bluuebunny/crossref_metadata_2025 huggingface dataset:
A Malaysian Delphi consensus on managing knee osteoarthritis
Authors: Yeap Swan Sim , Abu Amin Syamsul Rizal , Baharuddin Hazlyna , Koh Kar Chai , Lee Joon Kiong , Lee Verna Kar Mun , Mohamad Yahaya Nor Hamdan , Tai Cheh Chin , Tan Maw Pin
Published: June 2021

Background

The 2013 Malaysian Clinical Practice Guidelines on the Management of Osteoarthritis (OA) recommend a linear step-up approach to manage knee OA. However, patients with knee OA often require a multimodal approach to address OA-related pain symptoms and functional limitations. This consensus aimed to provide doctors with an updated set of evidence-based, clinical experience-guided recommendations to manage knee OA.

Methods

A multi-speciality expert panel consisting of nine Malaysian physicians from different healthcare settings who manage a diverse OA patient population was convened. Using a combination of the ADAPTE process and modified Delphi method, the panel reviewed current evidence on the management of knee OA and synthesised a set of nine recommendations on the management of knee OA, supported by an algorithm that summarises the consensus’ core messages.

Results

A multimodal intervention strategy is the mainstay of OA management and the choice of any single or multimodal intervention may vary over the course of the disease. Overall, a non-pharmacological core treatment set of patient education, weight loss and exercise is recommended for all patients. When pharmacotherapy is indicated, symptomatic slow-acting drugs for osteoarthritis are recommended at the early stage of disease, and they can be paired with physical therapy as background treatment. Concurrent advanced pharmacotherapy that includes non-steroidal anti-inflammatory drugs, intraarticular injections and short-term weak opioids can be considered if patients do not respond sufficiently to background treatment. Patients with severe symptomatic knee OA should be considered for knee replacement surgery. Management should begin with specific treatments with the least systemic exposure or toxicity, and the choice of treatment should be determined as a shared decision between patients and their team of healthcare providers.

Conclusions

This consensus presents nine recommendations that advocate an algorithmic approach in the management of patients living with knee OA. They are applicable to patients receiving treatment from primary to tertiary care providers in Malaysia as well as other countries.
Analysis and outcomes of wrong site thyroid surgery
Authors: Dionigi Gianlorenzo , Raffaelli Marco , Bellantone Rocco , De Crea Carmela , Ambrosini Carlo Enrico , Miccoli Paolo , Materazzi Gabriele , Ieni Antonio , Caruso Ettore , Zhang Daqi , Dralle Henning
Published: June 2021

Background

In thyroid surgery, wrong-site surgery (WSS) is considered a rare event and seldom reported in the literature.

Case presentation

This report presents 5 WSS cases following thyroid surgery in a 20-year period. We stratified the subtypes of WSS in wrong target, wrong side, wrong procedure and wrong patient. Only planned and elective thyroid surgeries present WSS cases. The interventions were performed in low-volume hospitals, and subsequently, the patients were referred to our centres. Four cases of wrong-target procedures (thymectomies [n = 3] and lymph node excision [n = 1] performed instead of thyroidectomies) and one case of wrong-side procedure were observed in this study. Two wrong target cases resulting additionally in wrong procedure were noted. Wrong patient cases were not detected in the review. Patients experienced benign, malignant, or suspicious pathology and underwent traditional surgery (no endoscopic or robotic surgery). 40% of WSS led to legal action against the surgeon or a monetary settlement.

Conclusion

WSS is also observed in thyroid surgery. Considering that reports regarding the serious complications of WSS are not yet available, these complications should be discussed with the surgical community. Etiologic causes, outcomes, preventive strategies of WSS and expert opinion are presented.
A strangulated internal hernia beneath the left external iliac artery after radical hysterectomy with laparoscopic pelvic lymphadenectomy: a case report and literature review
Authors: Zhang Zhenxing , Hu Gengyuan , Ye Minfeng , Zhang Yu , Tao Feng
Published: June 2021

Background

Ileum obstruction due to internal hernia beneath external iliac artery after pelvic lymph node dissection (PLND) is extremely rare. We reported a case of acute strangulated internal hernia between the left external iliac artery and psoas major as late complication of laparoscopic hysterectomy with pelvic lymphadenectomy.

Case presentation

A 46-year-old woman, who with histories of laparoscopic hysterectomy, bilateral salpingo-oophorectomy and PLND 9 years ago for the cervical malignant tumor, open appendectomy 18 years ago, visited our hospital complaining of aggravated left lower abdominal pain, bloating, nausea and vomiting from few hours ago. Left abdomen distention, tympanitic with rebound tenderness and muscular tension was detected during physical examinations. Accompanying with elevated inflammatory markers and mild intestinal dilatation showed in lab results and contrast-enhanced computed tomography (CT) respectively. After carefully reading the CT images, a small bowel was found between the left external iliac artery (EIA) and the psoas major, combined with the patient's surgical history, we suspected it might be internal hernia. Eventually, the emergency laparoscopic laparotomy confirmed our conjecture, the gap between the iliac vessels and the psoas major was closed with an absorbable suture, the patient was discharged on the fourth postoperative day.

