bluuebunny/crossref_metadata_2025 huggingface dataset:
Transforming a global human resource service delivery operating model using Lean Six Sigma
Authors: Trubetskaya Anna , Mullers Hermann
Published: November 2021

The purpose of this study is to outline a transformation model that can help commercial enterprises to design, develop and launch a transformation programme of change within its global human resource (HR) operations function using the Six Sigma Define-Measure-Analyse-Design-Verify (DMADV) methodology. A qualitative approach of a single descriptive case study using the Six Sigma DMADV methodology was chosen to develop an iterative strategic roadmap that enables a HR function to transform its current service delivery operating model in line with organisational challenges. The present results indicate that the design of a strategic planning process, transformation programme and roadmap of prioritised improvement initiatives can enable human resource management (HRM) functions to scale their operating model into the future. Furthermore, the flexibility of the DMADV methodology means that the proposed model may be applied in any function outside of HR and indeed may be of interest to private organisations seeking to develop a similar programme of change.
On the Art of Binocular Rivalry
Authors: Wade Nicholas J.
Published: November 2021

Binocular rivalry has a longer descriptive history than stereoscopic depth perception both of which were transformed by Wheatstone's invention of the stereoscope. Thereafter, artistic interest in binocular vision has been largely confined to stereopsis. A brief survey of research on binocular contour rivalry is followed by anaglyphic examples of its expression as art. Rivalling patterns can be photographs, graphics, and combinations of them. In addition, illustrations of binocular lustre and interactions between rivalry and stereopsis are presented, as are rivalling portraits of some pioneers of the science and art of binocular vision. The question of why a dynamic process like binocular rivalry has been neglected in visual art is addressed.
Novel therapeutic targets and agents for pediatric dyslipidemia
Authors: Sunil Bhuvana , Foster Christy , Wilson Don P. , Ashraf Ambika P.
Published: November 2021

Landmark studies have convincingly demonstrated that atherosclerosis begins in youth. While generally asymptomatic, an increasing number of youth with disorders of lipid and lipoprotein metabolism, such as familial hypercholesterolemia, are being identified through selective and universal screening. While a heart healthy lifestyle is the foundation of treatment for all youth with dyslipidemia, lipid-lowering therapy may be required by some to prevent morbidity and premature mortality, especially when initiated at a young age. When appropriate, use of statins has become standard of care for reducing low-density lipoprotein cholesterol, while fibrates may be beneficial in helping to lower triglycerides. Many therapeutic options commonly used in adults are not yet approved for use in youth less than 18 years of age. Although currently available lipid-lowering therapy is well tolerated and safe when administered to youth, response to treatment may vary and some conditions lack an efficient therapeutic option. Thus, newer agents are needed to aid in management. Many are in development and clinical trials in youth are currently in progress but will require FDA approval before becoming commercially available. Many utilize novel approaches to favorably alter lipid and lipoprotein metabolism. In the absence of long-term outcome data of youth who were treated beginning at an early age, clinical registries may prove to be useful in monitoring safety and efficacy and help to inform clinical decision-making. In this manuscript, we review currently available and novel therapeutic agents in development for the treatment of elevated cholesterol and triglycerides.
Perspectives of drug treatment and mental health professionals towards treatment provision for substance use disorders with coexisting mental health problems in England
Authors: Houghton Ben , Bailey Alexis , Kouimtsidis Christos , Duka Theodora , Notley Caitlin
Published: November 2021

Background

Opioid-related deaths are at record levels in the UK and contribute to over half of all drug-related deaths. The prevalence of psychiatric disorders within people who uses substances is known to be considerably higher than the general population, yet only 4% of people accessing treatment are thought to receive integrated care for coexisting conditions. This study aimed to explore perspectives on treatment for people with substance use disorders and coexisting psychiatric problems.

Methods

Face-to-face semi-structured interviews with community drug workers, specialist nurses, prescribing administration worker and one clinical psychologist were conducted. Deductive analysis of three preconceived themes (i.e. reasons for substance use, treatment provision, the role of medication) was conducted.

Results

There was agreement between drug treatment professionals and mental health professionals for the complexities for being in treatment for people who use substances. An expectancy of prolonged periods of abstinence from drug and alcohol use before psychological treatment would be initiated leading to relapse was reported. Individual judgements of practitioners, stigmatisation and fear of people who use substances and organisational barriers often meant psychological help was unavailable which contributed to a reliance on medication, against national clinical guidance which was known by only one interviewee.

Conclusion

The UK drug treatment and mental health services should review the pathways to ensure that national guidelines are followed so that people who use substances are not excluded from accessing psychological therapies. Data from the coronavirus pandemic indicates heightened psychiatric problems, where illicit drug use may escalate as a means of self-medication leading to further increases in drug-related deaths.
It’s difficult to say no: Development of a parenting booklet about physical activity restrictions and recommendations in pediatric hemophilia
Authors: Bérubé Sarah , Ogez David , Aramideh Jennifer , Amesse Claudine , Bourque Claude J , Longpré Claire , Muise Lorraine , Levesque Ariane , Sultan Serge
Published: November 2021

Physical activity restrictions can be particularly difficult for children with hemophilia and their parents, as most children want to engage in the same activities as their friends or siblings. This study aimed to assess parents’ need for a booklet on how to manage physical activity restrictions based on the self-determination theory and gather their suggestions for the booklet’s improvement in a focus group. Data were analyzed using thematic analyses to highlight to what extent the needs of parents were met by the booklet, as well as their suggestions for improvement. A discussion on the methodology of the booklet’s creation is also presented.
A multisite randomized controlled trial of two group education programs for fatigue in multiple sclerosis: Very long term (5–6 year) follow-up at one site
Authors: Norton Julia , Joos Sandra , Cameron Michelle H , Hugos Cinda L
Published: November 2021

Background

A multicomponent group MS fatigue self-management program reduced fatigue impact compared to a rigorous control 12 months after enrollment.

