bluuebunny/crossref_metadata_2025 huggingface dataset:
High-order three-scale computational method for elastic behavior analysis and strength prediction of axisymmetric composite structures with multiple spatial scales
Authors: Dong Hao , Cui Junzhi , Nie Yufeng , Jin Ke , Guan Xiaofei , Yang Zihao
Published: December 2020

A novel high-order three-scale (HOTS) computational method for elastic behavior analysis and strength prediction of axisymmetric composite structures with multiple spatial scales is developed in this paper. The multiple heterogeneities of axisymmetric composite structures we investigated are taken into account by periodic distributions of representative unit cells on the mesoscale and microscale. First, the new micro–meso–macro coupled HOTS computational model for elastic problems of axisymmetric composite structures is established based on multiscale asymptotic analysis, which breaks through the traditional multiscale assumptions and includes three main components. Two classes of mesoscopic and microscopic auxiliary cell functions are constructed on the mesoscale and microscale, respectively. The macroscopic homogenization problems are defined on global axisymmetric structures by twice up-scaling procedures from microscale to mesoscale and then from mesoscale to macroscale. Moreover, the asymptotic HOTS solutions are constructed for approximating multiscale elastic problems of axisymmetric structures and the numerical accuracy analysis of the HOTS solutions is given in detail. Then, the strength prediction formulas for axisymmetric composite structures with multiple spatial scales are presented based on the high-accuracy elastic behavior analysis from the proposed HOTS computational model. Furthermore, the corresponding HOTS numerical algorithm based on the finite element method (FEM) is presented for analyzing the mechanical behaviors and predicting the strength of axisymmetric composite structures with multiple spatial scales in detail. Finally, some numerical examples are reported to verify the feasibility and effectiveness of the proposed HOTS computational method. In this study, a unified three-scale computational framework is offered, which enables the simulation of mechanical behaviors of axisymmetric composite structures with multiple spatial scales.
Retrospective multi-centre study on head adapters in partial revision hip arthroplasty
Authors: D’Angelo Fabio , Zagra Luigi , Moretti Biagio , Virgilio Antonio , Mazzacane Michael , Solarino Giuseppe
Published: December 2020

Background:

Instability and dislocation after total hip arthroplasty (THA) is a common reason for revision surgery. THA head-neck adapters promise the reconstruction of optimal femoral offset and leg length in revision THA (rTHA) while retaining stable implants. The aim of this retrospective multi-centre study is to report on the results achieved with the use of head adapters in partial rTHA, to avoid the instability of the implant.

Methods:

55 cases of partial rTHA performed between February 2015 and April 2017 in 3 different hospitals using the Bioball Head Adapter (BHA) (Bioball Merete, Medical GmbH, Berlin, Germany) were retrospectively recorded. All patients were evaluated from a radiological point of view at an average follow-up of 3.5 years. Failure was defined as re-revision surgery for any cause as well as a subjective feeling of instability of the joint.

Results:

One failure was registered in an extreme case and radiological findings show no suggestive signs of radiolucencies or loosening and therefore all implants have been considered stable.

Conclusions:

Despite some limitations of this retrospective study and according to the relevant literature, our data confirms that BHA is a safe system that allows the flexibility to restore femoral offset and version, to adjust leg length, to minimise instability, to avoid unnecessary removal of otherwise well-fixed components thus improving tribology and reducing the risk of taper junction issues without major complications in partial rTHA.
Evidence based rehabilitation after hip arthroplasty
Authors: Colibazzi Virginia , Coladonato Adriano , Zanazzo Milco , Romanini Emilio
Published: December 2020

Background:

Hip arthroplasty is considered the treatment of choice to improve the quality of life of patients affected by degenerative arthritis. The post-op rehabilitation regimen, however, is still a matter of debate. The goal of this study was to perform a systematic review of the available best evidence to provide recommendations for rehabilitation after hip arthroplasty.

Materials and methods:

Biomedical databases were accessed to identify guidelines, systematic reviews and randomised controlled trials addressing rehabilitation after hip arthroplasty published between 2004 and 2019. Studies were selected and extracted by two independent evaluators with standardised tools.

Results:

1 guideline, 8 systematic reviews and 5 randomised controlled trials were included. All included papers were organised according the available evidence of clinical course chronology both in pre- and post-operation rehabilitation up to 6 weeks and thereafter. Although the value of a rehabilitation program after hip arthroplasty is universally recognised, the exact timing and number of sessions is still unknown. A solid literature review allows us to partially answer to this question.

Conclusions:

Evidence-based rehabilitation recommendations are proposed according to literature research findings. Clinical practice is still somewhat dependent on dogma and traditions, highlighting the need for additional high-quality clinical studies to address areas of uncertainty.
Polyamory in Paris: A social network theory application
Authors: Bennion Janet
Published: December 2020

