseases in Individuals Aged from 18 to 85 Years Old in Guangdong Province in China: A Population-Based Cross-Sectional Study
Authors: Chen Xie , Wang Shi-Bin , Li Xue-Li , Huang Zhuo-Hui , Tan Wen-Yan , Lin Hai-Cheng , Hou Cai-Lan , Jia Fu-Jun
Published: July 2020

Background: Sleep is vital for maintaining individual’s physical and mental health. Prior studies have reported close relationships between sleep duration and chronic diseases. However, in China, the prevalence of irregular sleep duration and the associations between sleep duration and chronic conditions still merit studying in Guangdong province. This study aimed at examining the relationship between sleep duration and multiple dimensions of sociodemographic characteristics, mental health and chronic diseases in Guangdong province in China, with a large population-based data of individuals aged from 18 to 85 years old conducted in Guangdong province.Methods: Multistage stratified cluster sampling was applied for this study. 13,768 participants from Guangdong province were interviewed with standardized assessment tools. Basic socio-demographic information, mental health and chronic diseases information were collected. Self-reported sleep duration was classified as three types: short (<7h), normative (7-8h) and long (>8h). Results: The mean sleep duration was 6.75±1.11h. Short sleepers had a higher prevalence of chronic diseases, including anemia (6.2%, P=0.024), gout (2.8%, P=0.010), hyperlipidemia (3.9%, P=0.003) and low back pain (5.6%, P=0.020) than other types of sleeper. Multinomial logistic regression analysis revealed that short sleepers were more likely to have low income level, have depressive symptoms, be ex- or current drinkers and be overweight. Anemia, hyperlipidemia and low back pain were all risk factors for short sleep, while malignant tumor was risky for long sleep. Conclusions: Low income level, drinking status, being overweight, and chronic conditions may be associated with abnormal sleep duration in Guangdong province general population. Short sleepers have a higher risk of suffering from anemia, hyperlipidemia, and low back pain, while long sleepers are more likely to have malignant tumor. Health professionals should value the sleep patterns in general health care and attach importance to conduct further epidemiologic surveys to explore the relationship between sleep duration and health.
Self-esteem, Social support and coping Strategies of left-behind Children in Rural China, and the intermediary role of subjective support
Authors: Cui Shu , Cheng Fangshuo , Zhang Ling , Zhang Chao , Yuan Qiuyu , Huang Cui , Zhang Kai , Zhou Xiaoqin
Published: July 2020

Background
Negative coping strategies and behavioral problems are common among Chinese left-behind children, which are related to a variety of negative consequences. At this stage of development, the relevant factors of coping strategies need to be further studied, in which social support and self-esteem are worthy of our attention. The aim of this study is to detected the self-esteem, social support, and coping strategy of left-behind children (LBC) in rural China.
Methods
322 children from 3 schools in China participated in this study, including 236 LBC and 86 non-left-behind children (NLBC) to assess self-esteem, social support and coping strategies.
Results
The LBC group had lower self-esteem score and lower total social support (subjective support, objective support and support-seeking behavior) than the NLBC group. In terms of coping strategies, the LBC group was lower than the NLBC group in problem-solving and rationalization. The self-esteem score in LBC was significant positive associated with the subjective support score, objective support score, problem-solving and help-seeking score. Based on the SES score, the LBC group was divided into low, moderate and high self-esteem groups. There were significant differences in the total scores of social support problem solving and seeking help between the low self-esteem group and the high self-esteem group. In addition, our study found that subjective support plays an intermediary role between self-esteem and problem-solving in LBC group, while the intermediary role of objective support is not obvious.
Conclusions
These results of this study indicate that providing more subjective support to LBC can reduce the negative consequences of low self-esteem and improve the tendency and effectiveness of problem-solving.
Combined Surgical And Medical Treatment For Periprosthetic Femoral Fractures Over A Stable Stem (Vancouver Type B1 And C): A Proposal Of A Therapeutic Algorithm To Reduce The Risk Of Nonunion.
Authors: Mondanelli Nicola , Colasanti Giovanni Battista , Cataldi Carlo , Moreschini Fabio , Bottai Vanna , Giannotti Stefano
Published: July 2020

