bluuebunny/crossref_metadata_2025 huggingface dataset:
Skeletal Muscle Involvement in Wilson Disease: Clinical and Magnetic Resonance Imaging (MRI) Observations in 2 Families
Authors: Bhoi Sanjeev Kumar , Naik Suprava , Jha Menka , Mishra Biswamohan , Pradhan Nikhilesh
Published: September 2020

Objective:

Skeletal muscle involvement in Wilson disease is rare. Calf muscle pain might be attributed as growing pain in children. We report calf muscle involvement in Wilson disease and describe the magnetic resonance imaging (MRI) findings of leg, differential diagnosis with literature review.

Patients and Methods:

Our observations describe calf muscle MRI abnormality in 5 cases of Wilson disease from 2 families. The clinical presentations were neurologic in 3, hepatic in 1, and asymptomatic in 1 patient. We systematically describe the clinical characteristics and their calf muscle MRI findings.

Results:

Three patients had bilateral calf pain and intermittent cramps. The pain was of mild to moderate intensity and managed symptomatically. Serum alkaline phosphatase, creatinine phosphokinase, and needle electromyography were normal. Turbo inversion recovery magnitude sequence MRI of calf muscle revealed hyperintensity in bilateral gastrocnemii muscles. These muscles appear hyperintense in diffusion-weighted imaging.

Conclusion:

The calf muscle involvement could be attributed to muscle edema due to copper-induced muscle toxicity mediated by inhibition of Na+/K+-ATPase on cellular membranes of fast-twitch gastrocnemii muscles which contain predominant type II myofiber. In Wilson disease patients with calf pain or cramps, muscle MRI may show nonspecific gastrocnemius hyperintensity. Further evaluation may give insight into its pathophysiology.
Making Ventilator Associated Pneumonia Rate a Meaningful Quality Marker
Authors: Keneally Ryan J. , Peterson Thomas J. , Benjamin John R. , Hawkins Katrina , Davison Danielle
Published: September 2020

Introduction:

Ventilator associated pneumonia (VAP) rate has been tracked as a comparable quality measure but there is significant variation between types of ICUs. We sought to understand variability and improve its utility as a marker of quality.

Methods:

The National Trauma Database was surveyed to identify risk factors for VAP. Logistic regression, χ2, Student’s T-test or Mann-Whitney U test were used.

Results:

Risk factors associated with developing VAP were: injury severity score (ISS) (OR 1.03, 95% CI 1.03 -1.04), prehospital assisted respiration (PHAR) (OR 1.10, 1.03 -1.17), thoracic injuries (OR 2.28, 1.69-3.08), diabetes (OR 1.32, 1.20 -1.46), male gender (OR 1.38, 1.28 -1.60), care at a teaching hospital (OR 1.40, 1.29 -1.47) and unplanned intubation (OR 2.76, 2.52-3.03).

Discussion:

ISS, PHAR, diabetes, male gender, care at a teaching hospital and unplanned intubation are risk factors for the development of VAP. These factors should be accounted for in order to make VAP an effective quality marker.
The Affordable Care Act and emergency department use by low acuity patients in a US hospital
Authors: Keyes Daniel , Valiuddin Hisham , Mouzaihem Hassan , Stone Patrick , Vidosh Jaqueline
Published: September 2020

Background

The Affordable Care Act (ACA) is one of the biggest healthcare reforms in US history. A key issue is the ACAs effect on low acuity, potentially primary care patients. This study evaluates the effect of the ACA on low acuity patients seen in the emergency department (ED).

Methods

This is an age-period-cohort analysis for a community hospital ED in Michigan, from 2009 to 2015. Patients were stratified by age, year seen, emergency severity index (ESI) and insurance status. Data were compared between before and after ACA along with descriptive statistics, Chi-square and Student t-tests. The primary outcome was the change in ED usage by low acuity. Patients > 65 were used as a temporal control.

Results

305,350 ED visits were analyzed. ED visits with ESI 4/5 increased from 11.9% to 14.8%. Patients < 19 years increased from 25.5% to 34.3% (p = .0026). Ages 19–25 increased from 16.3% to 19.7% (p = 0.0515). Ages 26–64 increased from 11% to 14.9% (p = 0.0129). Ages > 65 increased from 5.1% to 6.5%. Patients < 65 showed a decreased uninsured rate from 12.30% to 6.28% (p < 0.0001). Comparatively, for age > 65: uninsured rate remained the same 0.46% to 0.49%.