Multiple sexual partnerships can be viewed as networks in order to assess the nature of links between lovers and metamours (lover’s lovers) as well as the larger population. In such non-monogamous networks, where participants share sex, friendship, ideas, and economic resources, there exists a vast web of nodes connected in much more intimate and complex ways than one finds in the mono-normative landscape. This study explored gender dynamics in network centrality on a sample of 62 polyamorists in Paris, France using participant-observation, informal and structured interviews, and social network analysis. Though evolutionary psychology and pornographic film tend to reinforce heteronormative stereotypes of males as central social actors with multiple sexual partners and women as sexually passive, feminist theorists have argued for a more “agentic female sexual subjectivity”. My data showed that cis- and trans-women, with a strong sense of family and skills in interpersonal communication, score highest on network metrics of density/degree, homophily, indirectedness, and transitivity. The network data also indicate high modularity and endogamy with clustering tendencies for both cis-men and cis- and trans-women linked to kink, atypical intelligence, sexual and gender non-conformity, and mitigating factors of socioeconomic advantage and racial privilege.
Early Left Ventricular Global Longitudinal Strain Deterioration After Aortic Aneurysm Repair: Impact of Aortic Stiffness
Authors: Marketou Maria , Papadopoulos George , Kontopodis Nikolaos , Patrianakos Alexandros , Nakou Eleni , Maragkoudakis Spyros , Chlouverakis Gregory , Stratakis Stavros , Tavlas Emmanouel , Parthenakis Fragiskos , Ioannou Christos V.
Published: December 2020

Purpose

To associate the impact of aortic reconstruction using currently available grafts and endografts on pulse wave velocity in patients with abdominal aortic aneurysm (AAA) and to evaluate its effect on early cardiac systolic function indices.

Materials and Methods

Seventy-three consecutive patients with AAA (mean age 70±8 years; all men) who underwent open (n=12) or endovascular repair (EVAR; n=61) were prospectively enrolled in an observational cohort study. Left ventricular global longitudinal strain (GLS; an important diagnostic and prognostic index of early systolic dysfunction) and carotid-femoral pulse wave velocity (cf-PWV) were estimated 1 week preoperatively, as well as at 1 and 6 months postoperatively.

Results

A significant time effect was found for cf-PWV, which showed an increase at 1 month that remained through 6 months (p=0.007). Additionally, a deterioration in GLS values was revealed, with a significant change at 1 month that persisted 6 months later (p<0.001). No significant group effect was observed between EVAR and open repair (p=0.98), and there was no significant interaction (p=0.96). Notably, the difference in GLS between baseline and 6 months significantly correlated with the corresponding changes in cf-PWV (r=0.494, p<0.001).

Conclusion

AAA repair leads not only to an increase in aortic stiffness, as measured by the increase in pulse wave velocity, but also to reduced cardiac systolic function. Our findings highlight the need for a more intense cardiac surveillance program after aortic reconstruction. Further studies are needed to investigate how this may translate into long-term manifestations of cardiovascular complications and symptomatology.
Upper and lower airway inflammation in severe asthmatics: a guide for a precision biologic treatment
Authors: Latorre Manuela , Bacci Elena , Seccia Veronica , Bartoli Maria Laura , Cardini Cristina , Cianchetti Silvana , Cristofani Ludovica , Di Franco Antonella , Miccoli Mario , Puxeddu Ilaria , Celi Alessandro , Paggiaro Pierluigi
Published: December 2020

Background and aims:

Severe asthma may require the prescription of one of the biologic drugs currently available, using surrogate markers of airway inflammation (serum IgE levels and allergic sensitization for anti-IgE, or blood eosinophils for anti-IL5/IL5R). Our objective: to assess upper and lower airway inflammation in severe asthmatics divided according to the eligibility criteria for one of the target biologic treatments.

Methods:

We selected 91 severe asthmatics, uncontrolled despite high-dose ICS-LABA, and followed for >6 months with optimization of asthma treatment. Patients underwent clinical, functional and biological assessment, including induced sputum and nasal cytology. They were then clustered according to the eligibility criteria for omalizumab or mepolizumab/benralizumab.

Results:

Four clusters were selected: A (eligible for omalizumab, n = 23), AB (both omalizumab and mepolizumab, n = 26), B (mepolizumab, n = 22) and C (non-eligible for both omalizumab and mepolizumab, n = 20). There was no difference among clusters for asthma control (Asthma Control Test and Asthma Control Questionnaire 7), pre-bronchodilator forced expiratory volume in 1 s, serum IgE and fractional exhaled nitric oxide levels. Sputum eosinophils were numerically higher in clusters AB and B, in agreement with the higher levels of blood eosinophils. Allergic rhinitis was more frequent in clusters A and AB, while chronic rhinosinusitis with nasal polyps prevalence increased progressively from A to C. Eosinophils in nasal cytology were higher in clusters AB, B and C.

Conclusion:

Eosinophilic upper and lower airway inflammation is present in the large majority of severe asthmatics, independently from the prescription criteria for the currently available biologics, and might suggest the use of anti-IL5/IL5R or anti IL4/13 also in patients without blood eosinophilia. The reviews of this paper are available via the supplemental material section.
The negation of babysitting: Deconstruction and care in early childhood
Authors: Gibbons Andrew
Published: December 2020