Objectives

Assess and compare changes between groups in fatigue impact and behavior changes implemented 5–6 years after enrollment.

Methods

The Modified Fatigue Impact Scale (MFIS) and a behavior change questionnaire were administered 5–6 years after enrollment.

Results

There were no significant changes in mean MFIS scores within or between groups from baseline to 5–6 years later. Behavior changes were of similar frequency in both groups.

Conclusion

Fatigue impact was stable and behavior changes were similar between groups 5–6 years after a fatigue self-management program.
Vowel Modification (Aggiustamento) in Soprano Voices
Authors: Yu Chan May Pik , Do Youngah
Published: November 2021

Singers convey meaning via both text and music. As sopranos balance tone quality and diction, vowel intelligibility is often compromised at high pitches. This study examines how sopranos modify their vowels against an increasing fundamental, and in turn how such vowel modification affects vowel intelligibility. We examine the vowel modification process of three non-central vowels in Cantonese ([a], [ɛ] and [ɔ]) using the spectral centroid. Acoustic results suggest that overall vowel modification is conditioned by vowel height in mid-ranges and by vowel frontness in higher ranges. In a following perception task, listeners identified and discriminated vowels at pitches spanning an octave from A4 (nominally 440 Hz) to G♯5 (nominally 831 Hz). Results showed that perceptual accuracy rates of the three vowels’ match their acoustic patterns. The overall results suggest that vowels are not modified in a unified way in sopranos’ voices, implying that research on sopranos’ singing strategies should consider vocalic differences.
Caught in the middle? Chinese international students’ self-formation amid politics and pandemic
Authors: Yu Jing
Published: November 2021

With neo-nationalism spreading in both China and the US as well as the evolving COVID-19 pandemic, Chinese international undergraduate students are perceived as in-between: racialized in their host country and labeled as out-group members in their home country. In both contexts, their voices are constantly marginalized and silenced. Drawing upon the concept of self-formation, this article uses an ethical paradigm to emphasize students’ self-determining agency and capability in the process of personal transformation. Based on online observation and semistructured Zoom interviews, this study demonstrates that Chinese students tend to live and study resiliently amid current heightened uncertainties. More importantly, they actively exercise independent autonomy to facilitate plural identities, albeit under social circumstances beyond their control. Instead of being caught in the middle as framed by dominant discourses, this study shows that Chinese students’ decisions about study abroad, choices about social adaptation, and career ambition are deliberate and conscious, confronting ever-changing social, cultural, political, and economic conditions.
Analysing the Adoption of Intelligent Agent Technology in Food Supply Chain Management: An Empirical Evidence
Authors: Mukherjee Subhodeep , Chittipaka Venkataiah
Published: November 2021

This article aims to identify and analyse the factors that impact the adoption of intelligent agent technology (IAT) in the food supply chain (FSC). The research was conducted based on 329 respondents from various hotels and the theoretical framework adopted in this study, that is, technological, organizational and environmental (TOE) framework. The findings indicated that multiple factors in TOE contribute significantly to the adoption of IAT. We have validated the proposed framework by structural equation modelling utilizing AMOS 22.0. This research offers a new and vital paradigm for adopting this innovation in the FSC, thereby increasing the overall efficiency of a hotel. The proposed TOE framework has identified several factors like relative advantage, reliability, complexity, cost, innovation adoption, top management support, skilled employees, IT awareness, environmental uncertainty, competitive pressure, information intensity and supplier’s pressure, which helps in the adoption process of IAT in the FSC. It also provides a foundation for future research and significant insights to adopt this new technology in the hotel industry.
Optimizing HIV Services for Key Populations in Public-Sector Clinics in Myanmar
Authors: Lemons-Lyn Ansley , Reidy William , Myint Wah Wah , Chan Khin N. , Abrams Elaine , Aung Zaw Zaw , Benech Irene , Bingham Trista , Desai Mitesh , Khin Ei Ei , Lin Tharaphi , Olsen Halli , Oo Htun Nyunt , Wells Cassia , Mital Sasha
Published: November 2021