Conclusion

Low acuity ED visits increased with the ACA reform in conjunction with a more insured population.
Estimating prevalence and incidence of sexually transmitted infections among South African women: Implications of combined impacts of risk factors
Authors: Wand Handan , Reddy Tarylee , Dassaye Reshmi , Moodley Jothi , Naidoo Sarita , Ramjee Gita
Published: September 2020

In addition to being the epicentre of the HIV epidemic, South Africa also has the highest burden of sexually transmitted infections (STIs) in the world. Therefore, understanding the most influential risk factors of STIs is a research priority. Using the data from 9948 women who resided in KwaZulu Natal, South Africa, we estimated the population attributable risk to quantify the combined impacts of the most influential factors on STI diagnosis. Overall STI prevalence was 20%, and STI incidence was 15 per 100 person-years. Four factors: age at sexual debut, single/not cohabiting, two or more sex partners and parity <3 were identified as the most influential risk factors for STI prevalence and incidence rates. However, these factors collectively associated with only 51% and 53% of the excess STI prevalence and incidence rates, respectively. These relatively modest impacts provide empirical evidence for the significant impacts of unmeasured factors on STIs. Culturally and socially appropriate prevention programs may be more effective to target those at highest risk of STIs.
16th International Congress on Antiphospholipid Antibodies Task Force Report on Obstetric Antiphospholipid Syndrome
Authors: de Jesús Guilherme R , Benson Ashley E , Chighizola Cecilia B , Sciascia Savino , Branch David W
Published: September 2020

Obstetric antiphospholipid syndrome (APS) remains a clinical challenge for practitioners, with several controversial points that have not been answered so far. This Obstetric APS Task Force met on the 16th International Congress on Antiphospholipid Antibodies in Manchester, England, to discuss about treatment, diagnostic and clinical aspects of the disease. This report will address evidence-based medicine related to obstetric APS, including limitations on our current management, the relationship between antibodies against domain 1 of β2GPI and obstetric morbidity, hydroxychloroquine use in patients with obstetric APS and factors associated with thrombosis after obstetric APS. Finally, future directions for better understanding this complex condition are also reported by the Task Force coordinators.
A frog in boiling water? A qualitative analysis of psychiatrists’ use of metaphor in relation to psychological trauma
Authors: Isobel Sophie , McCloughen Andrea , Foster Kim
Published: September 2020

Objective:

Tensions about the definition, diagnostics, and role of psychological trauma in psychiatry are long-standing. This study sought to explore what metaphor patterns in qualitative interviews may reveal about the beliefs of psychiatrists in relation to trauma.

Method:

A qualitative inquiry using systematic metaphor analysis of 13 in-depth interviews with Australian psychiatrists.

Results:

Three themes were identified: a power struggle between people, trauma, and psychiatry; trauma is not a medical condition; and serving the profession to protect society.

Conclusions:

Metaphors present trauma as a powerful force that people can manage in different ways. Psychiatrists may view trauma as a social rather than medical issue. Psychiatrists experience role pressure associated with trauma including incongruence with risk management expectations of their roles.
Designing Game-Based Writing Projects to Foster Critical Ethical Reasoning in the English Classroom: A Case Study Using Plague Inc: Evolved
Authors: Kelly Matthew
Published: September 2020

Background.

Over the past two decades, scholars in the field of Critical Game Studies have discussed ethics in relation to the self-reflexive practices that players undertake when navigating in-game scenarios. Similarly, researchers who are interested in the pedagogical value of game-based learning activities also emphasize self-reflexive player practices when discussing the benefits of incorporating video games into traditional educational environments.

Problem.

Despite the shared interest in player self-reflexivity within ethics- and education-focused scholarship, qualitative research that explores the ability to design learning experiences around video games’ ethical dimensions is still in its emergent stages.

Intervention.

This article bridges the gap between ethics and pedagogy by discussing the author’s experience designing a long-form writing assignment around Plague Inc: Evolved for a college-level English seminar. For this project, students first narrated how they refined personal gameplay strategies over the course of several game sessions. Students then discussed how the logic underlying their in-game strategies could be used to further enhance or refine the rationale they use to navigate complex real-world issues in their daily lives beyond the classroom.

Results.

In undertaking this long-form writing project, students were able to use their self-reflexive gameplay strategies as an outlet for re-thinking how they interpret real-world problems. In doing so, students engaged in a form of ethical inquiry premised upon critical introspection.

Conclusion.

This examination demonstrates how game-based writing assignments can help students reflect upon and revise the ethical reasoning they use to diagnose and solve complex real-world problems.
Parents’ Part C Experiences in Rural Areas: Alignment With Recommended Practices
Authors: Decker Kalli B. , Meldrum Jacie , Vaterlaus J. Mitchell , Foster Tricia D.
Published: September 2020

The Division for Early Childhood (DEC) clearly outlined recommended practices for the provision of Part C services. However, there may be challenges in rural areas associated with services aligning with these recommended practices. Therefore, this study focuses on how families experience Part C services and the extent to which services align with specific areas the DEC recommended practices in the large, rural state of Montana. We interviewed parents ( N = 30) about their children’s Part C services. Deductive qualitative content analysis was used. Parents’ reports suggest that while some aspects of their Part C services align with specific recommended practices, others do not. There were some meaningful differences regarding alignment with these recommended practices depending on type of provider being described. The environments in which services take place are discussed, as these may influence aspects of collaboration and building family capacity.
Energy efficiency of nonlinear domain decomposition methods
Authors: Klawonn Axel , Lanser Martin , Rheinbach Oliver , Wellein Gerhard , Wittmann Markus
Published: September 2020