In April 2020, during the COVID-19 Pandemic, New Zealand media reports revealed competing discourses of care in education. Specifically, the media narrated an apparent resistance to care evident in a primary and secondary teacher resistance to a return to school. While the resistance was clearly and explicitly concerned with care for teachers and their communities, at the same time a negation of caring occurred in the positioning of babysitting and caregiving as unreasonable activities for teachers. In this paper these different discourses are explored through a deconstruction of care. The first section of this paper explores deconstruction through a range of texts that explain and explore Derrida’s thinking. The paper then presents a positioning of care through one news media article. An analysis of one text that speaks to the meaning and problem of care in early childhood provides not just a reading of care in and as education, but also a reading of deconstruction as care. Through a reading of deconstruction as care, this paper offers an understanding of the positioning of caring in relation to teaching. Taking deconstruction as more than an attempt to make a case for caring (the saving of caring so to speak), this paper also takes up the challenge of the relationship between caring and not-caring, or the uncaring. Caring in relation to uncaring provides a way past the prescription and exploitation of caring as teaching and recognises the limits of a professionalisation of caring for practices of care. In the sense that deconstruction is care, the paper concludes with a re-imagining of teacher education through deconstruction.
Responding to COVID-19 Stress: Disseminating Mind-Body Resiliency Approaches
Authors: Hall Daniel L , Millstein Rachel A , Luberto Christina M , Perez Giselle K , Park Elyse R
Published: December 2020

The COVID-19 pandemic has resulted in unprecedented stress and uncertainty, particularly among vulnerable populations such as healthcare workers who are facing a multitude of current and looming economic and psychosocial stressors. As clinician-scientists delivering mind-body interventions in our hospital, we suggest applying evidence-based mind-body techniques that promote resiliency and adaptive coping during these difficult times. Interventions that package a variety of mind-body skills into one cohesive program, such as the Stress Management and Resiliency Training – Relaxation Response Resiliency Program (SMART-3RP), offer promise for meeting the variety of stress management needs (e.g., health concerns, isolation) present during the COVID-19 pandemic. From our work with frontline healthcare clinicians and other caregiver populations, we offer recommendations for adapting the delivery, modality, and content of mind-body practices during the COVID-19 pandemic and suggest key skills for promoting resiliency and buffering against the future stressors that lie ahead for everyone.
A manifesto for shadow places: Re-imagining and co-producing connections for justice in an era of climate change
Authors: Potter Emily , Miller Fiona , Lövbrand Eva , Houston Donna , McLean Jessica , O'Gorman Emily , Evers Clifton , Ziervogel Gina
Published: December 2020

In this article, on behalf of The Shadow Places Network, we outline a working manifesto of politics and practice. We mobilise the format of the manifesto to speak to an uncertain and damaged future, to begin to imagine other possible worlds. For feminist philosopher Val Plumwood, whose thinking inspires this network, shadow places are the underside of the capitalist fantasy, ‘the multiple disregarded places of economic and ecological support’. In turning towards shadow places, and the unjust and unsustainable processes that produce them, we call for an environmental humanities that reaches beyond abstraction, fosters new responsibilities, considers the uncomfortable, and generates reparative possibilities and alternative futures. We aim to continue to trace out a world of shadow places. We acknowledge that these shadow places cannot be known in full, but through a willingness to engage in careful conversation with the beings and places harmed by (or strategically shielded from) processes of the Anthropocene, we can learn how to relate to each other and these places in more just ways. Recognising that shadow places are impermanent and contingent, this working manifesto does not look to predetermine or prescribe but rather invites conversation, encounter and exchange. In so doing we choose to contribute to making different worlds possible by pursuing new collaborations, new methods and new politics.
The prevalence of childhood bereavement in Scotland and its relationship with disadvantage: the significance of a public health approach to death, dying and bereavement
Authors: Paul Sally , Vaswani Nina
Published: December 2020

Background and Method:

There is an absence of research on the prevalence of bereavement during early childhood and the relationship between childhood bereavement and socioeconomic status (SES) and this poses a challenge in both understanding and supporting children’s bereavement experiences. Using longitudinal data from the Growing Up in Scotland study, which tracks the lives of three nationally representative cohorts of children, this paper aimed to address these gaps in research. It specifically drew on data from Birth Cohort 1 to document the recorded bereavements of 2,815 children who completed all 8 sweeps of data collection, from age 10 months to 10 years.

Findings:

The study found that 50.8% of all children are bereaved of a parent, sibling, grandparent or other close family member by age 8 and this rises to 62% by age 10. The most common death experienced was that of a grandparent or other close relative. The study also found that children born into the lowest income households are at greater risk of being bereaved of a parent or sibling than those born into the highest income households.

Discussion and Conclusion:

Given the prevalence of childhood bereavement and its relationship with disadvantage, this paper argues that there is an important need to understand bereavement as a universal issue that is affected by the social conditions in which a child becomes bereaved, as well as an individual experience potentially requiring specialist support. This paper thus seeks to position childhood bereavement more firmly within the public health approach to palliative and bereavement care discourse and contends that doing so provides a unique and comprehensive opportunity to better understand and holistically respond to the experience of bereavement during childhood.
Early diagnosis of COPD: myth or a true perspective
Authors: Laucho-Contreras Maria Eugenia , Cohen-Todd Mark
Published: December 2020

The early stages of COPD have recently become a hot topic as many new risk factors have been proposed, but substantial knowledge gaps remain in explaining the natural history of the disease. If we are to modify the outcomes of COPD, early detection needs to play a critical role. However, we need to sort out the barriers to early detection and have a better understanding of the definition of COPD and its diagnosis and therapeutic strategies to identify and treat patients with COPD before structural changes progress. In this review, we aim to clarify the differences between early COPD, mild COPD and early detection of COPD, with an emphasis on the clinical burden and how different outcomes (quality of life, exacerbation, cost and mortality) are modified depending on which definition is used. We will summarise the evidence for the new multidimensional diagnostic approaches to detecting early pathophysiologic changes that potentially allow for future studies on COPD management strategies to halt or prevent disease development.
Transcriptomic and proteomic analyses of a new cytoplasmic male sterile line with a wild Gossypium bickii genetic background
Authors: Zhao Haiyan , Wang Jianshe , Qu Yunfang , Peng Renhai , Magwanga Richard Odongo , Liu Fang , Huang Jinling
Published: December 2020