Key populations, ie, female sex workers, men who have sex with men, transgender people, people who inject drugs, and people in prisons and other closed settings, experience stigma, discrimination, and structural barriers when accessing HIV prevention and care. Public health facilities in Myanmar became increasingly involved in HIV service delivery, leading to an urgent need for healthcare workers to provide client-centred, key population-friendly services. Between July 2017–June 2018, the Myanmar Ministry of Health and Sports and National AIDS Programme collaborated with ICAP at Columbia University and the US Centers for Disease Control and Prevention to implement a quasi-experimental, multicomponent intervention including healthcare worker sensitization training with pre- and post- knowledge assessments, healthcare worker and client satisfaction surveys, and structural changes. We observed modest improvements among healthcare workers (n = 50) in knowledge assessments. Classification of clients into key population groups increased and fewer clients were classified as low risk. Key population clients reported favourable perceptions of the quality and confidentiality of care through self-administered surveys. Our findings suggest public health facilities can deliver HIV services that are valued by key population clients.
A Child’s Acute Intestinal Intussusception and Literature Review
Authors: Yehouenou Tessi Romeo Thierry , El Haddad Siham , Oze Koudouhonon Rita , Mohamed Traore Wend-Yam , Dinga Ekadza Jusly Amour , Allali Nazik , Chat Latifa
Published: November 2021

Acute intestinal intussusception remains a surgical emergency in infants and young children aged 3 months to 3 years. It results from the incarceration of the upstream intestinal segment in the downstream segment. In the majority of cases it is idiopathic, but can be secondary to certain pathologies notably Meckel’s diverticulum. The site is most often ileo cecal. The symptomatological triad is made up of pain, vomiting, and rectal bleeding. The diagnosis is confirmed by imaging, dominated by ultrasound which remains the reference imaging. We report the case of a 3 year-old boy, followed for a malformation who presented with abdominal distension, abdominal pain, and rectal bleeding. The diagnosis of acute ileo-ileal intussusception was made. After an attempt at hydrostatic reduction under ultrasound guidance, he underwent surgical management. The postoperative period was simple and uncomplicated. Intestinal intussusception remains a pathology with a low morbidity and mortality rate of 0% to 1% due to delayed diagnosis and delayed therapeutic management.
Status of Crime Victims in Bangladesh
Authors: Faruk Mohammad Omar , Sahni Sanjeev P. , Kirchhoff Gerd Ferdinand
Published: November 2021

Though a few provisions for the victim of crimes were indirectly recognized since the nineteenth century, from 2000 onwards, legal entitlements for crime victims are realized in Bangladesh with a specific focus on women and children. So far, few analyses are found to be performed mainly by the legal experts, emphasizing legal rights and remedies with recommendations for legal reform. However, studies on the status of victims’ rights seem to be incomplete without considering administrative as well as social reality—dominated by colonial legacy and traditional practices—beyond the written clauses in the law books. This study is one of the pioneering attempts in Bangladesh to understand the status of crime victims against the backdrop of recent legal changes and to examine the argument whether the legal provisions itself are enough in providing victims with intended benefits without simultaneous social and administrative changes. Within the theoretical framework of balancing victim’s rights and informal social control (victim blaming), this qualitative study (through content analysis) reviewed all criminal laws and research findings related to victim’s rights within a socio-legal approach in terms of victim’s access, participation, protection, services and compensation. Along with the rights legally granted to victims, available research findings were interpreted in connection to those particular rights. It is found that there are unsupportive social milieu, administrative subculture and political practices, where victims of crime are strongly restrained from enjoying their rights. Particularly, the status of crime victims is found to be undermined in the face of corruption, low public confidence on enforcing agencies, gross withdrawal or discharge of criminal cases on political grounds, limited geographical coverage of victim support services and shelter homes, lengthy process for compensation and unavailability of rules or guidelines to enforce the rights.
Selexipag for the treatment of chronic thromboembolic pulmonary hypertension
Authors: Ogo Takeshi , Shimokawahara Hiroto , Kinoshita Hideyuki , Sakao Seiichiro , Abe Kohtaro , Matoba Satoaki , Motoki Hirohiko , Takama Noriaki , Ako Junya , Ikeda Yasuhiro , Joho Shuji , Maki Hisataka , Saeki Takahiro , Sugano Teruyasu , Tsujino Ichizo , Yoshioka Koichiro , Shiota Naoki , Tanaka Shinichi , Yamamoto Chieko , Tanabe Nobuhiro , Tatsumi Koichiro ,   for the Study Group
Published: November 2021

Background

Treatment options for inoperable chronic thromboembolic pulmonary hypertension (CTEPH) remain limited. Selexipag, an oral selective IP prostacyclin receptor agonist approved for pulmonary arterial hypertension, is a potential treatment option for CTEPH.

Methods

In this multicentre, randomised, double-blind, placebo-controlled study, 78 Japanese patients with inoperable CTEPH or persistent/recurrent pulmonary hypertension after pulmonary endarterectomy and/or balloon pulmonary angioplasty were randomly assigned to receive placebo or selexipag. The primary end-point was the change in pulmonary vascular resistance (PVR) from baseline to week 20. Secondary end-points were changes in other haemodynamic parameters: 6-min walk distance (6MWD), Borg dyspnoea scale score, World Health Organization (WHO) functional class, EuroQol five-dimension five-level tool and N-terminal pro-brain natriuretic peptide.

Results

The change in PVR was −98.2±111.3 dyn·s·cm−5and −4.6±163.6 dyn·s·cm−5in the selexipag and placebo groups, respectively (mean difference −93.5 dyn·s·cm−5; 95% CI −156.8 to −30.3; p=0.006). The changes in cardiac index (p<0.001) and Borg dyspnoea scale score (p=0.036) were also significantly improved over placebo. 6MWD and WHO functional class were not significantly improved. The common adverse events in the selexipag group corresponded to those generally observed following administration of a prostacyclin analogue.

