bluuebunny/crossref_metadata_2025 huggingface dataset:
Short beam shear damage analysis of GLARE laminates based on digital image correlation and finite element analysis
Authors: Chen Yajun , Yang Jinchuan , Wang Fusheng , Peng Jianshu
Published: November 2021

The short beam shear performance of GLARE 3A-3/2 laminates with adhesive layers was investigated by combining the short beam test and the digital image correlation technique. The failure behavior was further analyzed based on finite element simulation and micro failure morphology. The results show an 8% and 58% difference in the short beam strength and bending displacement at failure of laminates along two orthogonal directions; The damage behavior of laminates is determined by the bottom unidirectional glass fiber reinforced plastic (GFRP) layers. The two typical failure modes are matrix and fiber fracture in the GFRP layer caused by local bending deformation, and interlaminar delamination between GFRP layers; The distribution of surface strain [Formula: see text] indicates the damage initiation and evolution process. The simulation result of the finite element model established in ABAQUS/Explicit shows consistency with digital image correlation analysis, which provides an effective method to predict the damage behavior of specimens with different ply structures.
The Behavioral Agency Model and Innovation Investment: Examining the Combined Effects of CEO and Board Ownership
Authors: Zona Fabio , Zamarian Marco
Published: November 2021

The Behavioral Agency Model (BAM) offers a behavioral account of executive incentives, according to which the perceived threats to CEO wealth, that is, CEO risk bearing, influence a CEO’s propensity to undertake innovation investments. While examining stock options extensively, the extant BAM research devotes relatively scant attention to other forms of incentives, such as stock ownership, that are conducive to one source of risk bearing, that is, employment risk. Furthermore, with an emphasis placed on the CEO, much BAM research neglects the interactive risk preferences of the CEO and the board. This study refines the BAM and empirically explores the countervailing forces exerted by the CEO and board ownership. It elucidates that while CEO ownership exhibits an inverted U-shaped relationship with innovation investment, board ownership weakens that relationship. An exploratory test on a sample of 108 Italian manufacturing firms provides support for the hypothesized effects. The refined BAM sheds further light on executive incentives through a behavioral lens, by elucidating the role of stock ownership and the interactive risk preferences of the CEO and the board.
Prenatal diagnosis of primary congenital glaucoma and histopathological features in a fetal globe with cytochrome p4501B1 mutations
Authors: Rezaei Kanavi Mozhgan , Yazdani Shahin , Elahi Elahe , Mirrahimi Mehraban , Hajizadeh Maryam , Khodaverdi Sepideh , Suri Fatemeh
Published: November 2021

Background/Objectives

This study aims to report the developmental and histopathological features of ocular tissues from an electively aborted human fetus with mutations in cytochrome p4501B1, and thus predisposed to primary congenital glaucoma in comparison to an age-matched healthy fetal globe.

Subjects/Methods

Both eyes of two 17-week gestational aged fetuses, the first with CYP1B1 mutations and the second as healthy control fetus, were studied. Hematoxylin and eosin, Periodic acid–Schiff, Gomori’s trichrome, and Verhoeff–Van Gieson staining protocols in addition to immunohistochemistry staining using anti-cytochrome p4501B1, anti-fibrillin-1, and anti-4-hydroxy-2-nonenal antibodies, as primary antibodies, were performed to assess the effect of the mutations on tissue development, cytochrome p4501B1 protein expression, extracellular matrix structure, and oxidative stress in the developing fetus eye. Quantitative analyses were performed using ImageJ software. Student’s t-test was used for statistical analysis and P-values <0.05 were considered as significant.

Results

Delayed development in ocular tissues, decreased expression of cytochrome p4501B1 protein, irregular extracellular matrix structure, and increased oxidative stress biomarker were evident in the ocular tissues of the fetus with cytochrome p4501B1 mutations as compared to a normal globe from an age-matched fetus.

Conclusion

To the best of our knowledge, this is the first report of prenatal diagnosis of primary congenital glaucoma. We also describe histopathological changes in the primary congenital glaucoma-affected globes revealing the effect of cytochrome p4501B1 deficiency on ocular tissues during early fetal development contributing to the glaucoma phenotype.
Subsurface stresses analysis of flexible ball bearing with bendable races in a harmonic reducer by superimposition method
Authors: Xiong Ying , Fang Bin , Zhang Jinhua , Yan Ke , Zhu Yongsheng
Published: November 2021