Background

Cotton is an important fiber crop but has serious heterosis effects, and cytoplasmic male sterility (CMS) is the major cause of heterosis in plants. However, to the best of our knowledge,

no studies have investigated CMS Yamian A in cotton with the genetic background of Australian wild Gossypium bickii. Conjoint transcriptomic and proteomic analysis was first performed between Yamian A and its maintainer Yamian B.

Results

We detected 550 differentially expressed transcript-derived fragments (TDFs) and at least 1013 proteins in anthers at various developmental stages. Forty-two TDFs and 11 differentially expressed proteins (DEPs) were annotated by analysis in the genomic databases of G. austral, G. arboreum and G. hirsutum. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway analyses were performed to better understand the functions of these TDFs and DEPs. Transcriptomic and proteomic results showed that UDP-glucuronosyl/UDP-glucosyltransferase, 60S ribosomal protein L13a-4-like, and glutathione S-transferase were upregulated; while heat shock protein Hsp20, ATPase, F0 complex, and subunit D were downregulated at the microspore abortion stage of Yamian A. In addition, several TDFs from the transcriptome and several DEPs from the proteome were detected and confirmed by quantitative real-time PCR as being expressed in the buds of seven different periods of development. We established the databases of differentially expressed genes and proteins between Yamian A and its maintainer Yamian B in the anthers at various developmental stages and constructed an interaction network based on the databases for a comprehensive understanding of the mechanism underlying CMS with a wild cotton genetic background.

Conclusion

We first analyzed the molecular mechanism of CMS Yamian A from the perspective of omics, thereby providing an experimental basis and theoretical foundation for future research attempting to analyze the abortion mechanism of new CMS with a wild Gossypium bickii background and to realize three-line matching.
Late-onset multiple acyl-CoA dehydrogenase deficiency mimicking myositis in an elderly patient: a case report
Authors: Zheng Yiming , Zhao Yawen , Zhang Wei , Wang Zhaoxia , Yuan Yun
Published: December 2020

Background

Late-onset multiple acyl-CoA dehydrogenase deficiency (MADD) is a rare and treatable inherited lipid storage myopathy. Here, we report an elderly patient with MADD mimicking myositis.

Case presentation

An 80-year-old woman had progressive weakness in her limbs, exercise intolerance, and no muscle pain for 3 months. The patient’s serum creatine kinase level was slightly elevated. The initial diagnosis was myositis. However, muscle biopsy showed many cytoplasmic vacuoles stained with oil red O, indicating the presence of lipid storage myopathy. The plasma acylcarnitine profile showed increased medium-chain and long-chain acylcarnitine species, consistent with the diagnosis of MADD. Riboflavin treatment dramatically improved muscle weakness.

Conclusions

MADD should be considered when evaluating elderly patients with subacute muscle weakness.
Sacrococcygeal teratoma in one twin: a case report and literature review
Authors: Hu Qing , Yan Yiyun , Liao Hua , Liu Hongyan , Yu Haiyan , Zhao Fumin
Published: December 2020

Background

Sacrococcygeal teratoma is one of the most common congenital tumors in newborns and infancy. The incidence is 1 per 20,000–40,000 live births. Ultrasonography is an optimal method for prenatal screening and diagnosis of fetal sacrococcygeal teratoma. MRI can be used to assist in the diagnosis. However, sacrococcygeal teratoma in the twin pregnancy is rare.

Case presentation

We reported a case of one twin with sacrococcygeal teratoma in dichorionic-diamniotic twin pregnancy.One twin with sacrococcygeal teratoma was diagnosed at the second trimester by ultrasonic examination and another twin was normal. A regular and careful antenatal care was conducted by the multidisciplinary team. The parents refused to perform the fetal MRI and examine the chromosome of both twin.At 37 + 1 of gestation, planned cesarean section was performed. The healthy male co-twin (twin A) weighed 2880 g.The male twin with SCT (twin B) weighed 2900 g, complying with 6 × 3 × 3 cm cystic and solid mass in sacrococcygeal region. At four days of age twin B underwent excisional surgery of the sacrococcygeal teratoma and coccyx and discharged 7 days after surgery. The mother and both babies were followed up and are all in good health until now.

Conclusion(s)

Sacrococcygeal teratoma in twin pregnancy is rare. Early antenatal diagnosis is important. Once the sacrococcygeal teratoma is diagnosed, clinicians should be aware of the associated maternal and fetal complications. Expecting parents should be counseled by the multidisciplinary team about the management and prognosis of the STC twin and co-twin. Prompt surgical excision of the sacrococcygeal teratoma after birth should be suggested.
Maternal and perinatal characteristics and outcomes of pregnancies complicated with COVID-19 in Kuwait
Authors: Ayed Amal , Embaireeg Alia , Benawadh Asmaa , Al-Fouzan Wadha , Hammoud Majdeda , Al-Hathal Monif , Alzaydai Abeer , Ahmad Ashraf , Ayed Mariam
Published: December 2020

Background

The effect of SARS-CoV-2 infection in pregnant women and newborns is incompletely understood. Preliminary data shows a rather fluctuating course of the disease from asymptomatic or mild symptoms to maternal death. However, it is not clear whether the disease increases the risk of pregnancy-related complications. The aim of the study is to describe the maternal and neonatal clinical characteristics and outcome of pregnancies with SARS-CoV-2 infection.