Background: There is lack of consensus regarding best operative fixation strategy for periprosthetic femoral fractures (PFFs) around a stable stem. Based on our experience in the treatment of nonunions after PFFs and other challenging cases and on Literature, we propose an algorithm that can guide in choosing the ideal surgical technique even for first-time PFFs with a stable stem.Methods: We retrospectively reviewed data on patients who failed to heal after a surgically treated Vancouver type B1 or C PFF. All patients were treated with locking plate, double structural allograft and autologous bone marrow concentrate (BMC) over a platelet-rich plasma (PRP)-based membrane at fracture site. All patients were also pharmacologically treated with Teriparatide in the postoperative period. We studied patients with radiograms, histological evaluation of the nonunion area, and phosphocalcic metabolism. Patients were assessed subjectively, clinically and radiographically until healing and then annually.Results: All nonunions healed over a six months period, and functional recovery appeared to be good. Retrospective evaluation of the proposed algorithm showed that none of the patients met biological or mechanical criteria such as to make valid the treatment with locking plate alone.Conclusion: Mechanical factors are not the only issues that should be taken into account when choosing the surgical approach to PFFs over a stable stem. Systemic and local biological conditions are factors that should drive to a rigid fixation with absolute stability (using a plate and structural allograft) plus local biological support (structural allograft and autologous BMC in a PRP-based scaffold) and systemic anabolic treatment (Teriparatide) in the first instance. A therapeutic algorithm is proposed, given the prosthetic stem to be stable, taking into account mechanical and biological criteria.
Pain at Rest as a Predictive Factor of Chronic Pain Related to Central Sensitization in Patients With Hip Osteoarthritis
Authors: Ohashi Yoshihisa , Fukushima Kensuke , Inoue Gen , Uchida Kentaro , Koyama Tomohisa , Tsuchiya Maho , Uchiyama Katsufumi , Takahira Naonobu , Takaso Masashi
Published: July 2020

Background
Central sensitization (CS) has been identified as a factor that induces chronic pain in patients with osteoarthritis (OA). Although there are some reports of CS in knee OA, studies on CS in hip OA are lacking. We aimed to evaluate chronic pain related to CS in patients with hip OA using the CS Inventory (CSI). Additionally, we aimed to clarify the characteristics of patients with pain related to CS.
Methods
A total of 100 patients scheduled to undergo total hip arthroplasty (THA) for hip OA were retrospectively reviewed. We investigated the CSI score as an assessment of the extent to which the patients had pain related to CS. Additionally, we assessed the relationships between the CSI score and clinical factors, including age, duration of pain, degree of pain at rest and on activity, by using the visual analogue scale (VAS) and the Harris Hip Score.
Results
The mean CSI score was 19.54 ± 11.25 points. Twenty-one percent of the patients with a score of ≥ 30 were diagnosed as having chronic pain related to CS. The CSI score correlated significantly only with the VAS pain score at rest (r = 0.348, P < 0.001). Fifteen patients were diagnosed with CS syndromes (CSSs) in the assessment of CSI Part B. The mean CSI score was significantly higher in patients diagnosed with CSSs (30.00 ± 12.50) than in patients without a CSS (17.70 ± 10.00; P < 0.001).
Conclusion
Twenty-one percent of the patients scheduled to undergo THA for hip OA were diagnosed with chronic pain related to CS, which might influence the clinical results after THA. As the VAS pain score at rest was significantly correlated with the CSI score, pain at rest might be a predictive factor of chronic pain related to CS in patients with hip OA.
GPs and Pharma Reps: Why Are We So Ambivalent? Crossing perspectives from sociology, psychology and general practice toward a qualitative study in France
Authors: BARBAROUX Adriaan , Pourrat Isabelle , FERONI Isabelle , Bouchez Tiphanie
Published: July 2020