Conclusion

Primary closure of peritoneal fissue maybe an effective measure to potentially prevent internal hernia. The choice of surgical approach for pelvic tumors still needs further exploration but faster diagnosis and immediate laparotomy might promise a better prognosis.
Iranian superwomen's career experiences: a qualitative study
Authors: Nosrati Beigzadeh Maryam , Ghamari Givi Hossein , Rezaei Sharif Ali , Sheykholeslami Ali , Reisy Leila , Hassankhani Hadi
Published: June 2021

Background

Superwoman refers to the identity of a woman who performs several important roles simultaneously and full-time, such as being a wife, mother, and homemaker while holding a job. This study aims to examine the career experiences of Iranian superwomen who maintained their mental health while holding multiple roles.

Methods

Data for this qualitative study were collected via semi-structured interview and analyzed using conventional content analysis. The study participants were 12 multi-role women from different occupations in Tabriz, North West of Iran selected through purposive and theoretical sampling. The women’s mental health status was assessed using Mental Health Continuum-Short Form questionnaire before participating in the research.

Results

The results were classified into three main categories. The first category included Underlying Factors of Job Experience with six subcategories, including Limited job opportunities for women, Educational context (mindset shaped in the parental home), Commitment or freedom in obtaining a job and its continuation, Personality traits, and Non-cognitive skills (emotional intelligence and spiritual intelligence); the second category included the adopted strategies to solve career problems with two subcategories: effective strategies, including the benefits of having a mindset of abundance and having a vision and strategic planning, and ineffective strategies, including the benefits of having a mindset of scarcity; and the third category included Perceived Consequences of employment with two subcategories: psychological consequences and social consequences, with both subcategories including some positive and negative further subcategories. Moreover, a conceptual relationship between the main categories and the subcategories was evident.

Conclusions

The content obtained not only supports the findings about the experiences of multi-role women in cultures outside Iran, but also points to the unique aspects of Iranian superwomen's life experiences and narratives. The findings of this study can help us perceive the real career experiences from the perspective of Iranian professional women with multiple roles.
Final-year medical students’ competence profiles according to the modified requirement tracking questionnaire
Authors: Zelesniack Elena , Oubaid Viktor , Harendza Sigrid
Published: June 2021

Background

Undergraduate medical education is supposed to equip medical students with basic competences to select any specialty of their choice for postgraduate training. Medical specialties are characterized by a great diversity of their daily work routines and require different sets of competence facets. This study examines the self-assessed competence profiles of final-year undergraduate medical students and their specialty choice for postgraduate training. Students’ profiles, who wish to choose anaesthesiology, internal medicine, or paediatrics, are compared with the physicians’ competence profiles from these three disciplines.

Methods

In this study, 148 volunteer final-year undergraduate medical students completed the modified requirement-tracking (R-Track) questionnaire for self-assessment of their competence profiles. The R-Track questionnaire contains 63 competence facets assigned to six areas of competence: “Mental abilities”, “Sensory abilities”, “Psychomotor & multitasking abilities”, “Social interactive competences”, “Motivation”, and “Personality traits”. The expression of the different competence facets had to be assessed on a 5-point Likert scale (1: “very low” to 5: “very high”). Additionally, socio-demographic data and the participants’ first choice of a medical speciality for postgraduate education were collected. We used analysis of variance (ANOVA) for mean score comparison of subgroups and least significant difference (LSD) tests for post hoc analysis.

Results

The competence area with the highest rating was “Motivation” (3.70 ± 0.47) while “Psychomotor & multitasking abilities” received the lowest rating (3.34 ± 0.68). Individual facets of competence ranked from “In need of harmony” (4.36 ± 0.72), followed by “Tactfulness” (4.26 ± 0.64), and “Cooperation/Agreeableness” (4.24 ± 0.53) to “Risk orientation” (2.90 ± 0.92), “Mathematical reasoning” (2.87 ± 1.25), and “Sanctioning” (2.26 ± 0.93). The students’ competence profiles showed 100 % congruence with physicians’ competence profiles of the postgraduate specialty of their choice for internal medicine, 33.3 % for paediatrics, and 0 % for anaesthesiology.

Conclusions

Undergraduate medical students could define their competence profiles with the modified R-Track questionnaire and compare them with the profile of their desired specialty for postgraduate training to discover possible learning gaps or to detect good specialty matches. A combination of students’ competence self-assessment with an external assessment of students’ facets of competence could provide curricular planners with useful information how to design learning opportunities for specific facets of competence.
Cultural competency and sensitivity in the curriculum for palliative care professionals: a survey in Switzerland
Authors: Weber Orest , Semlali Imane , Gamondi Claudia , Singy Pascal
Published: June 2021

Background

Cultural and linguistic diversity in patients and their relatives represents a challenge for clinical practice in palliative care around the world. Cross-cultural training for palliative care professionals is still scarce, and research can help determine and support the implementation of appropriate training. In Switzerland, health policies address diversity and equity issues, and there is a need for educational research on cross-cultural training in palliative care. The aim of this study was to investigate the clinical challenges faced by Swiss palliative care professionals when working with migrant patients and their relatives. We also documented professionals’ interests in cross-cultural training.

Methods

A web survey of professionals working in specialized palliative care in the French- and Italian-speaking areas of Switzerland investigated clinical challenges with migrant populations and interests in various training opportunities.