Methods

In this retrospective national-based study, we analyzed the medical records of all pregnant women infected with SARS-CoV-2 and their neonates who were admitted to New-Jahra Hospital (NJH), Kuwait, between March 15th 2020 and May 31st 2020. During the study period and as part of the public health measures, a total of 185 pregnant women infected with SARS-CoV-2, regardless of symptoms, were hospitalized at NJH, and were included. Maternal and neonatal clinical manifestations, laboratory tests and treatments were collected. The outcomes of pregnancies included miscarriage, intrauterine fetal death (IUFD), preterm birth and live birth were assessed until the end date of the outcomes follow-up (November 10th 2020).

Results

A total of 185 pregnant women infected with SARS-CoV-2 were enrolled with a median age of 31 years (interquartile range, IQR: 27.5–34), and median gestational age at diagnosis of SARS-CoV2 infection was 29 weeks (IQR: 18–34). The majority (88%) of these women had mild symptoms, with fever (58%) being the most common presenting symptom followed by cough (50.6%). At the time of the analysis, out of the 185, 3 (1.6%) of the pregnant women had a miscarriage, 1 (0.54%) had IUFD which was not related to COVID-19, 16 (8.6%) had ongoing pregnancies and 165 (89%) had a live birth. Only 2 (1.1%) of these women developed severe pneumonia and required intensive care. A total of 167 neonates with two sets of twins were born with median gestational age at birth was 38 (IQR: 36–39) weeks. Most of the neonates were asymptomatic, and only 2 of them tested positive on day 5 by nasopharyngeal swab testing.

Conclusions

In this national-based study, most of the pregnant women infected with SARS-CoV-2 showed mild symptoms. Although mother-to-child vertical transmission of SARS-CoV-2 is possible, COVID-19 infection during pregnancy may not lead to unfavorable maternal and neonatal outcomes.
Refractory dry eye disease associated with Meige’s syndrome induced by long-term use of an atypical antipsychotic
Authors: Kim Ji Eun , Jung Ji Won
Published: December 2020

Background

We report a case of Meige’s syndrome induced by an atypical antipsychotic (blonanserin) that presented with refractory dry eye disease.

Case presentation

A 37-year-old woman with a 6-month history of foreign body sensation in the eyes and difficulty in opening her eyes was treated at a local clinic for dry eye disease. Despite this treatment, her symptoms did not improve and she was transferred to our attention. Our assessment revealed involuntary movements of her eyelids accompanied by repetitive pursing of her lips. She had been undergoing treatment with blonanserin for 5 years for schizophrenia. She was diagnosed with drug-induced Meige’s syndrome after a psychiatric and neurological consultation. After a 2-month gradual dose reduction and discontinuing blonanserin, involuntary movements of the eyelids with oromandibular dystonia were resolved. Three months after discontinuing blonanserin, there was no recurrence of symptoms, and she had no exacerbation of psychotic symptoms.

Conclusions

In patients with refractory dry eye disease, especially those with involuntary movements of the eyelids with oromandibular dystonia, it is important to ask about their psychotropic medications and to consider the possibility of drug-induced Meige’s syndrome and discontinuation of medications, if possible.
A modified Delphi study to gain consensus for a taxonomy to report and classify physical activity referral schemes (PARS)
Authors: Hanson Coral L. , Oliver Emily J. , Dodd-Reynolds Caroline J. , Pearsons Alice , Kelly Paul
Published: December 2020

Background

Physical Activity Referral Schemes (PARS), including exercise referral schemes, are a popular approach to health improvement, but understanding of effectiveness is limited by considerable heterogeneity in reporting and evaluation. We aimed to gain consensus for a PARS taxonomy as a comprehensive method for reporting and recording of such schemes.

Methods

We invited 62 experts from PARS policy, research and practice to complete a modified Delphi study. In round one, participants rated the need for a PARS taxonomy, the suitability of three proposed classification levels and commented on proposed elements. In round two, participants rated proposed taxonomy elements on an 11-point Likert scale. Elements scoring a median of ≥7, indicating high agreement, were included in the final taxonomy.

Results

Of those invited, 47 (75.8%) participated in round one, with high retention in round two (n = 43; 91.5%). 42 were UK-based, meaning the resultant taxonomy has been scrutinised for fit to the UK context only. The study gained consensus for a three-level taxonomy: Level 1: PARS classification (primary classification, provider, setting, conditions accepted [have or at risk of], activity type and funding). Level 2: scheme characteristics (staff structure, staff qualifications, behaviour change theories, behaviour change techniques, referral source, referrers, referral process, scheme duration, session frequency, session length, session times, session type, exit routes, action in case of non-attendance, baseline assessment, exit assessment, feedback to referrer and exclusion criteria) and Level 3: participant measures (demographics, monitoring and evaluation, and measures of change).

