bluuebunny/crossref_metadata_2025_split huggingface dataset:
‘Intended’ and ‘unintended’ consequences of the privatisation of health and social care systems in Italy in light of the pandemic
Authors: Ciarini Andrea , Neri Stefano 
Published: July 2021

This article analyses the long-term effects of privatisation and marketisation on the Italian regional health and social care systems. The research focuses on three Italian regions – Lombardy, Veneto and Lazio – which are representative of three different models of governance in these sectors. We examine the effects of privatisation and marketisation on the health and social care system by discussing how the regional health-care systems have managed the impact of the COVID-19 pandemic. We also shed light on the dramatic consequences of the pandemic crisis on employment levels and working conditions.
Bacteriological Quality of Drinking Water and Associated Factors at the Internally Displaced People Sites, Gedeo Zone, Southern Ethiopia: A Cross-sectional Study
Authors: Ashuro Zemachu , Aregu Mekonnen Birhanie , Kanno Girum Gebremeskel , Negassa Belay , Soboksa Negasa Eshete , Alembo Awash , Ararsa Eshetu , Badecha Fikru , Tassew Solomon 
Published: July 2021

Background: Providing safe and adequate Water, Sanitation and Hygiene (WASH) services in response to emergencies is a major problem. Globally, few studies have investigated the bacteriological quality of drinking water at the IDP sites. Therefore, the objective of this study was to evaluate the bacteriological quality of drinking water and associated factors at the IDP sites of Gedeo zone. Methods: A cross-sectional study was conducted on 213 water samples collected from November to December 2018. The membrane filter technique was used to retain bacteria and lauryl sulphate broth media was used to detect faecal coliforms. After incubation of 14 hours at 44°C, faecal coliforms with yellow colonies were counted and expressed in terms of CFU/100 ml of water. The data were entered into Epi data version 3.1 and exported to STATA version 14 for analysis. Binary logistic regression analysis with 95%CI and P ⩽ .05 was used to identify factors associated with an outcome variable. Results: Out of 213 water samples collected, 107 (50.2%) samples were tested positive for faecal coliforms. The presence of latrines in uphill (AOR: 6.7, 95%CI: 1.0-42.9), other sources of pollution (AOR: 5.0, 95%CI: 1.1-22.3), inadequate fencing (AOR: 7.1, 95%CI: 1.3-40.2) and lack of diversion ditch (AOR: 6.3, 95%CI: 1.0-37.6) were factors significantly associated with faecal contamination of springs. Dug wells that had a latrine within 10 m (AOR: 11.4, 95%CI: 1.8-72.1), other pollution sources within 10 m (AOR: 7.9, 95%CI: 1.9-32.4), inadequate fencing (AOR: 2.8, 95%CI: 1.0-7.9), drawing water using a bucket with rope (AOR: 7.3, 95%CI: 1.6-33.4) and unsanitary well cover (AOR: 3.4, 95%CI: 1.1-10.4) were factors significantly associated with faecal contamination of wells. Conclusions: The majority of the water sources in internally displaced people sites were tested positive for faecal coliforms. The presence of latrine in uphill, other sources of pollution, inadequate fencing, lack of diversion ditch, drawing water using a bucket with rope and unsanitary well cover were factors associated with the presence of faecal coliforms. Therefore, adequate fencing, proper diversion ditch construction and hygiene promotion should be done to protect water sources from faecal contamination. Furthermore, latrines and other point sources of contamination should be located at least 10 m away or at a lower elevation from water sources.
High expression of cluster of differentiation 276 indicates poor prognosis in glioma
Authors: Li Linchen , Zhang Min , Zhu Dengna , Wang Xinjun 
Published: July 2021