A nonlinear domain decomposition (DD) solver is considered with respect to improved energy efficiency. In this method, nonlinear problems are solved using Newton’s method on the subdomains in parallel and in asynchronous iterations. The method is compared to the more standard Newton-Krylov approach, where a linear domain decomposition solver is applied to the overall nonlinear problem after linearization using Newton’s method. It is found that in the nonlinear domain decomposition method, making use of the asynchronicity, some processor cores can be set to sleep to save energy and to allow better use of the power and thermal budget. Energy savings on average for each socket up to 77% (due to the RAPL hardware counters) are observed compared to the more traditional Newton-Krylov approach, which is synchronous by design, using up to 5120 Intel Broadwell (Xeon E5-2630v4) cores. The total time to solution is not affected. On the contrary, remaining cores of the same processor may be able to go to turbo mode, thus reducing the total time to solution slightly. Last, we consider the same strategy for the ASPIN (Additive Schwarz Preconditioned Inexact Newton) nonlinear domain decomposition method and observe a similar potential to save energy.
Burning Questions in the Oncofertility Counseling of Young Breast Cancer Patients
Authors: Arecco Luca , Perachino Marta , Damassi Alessandra , Latocca Maria Maddalena , Soldato Davide , Vallome Giacomo , Parisi Francesca , Razeti Maria Grazia , Solinas Cinzia , Tagliamento Marco , Spinaci Stefano , Massarotti Claudia , Lambertini Matteo
Published: September 2020

The improved prognosis of breast cancer patients makes survivorship issues an area of crucial importance. In this regard, an increased attention is needed toward the development of potential anticancer treatment-related long-term side-effects, including gonadal failure and infertility in young women. Therefore, fertility preservation and family planning are crucial issues to be addressed in all young women of reproductive age with newly diagnosed cancer. Despite a growing availability of data on the efficacy and safety of fertility preservation options and the fact that conceiving after prior history of breast cancer has become more accepted over time, there are still several gray zones in this field so that many physicians remain uncomfortable to deal with these topics. The purpose of this review is to answer some of the most controversial questions frequently asked by patients during their oncofertility counseling, in order to provide a detailed and up-to-date overview on the evidence available in this field to physicians involved in the care of young women with breast cancer.
Conceptualizing and assessing norm strength in International Relations
Authors: Ben-Josef Hirsch Michal , Dixon Jennifer M.
Published: September 2020

What constitutes a strong or a weak norm? Scholars often refer to strong or weak, or strengthening or weakening norms, yet there are widespread inconsistencies in terminology and no agreed-upon measures. This has hindered the accumulation of knowledge and made it difficult to test competing hypotheses about norm development and contestation. To address these conceptual problems and their analytical implications, this article conceptualizes norm strength as the extent of collective expectations related to a principled idea and proposes two indicators to assess a norm’s strength: the level of international concordance with a principled idea, and the degree of international institutionalization of a principled idea. The article illustrates the applicability and utility of the proposed conceptualization by evaluating the strengths of two transitional justice norms: the norm of legal accountability and the norm of truth-seeking. In so doing, the article resolves empirical disputes over the origins and status of these norms. In particular, the analysis reveals that while legal accountability became a norm in the early 1990s and is today a strong norm, truth-seeking emerged later and remains a weak norm. More generally, the proposed framework should advance existing debates about norm contestation, localization, violation, and erosion.
Gender differences in attitudes towards a school-based smoking prevention intervention
Authors: Lund Lisbeth , Lauemøller Stine G. , Kjeld Simone G. , Andersen Anette , Bast Lotus S.
Published: September 2020

Aims:

There are well-known gender differences in smoking, including the pattern of use and the effectiveness of smoking prevention programs. However, little is known about the differences between boys and girls in their attitudes towards smoking prevention interventions. This study explores gender differences in attitudes towards a school-based intervention to prevent smoking.

Methods:

We used data from the X:IT II intervention study conducted in 46 Danish elementary schools.

Results:

Compared to boys, girls were more positive towards smoke-free school time, both concerning rules for teachers smoking (odds ratio (OR) = 1.69, 95% confidence interval (CI): 1.35–2.12) and for students smoking (OR = 1.41, 95% CI: 1.13–1.76). No difference was observed in students signing the smoke-free agreement. However, a larger proportion of girls reported that the agreement was a good occasion to talk about smoking with their parents (OR = 1.36, 95% CI: 1.13–1.76). Girls were also more positive towards the smoke-free curriculum (OR = 1.52, 95% CI: 1.19–1.94).

Conclusions:

This study showed that girls were, overall, more positive towards the components of the smoking preventive intervention. Our findings highlight the importance of considering differences in intervention preferences for boys and girls in future health prevention initiatives.
#qualitytime: Aspiring to temporal autonomy in harried leisure
Authors: Pentzold Christian , Konieczko Sebastian , Osterloh Florian , Plöger Ann-Christin
Published: September 2020