Conclusion

Using a modified Delphi method, this study developed UK-based consensus on a PARS classification taxonomy. We encourage PARS practitioners and public health colleagues, especially those working with similar service models internationally, to test, refine and use this taxonomy to inform policy and practice.
Decreasing incidence of pregnancy among HIV-positive adolescents in a large HIV treatment program in western Kenya between 2005 and 2017: a retrospective cohort study
Authors: Millar Heather C. , Keter Alfred K. , Musick Beverly S. , Apondi Edith , Wachira Juddy , MacDonald Katherine R. , Spitzer Rachel F. , Braitstein Paula
Published: December 2020

Background

The objective of this study was to estimate the prevalence, incidence and risk factors for pregnancy among HIV-positive adolescents in a large HIV treatment program in western Kenya.

Methods

The Academic Model Providing Access to Healthcare (AMPATH) program is a partnership between Moi University, Moi Teaching and Referral Hospital and a consortium of 11 North American academic institutions. AMPATH currently provides care to 85,000 HIV-positive individuals in western Kenya. Included in this analysis were adolescents aged 10–19 enrolled in AMPATH between January 2005 and February 2017. Socio-demographic, behavioural, and clinical data at baseline and time-updated antiretroviral treatment (ART) data were extracted from the electronic medical records and summarized using descriptive statistics. Follow up time was defined as time of inclusion in the cohort until the date of first pregnancy or age 20, loss to follow up, death, or administrative censoring. Adolescent pregnancy rates and associated risk factors were determined.

Results

There were 8565 adolescents eligible for analysis. Median age at enrolment in HIV care was 14.0 years. Only 17.7% had electricity at home and 14.4% had piped water, both indicators of a high level of poverty. 12.9% (1104) were pregnant at study inclusion. Of those not pregnant at enrolment, 5.6% (448) became pregnant at least once during follow-up. Another 1.0% (78) were pregnant at inclusion and became pregnant again during follow-up. The overall pregnancy incidence rate was 21.9 per 1000 woman years or 55.8 pregnancies per 1000 women. Between 2005 and 2017, pregnancy rates have decreased. Adolescents who became pregnant in follow-up were more likely to be older, to be married or living with a partner and to have at least one child already and less likely to be using family planning.

Conclusions

A considerable number of these HIV-positive adolescents presented at enrolment into HIV care as pregnant and many became pregnant as adolescents during follow-up. Pregnancy rates remain high but have decreased from 2005 to 2017. Adolescent-focused sexual and reproductive health and ante/postnatal care programs may have the potential to improve maternal and neonatal outcomes as well as further decrease pregnancy rates in this high-risk group.
Effects of icariin on the proliferation and osteogenic differentiation of human amniotic mesenchymal stem cells
Authors: Wang Fang , Yang Zhiyong , He Wei , Song Qinggao , Wang Kun , Zhou Yali
Published: December 2020

Background

Tissue engineering technology has been applied extensively for clinical research and human amnion mesenchymal stem cells (hAMSCs) could cause mesenchymal stem cells to differentiate into the bone tissue. However, it is necessary to develop and identify the safer appropriate amount of osteogenic inducer. The objective of this study is to investigate the effect of icariin (ICA) on the proliferation and osteogenic differentiation of hAMSCs.

Methods

The morphology and phenotype of hAMSCs were discovered by flow cytometry and immunocytochemical staining. The osteogenic differentiation of hAMSCs under the influence of different concentrations of ICA were assessed by alkaline phosphatase (ALP) activity substrate assay and alizarin red staining.

Results

MTT assay revealed that the hAMSCs pretreated with ICA exhibited increased proliferation when compared with the control group, and the most optimum concentration of ICA was 1 × 10− 6mol/L. The combined analysis of ALP activity and ARS staining showed that ICA could significantly promote the osteogenic differentiation of hAMSCs, and the effect was most significant when the concentration of ICA was 1 × 10− 6mol/L.

Conclusion

All the above results implied that ICA could significantly increase proliferation and enhance the osteogenic differentiation of hAMSCs, especially when the concentration of ICA was 1 × 10− 6mol/L.
Efficacy of closed reduction for developmental dysplasia of the hip: midterm outcomes and risk factors associated with treatment failure and avascular necrosis
Authors: Zhang Ge , Li Ming , Qu Xiangyang , Cao Yujiang , Liu Xing , Luo Cong , Zhang Yuan
Published: December 2020

Background

The purpose of this study was to evaluate the efficacy of closed reduction (CR) in the treatment of developmental dysplasia of the hip (DDH) and to investigate risk factors associated with CR failure and avascular necrosis (AVN) occurrence in follow-ups.

Methods

The study retrospectively included 110 patients and 138 hips with DDH diagnosis that underwent closed reduction between February 2012 and November 2015 in our single tertiary medical institution. The failure rate of CR and the underlying risk factors were evaluated. Meanwhile, the incidence of AVN and the related risk factors among the successful CR cases were assessed.

Results

The overall failure rate of DDH treated by CR in the present study was 31.16% (43/138). Risk factors for the CR failure were older age at the time of CR (≥ 18.35 month), large medical interval before CR (≥ 35.35 mm), and severer dislocation of the affected hip (IDHI grades III and IV). The incidence of AVN was 8.33% (6/72) in patients with successful CR at the last follow-up. No significant risk factors had been established in the present study that associated with the AVN occurrence.