Background: Glioma is the central nervous system tumor with the highest incidence rate and the molecular detection of gliomas has been the focus of research. This study aimed to investigate the guiding effect of cluster of differentiation 276 (CD276) expression on the clinical prognosis of glioma. Methods: The TCGA and CGGA databases were used to study whether CD 276 can be used as an independent prognostic factor for gliomas. Immunohistochemistry was used to detect the expression of CD276, isocitrate dehydrogenase-1 (IDH1), matrix metallopeptidase 9 (MMP9), p53, and Ki-67, and 1p/19q co-deletion was detected by fluorescence in situ hybridization (FISH). The effects of CD276 RNA interference (RNAi) on cell invasion, cell cycle and the expression of β-catenin, tumor necrosis factor receptor 1 (TNFR1), and MMP9 were observed. Furthermore, the biological effects of CD276 gene knockout on intracranial transplanted tumors in nude mice were studied. Results: CD276 expression was positively correlated with the extracellular matrix, collagen decomposition, and cell adhesion molecules. Immunohistochemistry and FISH showed that CD276 expression positively correlated with the glioma grade, p53 mutation, Ki-67 proliferation, and MMP9 expression; however, it negatively correlated with IDH1 mutation, 1p/19q co-deletion, and the survival rate. CD276 RNAi in U87 cells inhibited cell proliferation, migration, and invasion, but had no effect on the cell cycle. CD276 inhibited the expression of β-catenin, TNFR1, and MMP9 in U87 cells at the mRNA and protein levels. In vivo experiments showed that the tumor formation and invasion of the CD276 small interfering RNA glioma cell line in nude mice were reduced and the survival time was prolonged. Conclusions: The present study demonstrated that high expression of CD276 in gliomas indicates a poor prognosis.
Abnormal hearing patterns are not associated with endothelium-dependent vasodilation and carotid intima–media thickness: The Framingham Heart Study
Authors: Tyagi Sudhi , Friedland David R , Rein Lisa , Tarima Sergey S , Mueller Christopher , Benjamin Emelia J , Vasan Ramachandran S , Hamburg Naomi M , Widlansky Michael E 
Published: July 2021

Introduction: Prior data suggest associations between hearing loss, cardiovascular (CV) risk factors, and CV disease. Whether specific hearing loss patterns, including a strial pattern associated with inner ear vascular disease, are associated with systemic endothelial dysfunction and carotid intima–media thickness (IMT) remains unclear. Methods: We evaluated participants without prevalent CVD in the Framingham Offspring Study who underwent formal audiogram testing and brachial and carotid artery ultrasounds. Audiograms were categorized as normal or as belonging to one of four abnormal patterns: cochlear-conductive, low-sloping, sensorineural, or strial. Endothelial function as measured by brachial artery flow-mediated dilation (FMDmm and FMD%). Internal and common intima–media thicknesses (icIMT and ccIMT, respectively) were compared between audiogram patterns. Results: We studied 1672 participants (mean age 59 years, 57.6% women). The prevalence of each hearing pattern was as follows: 43.7% normal; 20.3% cochlear-conductive; 20.3% sensorineural; 7.7% low-sloping; and 8.0% strial. Strial pattern hearing loss was nearly twice as prevalent ( p = 0.001) in those in the highest quartile of ccIMT and nearly 50% higher in those in the highest icIMT quartile ( p = 0.04). There were no statistically significant differences between the prevalence of the strial pattern comparing the lowest quartiles of FMDmm and FMD% with the upper three quartiles. Age- and sex-adjusted linear regression models did not show significant associations between the vascular measures and hearing patterns. Conclusion: Abnormal hearing patterns were not significantly associated with impaired brachial FMD and increased carotid IMT after adjusting for age and sex effects, which may reflect age and sex-related distributional differences based on hearing loss pattern.
Angiographic flow velocity predicts lower limb outcomes after endovascular therapy: Application of the frame count method
Authors: Ito Naruhiko , Hishikari Keiichi , Yoshikawa Hiroshi , Tsujihata Shihoko , Abe Fumiyuki , Kanno Yoshinori , Iiya Munehiro , Murai Tadashi , Hikita Hiroyuki , Takahashi Atsushi , Yonetsu Taishi , Sasano Tetsuo 
Published: July 2021