Background: Receiving a gift from pharma reps or meeting them is correlated with an amount of bigger, more expensive and sometimes less rational prescriptions. French General Practitioners (GPs) tend to express an unfavorable opinion towards the pharmaceutical industry; they however adopt rather favorable behavior with pharmaceutical representatives. Yet no study has sought to understand the reasons for this discrepancy. The aim of this study was exploratory: why do some general practitioners receive pharmaceutical representatives when they express an unfavorable opinion regarding the pharmaceutical industry?Method: Qualitative descriptive study by semi-structured face to face interviews with French GPs of the south-east of France. A general inductive analysis was carried out. Data were analysed by researchers from different disciplines (psychology, sociology and general practice).Results: Ten GPs were interviewed for an average time of 50 minutes. The analysis yield to three forces competing to keep meeting pharmaceutical representatives despite unfavorable opinions towards it: practical reasons such as a substitute for continuous training; social and cultural reasons such as propriety toward representatives; psychological mechanisms such as cognitive dissonance and hidden curriculum. Cognitive dissonance is a well-supported social-psychology theory explaining how it is possible to maintain a behavior despite an unfavorable opinion. Since meeting pharma reps is implemented during traineeship, it could be considered as a part of the hidden curriculum. The strengths of this work are the confrontation of medicine, social psychology and sociology with the original approach of the interpretative phenomenological approach.Discussion: The GPs/representative relationship is complex, involving psychological mechanisms which are unknown to the medical profession. GPs use reps as a convenient continuous education tool furthermore in a private practice setting in which GPs feel they lack time. Lifting the veil of individual ambivalence raises questions which are more social and political than individual.
High in-hospital mortality due to COVID-19 in a community hospital in Spain: a prospective observational study
Authors: Trullàs Joan Carles , Ruiz Eva , Weisweiler Clara , Badosa Gemma , Serra Alba , Briceño Hugo , Soler Sílvia , Bisbe Josep
Published: July 2020

Background To describe the clinical characteristics and outcome of patients with COVID-19 in a community hospital in SpainMethods Prospective, single-centre case series of the first 100 consecutive hospitalized patients with COVID-19 at a community hospital in Spain, from March 16 to April 20, 2020. Demographics, comorbidities, clinical presentation, radiologic and laboratory findings, treatment and clinical outcome were collected.Results Of the 100 patients included in the study, the median age (IQR; range) was 75 years (20; 28–96) and 52% were men. The most common comorbidities were hypertension (63%), diabetes (22%) and cardiovascular diseases (28%). The most common symptoms were fever (80%), cough (69%), fatigue (59%) and dyspnea (52%) and 64% had respiratory insufficiency. Bilateral interstitial infiltrates (65/100, 65%) and bilateral vertical “B-kerley” lines (38/46, 82.6%) were the most common imaging manifestations in chest radiographs and lung ultrasound, respectively. All patients received supplementary oxygen, 69 (69%) received medical treatment (the most common regimen being hydroxychloroquine plus azithromycin in 66 patients) and 12% were treated with glucocorticoids. During hospitalization, 26 patients (26%) died, 10 (10%) were transferred to ICU and 64 (64%) were discharged at home. Mortality or ICU admission was more frequent in advanced age and with comorbidities.Conclusions This case series provides clinical characteristics and outcome of consecutively hospitalized patients with COVID-19 admitted to a community hospital in Spain. The majority were old patients, with comorbidities and in-hospital mortality was high (26%).
Pattern of Crimean-Congo hemorrhagic fever related high risk behaviors among Iranian butchers and its relation to perceived self-efficacy
Authors: Adham Davoud , Abazari Malek , Moradi-Asl Eslam , Abbasi-Ghahramanloo Abbas
Published: July 2020

Background
Crimean-Congo hemorrhagic fever (CCHF) is highly fatal to humans and an acute viral disease. The CCHF disease has been reported in occupations such as butchers, slaughterhouse butchers and workers. The aim of this study was to investigate the pattern of CCHF related high risk behaviors among butchers and determine the effects of perceived self-efficacy of the participants on their membership in latent classes.
Methods
The participants of this cross-sectional study were recruited from all the meat distribution centers in Ardabil Province in 2019–2020. The LCA approach was used to observe the CCHF related high risk behaviors patterns.
Results
The statistical significance level was assigned at P-value ˂ 0.05 in all the analyses. Three latent classes were identified; namely, 1) low risk (16.1%), 2) high risk (53.6%), and 3) very high risk (30.2%). After adjusting for other possible confounders higher score of perceived self-efficacy significantly decrease the odds of membership in high risk class (OR = 0.74) and very high risk class (OR = 0.62) compared to the low risk class. Also, age (OR = 1.07) and experience (OR = 0.91) associate with very high risk class.
Conclusions
This study revealed the co-occurrence of CCHF related high risk behaviors in the majority of workers in the livestock and meat industry. It is necessary to provide butchers and slaughterhouse workers with general education, force them to use protective equipment and investigate the rate of tick bites in risky occupations.
Revisiting the continuum of resistance theory in the digital age: A comparison of early and delayed respondents to the Norwegian Counties Public Health Survey
Authors: Clarsen Benjamin , Skogen Jens Christoffer , Nilsen Thomas Severinus , Aarø Leif Edvard
Published: July 2020