Conclusion

Selexipag significantly improved PVR and other haemodynamic variables in patients with CTEPH, although exercise capacity remained unchanged. Further large-scale investigation is necessary to prove the role of selexipag in CTEPH.
Urinary metabotype of severe asthma evidences decreased carnitine metabolism independent of oral corticosteroid treatment in the U-BIOPRED study
Authors: Reinke Stacey N. , Naz Shama , Chaleckis Romanas , Gallart-Ayala Hector , Kolmert Johan , Kermani Nazanin Z. , Tiotiu Angelica , Broadhurst David I. , Lundqvist Anders , Olsson Henric , Ström Marika , Wheelock Åsa M. , Gómez Cristina , Ericsson Magnus , Sousa Ana R. , Riley John H. , Bates Stewart , Scholfield James , Loza Matthew , Baribaud Frédéric , Bakke Per S. , Caruso Massimo , Chanez Pascal , Fowler Stephen J. , Geiser Thomas , Howarth Peter , Horváth Ildikó , Krug Norbert , Montuschi Paolo , Behndig Annelie , Singer Florian , Musial Jacek , Shaw Dominick E. , Dahlén Barbro , Hu Sile , Lasky-Su Jessica , Sterk Peter J. , Chung Kian Fan , Djukanovic Ratko , Dahlén Sven-Erik , Adcock Ian M. , Wheelock Craig E.
Published: November 2021

Introduction

Asthma is a heterogeneous disease with poorly defined phenotypes. Patients with severe asthma often receive multiple treatments including oral corticosteroids (OCS). Treatment may modify the observed metabotype, rendering it challenging to investigate underlying disease mechanisms. Here, we aimed to identify dysregulated metabolic processes in relation to asthma severity and medication.

Methods

Baseline urine was collected prospectively from healthy participants (n=100), patients with mild-to-moderate asthma (n=87) and patients with severe asthma (n=418) in the cross-sectional U-BIOPRED cohort; 12–18-month longitudinal samples were collected from patients with severe asthma (n=305). Metabolomics data were acquired using high-resolution mass spectrometry and analysed using univariate and multivariate methods.

Results

A total of 90 metabolites were identified, with 40 significantly altered (p<0.05, false discovery rate <0.05) in severe asthma and 23 by OCS use. Multivariate modelling showed that observed metabotypes in healthy participants and patients with mild-to-moderate asthma differed significantly from those in patients with severe asthma (p=2.6×10−20), OCS-treated asthmatic patients differed significantly from non-treated patients (p=9.5×10−4), and longitudinal metabotypes demonstrated temporal stability. Carnitine levels evidenced the strongest OCS-independent decrease in severe asthma. Reduced carnitine levels were associated with mitochondrial dysfunctionviadecreases in pathway enrichment scores of fatty acid metabolism and reduced expression of the carnitine transporter SLC22A5 in sputum and bronchial brushings.

Conclusions

This is the first large-scale study to delineate disease- and OCS-associated metabolic differences in asthma. The widespread associations with different therapies upon the observed metabotypes demonstrate the need to evaluate potential modulating effects on a treatment- and metabolite-specific basis. Altered carnitine metabolism is a potentially actionable therapeutic target that is independent of OCS treatment, highlighting the role of mitochondrial dysfunction in severe asthma.
Lung transplantation for acute respiratory distress syndrome: a retrospective European cohort study
Authors: Gottlieb Jens , Lepper Philipp M. , Berastegui Cristina , Montull Beatriz , Wald Alexandra , Parmar Jasvir , Magnusson Jesper M. , Schönrath Felix , Laisaar Tanel , Michel Sebastian , Larsson Hillevi , Vos Robin , Haneya Assad , Sandhaus Tim , Verschuuren Erik , le Pavec Jérôme , Tikkanen Jussi , Hoetzenecker Konrad
Published: November 2021

Background

The published experience of lung transplantation in acute respiratory distress syndrome (ARDS) is limited. The aim of this study was to investigate the contemporary results of lung transplantation attempts in ARDS in major European centres.

Methods

We conducted a retrospective multicentre cohort study of all patients listed for lung transplantation between 2011 and 2019. We surveyed 68 centres in 22 European countries. All patients admitted to the waitlist for lung transplantation with a diagnosis of “ARDS/pneumonia” were included. Patients without extracorporeal membrane oxygenation (ECMO) or mechanical ventilation were excluded. Patients were followed until 1 October 2020 or death. Multivariable analysis for 1-year survival after listing and lung transplantation was performed.

Results

55 centres (81%) with a total transplant activity of 12 438 lung transplants during the 9-year period gave feedback. 40 patients with a median age of 35 years were identified. Patients were listed for lung transplantation in 18 different centres in 10 countries. 31 patients underwent lung transplantation (0.25% of all indications) and nine patients died on the waitlist. 90% of transplanted patients were on ECMO in combination with mechanical ventilation before lung transplantation. On multivariable analysis, transplantation during 2015–2019 was independently associated with better 1-year survival after lung transplantation (OR 10.493, 95% CI 1.977–55.705; p=0.006). 16 survivors out of 23 patients with known status (70%) returned to work after lung transplantation.