The bending of races of the flexible ball bearing in a harmonic reducer inevitably results in significant hoop stresses, which leads to the bearing working under a complex stress state. Studies show that hoop stresses can affect bearing life considerably, and subsurface stresses are the fundamental nature of the bearing failure mechanism. This paper established a simplified theoretical model of subsurface stresses for flexible ball bearing by considering bending deformation and contact deformation. First, the plane curved bar theory was used to solve the hoop stresses of the races caused by bending deformation. Second, the hoop stresses were superimposed on the Hertzian principal stresses generated by the contact load to calculate the maximum shearing stress of the raceway. Then, the influence of hoop stresses on subsurface stresses of both the inner and outer races was analyzed based on the proposed model. The results indicated that the subsurface stresses of the inner race calculated by the model were in good agreement with that of the cam-inner race-single ball contact finite element model. In addition, hoop stresses of the inner race increase the maximum shearing stress but decrease its depth to the contact surface, making the inner race more prone to spalling failure, while the outer race is the opposite. At last, the influence of the design parameters of flexible ball bearing on the subsurface stresses of races was studied to provide a theoretical basis for the optimization design of flexible ball bearing and its fatigue failure analysis.
The limiting static and dynamic performance of foil bearings
Authors: Li Hao , Geng Haipeng , Li Xu , Qi Lei
Published: November 2021

Foil bearings have attracted considerable attention in small-sized turbomachines with its excellent stability, high compliance, and temperature durability. However, as the foil bearing is applied to turbine machinery with higher load and impact, the evaluation of its limiting performance becomes more important. Thus, a simple analytical method is proposed for predicting the limiting performance of the journal and thrust foil bearings. The analytical model is verified by comparing it with the full numerical algorithm. The results indicate that with the increase of rotating speed, the pressure distribution of both journal and thrust foil bearing approach to the analytical model but can never reach due to the boundary conditions. When the rotating speed tends to infinity, the principal stiffness Kxx, Kyy, Kzz converge to a certain value, while the cross stiffness Kxy and Kyx approach to infinity and 0, respectively. The static and dynamic performance are evaluated with foil compliance, rotor eccentricity, and film thickness as independent variables to provide further reference for system design.
The Challenge of Indigenous Healing for Global Mental Health
Authors: Csordas Thomas J.
Published: November 2021

Psychiatry and anthropology have a long relationship, and it is worth examining aspects of how that relation is carried over into the developing field of Global Mental Health (GMH). One place at which the two disciplines overlap significantly is in addressing religious phenomena and ritual performance in relation to mental health, and one of the greatest challenges for GMH is how productively to take into account forms of indigenous healing based on religion and ritual. In this paper I compare recent texts in GMH written from the standpoint of psychiatry and anthropology, observing that the psychiatric texts emphasize evidence-based determination of treatment efficacy, while the anthropological texts emphasize ethnographic understanding of treatment experience. Reconciling these two emphases constitutes a challenge to the field, attending to contextual variations in treatment events, illness episodes, phenomenological factors both endogenous and intersubjective, and sociopolitical factors both interpersonal and structural. In addressing this challenge, I propose an approach to therapeutic process that on the empirical level can facilitate comparison across the diversity of healing forms, and on the conceptual level can constitute a bridge between efficacy and experience. This approach is predicated on a rhetorical model of therapeutic process including components of disposition, experience of the sacred, elaboration of alternatives, and actualization of change that highlights experiential specificity and incremental change. Deploying this model can help meet the challenge of understanding efficacy and experience in indigenous healing, and prepare the ground for the further challenge of how practitioners of GMH relate to and interact with such forms of healing.
The Faroese Septuagenarians cohort: A comparison of well-being before and during the COVID-19 pandemic among older home-dwelling Faroese
Authors: Eliasen Eina H. , Weihe Pál , Petersen Maria Skaalum
Published: November 2021

Aims:

Despite success in avoiding morbidity and mortality in the oldest members of the population during the COVID-19 pandemic, the crisis may have affected the well-being of older adults, for example due to social distancing measures. The aim of this study was to examine the well-being of older Faroese by conducting a direct comparison of well-being indicators on the same group of elderly people before and during the COVID-19 pandemic.

Methods:

Data were collected from 227 home-dwelling adults aged 82–86 years from the Faroese Septuagenarians cohort. The pre-COVID-19 period was from December 2017 to January 2019, and the COVID-19 period was from 8 June to 15 July 2020. Three aspects of well-being were assessed: loneliness, self-rated health and quality of life (WHOQOL-BREF).

Results:

During the COVID-19 pandemic, there were significant increases in loneliness (21.8% vs. 6.8%; p<0.001) and in worse self-rated health compared to the previous year (37.2% vs. 19.0%; p<0.001). In terms of quality of life, the domains of overall quality of life (74.33±14.96 vs. 71.88±15.21; p=0.04) and physical health (73.81±17.11 vs. 71.66±17.37; p=0.03) deteriorated. On the other hand, the domains of social relationships (78.87±16.52 vs. 85.81±13.35; p<0.001), environment (82.49±10.78 vs. 87.06±7.88; p<0.001) and psychological health (77.07±11.52 vs. 80.53±10.89; p<0.001) improved during the pandemic.