Results

A total of 204 individuals responded to the survey, 48.5 % of whom were nurses. The major difficulties they reported were communication impediments associated with patients’ linguistic and/or cultural backgrounds. In relation to educational needs, they expressed a particular interest in communication techniques that would allow them to deal with these issues autonomously. The professionals expressed less interest in training on collaborating with other professionals and examining one’s own stereotypes.

Conclusions

Palliative care professionals’ post-graduate and continuing education must address communication techniques for sensitive palliative and end-of-life topics in cross-cultural contexts. Beginning with their pre-graduate studies, health professionals should assimilate the importance of collaborating with other professionals in complex cross-cultural situations and learn to reflect on their stereotypes and pre-conceptions in clinical practice.
What factors predict physicians' utilization behavior of contrast-enhanced ultrasound? Evidence from the integration of the Theory of Planned Behavior and Technology Acceptance Model using a structural equation modeling approach
Authors: Deng Qingwen , Zheng Yuhang , Lu Junhong , Zeng Zhichao , Liu Wenbin
Published: June 2021

Background

The promotion of early diagnosis is undoubtedly effective in reducing the burden of disease. Contrast-enhanced ultrasound (CEUS) is a diagnostic technology for liver cancer, but its implementation faces some challenges. Understanding the influencing factors of CEUS utilization is crucial for its successful implementation. However, such research is rare. The aims of this study were to investigate the status of CEUS utilization and its predictors in China.

Methods

Through multistage random sampling, a cross-sectional study design was conducted among physicians in charge of direct use of CEUS working at liver disease-related departments of sampled health institutions. To access the potential influencing factors of physicians' CEUS utilization, a structured questionnaire was developed based on the theoretical model, which was developed by integration of the Theory of Planned Behavior (TPB) and Technology Acceptance Model (TAM). Structural equation modeling was used to verify the proposed hypotheses, and analyze the relationship and mechanism between the factors.

Results

A total of 309 physicians were enrolled. The mean score of utilization behavior was 2.04 (SD = 1.07), and 37.22% above the mean. The favorable fitting results demonstrated that the integration of TAM and TPB was an acceptable model. SEM results also identified physicians’ intentions to use CEUS was directly associated with utilization behavior (β = 0.287,P < 0.001). Attitude (β = 0.272,P < 0.001), subjective norm (β = 0.172,P = 0.013), perceived behavioral control (β = 0.491,P < 0.001) and perceived usefulness (β = 0.108,P = 0.027) significantly influenced physicians’ intentions. Besides, subjective norm (β = 0.065,P = 0.021), perceived behavioral control (β = 0.141,P = 0.003), and perceived ease of use (β = 0.022,P = 0.033) indirectly affected physicians’ CEUS utilization.

Conclusions

The findings provide a reference for understanding the factors associated with physicians' utilization of CEUS. Additionally, the proposed measures such as building innovative and incentive environment, providing high quality and adequate training, etc., will help promote the utilization of CEUS, thereby increasing the detection rate of liver cancer, and improving the survival rate and the quality of life for liver cancer patients.
Clinical features of bacterial meningitis among hospitalised children in Kenya
Authors: Obiero Christina W. , Mturi Neema , Mwarumba Salim , Ngari Moses , Newton Charles R. , van Hensbroek Michaël Boele , Berkley James A.
Published: June 2021

Background

Diagnosing bacterial meningitis is essential to optimise the type and duration of antimicrobial therapy to limit mortality and sequelae. In sub-Saharan Africa, many public hospitals lack laboratory capacity, relying on clinical features to empirically treat or not treat meningitis. We investigated whether clinical features of bacterial meningitis identified prior to the introduction of conjugate vaccines still discriminate meningitis in children aged ≥60 days.

Methods

We conducted a retrospective cohort study to validate seven clinical features identified in 2002 (KCH-2002): bulging fontanel, neck stiffness, cyanosis, seizures outside the febrile convulsion age range, focal seizures, impaired consciousness, or fever without malaria parasitaemia and Integrated Management of Childhood Illness (IMCI) signs: neck stiffness, lethargy, impaired consciousness or seizures, and assessed at admission in discriminating bacterial meningitis after the introduction of conjugate vaccines. Children aged ≥60 days hospitalised between 2012 and 2016 at Kilifi County Hospital were included in this analysis. Meningitis was defined as positive cerebrospinal fluid (CSF) culture, organism observed on CSF microscopy, positive CSF antigen test, leukocytes ≥50/μL, or CSF to blood glucose ratio <0.1.

Results

Among 12,837 admissions, 98 (0.8%) had meningitis. The presence ofKCH-2002signs had a sensitivity of 86% (95% CI 77–92) and specificity of 38% (95% CI 37–38). Exclusion of ‘fever without malaria parasitaemia’ reduced sensitivity to 58% (95% CI 48–68) and increased specificity to 80% (95% CI 79–80). IMCI signs had a sensitivity of 80% (95% CI 70–87) and specificity of 62% (95% CI 61–63).