Conclusions

Lung transplantation in highly selected ARDS patients is feasible and outcome has improved in the modern era. The selection process remains ethically and technically challenging.
Dexamethasone in hospitalised COVID-19 patients not on intensive respiratory support
Authors: Crothers Kristina , DeFaccio Rian , Tate Janet , Alba Patrick R. , Goetz Matthew Bidwell , Jones Barbara , King Joseph T. , Marconi Vincent , Ohl Michael E. , Rentsch Christopher T. , Rodriguez-Barradas Maria C. , Shahrir Shahida , Justice Amy C. , Akgün Kathleen M. ,   for the Veterans Aging Cohort Study Clinical COVID-19 Working Group
Published: November 2021

Background

Dexamethasone decreases mortality in coronavirus disease 2019 (COVID-19) patients on intensive respiratory support (IRS) but is of uncertain benefit if less severely ill. We determined whether early (within 48 h) dexamethasone was associated with mortality in patients hospitalised with COVID-19 not on IRS.

Methods

We included patients admitted to US Veterans Affairs hospitals between 7 June 2020 and 31 May 2021 within 14 days after a positive test for severe acute respiratory syndrome coronavirus 2. Exclusions included recent prior corticosteroids and IRS within 48 h. We used inverse probability of treatment weighting (IPTW) to balance exposed and unexposed groups, and Cox proportional hazards models to determine 90-day all-cause mortality.

Results

Of 19 973 total patients (95% men, median age 71 years, 27% black), 15 404 (77%) were without IRS within 48 h. Of these, 3514 out of 9450 (34%) patients on no oxygen received dexamethasone and 1042 (11%) died; 4472 out of 5954 (75%) patients on low-flow nasal cannula (NC) only received dexamethasone and 857 (14%) died. In IPTW stratified models, patients on no oxygen who received dexamethasone experienced 76% increased risk for 90-day mortality (hazard ratio (HR) 1.76, 95% CI 1.47–2.12); there was no association with mortality among patients on NC only (HR 1.08, 95% CI 0.86–1.36).

Conclusions

In patients hospitalised with COVID-19, early initiation of dexamethasone was common and was associated with no mortality benefit among those on no oxygen or NC only in the first 48 h; instead, we found evidence of potential harm. These real-world findings do not support the use of early dexamethasone in hospitalised COVID-19 patients without IRS.
Randomized quantile residuals for diagnosing zero-inflated generalized linear mixed models with applications to microbiome count data
Authors: Bai Wei , Dong Mei , Li Longhai , Feng Cindy , Xu Wei
Published: November 2021

Background

For differential abundance analysis, zero-inflated generalized linear models, typically zero-inflated NB models, have been increasingly used to model microbiome and other sequencing count data. A common assumption in estimating the false discovery rate is that thepvalues are uniformly distributed under the null hypothesis, which demands that the postulated model fit the count data adequately. Mis-specification of the distribution of the count data may lead to excess false discoveries. Therefore, model checking is critical to control the FDR at a nominal level in differential abundance analysis. Increasing studies show that the method of randomized quantile residual (RQR) performs well in diagnosing count regression models. However, the performance of RQR in diagnosing zero-inflated GLMMs for sequencing count data has not been extensively investigated in the literature.

Results

We conduct large-scale simulation studies to investigate the performance of the RQRs for zero-inflated GLMMs. The simulation studies show that the type I error rates of the GOF tests with RQRs are very close to the nominal level; in addition, the scatter-plots and Q–Q plots of RQRs are useful in discerning the good and bad models. We also apply the RQRs to diagnose six GLMMs to a real microbiome dataset. The results show that the OTU counts at the genus level of this dataset (after a truncation treatment) can be modelled well by zero-inflated and zero-modified NB models.

Conclusion

RQR is an excellent tool for diagnosing GLMMs for zero-inflated count data, particularly the sequencing count data arising in microbiome studies. In the supplementary materials, we provided two generic R functions, called and , for calculating the RQRs given fitting outputs of the R package .
Alternative splicing level related to intron size and organism complexity
Authors: Yang Pengcheng , Wang Depin , Kang Le
Published: November 2021

Background

Alternative splicing is the process of selecting different combinations of splice sites to produce variably spliced mRNAs. However, the relationships between alternative splicing prevalence and level (ASP/L) and variations of intron size and organism complexity (OC) remain vague. Here, we developed a robust protocol to analyze the relationships between ASP/L and variations of intron size and OC. Approximately 8 Tb raw RNA-Seq data from 37 eumetazoan species were divided into three sets of species based on variations in intron size and OC.

Results

We found a strong positive correlation between ASP/L and OC, but no correlation between ASP/L and intron size across species. Surprisingly, ASP/L displayed a positive correlation with mean intron size of genes within individual genomes. Moreover, our results revealed that four ASP/L-related pathways contributed to the differences in ASP/L that were associated with OC. In particular, the spliceosome pathway displayed distinct genomic features, such as the highest gene expression level, conservation level, and fraction of disordered regions. Interestingly, lower or no obvious correlations were observed among these genomic features.