Conclusions:

Our findings suggest that attention should be directed to loneliness and physical well-being amongst home-dwelling old adults, despite the elderly showed resilience and improved psychological health, social relations and environment domains in a quality of life assessment during the COVID-19 pandemic.
BestBET: Is cross sectional imaging of the hip necessary in patients with isolated greater trochanter fracture?
Authors: Shirreff Henry , Jenkins Paul
Published: November 2021

A Best Evidence Topic review was undertaken to clarify whether patients with apparently isolated greater trochanter fracture on plain X-ray require urgent cross sectional imaging. A literature search was performed to establish what proportion of these patients have clinically important intertrochanteric extension. 11 papers were included showing intertrochanteric extension in 54% using magnetic resonance imaging and computed tomography and surgical management was in 37% but with marked disparity in the data. Further work is needed to completely answer this question, and to find the most clinically useful predictors of fracture completion and displacement.
The Shifting Interface of Public Health and Urban Policy in South Africa
Authors: Duminy James , Parnell Susan M.
Published: November 2021

The paper traces the evolution and periodization of shifting ideas about the critical issues shaping city planning in South Africa, looking both at the relative and variable importance ascribed to health and other factors such as labour, economic reconstruction and housing. While the evolution of the South African city cannot be read without an understanding of the role of public health, changing ideas about cities and public health necessitate careful historical unravelling before any causal relationships can be identified. Any urban reconstruction, including post-COVID-19 reform, will demand deep knowledge of how the health/planning nexus has evolved, alongside expert advice on how to maximize urban health.
Why Evolutionary Psychology Should Abandon Modularity
Authors: Pietraszewski David , Wertz Annie E.
Published: November 2021

A debate surrounding modularity—the notion that the mind may be exclusively composed of distinct systems or modules—has held philosophers and psychologists captive for nearly 40 years. Concern about this thesis—which has come to be known as the massive modularity debate—serves as the primary grounds for skepticism of evolutionary psychology’s claims about the mind. In this article we argue that the entirety of this debate, and the very notion of massive modularity itself, is ill-posed and confused. In particular, it is based on a confusion about the level of analysis (or reduction) at which one is approaching the mind. Here we provide a framework for clarifying at what level of analysis one is approaching the mind and explain how a systemic failure to distinguish between different levels of analysis has led to profound misunderstandings of not only evolutionary psychology but also of the entire cognitivist enterprise of approaching the mind at the level of the mechanism. We furthermore suggest that confusions between different levels of analysis are endemic throughout the psychological sciences—extending well beyond issues of modularity and evolutionary psychology. Therefore, researchers in all areas should take preventive measures to avoid this confusion in the future.
Thinking as an Engelsian
Authors: Royle Camilla
Published: November 2021

In this essay, I address the question of how Marxism influences our thought and action as radical intellectuals by focusing on Friedrich Engels’ work, Dialectics of Nature, the way it has been taken up in critical environmental studies and how Engels’ thinking has influenced me. In later life, Engels made important contributions on topics that are distinct from Marx's economic work. He attempted to apply dialectical methods to the “natural sciences” and he also used his knowledge of anthropology to produce a study of the historical origins of private property and women's oppression. In both cases he has been accused of adopting a positivist approach that lacks the emphasis on human agency found in Marx. Here, I challenge this view by showing how Engels’ work has been of use to practicing scientists – particularly to Richard Levins and Richard Lewontin in their book The Dialectical Biologist. I further argue that this understanding of dialectics is fully commensurable and actually advances an approach to Marxism that is based on human self-emancipation. As an undergraduate biology student these scientists inspired me with their approach to their subject as well as their activism. The essay concludes with some brief thoughts on the importance and limitations of adopting a Marxist method when considering socio-environmental change.
COVID-19 lockdown and recovery: a dental public health perspective from Lancashire and South Cumbria
Authors: Keat Ross
Published: November 2021

The COVID-19 pandemic has created novel barriers in providing and accessing all forms of healthcare, including dentistry. The national dental response during the first peak of the pandemic resulted in rapid changes in the provision of service, to safeguard providers and users of dental care.

Such rapidly leveraged changes resulted in several issues in service delivery, requiring careful input from managers and commissioners within NHS England and Improvement, trainees and consultants in dental public health within Public Health England, and frontline dental teams working across the health and social care system. The local response from Lancashire and South Cumbria is outlined within this article.

Teamwork, communication and reflexive, iterative learning from these groups ensured the delivery of an Urgent Dental Care service during the first lockdown of the pandemic.