This article examines the representation and use of quality time. It brings together an analysis of images tagged and shared under the hashtag #qualitytime on Instagram with an investigation into the trope’s resonance in everyday life. In the interviews and profiles studied in this article, people used the term to indicate and display instances of self-determined solitude or of fulfilling conviviality in which mobile phones and social media were conspicuously absent. At the same time, the notion required them to carve out and valorize moments of purpose, a goal that was often unattainable. Use of the hashtag was thus accompanied by both the opportunity and the obligation to aspire to temporary retreats in which free time was employed for meaningful activity. This means that the somewhat pretentious keyword signifies the ideal of temporal autonomy while also pointing to the slim chance of finding uncompromised spells of time within harried leisure.
Doing time, the smart way? Temporalities of the smart prison
Authors: Kaun Anne , Stiernstedt Fredrik
Published: September 2020

The article engages with the notion of the smart prison to develop an understanding of emerging temporalities of digital technologies. The prison context serves here as a magnifying glass that makes certain contradictions and paradoxes of the digital imperative visible. Starting with a brief discussion of smart technology discourses, the article explores the temporalities of real-timeness, prediction and pre-emption that are entangled with digital technologies. Analysing the Spartan RFID tracking tool, the use of algorithms in prison administration and a mobile phone application used in Swedish probation, the article identifies a desynchronization between the temporalities of the incarcerated individuals’ lived experience and the (imagined) temporalities of the smart prison. The findings point to developments that are relevant for the smart, digital society beyond the prison walls.
Zofenopril versus ramipril in the early phase of acute myocardial infarction with systolic dysfunction: A retrospective study
Authors: Liu Xiaoyang , Xu Xiaoling , Chu Yi , Ren Yingang , Wang Liping
Published: September 2020

Introduction:

Prognostic benefits of zofenopril over ramipril in the early phase of acute myocardial infarction have been reported by the SMILE study, but these benefits have not been tested in clinical practice in the Chinese population. The objective of this study was to compare the effectiveness and safety of zofenopril plus aspirin against ramipril plus aspirin in patients with acute myocardial infarction.

Methods:

Patients in the early phase of acute myocardial infarction received 30 mg zofenopril (ZF cohort, N=191) or 5 mg ramipril (RP cohort, N=256) b.i.d. plus 100 mg aspirin/day. Data regarding hospitalisation for cardiovascular disease, non-cardiovascular events and mortality were collected and analysed.

Results:

During 1 year of treatment, 47 (25%) patients in the ZF cohort and 97 (40%) patients in the RP cohort were hospitalised due to cardiovascular disease ( p=0.002), and three (2%) patients in the ZF cohort and 14 (6%) patients in the RP cohort died ( p=0.043). Lower incidences of dry cough ( p=0.001) and anaemia ( p=0.049) were reported in the ZF cohort.

Conclusions:

The study recommends zofenopril with 100 mg aspirin for a longer period in patients with acute myocardial infarction with systolic dysfunction.
Parent–Child Interaction Therapy-Callous Unemotional Adaptation for a Preschool Boy With Conduct Problems
Authors: Agazzi Heather , Knap Kimberly , Kimonis Eva R.
Published: September 2020

Young children with conduct problems (CPs) and elevated callous unemotional (CU) traits (CP+CU) show more severe, stable, and aggressive CPs relative to children with CP traits alone. Children with CP+CU tend to benefit less from traditional treatment modalities for child CPs that rely on social attention and punishments compared with children with CP-alone, but respond well to reward-based behavioral management strategies. Emerging research suggests that the Parent–Child Interaction Therapy-Callous Unemotional adaptation (PCIT-CU) may be a compelling mechanistically targeted intervention for young children with CP+CU. This case study presents the treatment of a 4½-year-old boy with oppositional defiant disorder (ODD), attention-deficit/hyperactivity disorder–combined presentation (ADHD-C), and CU traits using PCIT-CU. Findings from this case study include (a) improvement in CP that was maintained at 4-month follow-up, (b) reduced parent ratings of CU traits over the course of treatment, (c) reduced negative parenting practices, and (d) preliminary support for adapting parent behavioral management training interventions for young children with CP+CU and comorbid ADHD-C.
CO2 Laser Debridement and Negative Pressure Wound Therapy With Endoscopic Support for Treatment of Sinus Wound at the Ischial Tuberosity: Case Report
Authors: Tang JiaJun , Tao Guilu , Liu Yingkai , Ma Xian , Aobuliaximu Yakupu , Lu Shuliang
Published: September 2020

The sinus tract of the ischial tuberosity is often caused by pressure injury. It has the characteristics of difficult treatment and high cost, which increases the anxiety of patients and reduces the quality of life of patients. This case report is to describe an effective method to treat sinus wound at the ischial tuberosity. A 53-year-old male suffered pressure ulcer with sinus wound at the left ischial tuberosity due to inadequate walking and sedentary activity. On the basis of pressure relief and immobilization, the patient was treated with CO2 laser debridement and negative pressure wound therapy under endoscope support 3 times, the deep of the sinus wound was completely closed, and then the residual superficial wound was treated by skin grafting. Follow-up of 1 year after healing showed no recurrence of wound.
Educational modules and research surveys on critical cybersecurity topics
Authors: Wang Lixin , Yang Jianhua , Wan Peng-Jun
Published: September 2020