Conclusions

The positive correlation between ASP/L and OC ubiquitously exists in eukaryotes, and this correlation is not affected by the mean intron size of these species. ASP/L-related splicing factors may play an important role in the evolution of OC.
Comparison of the effects of open vs. closed skill exercise on the acute and chronic BDNF, IGF-1 and IL-6 response in older healthy adults
Authors: Behrendt Tom , Kirschnick Franziska , Kröger Lasse , Beileke Phillip , Rezepin Maxim , Brigadski Tanja , Leßmann Volkmar , Schega Lutz
Published: November 2021

Background

Accumulating evidence shows that physical exercise has a positive effect on the release of neurotrophic factors and myokines. However, evidence regarding the optimal type of physical exercise for these release is still lacking. The aim of this study was to assess the acute and chronic effects of open-skill exercise (OSE) compared to closed-skill exercise (CSE) on serum and plasma levels of brain derived neurotrophic factor (BDNFS, BDNFP), and serum levels of insulin like growth factor 1 (IGF-1), and interleukin 6 (IL-6) in healthy older adults.

Methods

To investigate acute effects, thirty-eight participants were randomly assigned to either an intervention (badminton (aOSE) and bicycling (aCSE), n  = 24, 65.83 ± 5.98 years) or control group (reading (CG), n  = 14, 67.07 ± 2.37 years). Blood samples were taken immediately before and 5 min after each condition. During each condition, heart rate was monitored. The mean heart rate of aOSE and aCSE were equivalent (65 ± 5% of heart rate reserve). In a subsequent 12-week training-intervention, twenty-two participants were randomly assigned to either a sport-games (cOSE, n  = 6, 64.50 ± 6.32) or a strength-endurance training (cCSE, n  = 9, 64.89 ± 3.51) group to assess for chronic effects. Training intensity for both groups was adjusted to a subjective perceived exertion using the CR-10 scale (value 7). Blood samples were taken within one day after the training-intervention.

Results

BDNFS, BDNFP, IGF-1, and IL-6 levels increased after a single exercise session of 30 min. After 12 weeks of training BDNFSand IL-6 levels were elevated, whereas IGF-1 levels were reduced in both groups. However, only in the cOSE group these changes were significant. We could not find any significant differences between the exercise types.

Conclusion

Our results indicate that both exercise types are efficient to acutely increase BDNFS, BDNFP, IGF-1 and IL-6 serum levels in healthy older adults. Additionally, our results tend to support that OSE is more effective for improving basal BDNFSlevels after 12 weeks of training.
Genome-wide identification and expression profiling of invertase gene family for abiotic stresses tolerance in Poncirus trifoliata
Authors: Dahro Bachar , Wang Yue , Alhag Ahmed , Li Chunlong , Guo Dayong , Liu Ji-Hong
Published: November 2021

Background

Sucrose (Suc) hydrolysis is directly associated with plants tolerance to multiple abiotic stresses. Invertase (INV) enzymes irreversibly catalyze Suc degradation to produce glucose (Glc) and fructose (Frc). However, genome-wide identification and function of individual members of the INV gene family in Poncirus trifoliata or its Citrus relatives in response to abiotic stresses are not fully understood.

Results

In this report, fourteen non-redundant PtrINV family members were identified in P. trifoliata including seven alkaline/neutral INV genes (PtrA/NINV1–7), two vacuolar INV genes (PtrVINV1–2), and five cell wall INV isoforms (PtrCWINV1–5). A comprehensive analysis based on the biochemical characteristics, the chromosomal location, the exon–intron structures and the evolutionary relationships demonstrated the conservation and the divergence of PtrINVs. In addition, expression analysis of INV genes during several abiotic stresses in various tissues indicated the central role of A/NINV7 among INV family members in response to abiotic stresses. Furthermore, our data demonstrated that high accumulation of Suc, Glc, Frc and total sugar contents were directly correlated with the elevated activities of soluble INV enzymes in the cold-tolerant P. trifoliata, C. ichangensis and C. sinensis, demonstrating the potential role of soluble INV enzymes for the cold tolerance of Citrus.

Conclusions

This work offered a framework for understanding the physiological role of INV genes and laid a foundation for future functional studies of these genes in response to abiotic stresses.
Human granulocytic anaplasmosis combined with rhabdomyolysis: a case report
Authors: Cho Jeong Min , Chang Jeonghyun , Kim Dong-Min , Kwak Yee Gyung , Cho Chong Rae , Song Je Eun
Published: November 2021

Background

Human granulocytic anaplasmosis (HGA) is a systemic inflammatory response caused by the rickettsial bacteriumAnaplasma phagocytophilum. Rhabdomyolysis and acute kidney injury (AKI) are rare complications of HGA. Here, we report a case of HGA concurrent with rhabdomyolysis and AKI in an elderly patient.

Case presentation

An 84-year old woman with a medical history of hypertension was hospitalised after two days of fever, dizziness, whole body pain, and general weakness. Laboratory investigations showed severe thrombocytopenia, leukopenia, impaired renal function, and elevated cardiac enzyme and myoglobin levels. On the day after admission, peripheral blood smear revealed morula inclusions in neutrophils, a suggestive finding of HGA. Real-time polymerase chain reaction (PCR) results indicated the presence ofA. phagocytophilum. Antibiotics were de-escalated to doxycycline monotherapy. After 10 days of antibiotic treatment, laboratory tests showed complete recovery from HGA complicated with rhabdomyolysis and AKI.