The impact of COVID-19 has enabled considerable learning which will inform future pandemic planning, alongside providing the opportunity to deliver meaningful change within NHS dentistry as the service continues to recover.
The fourth coast, revisited
Authors: Kim John
Published: November 2021

The author traveled for 2.5 months by canoe and other modes of transport down the entire length of the Mississippi River with the Mississippi. An Anthropocene River project. Reflecting on this journey, this essay revisits Catherine Brown and William Morrish’s 1991 essay, The Fourth Coast: An Expedition on the Mississippi River, in which Brown and Morrish document their research efforts to identify coherent anthropogenic structures and systems that could warrant the characterization of the Mississippi River as a Fourth Coast. To encourage a flourishing of overlapping multispecies life, the essay moves beyond their spatial reimagining by defining the “distributed nature of home” as a model for conceptualizing distributed spatialities and plural temporalities along the Mississippi River.
Gendered Acts of Face Negotiations in Teacher-Student Interaction: A Linguistic Ethnographic Investigation of Salutation
Authors: Gonsum Longji Christopher , Çavuşoğlu Çise
Published: November 2021

This article examined salutation as a valued and nuanced socio-cultural practice that serves the purpose of socially positioning interactants and impacting on face negotiations in interaction in Nigeria. This was done with the aim of demonstrating its significance in the shaping and ordering of naturally occurring interaction. The data for the study comprise naturally occurring interaction of 30 participants whose interactions were collected using linguistic ethnographic tools of recording, note taking, and observation while micro discourse analysis, with emphasis on notions of face negotiations as interaction strategies was used for the analysis of the data. The study revealed that students who failed to salute the teachers were offered varying face negotiations based on their gender differences. The study also found that both the office context and the power position of the teachers impacted variously on face negotiations. From the Nigerian sociolinguistic context and interpersonal pragmatics, salutation is viewed as a social solidarity and social positioning strategy especially in contexts where age, gender, and power are sensitive components of the context as such its observation or failure to observe it could easily affect the outcome of the entire interaction.
Visitor Restrictions, Palliative Care, and Epistemic Agency: A Qualitative Study of Nurses’ Relational Practice During the Coronavirus Pandemic
Authors: McMillan Kim , Wright David Kenneth , McPherson Christine J. , Ma Kristina , Bitzas Vasiliki
Published: November 2021

Efforts to curb spread of COVID-19 has led to restrictive visitor policies in healthcare, which disrupt social connection between patients and their families at end of life. We interviewed 17 Canadian nurses providing palliative care, to solicit their descriptions of, and responses to, ethical issues experienced as a result of COVID-19 related circumstances. Our analysis was inductive and scaffolded on notions of nurses’ moral agency, palliative care values, and our clinical practice in end-of-life care. Our findings reveal that while participants appreciated the need for pandemic measures, they found blanket policies separating patients and families to be antithetical to their philosophy of palliative care. In navigating this tension, nurses drew on the foundational values of their practice, engaging in ethical reasoning and action to integrate safety and humanity into their work. These findings underscore the epistemic agency of nurses and highlight the limits of a purely biomedical logic for guiding the nursing ethics of the pandemic response.
Economic Impact and Health Care Utilization Outcomes of Diabetes Self-Management Education and Support Interventions for Persons With Diabetes: A Systematic Review and Recommendations for Future Research
Authors: Whitehouse Christina R. , Haydon-Greatting Starlin , Srivastava Sneha Baxi , Brady Veronica J. , Blanchette Julia E. , Smith Tierra , Yehl Kirsten E. , Kauwetuitama Adonica Ihilani , Litchman Michelle L. , Bzowyckyj Andrew S.
Published: November 2021

Purpose

Value-driven outcomes are important because health systems determine sustainability of diabetes self-management education and support (DSMES) programming. Health care utilization and clinical outcomes are critical factors when considering the impact of DSMES programs.

Objective

The aim of this systematic review was to describe studies that report on the economic and health care utilization outcomes of diabetes self-management programs.

Methods

A systematic literature review was performed in multiple databases. Studies reporting economic and health care utilization outcomes related to DSMES and including 1 or more of the ADCES7 Self-Care BehaviorsTM from January 2006 to May 2020 were included. Eligible articles needed to compare the intervention and comparison group and report on economic impact. The methodological quality was assessed with the Joanna Briggs Institute Critical Appraisal Checklist specific to each individual study design.

Results

A total of 22 of 14 556 articles published between 2007 and 2020 were included. Cost benefits varied, and there were considerable methodological heterogeneity among design, economic measures, population, perspective, intervention, and biophysical outcomes.

Conclusion

DSMES interventions may positively impact economic outcomes and/or health care utilization, although not all studies showed consistent benefit. This review highlights an evidence gap, and future health economic evaluations are warranted.
Laminin G1 residues of protein S mediate its TFPI cofactor function and are competitively regulated by C4BP
Authors: Teraz-Orosz Adrienn , Gierula Magdalena , Petri Anastasis , Jones David , Keniyopoullos Renos , Folgado Patricia Badia , Santamaria Salvatore , Crawley James T. B. , Lane David A. , Ahnström Josefin
Published: November 2021