Conclusions

A lower prevalence of bacterial meningitis and less typical signs than in 2002 meant the lower performance ofKCH-2002signs. Clinicians and policymakers should be aware of the number of lumbar punctures (LPs) or empirical treatments needed for each case of meningitis. Establishing basic capacity for CSF analysis is essential to exclude bacterial meningitis in children with potential signs.
Roles of lysine-specific demethylase 1 (LSD1) in homeostasis and diseases
Authors: Kim Dongha , Kim Keun Il , Baek Sung Hee
Published: June 2021

Lysine-specific demethylase 1 (LSD1) targets mono- or di-methylated histone H3K4 and H3K9 as well as non-histone substrates and functions in the regulation of gene expression as a transcriptional repressor or activator. This enzyme plays a pivotal role in various physiological processes, including development, differentiation, inflammation, thermogenesis, neuronal and cerebral physiology, and the maintenance of stemness in stem cells. LSD1 also participates in pathological processes, including cancer as the most representative disease. It promotes oncogenesis by facilitating the survival of cancer cells and by generating a pro-cancer microenvironment. In this review, we discuss the role of LSD1 in several aspects of cancer, such as hypoxia, epithelial-to-mesenchymal transition, stemness versus differentiation of cancer stem cells, as well as anti-tumor immunity. Additionally, the current understanding of the involvement of LSD1 in various other pathological processes is discussed.
Prevention of re-establishment of malaria
Authors: Schapira Allan , Kondrashin Anatoly
Published: June 2021

The current consensus on prevention of re-establishment of malaria is based on the following principles: (1) Fundamental role of general health services; (2) Surveillance; (3) Vector control; (4) Border actions; (5) Intersectoral collaboration. These principles are critically reviewed, and it is pointed out that alertness of the general health services to suspected malaria (vigilance) needs to be maintained everywhere, while health education is rational only if targeting high-risk sub-populations. It is argued that prevention of re-establishment of malaria transmission should be integrated with prevention of malaria mortality in cases of imported malaria, and that this requires collaboration with entities dealing with travellers’ health and the availability of chemoprophylaxis and other measures for travellers to malaria endemic countries.
Autophagy deficiency exacerbates acute lung injury induced by copper oxide nanoparticles
Authors: Xiao Junting , Tu Baijie , Zhou Xin , Jiang Xuejun , Xu Ge , Zhang Jun , Qin Xia , Sumayyah Golamaully , Fan Jingchuan , Wang Bin , Chen Chengzhi , Zou Zhen
Published: June 2021

Copper oxide nanoparticles (CuONPs) are one of the widely used metal nanoparticles in the industrial and commercial fields. Autophagy is an intracellular degradation system that delivers cytoplasmic constituents to the lysosome and has been linked to nanoparticles-induced toxicity. In particular, the roles of autophagy in response to CuONPs have been explored in vitro, although the conclusions are controversial. To clarify the role of autophagy in CuONPs-induced acute lung injury, microtubule-associated protein 1 light chain 3 beta (Map1lc3b or lc3b) knockout mice and their corresponding wild type mice are applied. Our results showed that single-dose intratracheal instillation of CuONPs with dosages of 1.25, 2.5 or 5 mg/kg caused acute lung injury 3 days after treatment in a dose-dependent manner, as evidenced by deteriorative lung histopathology, more infiltration of macrophage cells, increased oxidative stress and copper ions. Loss of lc3b resulted in aggravated lung injury induced by CuONPs, which was probably due to the blockade of mitophagy and consequently the accumulation of aberrant mitochondria with overloaded copper ions. Our study provides the first in vivo evidence that autophagy deficiency exacerbates CuONPs-induced acute lung injury, and highlights that targeting autophagy is a meaningful strategy against CuONPs-associated respiratory toxicity.
Ecotoxicity evaluation of polymeric nanoparticles loaded with ascorbic acid for fish nutrition in aquaculture
Authors: Luis Angélica I. S. , Campos Estefânia V. R. , Oliveira Jhones L. , Vallim José Henrique , Proença Patrícia L. F. , Castanha Rodrigo F. , de Castro Vera L. S. S. , Fraceto Leonardo F.
Published: June 2021

Background

Ascorbic acid (AA) is a micronutrient essential for the mechanisms of reproduction, growth, and defense in fish. However, the biosynthesis of this micronutrient does not occur in fish, so it must be supplied with food. A difficulty is that plain AA is unstable, due to the effects of light, high temperature, and oxygen, among others. The use of nanoencapsulation may provide protection and preserve the physicochemical characteristics of AA for extended periods of time, decreasing losses due to environmental factors.

Method

This study evaluated the protective effect of nanoencapsulation in polymeric nanoparticles (chitosan and polycaprolactone) against AA degradation. Evaluation was made of the physicochemical stability of the nanoformulations over time, as well as the toxicological effects in zebrafish (Danio rerio), considering behavior, development, and enzymatic activity. For the statistical tests, ANOVA (two-way, significance of p < 0.05) was used.

Results

Both nanoparticle formulations showed high encapsulation efficiency and good physicochemical stability during 90 days. Chitosan (CS) and polycaprolactone (PCL) nanoparticles loaded with AA had mean diameters of 314 and 303 nm and polydispersity indexes of 0.36 and 0.28, respectively. Both nanosystems provided protection against degradation of AA exposed to an oxidizing agent, compared to plain AA. Total degradation of AA was observed after 7, 20, and 480 min for plain AA, the CS nanoparticle formulation, and the PCL nanoparticle formulation, respectively. For zebrafish larvae, the LC50values were 330.7, 57.4, and 179.6 mg/L for plain AA, the CS nanoparticle formulation, and the PCL nanoparticle formulation, respectively. In toxicity assays using AA at a concentration of 50 mg/L, both types of nanoparticles loaded with AA showed lower toxicity towards the development of the zebrafish, compared to plain AA at the same concentration. Although decreased activity of the enzyme acetylcholinesterase (AChE) did not affect the swimming behavior of zebrafish larvae in the groups evaluated, it may have been associated with the observed morphometric changes, such as curvature of the tail.