Conclusions

HGA can lead to serious complications in patients with associated risk factors. Therefore, in patients with HGA accompanied by rhabdomyolysis, management with antibiotics and hydration should be initiated immediately, and not delayed until diagnostic confirmation.
Correction to: A time-driven activity-based costing approach for identifying variability in costs of childbirth between and within types of delivery
Authors: Dubron Kathia , Verschaeve Mathilde , Roodhooft Filip
Published: November 2021

An amendment to this paper has been published and can be accessed via the original article.
Personal exposure to particulate matter and heart rate variability among informal electronic waste workers at Agbogbloshie: a longitudinal study
Authors: Amoabeng Nti Afua A. , Robins Thomas G. , Mensah John Arko , Dwomoh Duah , Kwarteng Lawrencia , Takyi Sylvia A. , Acquah Augustine , Basu Niladri , Batterman Stuart , Fobil Julius N.
Published: November 2021

Background

Informal electronic waste recycling activities are major contributors to ambient air pollution, yet studies assessing the effects or relationship between direct/continuous exposure of informal e-waste workers to particulate matter and cardiovascular function are rare.

Methods

Repeated measurements of fractions of PM2.5, PM10–2.5, and PM10 in personal air of informal e-waste workers, (n = 142) and a comparable group (n = 65) were taken over a period of 20 months (March 2017 to November, 2018). Concurrently, 5-min resting electrocardiogram was performed on each participant to assess resting heart rate variability indices. Linear mixed-effects models were used to assess the association between PM fractions and cardiac function.

Results

SDNN, RMSSD, LF, HF and LH/HF ratio were all associated with PM. Significant associations were observed for PM2.5 and Mean NN (p = 0.039), PM10 and SDNN (p = 0.035) and PM 10–2.5 and LH/HF (p = 0.039). A 10 μg/m3 increase in the concentrations of PM 2.5, PM10–2.5, and PM10 in personal air was associated with reduced HRV indices and increased resting HR. A 10 μg/m3 per interquartile (IQR) increase in PM10–2.5 and PM10, decreased SDNN by 11% [(95% CI: − 0.002- 0.000); (p = 0.187)] and 34% [(95% CI: − 0.002-0.001); (p = 0.035)] respectively. However, PM2.5 increased SDNN by 34% (95% CI: − 1.32-0.64); (p = 0.493). Also, 10 μg/m3 increase in PM2.5, PM10–2.5 and PM10 decreased RMSSD by 27% [(− 1.34–0.79); (p = 0.620)], 11% [(− 1.73, 0.95); (p = 0.846)] and 0.57% [(− 1.56–0.46); (p = 0.255%)].

Conclusion

Informal e-waste workers are at increased risk of developing cardiovascular disease from cardiac autonomic dysfunction as seen in reduced HRV and increased heart rate.
Development and validation of a prognostic nomogram for predicting overall survival in patients with primary bladder sarcoma: a SEER-based retrospective study
Authors: Li Shijie , Liu Xuefeng , Chen Xiaonan
Published: November 2021

Background

Primary bladder sarcoma (PBS) is a rare malignant tumor of the bladder with a poor prognosis, and its disease course is inadequately understood. Therefore, our study aimed to establish a prognostic model to determine individualized prognosis of patients with PBS.

Patients and Methods

Data of 866 patients with PBS, registered from 1973 to 2015, were extracted from the surveillance, epidemiology, and end result (SEER) database. The patients included were randomly split into a training (n = 608) and a validation set (n = 258). Univariate and multivariate Cox regression analyses were employed to identify the important independent prognostic factors. A nomogram was then established to predict overall survival (OS). Using calibration curves, receiver operating characteristic curves, concordance index (C-index), decision curve analysis (DCA), net reclassification improvement (NRI) and integrated discrimination improvement (IDI), the performance of the nomogram was internally validated. We compared the nomogram with the TNM staging system. The application of the risk stratification system was tested using Kaplan–Meier survival analysis.

Results

Age at diagnosis, T-stage, N-stage, M-stage, and tumor size were identified as independent predictors of OS. C-index of the training cohort were 0.675, 0.670, 0.671 for 1-, 3- and 5-year OS, respectively. And that in the validation cohort were 0.701, 0.684, 0.679, respectively. Calibration curves also showed great prediction accuracy. In comparison with TNM staging system, improved net benefits in DCA, evaluated NRI and IDI were obtained. The risk stratification system can significantly distinguish the patients with different survival risk.

Conclusion

A prognostic nomogram was developed and validated in the present study to predict the prognosis of the PBS patients. It may assist clinicians in evaluating the risk factors of patients and formulating an optimal individualized treatment strategy.
Triple-negative apocrine carcinoma as a rare cause of a breast lump in a Syrian female: a case report and review of the literature
Authors: Ismail Sawsan , Kherbek Haidara , Skef Jana , Zahlouk Nadim , Abdulal Rafik , Alshehabi Zuheir
Published: November 2021

Background

Apocrine carcinoma is a rare tumor that constitutes < 4% of all breast malignancies, characterized by the proliferation of large atypical cells with strictly defined borders, abundant eosinophilic cytoplasm, large nuclei, and prominent nucleoli in more than 90% of tumor cells. Triple-negative apocrine carcinoma is a rare molecular subtype that constitutes less than 1% of triple-negative breast cancers and is characterized by negative expression of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor, with positive expression of androgen receptor.