Protein S is a cofactor in the tissue factor pathway inhibitor (TFPI) anticoagulant pathway. It enhances TFPIα-mediated inhibition of factor (F)Xa activity and generation. The enhancement is dependent on a TFPIα-protein S interaction involving TFPIα Kunitz 3 and protein S laminin G-type (LG)-1. C4b binding protein (C4BP), which binds to protein S LG1, almost completely abolishes its TFPI cofactor function. However, neither the amino acids involved in TFPIα enhancement nor the mechanisms underlying the reduced TFPI cofactor function of C4BP-bound protein S are known. To screen for functionally important regions within protein S LG1, we generated 7 variants with inserted N-linked glycosylation attachment sites. Protein S D253T and Q427N/K429T displayed severely reduced TFPI cofactor function while showing normal activated protein C (APC) cofactor function and C4BP binding. Based on these results, we designed 4 protein S variants in which 4 to 6 surface-exposed charged residues were substituted for alanine. One variant, protein S K255A/E257A/D287A/R410A/K423A/E424A, exhibited either abolished or severely reduced TFPI cofactor function in plasma and FXa inhibition assays, both in the presence or absence of FV-short, but retained normal APC cofactor function and high-affinity C4BP binding. The C4BP β-chain was expressed to determine the mechanisms behind the reduced TFPI cofactor function of C4BP-bound protein S. Like C4BP-bound protein S, C4BP β-chain-bound protein S had severely reduced TFPI cofactor function. These results show that protein S Lys255, Glu257, Asp287, Arg410, Lys423, and Glu424 are critical for protein S-mediated enhancement of TFPIα and that binding of the C4BP β-chain blocks this function.
Complete mitochondrial genomes reveal robust phylogenetic signals and evidence of positive selection in horseshoe bats
Authors: Zhang Lin , Sun Keping , Csorba Gábor , Hughes Alice Catherine , Jin Longru , Xiao Yanhong , Feng Jiang
Published: November 2021

Background

In genus Rhinolophus, species in the Rhinolophus philippinensis and R. macrotis groups are unique because the horseshoe bats in these group have relatively low echolocation frequencies and flight speeds compared with other horseshoe bats with similar body size. The different characteristics among bat species suggest particular evolutionary processes may have occurred in this genus. To study the adaptive evidence in the mitochondrial genomes (mitogenomes) of rhinolophids, especially the mitogenomes of the species with low echolocation frequencies, we sequenced eight mitogenomes and used them for comparative studies of molecular phylogeny and adaptive evolution.

Results

Phylogenetic analysis using whole mitogenome sequences produced robust results and provided phylogenetic signals that were better than those obtained using single genes. The results supported the recent establishment of the separate macrotis group. The signals of adaptive evolution discovered in the Rhinolophus species were tested for some of the codons in two genes (ND2 and ND6) that encode NADH dehydrogenases in oxidative phosphorylation system complex I. These genes have a background of widespread purifying selection. Signals of relaxed purifying selection and positive selection were found in ND2 and ND6, respectively, based on codon models and physicochemical profiles of amino acid replacements. However, no pronounced overlap was found for non-synonymous sites in the mitogenomes of all the species with low echolocation frequencies. A signal of positive selection for ND5 was found in the branch-site model when R. philippinensis was set as the foreground branch.

Conclusions

The mitogenomes provided robust phylogenetic signals that were much more informative than the signals obtained using single mitochondrial genes. Two mitochondrial genes that encoding proteins in the oxidative phosphorylation system showed some evidence of adaptive evolution in genus Rhinolophus and the positive selection signals were tested for ND5 in R. philippinensis. These results indicate that mitochondrial protein-coding genes were targets of adaptive evolution during the evolution of Rhinolophus species, which might have contributed to a diverse range of acoustic adaptations in this genus.
Deep transcriptomic study reveals the role of cell wall biosynthesis and organization networks in the developing shell of peanut pod
Authors: Gupta Kapil , Gupta Shubhra , Faigenboim-Doron Adi , Patil Abhinandan Surgonda , Levy Yael , Carrus Scott Cohen , Hovav Ran
Published: November 2021

Background

Peanut (Arachis hypogaeaL.) belongs to an exceptional group of legume plants, wherein the flowers are produced aerially, but the pods develop under the ground. In such a unique environment, the pod’s outer shell plays a vital role as a barrier against mechanical damage and soilborne pathogens. Recent studies have reported the uniqueness and importance of gene expression patterns that accompany peanut pods’ biogenesis. These studies focused on biogenesis and pod development during the early stages, but the late developmental stages and disease resistance aspects still have gaps. To extend this information, we analyzed the transcriptome generated from four pod developmental stages of two genotypes, Hanoch (Virginia-type) and IGC53 (Peruvian-type), which differs significantly in their pod shell characteristics and pathogen resistance.

Results

The transcriptome study revealed a significant reprogramming of the number and nature of differentially expressed (DE) genes during shell development. Generally, the numbers of DE genes were higher in IGC53 than in Hanoch, and the R5-R6 transition was the most dynamic in terms of transcriptomic changes. Genes related to cell wall biosynthesis, modification and transcription factors (TFs) dominated these changes therefore, we focused on their differential, temporal and spatial expression patterns. Analysis of the cellulose synthase superfamily identified specificCellulose synthase(CesAs)andCellulose synthase-like(Csl)genes and their coordinated interplay with other cell wall-related genes during the peanut shell development was demonstrated. TFs were also identified as being involved in the shell development process, and their pattern of expression differed in the two peanut genotypes. The shell component analysis showed that overall crude fiber, cellulose, lignin, hemicelluloses and dry matter increased with shell development, whereas K, N, protein, and ash content decreased. Genotype IGC53 contained a higher level of crude fiber, cellulose, NDF, ADF, K, ash, and dry matter percentage, while Hanoch had higher protein and nitrogen content.