Cybersecurity comprised all the technologies and practices that protect data as well as computer and network systems. In this article, we develop four course modules on critical cybersecurity topics that can be adopted in college-level cybersecurity courses in which these topics are covered. Our goal for developing these course modules with the hands-on labs is to increase students’ understanding and hands-on experiences on these critical topics that support cyber skills development for college students. The hands-on labs are designed to enhance students’ engagement and provide them hands-on experiences with real-world cyber activities to augment their cyber education of both foundational and advanced skills. We also conduct research surveys on the most-recent significant research in these critical cybersecurity fields. These cybersecurity course modules with the labs are also designed to help college/university professors enhance and update their cybersecurity course content, activities, hands-on lab exercises, and pedagogical methods, as well as emphasize the cyber skills to meet today’s pressing cybersecurity education needs for college students. Our proposed cybersecurity modules with hands-on labs will also help building the nation’s cybersecurity workforce.
Generics competition in the Portuguese pharmaceutical market
Authors: Correia Isabel , Armada Luís , Veiga Paula
Published: September 2020

A large number of studies have focussed on the determinants of the entry of generics in the pharmaceuticals market. Most of them focus on the United States market. Much less evidence is found about heavily regulated pharmaceutical markets, such as the Portuguese market. This study uses data from Portugal, for the period 2000–2015. Based on a sample of 50 reimbursable outpatient drugs, that face potential entry of generics, two econometric models were estimated aiming to identify the determinants of entry and penetration of generics. The active substances included were chosen among those that represent the highest financial burden to the National Health System or are the most sold (in volume). To each of those active substances, the most sold pharmaceutical form, dosage, and package size was chosen. Our results suggest that market size is the main determinant of the generics entry. Concerning market penetration, our results show that it is determined by the number of marketed generics, as well as by price differences between brands and generics.
Leadership as a lever for inclusive education in Flanders: A multiple case study using qualitative comparative analysis
Authors: Van Mieghem Aster , Verschueren Karine , Donche Vincent , Struyf Elke
Published: September 2020

Belgium ratified the United Nations Convention on the Rights of Persons with Disabilities in 2009, which implies that an inclusive education (IE) system at all levels should be realized. Consequently, recent legislation in Flanders (Belgium) aims to reduce the current segregated school system, which has caused some resistance from practitioners. This study examines the way in which leadership that promotes IE can reduce this resistance. Leadership is defined in terms of the dimensions put forward by Robinson and Timperley (2007): (a) providing educational direction; (b) ensuring strategic alignment; (c) creating a community that learns how to improve student success; (d) engaging in constructive problem talk; and (e) selecting and developing smart tools that facilitate IE. Based on case study research in 20 schools (10 primary, 10 secondary), a crisp-set qualitative comparative analysis was conducted to identify (combinations of) leadership dimensions associated with the willingness of school team members to include students with special educational needs (SEN) in mainstream schools. The results reveal that schools in which leaders provide educational direction towards a more inclusive school system, and that engage in constructive problem talk and select and develop smart tools in support of IE, are more willing to include students with SEN.
A description of students’ commenting behaviours in an online blogging activity
Authors: Cheng Jiaming , Lei Jing
Published: September 2020

Student-student interaction can benefit learning as well as provide a sense of community in online courses. Blogging is a common approach to provide opportunities for students to communicate with each other. This study used Social Network Analysis to depict commenting behaviour between students in an online graduate-level course. By examining the weekly interaction data, the results revealed how students’ commenting behaviours changed during the semester. Student participation and interaction in the blogging activity was influenced by the various pedagogical elements that were either directly or indirectly related to the blogging activity.
Mental health among Vietnamese urban late adolescents: The association of parenting styles
Authors: La Thu-Thuy Thi , Dinh Hong-Van Thi , Phan Mai-Huong Thi , Do Le-Hang Thi , Nguyen Phuong-Hoa Thi , Nguyen Quynh-Anh Ngoc
Published: September 2020

The aim of this study was to explore the correlation between parental styles and mental problems among Vietnamese high school students. In total, 16.4 percent of 757 eligible participants reported mental difficulties. Findings showed that being female and in grade 12 were risk factors to mental problems while living in Hue city was likely as a protective factor. The father’s warmth reduced the risk of having mental problems among adolescents, while an overprotective mother increased the risk. There was no correlation between authoritarianism of both mother and father and mental difficulties. These results suggest that a parenting program for parents might reduce the risk of mental problems among Vietnamese youth.
The Interaction Effect of Crisis Communication and Social Support on The Emotional Exhaustion of University Employees during the COVID-19 Crisis
Authors: Charoensukmongkol Peerayuth , Phungsoonthorn Tipnuch
Published: September 2020