Introduction: Several factors related to lesion characteristics and endovascular therapy (EVT) procedures have been reported to affect primary patency after EVT. However, it is unknown why these factors were associated with primary patency. We hypothesized patency failure was related to poor blood flow in affected arteries. Methods: This retrospective study included 131 consecutive patients who had received EVT with bare metal stents for peripheral artery disease caused by femoropopliteal artery lesions. Based on the tertile post-EVT flow velocity of the superficial femoral artery (SFA), patients were divided into high ( n = 43), middle ( n = 44), and low ( n = 44) flow velocity groups. Flow velocity was measured using the frame count method. We measured incidence of major adverse limb events (MALE), composed of target lesion revascularization (TLR), non-TLR, and major amputation. Results: At a median follow-up period of 22.7 months, MALE had occurred in 7 (16.3%), 10 (22.7%), and 29 (65.9%) of patients from the high, middle, and low SFA flow velocity groups, respectively ( p < 0.001). Kaplan–Meier analysis showed incidence of MALE was significantly higher in the patients of low SFA flow velocity (log-rank test χ2 = 38.8, p < 0.001). Multivariate analysis found low SFA flow velocity to be an independent predictor for MALE (hazard ratio: 4.42; 95% CI: 2.27 to 8.60; p < 0.001) as was ankle–brachial index. Conclusion: Post-EVT SFA flow velocity for femoropopliteal artery lesions treated with bare metal stents is an independent predictor of limb patency. The frame count method for assessing arterial flow velocity is convenient and has potential for wide applications in EVT.
Stomas
Authors: Thomas Michael , MacLean Ailsa , McDermott Benjamin , Epstein Jonathan 
Published: July 2021

A stoma is a surgically created opening between a hollow viscus and the skin. Abdominal stomas are used to divert the flow of bowel contents or urine into a bag attached to the skin of the anterior abdominal wall. It is estimated that 1 in 500 people in the UK are currently living with a stoma, and approximately 13 500 people undergo stoma formation every year. Understanding why patients have stomas, how these should be managed, and what potential complications may arise from their formation can help healthcare professionals to provide safe and effective patient care. It is also important to appreciate the impact of a stoma on a patient and how this may affect quality of life.
Evaluation of the impact of marijuana use on semen quality: a prospective analysis
Authors: Hehemann Marah C. , Raheem Omer A. , Rajanahally Saneal , Holt Sarah , Chen Tony , Fustok Judy N. , Song Kelly , Rylander Heather , Chow Emma , Ostrowski Kevin A. , Muller Charles H. , Walsh Thomas J. 
Published: July 2021

Aims: To assess if marijuana consumption – prevalent among men of reproductive age and becoming widespread due to decriminalization – is associated with changes in semen parameters. Marijuana’s active metabolite, tetrahydrocannabinol, can alter signaling pathways within spermatozoa, affecting spermatogenesis and fertility. Methods: We prospectively evaluated semen analyses (SA) from men presenting for infertility evaluation at one institution from July 2017 to April 2018. Participants completed a reproductive health questionnaire including items regarding marijuana consumption. SA was performed in accordance with World Health Organization (WHO) 5th Edition criteria. SA parameters included volume (ml), concentration (million/ml), motility (%), progressive motility (%), and Tygerberg strict morphology (%). Results: A total of 409 patients completed the questionnaire; 174 (43%) men reported marijuana use (ever-users). Current and past users comprised 71 (17%) and 103 (25%), respectively. Compared with never-users, current and past users had a significantly higher likelihood of abnormal sperm strict morphology (33.1% versus 50.7% and 53.4%, respectively; p < 0.001). However, sperm motility was more likely to be less than WHO reference values in never-users than current and past-users (38.3% versus 21.1% and 27.2%, respectively; p = 0.01). In multivariate logistic regression analyses, current use was associated with increased odds of abnormal strict morphology [odds ratio (OR) 2.15, 95% confidence interval (CI): 1.21–3.79] and semen volume less than WHO reference value (OR 2.76, 95%CI: 1.19–6.42), while odds of less than WHO reference value sperm motility were reduced (OR 0.47, 95%CI: 0.25–0.91). Conclusion: Marijuana use is common among men presenting for fertility evaluation, and may have a detrimental effect on semen quality, particularly morphology and volume, but may be protective against abnormal sperm motility. Large, prospective studies of both semen quality and fertility in this growing, at-risk population are warranted.
Sacral neuromodulation implanted patients: Patient concerns during the COVID-19 pandemic and practical modifications
Authors: Banakhar Mai Ahmed 
Published: July 2021