Conclusions

The comparative transcriptome analysis identified differentially expressed genes, enriched processes, and molecular processes like cell wall biosynthesis/modifications, carbohydrate metabolic process, signaling, transcription factors, transport, stress, and lignin biosynthesis during the peanut shell development between two contrasting genotypes. TFs and other genes like chitinases were also enriched in peanut shells known for pathogen resistance against soilborne major pathogens causing pod wart disease and pod damages. This study will shed new light on the biological processes involved with underground pod development in an important legume crop.
Demographic, tumour, and treatment characteristics of female patients with breast cancer in Sri Lanka; results from a hospital-based cancer registry
Authors: Wijeratne Don Thiwanka , Gunasekera Sanjeeva , Booth Christopher M. , Promod Hasitha , Jalink Matthew , Jayarajah Umesh , Seneviratne Sanjeewa
Published: November 2021

Background

Although breast cancer is the most common cancer among Sri Lankan women, there is little published data on patient characteristics and treatment in the local context. We aimed to describe disease characteristics and management in a large contemporary cohort of women with breast cancer at the National Cancer Institute of Sri Lanka (NCISL).

Methods

All women with invasive primary breast cancers diagnosed during 2016–2020 were identified from the NCISL breast cancer registry. The NCISL sees approximately 40% of all cancer patients in Sri Lanka. Cancer stage at diagnosis was defined according to the Tumour, Node, and Metastasis (TNM) staging system and the Estrogen (ER) and progesterone (PR) receptor status was determined based on the results of immunohistochemistry tests. Descriptive statistics were used to describe the study cohort and treatment patterns.

Results

Over 5100 patients were diagnosed with breast cancer during the study period at the NCISL. The mean age of the women was 56 (SD 12) years. Common co-morbidities were hypertension (n = 1566, 30%) and diabetes mellitus (n = 1196, 23%). Two thirds (66%) of the cancers were early stage (stage I & II) at diagnosis. ER/PR positivity rate was 72% and HER-2 positivity rate was 22%. Two thirds of the women had undergone mastectomy while 68% had undergone axillary clearance. The rate of chemotherapy delivery was 91% for women with node positive disease while 77% of eligible women (i.e., after wide local excision or with > 3 positive lymph nodes) had received adjuvant radiotherapy. Endocrine therapy was initiated in 88% of eligible women with hormone receptor positive disease while rate of trastuzumab use was 59% among women with HER2 positive breast cancer.

Conclusions

High percentage of advanced breast cancer at diagnosis and high prevalence of comorbidities are some of the major challenges faced in the management of breast cancer in Sri Lanka. Given that stage at diagnosis is the most important prognostic factor determining survival, greater efforts are needed to promote early diagnosis of breast cancer. Considerable lapses in the concordance between guideline recommendations and the delivery of cancer care warrants closer assessment and intervention.
Developing a prioritisation framework for patients in need of coronary artery angiography
Authors: Doshmangir Leila , Pourasghar Faramarz , Sharghi Rahim , Rezapour Ramin , Gordeev Vladimir Sergeevich
Published: November 2021

Background

Effective waiting list management and comprehensive prioritisation can provide timely delivery of appropriate services to ensure that the patient needs are met and increase equity in the provision of health services. We developed a prioritisation framework for patients in need of coronary artery angiography (CAA).

Methods

We used a multi-methods approach to elicit effective factors that affect CAA patient prioritisation. Qualitative data wase collected using semi-structured interviews with 15 experts. The final set of factors was selected using experts’ consensus through modifed Delphi technique. The framework was finalised during expert panel meetings.

Results

212 effective factors were identified based on the literature review, interviews, and expert panel discussion of them, 37 factors were selected for modifed Delphi study. Following two rounds of Delphi discussions, seven final factors were selected and weighed by ten experts using pair-wise comparisons. The following weights were given: the severity of pain and symptoms (0.22), stress testing (0.18), background diseases (0.15), number of myocardial infarctions (0.15), waiting time (0.10), reduction of economic and social performance (0.12), and special conditions (0.08).