Conclusions

This study showed that the use of nanosystems is promising for fish nutritional supplementation in aquaculture. In particular, PCL nanoparticles loaded with AA seemed to be most promising, due to higher protection against AA degradation, as well as lower toxicity to zebrafish, compared to the chitosan nanoparticles. The use of nanotechnology opens new perspectives for aquaculture, enabling the reduction of feed nutrient losses, leading to faster fish growth and improved sustainability of this activity.

Graphic Abstract
Exploring what is important to patients with regards to quality of life after experiencing a lower limb reconstructive procedure: a qualitative evidence synthesis
Authors: Leggett H. , Scantlebury A. , Byrne A. , Harden M. , Hewitt C. , O’Carroll G. , Sharma H. , McDaid C. ,   the PROLLIT study collaborators, Adamson Joy , Cocks Kim , Gagnier Joel , Harwood Paul , Ferguson David , Hamdy Reggie , Ferriera Nando
Published: June 2021

Background

Patient reported outcome measures (PROMs) are used to understand the impact of lower limb reconstruction surgery on patients’ quality of life (QOL). Existing measures have not been developed to specifically capture patient experiences amongst adults with lower limb conditions that require reconstruction surgery. This review aimed to synthesise qualitative evidence to identify what is important to patients requiring, undergoing, or following reconstructive surgery for lower limb conditions.

Methods

MEDLINE, Embase, PsychINFO and Cinahl were searched from inception until November 2020. Studies were included if they employed qualitative research methods, involved patients requiring, undergoing or following lower limb reconstruction and explored patients’ experiences of care, treatment, recovery and QOL. Mixed methods studies that did not separately report qualitative findings, mixed population studies that were not separately reported and studies in languages other than English were excluded. Included studies were analysed using thematic synthesis. The Critical Appraisal Skills Programme qualitative studies checklist was used to undertake quality assessment.

Results

Nine studies met the inclusion criteria. The thematic synthesis identified two overarching themes: (1) areas of living key to QOL for lower limb reconstruction patients and (2) moving towards a new normal. The way in which lower limb reconstruction affects an individual’s QOL and their recovery is complex and is influenced by a range of inter-related factors, which will affect patients to varying degrees depending on their individual circumstances. We identified these factors as: pain, daily functioning and lifestyle, identity, income, emotional wellbeing, support, the ability to adapt and adjust and the ability to move forwards.

Conclusions

The way patients’ QOL is affected after a lower limb reconstruction is complex, may change over time and is strongly linked to their recovery. These findings will aid us in developing a conceptual framework which identifies the outcomes important to patients and those that should be included in a PROM. Further research is then required to establish whether the range of factors we identified are captured by existing PROMs. Depending on the outcome of this work, a new PROM for patients following lower limb reconstruction may be required.
A systematic review of cross-cultural adaptation of the National Institutes of Health Chronic Prostatitis Symptom Index
Authors: Dun Rong-liang , Tsai Jennifer , Hu Xiao-hua , Mao Jian-min , Zhu Wen-jing , Qi Guang-chong , Peng Yu
Published: June 2021

Background

The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) was developed to accurately assess the pain, urinary symptoms, and quality of life related to chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). This study aimed to evaluate the cross-cultural adaptations of the NIH-CPSI.

Method

PubMed, Embase, CINAHL, and SciELO databases were searched from their established year to September 2020. Cross-cultural adaptations and the quality control of measurement properties of adaptations were conducted by two reviewers independently according to the Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures and the Quality Criteria for Psychometric Properties of Health Status Questionnaire.

Results

Area total of 21 papers with 16 adaptations, and six studies of the original version of the NIH-CPSI were enrolled in the systematic review. Back translation was the weakest process for the quality assessment of the cross-cultural adaptations of the NIH-CPSI. Internal consistency was analyzed for most of the adaptations, but none of them met the standard. Only 11 adaptations reported test reliability, then only the Arabic-Egyptian, Chinese-Mainland, Danish, Italian, Persian, and Turkish adaptations met the criterion. Most adaptations reported the interpretability, but only the Danish adaptation reported the agreement. The other measurement properties, including responsiveness, and floor as well as ceiling effects were not reported in any of the adaptations.

Conclusions

The overall quality of the NIH-CPSI cross-cultural adaptations was not organized as expected. Only the Portuguese-Brazilian, Italian, and Spanish adaptations reached over half the process for the cross-cultural adaptation. Only the Turkish adaptations finished half of the measurement properties of cross-cultural adaptations.
Health promoting behaviour of medical versus non-medical students during COVID-19 pandemic: results from the COLA cross-sectional study
Authors: Steffen Julius , Schlichtiger Jenny , Brunner Stefan , Huber Bruno C.
Published: June 2021

To investigate the COVID-19 pandemic related alteration of health promoting behaviour during lockdown among medical students compared to other students.

In this cross-sectional study, we enrolled 1940 Bavarian students. Participants were asked to complete an online questionnaire 3 weeks after lockdown implementation, evaluating their lifestyle behaviour focusing on self-reported and objectively assessed physical activity.