BackgroundThe continuum of resistance model’s premise is that delayed respondents to a survey are more similar to non-respondents than early respondents are. For decades, survey researchers have applied this model in attempts to evaluate and adjust for non-response bias. Despite a recent resurgence in the model’s popularity, its value has not been assessed in a large online population health survey.MethodsRespondents to the Norwegian Counties Public Health Survey in Hordaland, Norway, were divided into three groups: those who responded within 7 days of the initial email/SMS invitation (wave 1, n = 6950); those who responded after 8 to 14 days and 1 reminder (wave 2, n =4950); and those who responded after 15 or more days and 2 reminders (wave 3, n = 4045). Logistic regression analyses were used to compare respondents’ age, sex and educational level between waves, as well as the prevalence of poor general health, life dissatisfaction, mental distress, chronic health problems, weekly alcohol consumption, monthly binge drinking, daily smoking, physical activity, low social support and receipt of a disability pension.ResultsThe overall response to the survey was 41.5%. Respondents in wave 1 were more likely to be older, female and more highly educated than those in waves 2 and 3. However, there were no substantial differences between waves for any health outcomes, with a maximal prevalence difference of 2.6% for weekly alcohol consumption (wave 1: 21.3%, wave 3: 18.7%).ConclusionsThere appeared to be a mild continuum of resistance for demographic variables. However, this was not reflected in health and related outcomes, which were uniformly similar across waves. The continuum of resistance model is unlikely to be useful to adjust for nonresponse bias in large online surveys of population health.
Construction and description of a constitutive plipastatin mono-producing Bacillus subtilis
Authors: Vahidinasab Maliheh , Lilge Lars , Reinfurt Aline , Pfannstiel Jens , Henkel Marius , Heravi Kambiz Morabbi , Hausmann Rudolf
Published: July 2020

Background Fengycin and plipastatin are potent Bacillus antimicrobial lipopeptide with the prospect to replace conventional antifungal chemicals for controlling plant pathogens. However, the application of these lipopeptides has so far been investigated in a few cases, principally because of their yield in low concentration and unknown regulation of biosynthesis pathways. B. subtilis synthesizes plipastatin by a non-ribosomal peptide synthetase encoded by the ppsABCDE operon. In this study, B. subtilis 3NA (a non-sporulation strain) was engineered to construct an efficient plipastatin mono-producer strain and to gain more insights about bottlenecks of plipastatin production.Results The first step toward the construction of a plipastatin mono-producer was repairing the defective sfp gene in strain 3NA to construct strain BMV9. Production of plipastatin was doubled after repairing the gene expression of the pleiotropic regulator degQ (strain BMV10) compared to BMV9. Moreover, substitution of the plipastatin promoter (Ppps) against the strong constitutive promoter Pveg led to approximately fivefold enhancement of plipastatin production in BMV11 compared to BMV9. Intriguingly, combination of both repaired degQ expression and promoter exchange (Ppps::Pveg) did not increase the plipastatin yield. Surprisingly, deletion of surfactin (srfAA-AD) operon by the retaining the functional comS gene, which is located within srfAB, resulted in the loss of plipastatin production in BMV9 and significantly decreased the plipastatin production of BMV11. We also observed that supplementation of ornithine as a precursor for plipastatin formation caused higher production of plipastatin in mono-producer strains, albeit with a modified pattern of plipastatin composition.Conclusions This study provides evidence that degQ stimulates the native plipastatin production. Surprisingly, it seems that surfactin synthetase or one of its subunits positively regulates plipastatin production by an unknown mechanism. Furthermore, as another conclusion of this study, results point towards ornithine provision being a bottleneck for plipastatin production. Therefore, targeting the ornithine metabolic flux might be a promising strategy to further investigate and enhance plipastatin production.
Analgesic Efficacy of Ultrasound-Guided Paravertebral Block in Patients Undergoing Percutaneous Nephrolithotomy: A Randomised, Controlled Clinical Study
Authors: Yaman Ferda , Tuglu Devrim
Published: July 2020