Conclusion

Clinical effective factors were important for CAA prioritisation framework. Using this framework can potentially lead to improved accountability and justice in the health system.
Spirometric reference equations for Cameroonians aged 4 to 89 years derived using lambda, mu, sigma (LMS) method
Authors: Pefura-Yone Eric Walter , Balkissou Adamou Dodo , Poka-Mayap Virginie , Djenabou Amadou , Massongo Massongo , Ofimboudem Nguetsa Arsene , Mayoh-Nguemfo Catherine Fanny , Tsala Antoinette Ghislaine , Hadjara Halidou , Amougou Francine
Published: November 2021

Background

Spirometric reference values are well known in several ethnic groups but the normative spirometric values of blacks living in Africa have been less studied. The purpose of this study is to establish normative spirometric equations from a representative population of Cameroonian children and adults and compare these equations with those developed by the Global Lung Initiative (GLI) and in Nigerians.

Methods

Spirometric data from healthy Cameroonians aged 4–89 years randomly collected between 2014 and 2018 were used to derive reference equations using generalized additive model for location (mu), shape (lambda) and scale (sigma).

Results

A total of 625 children and adolescents (290 males and 335 females) and 1152 adults (552 males and 600 females) were included in the study. The prediction equation for spirometric index was written as: M = Exp[a0 + a1*ln (Height) + a2*ln (Age) + Mspline, Mspline was age related spline contribution]. Applying the GLI standards for African Americans resulted in overall values greater than those found in our study for forced expiratory volume in 1s (FEV1) and forced vital capacity (FVC). These values were very close in children and adolescents while the values obtained with the GLI equations for African Americans were significantly higher in adults. FEV1/FVC ratio in our study was similar for adult males but lower in adult females (88% vs 85%, difference =  + 3.5%) when applying Nigerian standards.

Conclusions

FEV1 and FVC of the Cameroonian infant and adolescent population are very close to those of black Americans. However, FEV1 and FVC of Cameroonian adults are significantly lower than those of black American adults. These equations should allow a more suitable interpretation of spirometry in the Cameroonian population.
Midwives’ strategies for coping with barriers to providing quality maternal and neonatal care: a Glaserian grounded theory study
Authors: Ismaila Yakubu , Bayes Sara , Geraghty Sadie
Published: November 2021

Background

Midwives face direct and indirect barriers in their workplaces that have negative consequences on their ability to provide quality care to women and neonates, however, they still carry on with their duties. This study aimed at investigating the coping strategies that Ghanaian midwives adopt to be able to complete their work.

Methods

Glaserian Grounded theory was used in this study. Data were collected through non-participant observations and semi-structured interviews. The study participants included 29 midwives who worked in labour/birthing environments and a pharmacist, a social worker, a national Health Insurance Scheme manager and a health services manager.

Findings

The midwives’ motivation due to their strong desire to save the lives of women and neonates and their strong affection for the midwifery profession was identified to help them cope with the barriers that they faced in their workplaces. The midwives’ motivation was found to spur actions such as improvising, taking control of the birthing process and the birthing environment and the maintenance of social and professional networks to help them to complete their duties.

Conclusion

Ghanaian midwives face myriad barriers in their workplaces; however, they are able to adopt coping strategies that enable them to complete their duties. The provision of care resources for maternity services in the country will reduce the barriers that the midwives face and improve the quality of maternal and neonatal care. In the short term however, pre and post midwifery educational programmes should focus on developing resilience in the midwifery workforce to help midwives cope more effectively with the challenges that they face in their workplaces.
Emergency hospital admissions among older adults living alone in the community
Authors: Barrenetxea Jon , Tan Kelvin Bryan , Tong Rachel , Chua Kevin , Feng Qiushi , Koh Woon-Puay , Chen Cynthia
Published: November 2021

Background

Among older adults, living alone is often associated with higher risk of Emergency Department (ED) admissions. However, older adults living alone are very heterogeneous in terms of health. As more older adults choose to live independently, it remains unclear if the association between living alone and ED admissions is moderated by health status. We studied the association between living alone and ED admission outcomes (number of admissions, inpatient days and inpatient costs) among older adults with and without multimorbidity.

Methods

We used data from 16,785 individuals of the third follow-up of the Singapore Chinese Health Study, a population-based cohort of older Singapore Chinese (mean age: 73(61-96) years). Participants were interviewed face-to-face from 2014 to 2016 for sociodemographic/health factors and followed-up for one year on ED admission outcomes using Singapore Ministry of Health’s Mediclaim Database. We first applied multivariable logistic regression and two-part models to test if living alone is a risk factor for ED admission outcomes. We then ran stratified and joint effect analysis to examine if the associations between living alone and ED admission outcomes were moderated by multimorbidity.

Results

Compared to living with others, living alone was associated with higher odds of ED admission [Odds Ratio (OR) 1.28, 95 % Confidence Interval(CI) 1.08-1.51)], longer inpatient days (+0.61, 95 %CI 0.25-0.97) and higher inpatient costs (+322 USD, 95 %CI 54-591). The interaction effects of living arrangement and multimorbidity on ED admissions and inpatient costs were not statistically different, whereas the interaction between living arrangements and multimorbidity on inpatient days was borderline significant (p-value for interaction=0.050). Compared to those living with others and without multimorbidity, the relative mean increase was 1.13 inpatient days (95 %CI 0.39-1.86) for those living alone without multimorbidity, and 0.73 inpatient days ( 95 %CI 0.29-1.17) for those living alone with multimorbidity.