1154 medical (59.5%) and 786 non-medical (40.5%) students were included (median age 22.0 [IQR, 20.0–25.0], 71.5% female). Physical activity decreased in both groups after lockdown implementation. During lockdown, medical students reported higher physical activity levels compared to non-medical students. This was corroborated by daily step count data assessed by wearables (median steps per day [IQR], 6979 [5218–9348] versus 6581 [4497–8491], p = 0.02). Smoking behaviour during lockdown did not differ between medical and non-medical students (increased in 11.8% vs 13.6%, decreased in 31.9% versus 36.9%).

During the COVID-19 pandemic, alteration of lifestyle behaviour among medical students was significantly different compared to non-medical students. This result suggests that medical students are more concerned about health promoting behaviour even in crisis situations.
Collective Critical Care Ambulance: an innovative transportation of critical care patients by bus in COVID-19 pandemic response
Authors: Lentz Thierry , Groizard Charles , Colomes Abel , Ozguler Anna , Baer Michel , Loeb Thomas
Published: June 2021

Background

During the COVID-19 pandemic, as the number of available Intensive Care beds in France did not meet the needs, it appeared necessary to transfer a large number of patients from the most affected areas to the less ones. Mass transportation resources were deemed necessary. To achieve that goal, the concept of a Collective Critical Care Ambulance (CCCA) was proposed in the form of a long-distance bus re-designed and equipped to accommodate up to six intensive care patients and allow Advanced Life Support (ALS) techniques to be performed while en route.

Methods

The expected benefit of the CCCA, when compared to ALS ambulances accommodating a single patient, was to reduce the resources requirements, in particular by a lower personnel headcount for several patients being transferred to the same destination. A foreseen prospect, comparing to other collective transportation vectors such as airplanes, was the door-to-door capability, minimalizing patients’ handovers for safety concerns and time efficiency.

With the project of a short-distance transfer of several Intensive Care Unit (ICU) patients together, the opportunity came to test the CCCA under real-life conditions and evaluate safely its technical feasibility and impact in time and resources saving, before it could be proposed for longer distances.

Results

Four COVID-19 patients were transported over 37 km. All patients were intubated and under controlled ventilation. One of them was under Norepinephrine support. Mean loading time was 1 min 39 s. Transportation time was 29 min. At destination, the mean unloading time was 1 min 15 s. No serious adverse effect, in particular regarding hemodynamic instability or ventilation disorder, has been observed. No harmful incident has occurred.

Conclusions

It was a very instructive test. Collective medical evacuation by bus for critically ill patients under controlled ventilation is suitable and easy to implement. Design, ALS equipment, power autonomy, safety and resources saving, open the way for carrying up to 6 ICU-patients over a long distance. The CCCA could bring a real added-value in an epidemic context and could also be helpful in many other events generating multiple victims such as an armed conflict, a terrorist attack or a natural disaster.
A point-of-care thoracic ultrasound protocol for hospital medical emergency teams (METUS) improves diagnostic accuracy
Authors: Blans M. J , Bousie E , van der Hoeven J. G , Bosch F. H
Published: June 2021

Background

Point-of-care ultrasound (POCUS) has proven itself in many clinical situations. Few data on the use of POCUS during Medical Emergency Team (MET) calls exist. In this study, we hypothesized that the use of POCUS would increase the number of correct diagnosis made by the MET and increase MET’s certainty.

Methods

Single-center prospective observational study on adult patients in need for MET assistance. Patients were included in blocks (weeks). During even weeks, the MET physician performed a clinical assessment and registered an initial diagnosis. Subsequently, the POCUS protocol was performed and a second diagnosis was registered (US+). During uneven weeks, no POCUS was performed (US−). A blinded expert reviewed the charts for a final diagnosis. The number of correct diagnoses was compared to the final diagnosis between both groups. Physician’s certainty, mortality and possible differences in first treatment were also evaluated.

Results

We included 100 patients: 52 in the US + and 48 in the US−  group. There were significantly more correct diagnoses in the US+ group compared to the US− group: 78 vs 51% (P  = 0.006). Certainty improved significantly with POCUS (P  <  0.001). No differences in 28-day mortality and first treatment were found.

Conclusions

The use of thoracic POCUS during MET calls leads to better diagnosis and increases certainty.

Trial registration. ClinicalTrials.gov. Registered 12 July 2017, NCT03214809 https://www.clinicaltrials.gov/ct2/show/NCT03214809?term=metus&cntry=NL&draw=2&rank=1
Feasibility of a school-based physical activity intervention for adolescents with disability
Authors: Leahy Angus A. , Kennedy Sarah G. , Smith Jordan J. , Eather Narelle , Boyer James , Thomas Matthew , Shields Nora , Dascombe Ben , Lubans David R.
Published: June 2021

Background

Adolescents with disability are less active and have lower levels of physical fitness than their typically developing peers. Schools are ideal settings to address this; however, few school-based interventions have been designed and evaluated among this group. Therefore, the aim of this pilot study was to determine the feasibility of a time-efficient school-based physical activity intervention for adolescents with disability.