Conclusions

For the treatment of DDH with CR, patients with younger age might achieve better outcomes; early diagnosis and early treatment might be the key point in the DDH treatment.
Intra-articular vs. intravenous administration: a meta-analysis of tranexamic acid in primary total knee arthroplasty
Authors: Li Jin , Liu Ruikang , Rai Saroj , Ze Renhao , Tang Xin , Hong Pan
Published: December 2020

Background

The optimal dosage and administration approach of tranexamic acid (TXA) in primary total knee arthroplasty (TKA) remains controversial. In light of recently published 14 randomized controlled trials (RCTs), the study aims to incorporate the newly found evidence and compare the efficacy and safety of intra-articular (IA) vs. intravenous (IV) application of TXA in primary TKA.

Methods

PubMed, Embase, Web of Science, and Cochrane Library were searched for RCTs comparing IA with IV TXA for primary TKA. Primary outcomes included total blood loss (TBL) and drain output. Secondary outcomes included hidden blood loss (HBL), hemoglobin (Hb) fall, blood transfusion rate, perioperative complications, length of hospital stay, and tourniquet time.

Result

In all, 34 RCTs involving 3867 patients were included in our meta-analysis. Significant advantages of IA were shown on TBL (MD = 33.38, 95% CI = 19.24 to 47.51, P < 0.001), drain output (MD = 28.44, 95% CI = 2.61 to 54.27, P = 0.03), and postoperative day (POD) 3+ Hb fall (MD = 0.24, 95% CI = 0.09 to 0.39, P = 0.001) compared with IV. There existed no significant difference on HBL, POD1 and POD2 Hb fall, blood transfusion rate, perioperative complications, length of hospital stay, and tourniquet time between IA and IV.

Conclusion

Intra-articular administration of TXA is superior to intravenous in primary TKA patients regarding the performance on TBL, drain output, and POD3+ Hb fall, without increased risk of perioperative complications. Therefore, intra-articular administration is the recommended approach in clinical practice for primary TKA.
Shotgun proteomics coupled to nanoparticle-based biomarker enrichment reveals a novel panel of extracellular matrix proteins as candidate serum protein biomarkers for early-stage breast cancer detection
Authors: Fredolini Claudia , Pathak Khyatiben V. , Paris Luisa , Chapple Kristina M. , Tsantilas Kristine A. , Rosenow Matthew , Tegeler Tony J. , Garcia-Mansfield Krystine , Tamburro Davide , Zhou Weidong , Russo Paul , Massarut Samuele , Facchiano Francesco , Belluco Claudio , De Maria Ruggero , Garaci Enrico , Liotta Lance , Petricoin Emanuel F. , Pirrotte Patrick
Published: December 2020

Background

The lack of specificity and high degree of false positive and false negative rates when using mammographic screening for detecting early-stage breast cancer is a critical issue. Blood-based molecular assays that could be used in adjunct with mammography for increased specificity and sensitivity could have profound clinical impact. Our objective was to discover and independently verify a panel of candidate blood-based biomarkers that could identify the earliest stages of breast cancer and complement current mammographic screening approaches.

Methods

We used affinity hydrogel nanoparticles coupled with LC-MS/MS analysis to enrich and analyze low-abundance proteins in serum samples from 20 patients with invasive ductal carcinoma (IDC) breast cancer and 20 female control individuals with positive mammograms and benign pathology at biopsy. We compared these results to those obtained from five cohorts of individuals diagnosed with cancer in organs other than breast (ovarian, lung, prostate, and colon cancer, as well as melanoma) to establish IDC-specific protein signatures. Twenty-four IDC candidate biomarkers were then verified by multiple reaction monitoring (LC-MRM) in an independent validation cohort of 60 serum samples specifically including earliest-stage breast cancer and benign controls (19 early-stage (T1a) IDC and 41 controls).

Results

In our discovery set, 56 proteins were increased in the serum samples from IDC patients, and 32 of these proteins were specific to IDC. Verification of a subset of these proteins in an independent cohort of early-stage T1a breast cancer yielded a panel of 4 proteins, ITGA2B (integrin subunit alpha IIb), FLNA (Filamin A), RAP1A (Ras-associated protein-1A), and TLN-1 (Talin-1), which classified breast cancer patients with 100% sensitivity and 85% specificity (AUC of 0.93).

Conclusions

Using a nanoparticle-based protein enrichment technology, we identified and verified a highly specific and sensitive protein signature indicative of early-stage breast cancer with no false positives when assessing benign and inflammatory controls. These markers have been previously reported in cell-ECM interaction and tumor microenvironment biology. Further studies with larger cohorts are needed to evaluate whether this biomarker panel improves the positive predictive value of mammography for breast cancer detection.
Gastric carcinoma and renal cell carcinoma as an atypical presentation of multiple primary malignancies: a case report and review of the literature
Authors: Martín-Pérez J. A. , Torres-Silva C. , Tenorio-Arguelles R. , García-Corona D. A. , Silva-González S. , Dominguez-Rodriguez J. A. , De Alba-Cruz I. , Nagore-Ancona J. F. , González-Luna J. A. , López-Bochm K. A.
Published: December 2020

Background

Gastric carcinoma (GC) with second primary malignancy (SPM) is the most frequent combination within the multiple primary malignancies (MPM) group. The presentation of a GC associated with a synchronized SPM in the kidney is extremely rare and unusual. This study presents a rare case of synchronous tumors, describes the main associated risk factors, and emphasizes the need to rule out SPM.