Objective: To study the effect of the COVID-19 pandemic on sacral neuromodulation (SNM) implanted patients and examine patient concerns. Methodology: A web-based survey was sent to all SNM patients, including those with implants and who had a cancelled operation because of the pandemic. The survey consisted of 15 questions in Arabic language, which sought to evaluate outcomes, as well as patient concerns and preferences during the COVID-19 pandemic. Results: A total of 66 patients were contacted, and of which, 62 replied. Most of the patients ( n = 51; 82.3%) had the device implanted, and 11 (17.7%) patients had a postponed operation secondary to the pandemic. There were 20 males and 42 females. The mean age was 34 years ± SD 16.5 (9–62 years). Indications for sacral neuromodulation therapy were refractory overactive bladder OAB 35 (56.5%), retention 17 (27.4%), OAB + retention 3 (4.8%). When questioning the effect of the lockdown on patients, most reported no effect (43.5%), while 14.5% had some programming difficulties. The patients preferred telephone calls for device emergencies and clinic follow-up with 88.7% and 98.4%, respectively. Most patients had no concerns regarding their Interstim device during the pandemic and found it manageable; 8.1% had insurance concerns due to the economic changes. Conclusion: Patients with implanted SNM for lower urinary tract symptoms were mainly concerned with device programming. Telemedicine is a great solution for continuous care in this group.
Diagnostic Accuracy of Clinical Tests Assessing Ligamentous Injury of the Talocrural and Subtalar Joints: A Systematic Review With Meta-Analysis
Authors: Netterström-Wedin Fredh , Matthews Mark , Bleakley Chris 
Published: July 2021

Context: Ankle sprains are the most common acute musculoskeletal injury. Clinical tests represent the first opportunity to assess the sprain’s severity, but no systematic review has compared these tests to contemporary reference standards. Objective: To determine the diagnostic accuracy of clinical tests assessing the talocrural and subtalar joint ligaments after ankle sprain. Data Sources: CINAHL, EMBASE, MEDLINE, hand-searching, and PubMed-related article searches (inception to November 18, 2020). Study Selection: Eligible diagnostic studies compared clinical examination (palpation, joint laxity) against imaging or surgery. Studies at a high risk of bias or with high concerns regarding applicability on Quality Assessment of Diagnostic Accuracy Studies-2 were excluded from the meta-analysis. Study Design: Systematic review and meta-analysis. Level of Evidence: Level 3a. Data Extraction: True-positive, false-negative, false-positive, and true-negative findings were extracted to calculate sensitivity, specificity, and likelihood ratios. If ordinal data were reported, these were extracted to calculate Cohen’s kappa. Results: A total of 14 studies met the inclusion criteria (6302 observations; 9 clinical tests). No test had both sensitivity and specificity exceeding 90%. Palpation of the anterior talofibular ligament is highly sensitive (sensitivity 95%-100%; specificity 0%-32%; min-max; n = 6) but less so for the calcaneofibular ligament (sensitivity 49%-100%; specificity 26%-79%; min-max; n = 6). Pooled data from 6 studies (885 observations) found a low sensitivity (54%; 95% CI 35%-71%) but high specificity (87%; 95% CI 63%-96%) for the anterior drawer test. Conclusion: The anterior talofibular ligament is best assessed using a cluster of palpation (rule out), and anterior drawer testing (rule in). The talar tilt test can rule in injury to the calcaneofibular ligament, but a sensitive clinical test for the ligament is lacking. It is unclear if ligamentous injury grading can be done beyond the binary (injured vs uninjured), and clinical tests of the subtalar joint ligaments are not well researched. The generalizability of our findings is limited by insufficient reporting on blinding and poor study quality. Registration: Prospero ID: CRD42020187848. Data Availability: Data are available in a public, open access repository on publication, including our RevMan file and the CSV file used for meta-analysis: http://doi.org/10.5281/zenodo.4917138
Intracranial meningioma in two coeval adult cats from the same litter
Authors: Orgonikova Ivona , Mari Lorenzo , Giannasi Chiara , Batlle Martí Pumarola i , Behr Sebastien , Brocal Josep 
Published: July 2021

Case summary In this report we describe the occurrence of intracranial meningioma in two adult cats from the same litter. The location of the meningioma varied: one tumour was at the level of the brainstem, and the other was affecting the temporal and piriform lobes. The cat with the brainstem meningioma was treated with radiotherapy and the littermate had a rostrotentorial craniectomy for tumour removal. Both cats had a histopathological diagnosis of grade I meningioma of a predominantly fibrous subtype. Relevance and novel information Cases of familial meningioma in cats have not previously been described in the veterinary literature. However, familial meningioma is well described in humans and it is possible that cases are underestimated in animals. We discuss the possible genetic background and other causes, as well as challenges we may face in veterinary medicine in identifying these associations.
Outcomes After Arthroscopic Anterior Shoulder Stabilization in Professional Handball Players
Authors: Pavlik Attila , Tátrai Miklós , Tátrai Annamária , Tállay András 
Published: July 2021