Methods

A non-randomized pilot trial was conducted with adolescents in the special education unit at one secondary school in New South Wales, Australia. Sixteen grade 11 and 12 students (aged 17.3 ± 0.7 years) participated in the 2-month physical activity intervention. Two classroom teachers were trained to facilitate the delivery of a high-intensity interval training (HIIT) program, known as Burn 2 Learn adapted (B2La). Teachers were asked to deliver 2–3 weekly HIIT sessions for a period of 2 months. Four domains of feasibility (acceptability, implementation, adaptability, and practicality) were assessed using quantitative measures at the student and teacher levels (e.g., observations, process evaluation questionnaires, and heart rate [HR] monitoring). Data were also collected from three learning and support teachers who assisted classroom teachers with intervention delivery. Preliminary efficacy of the intervention on measures of adolescents’ functional capacity (6-min walk/run test) and muscular fitness (sit-to-stand test and modified push-up test) were analyzed using paired sample t-tests.

Results

Moderate-to-high levels of program satisfaction were reported by both students (80% rated “Good” or “Excellent”) and teachers (100% rated “Good” or “Excellent”). Teachers reported delivering 2.5 ± 0.7 sessions per week during the study. Based on researcher session observations, the program was delivered effectively by teachers (14/20). However, HR data indicated session intensity was lower than intended. The program was considered “adaptable” by teachers, with several observed modifications to HIIT sessions to cater for the needs of adolescents with disability. No adverse events were reported. We observed improvements in preliminary efficacy measures.

Conclusions

Our findings suggest it is feasible to train teachers to deliver a school-based HIIT program for adolescents with disability. Evaluation of B2La within a larger-scale effectiveness trial is warranted.

Trial registration

ACTRN12621000219886.
Childhood-onset Craniopharyngioma
Authors: Otte Anna , Müller Hermann L
Published: June 2021

Craniopharyngiomas are rare embryonic malformational tumors of the sellar/parasellar region, classified by the World Health Organization (WHO) as tumors with low-grade malignancy (WHO I). The childhood adamantinomatous subtype of craniopharyngioma is usually cystic with calcified areas. At the time of diagnosis, hypothalamic/pituitary deficits, visual disturbances, and increased intracranial pressure are major symptoms. The treatment of choice in case of favorable tumor location (without hypothalamic involvement) is complete resection. It is important to ensure that optical and hypothalamic functionality are preserved. In case of unfavorable tumor location, that is with hypothalamic involvement, a hypothalamus-sparing surgical strategy with subsequent local irradiation of residual tumor is recommended. In the further course of the disease, recurrences and progression often occur. Nevertheless, overall survival rates are high at 92%. Severe impairment of quality of life and comorbidities such as metabolic syndrome, hypothalamic obesity, and neurological consequences can be observed in patients with disease- and/or treatment-related lesions of hypothalamic structures. Childhood-onset craniopharyngioma frequently manifests as a chronic disease so that patients require lifelong, continuous care by experienced multidisciplinary teams to manage clinical and quality of life consequences. For this review, a search for original articles and reviews published between 1986 and 2020 was performed in Pubmed, Science Citation Index Expanded, EMBASE, and Scopus. The search terms used were “craniopharyngioma, hypothalamus, pituitary obesity, irradiation, neurosurgery.
The physiology, pathology and potential therapeutic application of serotonylation
Authors: Jiang Shu-Heng , Wang Ya-Hui , Hu Li-Peng , Wang Xu , Li Jun , Zhang Xue-Li , Zhang Zhi-Gang
Published: June 2021

The classical neurotransmitter serotonin or 5-hydroxytryptamine (5-HT), synthesized from tryptophan, can be produced both centrally and peripherally. Through binding to functionally distinct receptors, serotonin is profoundly implicated in a number of fundamental physiological processes and pathogenic conditions. Recently, serotonin has been found covalently incorporated into proteins, a newly identified post-translational modification termed serotonylation. Transglutaminases (TGMs), especially TGM2, are responsible for catalyzing the transamidation reaction by transferring serotonin to the glutamine residues of target proteins. Small GTPases, extracellular matrix protein fibronectin, cytoskeletal proteins and histones are the most reported substrates for serotonylation, and their functions are triggered by this post-translational modification. This Review highlights the roles of serotonylation in physiology and diseases and provides perspectives for pharmacological interventions to ameliorate serotonylation for disease treatment.
14-3-3 and erlin proteins differentially interact with RIPK2 complexes
Authors: Steinle Heidrun , Ellwanger Kornelia , Mirza Nora , Briese Selina , Kienes Ioannis , Pfannstiel Jens , Kufer Thomas A.
Published: June 2021