Conclusions

Older adults living alone were at higher risk of ED admission and higher inpatient costs regardless of multimorbidity, while those living alone without multimorbidity had the longest average inpatient days. To enable aging in place while avoiding ED admissions, interventions could provide instrumental support and regular health monitoring to older adults living alone, regardless of their health status.
Reduced risk of recurrent pneumothorax for sirolimus therapy after surgical pleural covering of entire lung in lymphangioleiomyomatosis
Authors: Sakurai Teiko , Arai Toru , Hirose Masaki , Kojima Kensuke , Sakamoto Tetsuki , Matsuda Yoshinobu , Sugimoto Chikatoshi , Yoon Hyung-Eun , Inoue Yoshikazu
Published: November 2021

Background

Patients with lymphangioleiomyomatosis (LAM) frequently experience pneumothorax. Although sirolimus is the standard therapy for LAM, its effect on pneumothorax is controversial. Recently, total pleural covering (TPC) and modified TPC (mTPC) were introduced as surgical treatment options for pneumothorax for patients with LAM. However, the effect of sirolimus on the recurrence of pneumothorax in patients who underwent the treatments is still uncertain. We hypothesized that some clinical factors including sirolimus treatment could predict postoperative recurrence of pneumothorax. In order to clarify this hypothesis, we retrospectively analyzed the clinical data from 18 consecutive patients with LAM who underwent 24 surgical pleural covering of entire lung (SPC) as 17 TPC and 7 mTPC against pneumothoraces from surgical database between January 2005 and January 2019, and we determined the predictors of postoperative recurrence.

Results

Of the 24 surgeries of SPC, 14 surgeries (58.3%) had a history of two or more ipsilateral pneumothoraces, and 11 surgeries (45.8%) had a history of ipsilateral pleural procedures before SPC. Sixteen surgeries (66.6%) in 12 patients received treatment of sirolimus after SPC (sirolimus group). With a median follow-up time of 69.0 months after SPC, four surgeries (16.6%) in three patients had a postoperative recurrence, and the 5-year recurrence-free survival (RFS) after SPC was 82.9%. In patients with postoperative recurrence, serum level of vascular endothelial growth factors D was significantly higher than that in those with non-recurrence (3260.5 vs. 892.7 pg/mL, p = 0.02), and the rate of sirolimus treatment in the recurrence group was significantly lower than that in the no-recurrence group (0 vs. 80%, p = 0.006). The log-rank test showed that the RFS of the sirolimus group (sirolimus use after SPC) was significantly better than that of the non-sirolimus group (p = 0.001), and no significant difference was observed for other factors.

Conclusion

We first reported sirolimus might effectively suppress the recurrence of pneumothoraces in LAM patients who received SPC. Sirolimus induction after SPC (TPC or mTPC) might be a feasible option for frequent pneumothorax in LAM.
Comparison of trapping methods for use in surveys for potential Culicoides vectors of orbiviruses
Authors: Becker Michael , Park Jeong-Seok , Gentry Glen , Husseneder Claudia , Foil Lane
Published: November 2021

Background

Bluetongue virus (BTV) and epizootic hemorrhagic disease virus (EHDV) are orbiviruses that can cause fatal vector-borne diseases in white-tailed deer (Odocoileus virginianus). Trapping methods for collecting potentialCulicoidesvectors of orbiviruses were compared to optimize surveillance studies.

Methods

The number of captured midges and the virus infection rates of midge pools were compared for dry ice-baited Centers for Disease Control and Prevention (CDC) traps with or without black light. The number of individual midges of differentCulicoidesspecies captured at different crepuscular and nocturnal periods using rotator traps also was determined. The number of species/specimens ofCulicoideswas measured using five different trap methods including three animal-baited methods, a CDC trap with black light, and a CDC trap with no light.

Results

In trial one, there was no significant difference (P = 0.37) in the proportion of BTV-infected flies caught in traps with light compared to traps without light. However, there was a significant difference (P = 0.026) for EHDV-infected flies, and 89% were captured in traps with light. In trial two, more specimens ofC. debilipalpiswere captured in the morning hours (06:00–08:00) than in the evening hours (18:00–20:00). For trial three, the animal-baited traps did not capture any species ofCulicoidesthat were not captured in the CDC light traps. There was no significant difference (P = 0.22) in total specimens captured among all five trap types.

Conclusions

Specimens ofCulicoidesinfected with BTV were not repelled by light traps in the first trial, while the majority of the specimens positive for EHDV were caught in traps with light. For the second trial, specimens ofC. debilipalpiswere most abundant during early morning hours, and thus spray applications of insecticides for control of that species may be more effective at sunrise rather than sunset. For objective three, no animal-baited trapping method collected different species of midges when compared to the CDC traps with light, which is unlike certain studies conducted in other geographical regions.

Graphical abstract