Background Paravertabral blocks (PVB) are in use to adequately manage pain arising from a variety of operations on the thorax, abdomen or pelvis. PVB is straightforward, efficacious in operations performed. This study was undertaken to evaluate how efficacious ultrasound-guided thoracic paravertebral block is when used in patients undergoing percutaneous nephrolithotomy (PCN).Methods A total of forty-four patients, falling in categories I to III of the American Society of Anesthesiologists, and aged between 18 and 65 years, who were scheduled for PCN, were randomly distributed into two groups. The anaesthetic intervention group (PVB) contained 22 individuals, who were injected at level T8-T9 with 20 mL 0.25% bupivacaine as a single administration. In the control group C, also containing 22 individuals, the intervention was not carried out. The groups were compared after PCN in terms of opioid use, pain score, opioid adverse effects profile and the need for supplemental analgesia.Results Visual analogue scale pain scores whilst at rest or moving were lower at the level of statistical significance in the PVB group compared to controls at 2 and 4 hours post-surgery. At 6 and 8 hours post-surgery, the control group had a lower VAS score when moving, and this result reached statistical significance (p < 0.05). The controls used more opioid relief than the PVB group and had lower scores for satisfaction (p < 0.05).Conclusion Ultrasound-guided PVB using bupivacaine and an in-plane technique provides effective analgesia in PNL. It is associated with high scores on patient satisfaction and minimal complications.Trial registration: ClinicalTrials.gov, NCT04406012. Registered retrospectively, on 27 May 2020.
Dexmedetomidine intravesical instillation reduces postoperative catheter-related bladder discomfort in male patients under general anesthesia: a randomized controlled study
Authors: Chen Hong , Wang Bin , Li Qin , Zhou Juan , Li Rui , Zhang Ye
Published: July 2020

Background The catheter-related bladder discomfort (CRBD) of male patients is a common clinical problem, albeit lacking effective solutions. The present study aimed to investigate whether dexmedetomidine intravesical instillation alleviates the postoperative urinary discomfort in male patients with catheter under general anesthesia.Methods This single-blinded, prospective, randomized study included a total of 167 male patients American Society of Anesthesiologists (ASA) physical status I-II scheduled for surgery under general anesthesia were allocated to two groups: 84 in the dexmedetomidine (Dex) group and 83 in the control group. Dex group patients received intravesical instillation of the drug 0.5 µg/kg and normal saline 20 mL, while the control group received intravesical instillation of 20 mL normal saline. The catheter was clamped for 30 min after intravesical instillation for all patients. Bladder stimulation scales and urethra pain numerical rating scale (NRS) scores were measured at admittance to post-anesthesia care unit (PACU) (T0), intravesical instillation (T1), 30 min (T2), 60 min (T3), 2 h (T4) after intravesical instillation, discharged from PACU (T5), and 6 h (T6) and 24 h (T7) after the operation. Patient satisfaction at discharge from PACU and 24 h post-operation were compared between the two groups.Results Bladder stimulation scales and urethra pain NRS scores after 30 min of dexmedetomidine intravesical instillation to 24 h post-operation were significantly lower than the control group (p < 0.001), and patient satisfaction was higher at discharge from PACU and 24 h post-operation (p < 0.001). No differences were detected in Steward score out of PACU (p = 0.213) and from the time of the end of operation to fully awake (p = 0.417).Conclusion Dex intravesical instillation reduces postoperative urinary discomfort and urethra pain and improves satisfaction in male patients under general anesthesia.Clinical Trial Registration: Chinese Clinical Trial Registry (No. ChiCTR1800016429), date of registration 1st June 2018
Association Between Non-traumatic Vertebral Fractures and Adjacent Discs Degeneration: A Cross-sectional Study and Literature Review
Authors: Takegami Norihiko , Akeda Koji , Murata Koichiro , Yamada Junichi , Sudo Akihiro
Published: July 2020