Case presentation

We report a case of a 45-year-old Syrian female who presented to our hospital due to a painless palpable mass in her left breast. Following physical and radiological examinations, an excisional biopsy was performed. Microscopic examination of the specimen followed by immunohistochemical staining revealed the diagnosis of a triple-negative apocrine carcinoma.

Conclusion

Triple-negative apocrine carcinoma is an extremely rare neoplasm that must be considered in the differential diagnoses of breast lesions through detailed clinical, histological, and immunohistochemical correlations. In our manuscript, we aimed to present the first case report of a Syrian female who was diagnosed with a triple-negative apocrine carcinoma, aiming to highlight the importance of detailed clinical, histological and immunohistochemical correlations with a detailed review of diagnostic criteria, molecular characteristics, and treatment recommendations.
Contribution of a positive psychology-based conceptual framework in reducing physician burnout and improving well-being: a systematic review
Authors: Bazargan-Hejazi Shahrzad , Shirazi Anaheed , Wang Andrew , Shlobin Nathan A. , Karunungan Krystal , Shulman Joshua , Marzio Robert , Ebrahim Gul , Shay William , Slavin Stuart
Published: November 2021

Background

The PERMA Model, as a positive psychology conceptual framework, has increased our understanding of the role of Positive emotion, Engagement, Relationships, Meaning, and Achievements in enhancing human potentials, performance and wellbeing. We aimed to assess the utility of PERMA as a multidimensional model of positive psychology in reducing physician burnout and improving their well-being.

Methods

Eligible studies include peer-reviewed English language studies of randomized control trials and non-randomized design. Attending physicians, residents, and fellows of any specialty in the primary, secondary, or intensive care setting comprised the study population. Eligible studies also involved positive psychology interventions designed to enhance physician well-being or reduce physician burnout. Using free text and the medical subject headings we searched CINAHL, Ovid PsychINFO, MEDLINE, and Google Scholar (GS) electronic bibliographic databases from 2000 until March 2020. We use keywords for a combination of three general or block of terms (Health Personnel OR Health Professionals OR Physician OR Internship and Residency OR Medical Staff Or Fellow) AND (Burnout) AND (Positive Psychology OR PERMA OR Wellbeing Intervention OR Well-being Model OR Wellbeing Theory).

Results

Our search retrieved 1886 results (1804 through CINAHL, Ovid PsychINFO, MEDLINE, and 82 through GS) before duplicates were removed and 1723 after duplicates were removed. The final review included 21 studies. Studies represented eight countries, with the majority conducted in Spain (n = 3), followed by the US (n = 8), and Australia (n = 3). Except for one study that used a bio-psychosocial approach to guide the intervention, none of the other interventions in this review were based on a conceptual model, including PERMA. However, retrospectively, ten studies used strategies that resonate with the PERMA components.

Conclusion

Consideration of the utility of PERMA as a multidimensional model of positive psychology to guide interventions to reduce burnout and enhance well-being among physicians is missing in the literature. Nevertheless, the majority of the studies reported some level of positive outcome regarding reducing burnout or improving well-being by using a physician or a system-directed intervention. Albeit, we found more favorable outcomes in the system-directed intervention. Future studies are needed to evaluate if PERMA as a framework can be used to guide system-directed interventions in reducing physician burnout and improving their well-being.
Analysis of the potential inappropriate use of medications in pediatric outpatients in China
Authors: Cui Jing , Zhao Lei , Liu Xianghong , Liu Mengyujie , Zhong Lihong
Published: November 2021

Background

The appropriate use of medications is essential in children. Yet, detailed information on how drugs are being prescribed and dispensed to pediatric populations is not documented in China.

Aim

The study objective was to analyze the details of medicine use and categorize the types of inappropriate use of medications on children.

Methods

A retrospective cross-sectional study was conducted on the prescriptions of pediatric outpatients aged < 18 years from 2019 to 2020 at a major Chinese tertiary academic center. Each age group’s demographic and clinical characteristics were collected, and the ratios of inappropriate prescriptions were analyzed.

Results

The total number of pediatric outpatients was 652,152, and 49.37% (322000) were prescribed medications, in which the most widely used medicines were respiratory, anti-infectives, and Traditional Chinese Medicines (TCMs). The prevalence rate of inappropriate prescriptions reached 20.49%, and in 2019 it was higher (21.71%) than that in 2020 (18.36%). The top three common inappropriate categories were indication-related off-label drug use, improper administration frequency, and overdosing, accounting for 67.93, 17.80 and 11.06% of all inappropriate prescriptions, respectively. The inappropriate prescriptions were more likely seen in patients aged 2–5 years and respiratory medicines.

Conclusions

The study findings indicate that inappropriate drug use in pediatric outpatients is still common, and great attention needs to be paid. More prospective trials are required to identify the effectiveness, safety, and necessity of off-label drug use of medicines in children.