Although formal communication from an organization’s management is crucial during a crisis to reduce the uncertainties of employee, less is known about the moderating role of social support that could make employees rely less on formal communication to reduce those uncertainties. Grounded in uncertainty reduction theory, this research examines the role of crisis communication on the perceived uncertainties and emotional exhaustion of employees who work at private international universities that have been affected by the COVID-19 crisis. Furthermore, this research explores the moderating effect of social support in terms of supervisor support and coworker support on the association between crisis communication and perceived uncertainties. Questionnaire data were collected from 300 employees from two private international universities in Thailand. Partial least squares structural equation modeling was used for data analysis. The analysis shows that perceived uncertainties mediate the negative association between crisis communication and emotional exhaustion. Moreover, the moderating effect analysis shows that the association between crisis communication and perceived uncertainties is significantly moderated by coworker support, but not by supervisor support. Simple slope analysis also clearly shows that the negative association between crisis communication and perceived uncertainties only presents in employees with a low level of coworker support. For employees with high coworker support, crisis communication does not associate negatively with perceived uncertainties. This research implies that the informal communication that employees obtain from social support could play a compensatory role for their need to rely on formal communication to reduce uncertainties during the crisis.
Skeleton optimization of neuronal morphology based on three-dimensional shape restrictions
Authors: Jiang Siqi , Pan Zhengyu , Feng Zhao , Guan Yue , Ren Miao , Ding Zhangheng , Chen Shangbin , Gong Hui , Luo Qingming , Li Anan
Published: September 2020

Background

Neurons are the basic structural unit of the brain, and their morphology is a key determinant of their classification. The morphology of a neuronal circuit is a fundamental component in neuron modeling. Recently, single-neuron morphologies of the whole brain have been used in many studies. The correctness and completeness of semimanually traced neuronal morphology are credible. However, there are some inaccuracies in semimanual tracing results. The distance between consecutive nodes marked by humans is very long, spanning multiple voxels. On the other hand, the nodes are marked around the centerline of the neuronal fiber, not on the centerline. Although these inaccuracies do not seriously affect the projection patterns that these studies focus on, they reduce the accuracy of the traced neuronal skeletons. These small inaccuracies will introduce deviations into subsequent studies that are based on neuronal morphology files.

Results

We propose a neuronal digital skeleton optimization method to evaluate and make fine adjustments to a digital skeleton after neuron tracing. Provided that the neuronal fiber shape is smooth and continuous, we describe its physical properties according to two shape restrictions. One restriction is designed based on the grayscale image, and the other is designed based on geometry. These two restrictions are designed to finely adjust the digital skeleton points to the neuronal fiber centerline. With this method, we design the three-dimensional shape restriction workflow of neuronal skeleton adjustment computation. The performance of the proposed method has been quantitatively evaluated using synthetic and real neuronal image data. The results show that our method can reduce the difference between the traced neuronal skeleton and the centerline of the neuronal fiber. Furthermore, morphology metrics such as the neuronal fiber length and radius become more precise.

Conclusions

This method can improve the accuracy of a neuronal digital skeleton based on traced results. The greater the accuracy of the digital skeletons that are acquired, the more precise the neuronal morphologies that are analyzed will be.
De novo transcriptome sequencing of Rhododendron molle and identification of genes involved in the biosynthesis of secondary metabolites
Authors: Zhou Guo-Lin , Zhu Ping
Published: September 2020

Background

Rhododendron molle (Ericaceae) is a traditional Chinese medicinal plant, its flower and root have been widely used to treat rheumatism and relieve pain for thousands of years in China. Chemical studies have revealed that R. molle contains abundant secondary metabolites such as terpenoinds, flavonoids and lignans, some of which have exhibited various bioactivities including antioxidant, hypotension and analgesic activity. In spite of immense pharmaceutical importance, the mechanism underlying the biosynthesis of secondary metabolites remains unknown and the genomic information is unavailable.

Results

To gain molecular insight into this plant, especially on the information of pharmaceutically important secondary metabolites including grayanane diterpenoids, we conducted deep transcriptome sequencing for R. molle flower and root using the Illumina Hiseq platform. In total, 100,603 unigenes were generated through de novo assembly with mean length of 778 bp, 57.1% of these unigenes were annotated in public databases and 17,906 of those unigenes showed significant match in the KEGG database. Unigenes involved in the biosynthesis of secondary metabolites were annotated, including the TPSs and CYPs that were potentially responsible for the biosynthesis of grayanoids. Moreover, 3376 transcription factors and 10,828 simple sequence repeats (SSRs) were also identified. Additionally, we further performed differential gene expression (DEG) analysis of the flower and root transcriptome libraries and identified numerous genes that were specifically expressed or up-regulated in flower.

Conclusions

To the best of our knowledge, this is the first time to generate and thoroughly analyze the transcriptome data of both R. molle flower and root. This study provided an important genetic resource which will shed light on elucidating various secondary metabolite biosynthetic pathways in R. molle, especially for those with medicinal value and allow for drug development in this plant.
IMAGINE study protocol of a clinical trial: a multi-center, investigator-blinded, randomized, 36-month, parallel-group to compare the effectiveness of motivational interview in rehabilitation of older stroke survivors
Authors: Gual Neus , Pérez Laura Mónica , Castellano-Tejedor Carmina , Lusilla-Palacios Pilar , Castro Judith , Soto-Bagaria Luís , Coll-Planas Laura , Roqué Marta , Vena Ana Belen , Fontecha Benito , Santiago Jose M. , Lexell Eva Månsson , Chiatti Carlos , Iwarsson Susanne , Inzitari Marco
Published: September 2020

Background

Rehabilitation pathways are crucial to reduce stroke-related disability. Motivational Interviewing (MI), as a person-centered complex intervention, aimed to empower and motivate, and could be a resource to improve rehabilitation outcomes for older stroke survivors. The IMAGINE project aims to assess the impact of MI, as a complement to standard geriatric rehabilitation, on functional improvement at 30 days after admission, compared to standard geriatric rehabilitation alone, in persons admitted to geriatric rehabilitation after a stroke. Secondary objectives include assessing the impact of MI on physical activity and performance, self-efficacy, safety, cost-utility, participants’ experiences and functional status at 3 months.