Background: Although numerous studies have reported on the redislocation rate and functional results of arthroscopic treatment for anterior shoulder instability in athletes, they have not disclosed outcomes in the high-risk group of elite handball players. Purpose: To investigate the postoperative outcomes of arthroscopic treatment for anterior shoulder instability as well as the return-to-sport (RTS) rate in professional handball players. Study Design: Case series; Level of evidence, 4. Methods: Involved in this study were 44 competitive handball players (47 shoulders) who underwent arthroscopic anterior capsulolabral reconstruction between 2010 and 2018 and had a minimum follow-up of 24 months. After surgery, patients completed a questionnaire that collected Rowe and American Shoulder and Elbow Surgeons (ASES) scores and RTS data, and we compared these results with their preoperative scores. We also compared results according to the following subgroups: true dislocations versus recurrent subluxations, younger (<20 years) versus older (≥20 years) age, male versus female sex, and shorter versus longer duration of instability. Statistical analysis included the paired-samples t test and nonparametric Fisher exact test. Results: The mean follow-up period was 52.2 ± 21.4 months. There were 4 shoulders (9%) with recurrent instability. There were significant preoperative to postoperative improvements in the mean Rowe score (from 45.2 to 91.8) and mean ASES score (from 70.6 to 95.7) ( P < .001 for both). Overall, the RTS rate was 83%, and 64% (30/47 shoulders) were able to return to their preinjury level. The RTS rate was significantly lower in the younger players than in the older players (46% vs 86%, respectively; P = .005). Conclusion: The study results indicated that handball players with anterior shoulder instability can be treated using arthroscopic labral reconstruction successfully and 83% of the athletes were able to RTS activity. The handball players aged ≥20 years returned to their preinjury level of sport at a higher rate than did those aged <20 years.
Evolution of Toll, Spatzle and MyD88 in insects: the problem of the Diptera bias
Authors: Lima Letícia Ferreira , Torres André Quintanilha , Jardim Rodrigo , Mesquita Rafael Dias , Schama Renata 
Published: July 2021

Abstract
Background
Arthropoda, the most numerous and diverse metazoan phylum, has species in many habitats where they encounter various microorganisms and, as a result, mechanisms for pathogen recognition and elimination have evolved. The Toll pathway, involved in the innate immune system, was first described as part of the developmental pathway for dorsal-ventral differentiation in Drosophila. Its later discovery in vertebrates suggested that this system was extremely conserved. However, there is variation in presence/absence, copy number and sequence divergence in various genes along the pathway. As most studies have only focused on Diptera, for a comprehensive and accurate homology-based approach it is important to understand gene function in a number of different species and, in a group as diverse as insects, the use of species belonging to different taxonomic groups is essential.

Results
We evaluated the diversity of Toll pathway gene families in 39 Arthropod genomes, encompassing 13 different Insect Orders. Through computational methods, we shed some light into the evolution and functional annotation of protein families involved in the Toll pathway innate immune response. Our data indicates that: 1) intracellular proteins of the Toll pathway show mostly species-specific expansions; 2) the different Toll subfamilies seem to have distinct evolutionary backgrounds; 3) patterns of gene expansion observed in the Toll phylogenetic tree indicate that homology based methods of functional inference might not be accurate for some subfamilies; 4) Spatzle subfamilies are highly divergent and also pose a problem for homology based inference; 5) Spatzle subfamilies should not be analyzed together in the same phylogenetic framework; 6) network analyses seem to be a good first step in inferring functional groups in these cases. We specifically show that understanding Drosophila’s Toll functions might not indicate the same function in other species.

Conclusions
Our results show the importance of using species representing the different orders to better understand insect gene content, origin and evolution. More specifically, in intracellular Toll pathway gene families the presence of orthologues has important implications for homology based functional inference. Also, the different evolutionary backgrounds of Toll gene subfamilies should be taken into consideration when functional studies are performed, especially for TOLL9, TOLL, TOLL2_7, and the new TOLL10 clade. The presence of Diptera specific clades or the ones lacking Diptera species show the importance of overcoming the Diptera bias when performing functional characterization of Toll pathways.