The receptor interacting serine/threonine kinase 2 (RIPK2) is essential for signal transduction induced by the pattern recognition receptors NOD1 and NOD2 (referred to collectively as NOD1/2). Upon NOD1/2 activation, RIPK2 forms complexes in the cytoplasm of human cells. Here, we identified the molecular composition of these complexes. Infection with Shigella flexneri to activate NOD1–RIPK2 revealed that RIPK2 formed dynamic interactions with several cellular proteins, including A20 (also known as TNFAIP3), erlin-1, erlin-2 and 14-3-3. Whereas interaction of RIPK2 with 14-3-3 proteins was strongly reduced upon infection with Shigella, erlin-1 and erlin-2 (erlin-1/2) specifically bound to RIPK2 complexes. The interaction of these proteins with RIPK2 was validated using protein binding assays and immunofluorescence staining. Beside bacterial activation of NOD1/2, depletion of the E3 ubiquitin ligase XIAP and treatment with RIPK2 inhibitors also led to the formation of RIPK2 cytosolic complexes. Although erlin-1/2 were recruited to RIPK2 complexes following XIAP inhibition, these proteins did not associate with RIPK2 structures induced by RIPK2 inhibitors. While the specific recruitment of erlin-1/2 to RIPK2 suggests a role in innate immune signaling, the biological response regulated by the erlin-1/2–RIPK2 association remains to be determined.
Mechanism of 2,6-Dichloro-4,4′-bipyridine-Catalyzed Diboration of Pyrazines Involving a Bipyridine-Stabilized Boryl Radical
Authors: Ohmura Toshimichi , Morimasa Yohei , Ichino Tomoya , Miyake Yusuke , Murata Yasujiro , Suginome Michinori , Tajima Kunihiko , Taketsugu Tetsuya , Maeda Satoshi
Published: June 2021

The mechanism of 4,4′-bipyridine-catalyzed diboration of pyrazines was studied by experimental observation of the intermediates and by theoretical calculations. Intermediary radical species were detected by ESR measurement of the reactions of 2,6-dichloro-4,4′-bipyridines with bis(pinacolato)diboron and identified by simulation. Based on these observations, radical processes involving 4,4′-bipyridine-stabilized boryl radicals were evaluated by DFT calculations combined with single-component artificial force induced reaction (SC-AFIR). The results of calculations indicate that a radical transfer process from 4,4′-bipyridine-stabilized boryl radical to pyrazine is a major pathway in the catalytic reaction. The origin of the high catalytic efficiency of 2,6-dichloro-4,4′-bipyridine is ascribed to the effect of the chlorine atom on the stability of the corresponding N,N′-diboryl-4,4′-bipyridinylidene.
Higher COVID-19 mortality in low-income communities in the City of Cape Town – a descriptive ecological study
Authors: Hussey Hannah , Zinyakatira Nesbert , Morden Erna , Ismail Muzzammil , Paleker Masudah , Bam Jamy-Lee , London Leslie , Boulle Andrew , Davies Mary-Ann
Published: June 2021

Background

Cape Town, a South African city with high levels of economic inequality, has gone through two COVID-19 waves. There is evidence globally that low-income communities experience higher levels of morbidity and mortality during the pandemic.

Methods

Age-standardized COVID-19 mortality in the eight sub-districts of Cape Town was compared by economic indicators taken from the most recent Census (unemployment rate, monthly income).

Results

The overall Standardized Death Rate (SDR) for COVID-19 in Cape Town was 1 640 per million, but there was wide variation across the different sub-districts. A linear relationship was seen between sub-districts with high poverty and high COVID-19 SDRs.

Conclusions

Low-income communities in Cape Town experienced higher levels of COVID-19 mortality. As we continue to contend with COVID-19, these communities need to be prioritized for access to quality health care.
Trajectories of anticipation: Preconceptuality and the task of reading habit
Authors: Feil Sebastian
Published: June 2021

The article characterizes Peirce’s concept of habit as a major contribution to a Peircean concept of preconceptuality, first, in relation to its function in the sign process, and second, in relation to other concepts of preconceptuality in cultural studies. Hans-Georg Gadamer’s notion of prejudice, Michel Foucault’s notions of the preconceptual and the dispositif, and Hans Blumenberg’s conception of metaphor all share certain key characteristics with Peirce’s notion of habit. The same comparison also highlights the fact that certain elements are missing from the current discourse on Peirce’s notion of habit: although any rendition of the concept of habit itself implicitly relies on a theory of historicity and of rule-association, these aspects only emerge explicitly in comparison with theories that more explicitly focus on such aspects.

Another question raised in the context of such a comparison is the relevance of habit for theories of conceptuality. Peirce claims that descriptions of concepts are best realized through the description of the habits involved in them. A major part of a concept’s coordinative power lies with the habits associated with the concept. However, no systematic inquiry into the possibility of rendering actual habits more definitive in comprehension has been undertaken. An attempt is therefore made to remedy that situation by elaborating on those aspects of Peirce’s theory of habit relevant to a theory of “reading” habit, and to sketch an outline of such a theory.
Narratives and the semiotic freedom of children
Authors: Lenninger Sara
Published: June 2021

Both adults’ habits-of-thought and their understanding of children’s stories shape how adults interpret children’s participation in conversations. In the light of the requests on children’s rights that follow from the Convention on the Rights of the Child (CRC) this paper stresses the relevance of authorities having semiotically informed knowledge on children’s meaning-making within conversations with adults. In Article 12, the CRC stipulates the right of children to participate in and to be heard about decisions that affect their everyday lives. According to the same Article, however, these rights can be restrained, based on the authority’s judgements of the child’s age and maturity. Sociological studies have highlighted the importance of adopting the child’s perspective in judging matters that concern her. The present paper further suggests that narrow conceptualization of the sign can help one to observe different levels of meaning in adults’ and children’s conversations better. Although Paul Ricoeur did not investigate children’s narratives per se, his theory of narratives and narrativity offers a phenomenological approach to development that allows for better theoretical discriminations of narrative as a semiotic resource, and can thus assist adults in truly listening to children.