Methods

We will conduct a multicenter randomized clinical trial in three geriatric rehabilitation hospitals in Spain. Older adults after mild-moderate stroke without previous severe cognitive impairment or disability will be randomized into the control or intervention group (136 per group, total N = 272). The intervention group will receive 4 sessions of MI by trained nurses, including the design of a personalized rehabilitation plan agreed between stroke survivors and nurses based on stroke survivors´ goals, needs, preferences and capabilities. Main outcome will be the Functional Independence Measure (FIM). In-hospital physical activity will be measured through accelerometers and secondary outcomes using validated scales. The study includes a process evaluation and cost-utility analysis.

Discussion

Final results are expected by end of 2020. This study will provide relevant information on the implementation of MI as a rehabilitation reinforcement tool in older stroke survivors. A potential reduction in post-stroke disability and dependence would increase person’s health-related quality of life and well-being and reduce health and social care costs. IMAGINE has the potential to inform practice and policymakers on how to move forward towards shared decision-making and shared responsibilities in the vulnerable population of older stroke survivors.

Trial registration

ClinicalTrials.gov: NCT03434938, registered on January 2018.
Factors associated with self-rated health in a Norwegian population of older people participating in a preventive home visit program: a cross-sectional study
Authors: Fjell Astrid , Cronfalk Seiger Berit , Hermann Monica , Rongve Arvid , Aßmus Jörg , Kvinge Lars , Seiger Åke , Skaug Knut , Boström Anne-Marie
Published: September 2020

Background

Assessing self-rated health by preventive home visits of older people can provide information about the person’s well-being, quality of life and risk of developing illness. The aim of this study was to examine associations between self-rated health and factors related to demographics, lifestyle, health conditions and medical diagnoses by older people participating in a preventive home visit program.

Methods

A cross-sectional study including 233 participants (age 75–79) from three municipalities of Western Norway was conducted. Data were collected through preventive home visits performed by six nurses, using a questionnaire including self-rated health assessment and questions and tests related to demographics (e.g. education and housing), lifestyle (e.g. social activities, alcohol and smoking), health conditions (e.g. sensory impairment, pain and limited by disease) and medical diagnoses. Descriptive and inferential statistics including linear block-wise regression model were applied.

Results

The block-wise regression model showed that the variables Limited by disease and Pain were negatively associated with self-rated health and Use internet was positively associated. The model had a R2 0.432. The variable that contributed to largest change in the model was Limited by disease (R2 Change; 0.297, p-value< 0.001).

Conclusions

In the present study, being limited by disease and pain were strongly associated with poor self-rated health, indicating that these are important factors to assess during a preventive home visit. Also, digital competence (Use internet) was associated with a better self-rated health, suggesting that it could be useful to ask, inform and motivate for the use of digital tools that may compensate for or improve social support, social contact and access to health -related information.
Whole exome sequencing highlights variants in association with Keratoconus in Jordanian families
Authors: Froukh Tawfiq , Hawwari Ammar , Al Zubi Khalid
Published: September 2020

Background

Keratoconus (KC) is usually bilateral, noninflammatory progressive corneal ectasia in which the cornea becomes progressively thin and conical, resulting in myopia, irregular astigmatism, and corneal scarring.

Methods

Eight families characterized by consanguineous marriages and/or multiple keratoconic individuals were examined genetically. Whole exome sequencing was done as trio or quadro per family. The output of the filtration procedure, based on minor allele frequency (MAF) less than 0.01 for homozygous variants and MAF equals 0 for heterozygous variants, is 22 missense variants.

Results

Based on the gene/protein function five candidate variants were highlighted in four families. Two variants were highlighted in one family within the genes MYOF and STX2, and one variant is highlighted in each of the other three families within the genes: COL6A5, ZNF676 and ZNF765.

Conclusion

This study is one of the very rare that highlights genetic variants in association with KC.
Association of pregnancy outcomes in women with type 2 diabetes treated with metformin versus insulin when becoming pregnant
Authors: Lin Shu-Fu , Chang Shang-Hung , Kuo Chang-Fu , Lin Wan-Ting , Chiou Meng-Jiun , Huang Yu-Tung
Published: September 2020

Background

Metformin use in pregnancy is controversial because metformin crosses the placenta and the safety on the fetus has not been well-established. This retrospective study aimed to compare pregnancy outcomes in women with preexisting type 2 diabetes receiving metformin or standard insulin treatment.