Background
Previous clinical studies reported that thoracolumbar vertebral fractures (VFs) associated with high energy spine trauma cause adjacent intervertebral disc (IVD) degeneration; however, there has been no study that evaluates the effect of non-traumatic VFs on the progression of adjacent disc degeneration. The purpose of this study was to examine the association between non-traumatic VFs and degenerative changes of adjacent IVDs.
Methods
98 consecutive patients undergoing spinal surgery were included in this study. VFs were semi-quantitatively evaluated by lateral lumbar radiography. The degree of IVD degeneration was evaluated by MRI and classified into two groups (early and advanced). Intradiscal vacuum phenomena (VPs) were evaluated by computed tomography. Adjacent IVDs were categorized according to the locations of VFs (superior, inferior, and bilateral). Associations between the presence of VFs and the extent of IVD degeneration or the presence of VPs were statistically analyzed.
Results
IVDs adjacent to VFs were identified in 115 IVDs (31.1% of total; superior: 11.4%, bilateral: 8.6%, inferior: 11.1%). The presence of VFs was significantly associated with MRI grades of adjacent IVD degeneration (P < 0.01) and the prevalence of VPs within adjacent IVDs (P < 0.01). From logistic regression analysis, age, disc level, and VFs were independent related factors for disc degeneration (P < 0.05).
Conclusion
This study showed that VFs were an independent related factor for adjacent disc degeneration and occurrence of intradiscal VPs. VFs may affect the micro-environment of adjacent IVDs, leading to disc degeneration and disc rupture.
Comparison of chest drainage tube types (24Fr silastic vs. thoracic catheter) after lung resection
Authors: Hato Tai , Yamaguchi Masatoshi , Kashimada Hiroaki , Sugiyama Ato , Inoue Yoshiaki , Aoki Kohei , Fukuda Hiroaki , Gika Masathoshi , Nakayama Mitsuo
Published: July 2020

Background: Silastic drains (SDs) are widely used for postoperative chest drainage. We performed a direct comparison of SDs and conventional single-lumen thoracic catheters (TCs) with similar sizes.Methods: We performed a historically controlled retrospective study. SDs (24 Fr in size) were used for postoperative drainage from September 2017 to May 2018, and TCs (24 or 28Fr) were used from June 2018 to March 2019. Drainage tubes were maintained with a water seal alone. A comparison was performed of the volume and the speed of fluid until 48 hrs after surgery, the undrained area on chest X-ray, expansion of subcutaneous emphysema, and the duration of drainage.Results: One hundred fifty-eight patients with SDs and one hundred fifty-five patients with TCs were included. The patient characteristics were equivalent between the groups. The median length of drainage was two days for both groups. The fluid drainage speed was similar between the groups. While the incidence of expansion of subcutaneous emphysema was equivalent for both groups, reinsertion of drainage tubes was more frequent in the SD group due to insufficient air drainage.Conclusions: SDs and TCs have almost equivalent drainage performances. For patients with a risk of massive air leakage, SDs should be avoided.
Comparison of the clinical manifestations and cement distribution after percutaneous vertebroplasty between thoracolumbar Kümmell’s disease and OVCFs
Authors: Wang Cheng-Liang , Chen Ji-Bin , Li Te
Published: July 2020

Background：Kümmell's disease is a chronic, non-healing osteoporotic vertebral compression fractures (OVCFs), which is associated with ischemic necrosis and vertebral pseudarthrosis. The purpose of this study was to compare the therapeutic effect and distribution characteristics of bone cement in the percutaneous vertebroplasty (PVP) treatment between thoracolumbar Kümmell's diseases and OVCFs.Methods: A total of 70 patients with Kümmell ’s disease (K group) or OVCFs (O group) who underwent PVP surgery from February 2016 to February 2018 were included in this study. The follow-up time was 24-48 months. The course of disease was significantly longer in the K group than in the O group (P=0.000). Most cases in the K group had no history of trauma, while most cases in the O group had a history of falls (P=0.001). The vertebral compression rate and degree of osteoporosis were more serious in the K group than in the O group (P<0.05, respectively). Distribution pattern, volume and leakage rate of bone cement, operation time, VAS score, ODI, correction rates of vertebral compression and kyphosis, re-fracture rate of adjacent vertebrae between the two groups were compared to assess clinical effect.Results: The amount of bone cement injected was significantly higher in the K group than in the O group (P=0.025). The cement distribution pattern of local solid lump was dominant in the K group (65.71%), while intercalation with trabeculae was dominant in the O group (74.29%) (P<0.001). VAS and ODI were significantly lower both in the two groups at the 1st day, 1st year and 2nd years after surgery than before surgery (all P<0.05), but significantly lower in the K group than in the O group at each time point after surgery (all P<0.05). The correction rates of kyphosis and vertebral compression in both groups were significantly improved (P<0.05, respectively) and gradually lost with time (P<0.05, respectively). The correction rates of kyphosis and vertebral compression were significantly higher in the K group than in the O group at each time point after surgery (all P<0.05).Conclusion: Kümmell's disease has a higher degree of disease progression and osteoporosis than OVCFs. PVP can better restore partial vertebral height and correct kyphosis in the treatment of Kümmell's disease, while can better alleviate pain and improve ODI in the treatment of OVCFs.