Main body

We present the case of a 63-year-old Hispanic woman with a history of smoking, weight loss, and gastrointestinal (GI) bleeding. GC was diagnosed by endoscopy, and during her workup for metastatic disease, a synchronous SPM was noted in the left kidney. The patient underwent resection of both tumors with a satisfactory postoperative course. A systematic review of the literature was performed using the Medline/PubMed, Science Direct, Scopus, and Google Scholar databases. A search of the literature yielded 13 relevant articles, in which the following main risk factors were reported: the treatment utilized, the grade and clinical stage, histopathological report, and in some cases survival. It is concluded that advanced age (> 60 years) and smoking are the main associated risk factors.

Conclusion

Gastric carcinoma is the second most frequent neoplasm of the GI tract and the main neoplasm that presents a SPM. MPM screening is recommended in patients with gastric cancer. The clinical discovery of MPM of renal origin is rare and hence the importance of the current report.
A COVID-19 call center for healthcare providers: dealing with rapidly evolving health policy guidelines
Authors: Glatman-Freedman Aharona , Bromberg Michal , Ram Amit , Lutski Miri , Bassal Ravit , Michailevich Olga , Saban Mor , Frankental Dvora , Dichtiar Rita , Kruglikov-Moldavsky Anna , Rozani Violetta , Karolinsky Dolev , Braun Tali , Zuker Inbar , Keinan-Boker Lital , Silverman Barbara G.
Published: December 2020

Background

Communication between health authorities and healthcare providers is an essential element of the response to public health emergencies. Although call centers can facilitate such communication, no published reports describing their outcomes exist. In advance of the expected COVID-19 outbreak in Israel, the Israel Center for Disease Control established a call center dedicated to queries from healthcare professionals.

Methods

The call center operated from February 5, 2020 (week 6) to May 14, 2020 (week 20). Data on calls received, including date and time, caller characteristics, questions and responses were recorded in a database designed for this purpose. The volume, sources and content of queries were analyzed.

Results

In 15 weeks of operation, the call center responded to 6623 calls. The daily number of calls ranged from 1 to 371 (mean 79.8, median 40), peaking on week 12, 2 weeks prior to a peak in new COVID-19 cases. Callers were predominantly physicians (62.4%), nurses (18.7%) and administrators (4.4%). Most worked in primary care clinics (74.2%) or hospitals (8.7%). Among physicians, 42.3% were family physicians or internists, and 10.0% were pediatricians.

The issues most commonly addressed were home quarantine (21.6%), criteria for suspected cases (20.6%), and SARS-CoV2 testing (14.1%). Twenty-five percent of questions involved requests for clarifications of MOH guidelines regarding travel restrictions, clinic management, triage of symptomatic patients, routine medical and dental care, recommended precautions for health care workers with preexisting medical conditions, and other matters. A total of 119 queries were not resolved on the basis of existing guidelines and were referred to MOH headquarters.

Conclusions

This is the first report of a call center established to serve the needs of healthcare providers seeking guidance on COVID-19 management, and to facilitate communication of providers’ concerns to the central health authority. Our work indicates that a central call center for healthcare providers can facilitate the development, implementation and amendment of guidelines and should be an integral element of the early response to public health emergencies. Real-time analysis of the call data may reveal important trends requiring prompt attention.
Towards cross-modal pre-training and learning tempo-spatial characteristics for audio recognition with convolutional and recurrent neural networks
Authors: Amiriparian Shahin , Gerczuk Maurice , Ottl Sandra , Stappen Lukas , Baird Alice , Koebe Lukas , Schuller Björn
Published: December 2020

In this paper, we investigate the performance of two deep learning paradigms for the audio-based tasks of acoustic scene, environmental sound and domestic activity classification. In particular, a convolutional recurrent neural network (CRNN) and pre-trained convolutional neural networks (CNNs) are utilised. The CRNN is directly trained on Mel-spectrograms of the audio samples. For the pre-trained CNNs, the activations of one of the top layers of various architectures are extracted as feature vectors and used for training a linear support vector machine (SVM).Moreover, the predictions of the two models—the class probabilities predicted by the CRNN and the decision function of the SVM—are combined in a decision-level fusion to achieve the final prediction. For the pre-trained CNN networks we use as feature extractors, we further evaluate the effects of a range of configuration options, including the choice of the pre-training corpus. The system is evaluated on the acoustic scene classification task of the IEEE AASP Challenge on Detection and Classification of Acoustic Scenes and Events (DCASE 2017) workshop, ESC-50 and the multi-channel acoustic recordings from DCASE 2018, task 5. We have refrained from additional data augmentation as our primary goal is to analyse the general performance of the proposed system on different datasets. We show that using our system, it is possible to achieve competitive performance on all datasets and demonstrate the complementarity of CRNNs and ImageNet pre-trained CNNs for acoustic classification tasks. We further find that in some cases, CNNs pre-trained on ImageNet can serve as more powerful feature extractors than AudioSet models. Finally, ImageNet pre-training is complimentary to more domain-specific knowledge, either in the form of the convolutional recurrent neural network (CRNN) trained directly on the target data or the AudioSet pre-trained models. In this regard, our findings indicate possible benefits of applying cross-modal pre-training of large CNNs to acoustic analysis tasks.