Methods

The cohort of this population-based study includes women of age 20–44 years with preexisting type 2 diabetes and singleton pregnancies in Taiwan between 2003 and 2014. Subjects were classified into three mutually exclusive groups according to glucose-lowering treatments received before and after becoming pregnant: insulin group, switching group (metformin to insulin), and metformin group. A generalized estimating equation model adjusted for patient age, duration of type 2 diabetes, hypertension, hyperlipidemia, retinopathy, and aspirin use was used to estimate the adjusted odds ratio (aOR) and 95% confidence interval (CI) of adverse pregnancy outcomes.

Results

A total of 1166 pregnancies were identified in the insulin group (n = 222), the switching group (n = 318) and the metformin group (n = 626). The insulin group and the switching group had similar pregnancy outcomes for both the mother and fetus, including risk of primary cesarean section, pregnancy-related hypertension, preeclampsia, preterm birth (< 37 weeks), very preterm birth (< 32 weeks), low birth weight (< 2500 g), high birth weight (> 4000 g), large for gestational age, and congenital malformations. The metformin group had a lower risk of primary cesarean section (aOR = 0.57; 95% CI, 0.40–0.82) and congenital malformations (aOR, 0.51; 95% CI; 0.27–0.94) and similar risk for the other outcomes as compared with the insulin group.

Conclusions

Metformin therapy was not associated with increased adverse pregnancy outcomes in women with type 2 diabetes as compared with standard insulin therapy.
Maternal oxygen exposure may not change umbilical cord venous partial pressure of oxygen: non-random, paired venous and arterial samples from a randomised controlled trial
Authors: Chuai Yunhai , Jiang Wen , Xu Xiaobin , Wang Aiming , Yao Yuanqing , Chen Lei
Published: September 2020

Background

Despite the widespread use of oxygen (O2) in intrauterine resuscitation, the obstetric scientists’ understanding of O2 therapy is full of contradictions. We tested the hypothesis that higher maternal arterial partial pressure of oxygen (PO2) is associated with higher umbilical cord venous PO2 (UvPO2).

Methods

This is a planned secondary analysis of a randomised controlled trial (RCT), 443 normal women were 1:1 randomly allocated to receive 2 L/min O2 or room air from the onset of second stage to delivery. We reported that maternal 2 L/min O2 exposure cannot affect the umbilical cord arterial pH or the fetal heart rate (FHR) pattern. In 217 non-random samples, we found 2 L/min O2 exposure increased the maternal arterial PO2 to the median 150 mmHg (hemoglobin would be saturated). The primary outcome for this analysis was UvPO2 in these non-random samples.

Results

There were no significant differences between the O2 group (N = 107) and the control group (N = 110) in the UvPO2 (median 30.2, interquartile 25.4–35.2 versus median 28.3, interquartile 23.4–35.3, mmHg, P = 0.379). There were also no significant differences between room air and different percentiles of O2 exposure duration (< 25th, ≧ 25th < 50th, ≧ 50th < 75th, ≧ 75th percentile) in the UvPO2.

Conclusions

Maternal O2 exposure at super-physiological levels (median arterial blood PO2 150 mmHg) in normal labor may not change the UvPO2.

Clinical trial registration

ClinicalTrials.govNCT02221440, first posted in 20 August 2014.
Interconnectivity between molecular subtypes and tumor stage in colorectal cancer
Authors: Coebergh van den Braak R. R. J. , ten Hoorn S. , Sieuwerts A. M. , Tuynman J. B. , Smid M. , Wilting S. M. , Martens J. W. M. , Punt C. J. A. , Foekens J. A. , Medema J. P. , IJzermans J. N. M. , Vermeulen L.
Published: September 2020

Background

There are profound individual differences in clinical outcomes between colorectal cancers (CRCs) presenting with identical stage of disease. Molecular stratification, in conjunction with the traditional TNM staging, is a promising way to predict patient outcomes. We investigated the interconnectivity between tumor stage and tumor biology reflected by the Consensus Molecular Subtypes (CMSs) in CRC, and explored the possible value of these insights in patients with stage II colon cancer.

Methods

We performed a retrospective analysis using clinical records and gene expression profiling in a meta-cohort of 1040 CRC patients. The interconnectivity of tumor biology and disease stage was assessed by investigating the association between CMSs and TNM classification. In order to validate the clinical applicability of our findings we employed a meta-cohort of 197 stage II colon cancers.

Results

CMS4 was significantly more prevalent in advanced stages of disease (stage I 9.8% versus stage IV 38.5%, p < 0.001). The observed differential gene expression between cancer stages is at least partly explained by the biological differences as reflected by CMS subtypes. Gene signatures for stage III-IV and CMS4 were highly correlated (r = 0.77, p < 0.001). CMS4 cancers showed an increased progression rate to more advanced stages (CMS4 compared to CMS2: 1.25, 95% CI: 1.08–1.46). Patients with a CMS4 cancer had worse survival in the high-risk stage II tumors compared to the total stage II cohort (5-year DFS 41.7% versus 100.0%, p = 0.008).

Conclusions

Considerable interconnectivity between tumor biology and tumor stage in CRC exists. This implies that the TNM stage, in addition to the stage of progression, might also reflect distinct biological disease entities. These insights can potentially be utilized to optimize identification of high-risk stage II colon cancers.