bluuebunny/crossref_metadata_2025 huggingface dataset:
Prognostic Factors in Patients With Borderline Resectable Pancreatic Ductal Adenocarcinoma Undergoing Resection
Authors: Ren Weizheng , Xourafas Dimitrios , Ashley Stanley W. , Clancy Thomas E.
Published: January 2021

Background

Neoadjuvant treatment (NT) has become standard in the management of borderline resectable pancreatic cancer (BR-PDAC), improving prognosis. The primary mechanism for this improvement remains unclear.

Methods

Clinicopathological data of patients with BR-PDAC who underwent resection between January 2008 and December 2018 at a single institution were retrospectively reviewed. Univariable and multivariate analyses were used to compare survival between patients who received NT vs. those who underwent upfront resection (UR).

Results

A total of 138 patients were included, 64 underwent UR and 74 NT. Neoadjuvant treatment resulted in higher margin-negative (R0) resection rate (68.9%) than UR (43.8%, P = .005). Neoadjuvant treatment was associated with improved overall survival (OS, P = .009) and progression-free survival (PFS, P = .027). R0 resection was also associated with improved OS ( P < .001) and PFS ( P < .001). On multivariable analysis, when adjusting for clinically relevant variables without considering R status, NT was an independent predictor for improved OS ( P = .046) and PFS ( P = .040). When additionally accounting for margin status, R0 was an independent predictor for improved OS ( P < .001) and PFS ( P < .001), while NT was not. Subgroup analysis, stratified by margin status, revealed that NT was not an independent predictor for OS or PFS for either subgroup.

Discussion

Neoadjuvant treatment is associated with improved OS and PFS in patients with BR-PDAC; however, this effect is outweighed by margin status. These results suggest that the primary benefit of NT was dependent on facilitating R0 resection. Upfront resection might remain a valid treatment option if R0 resection could be accurately predicted.
Vibration control of cantilever blade based on trailing-edge flap by restricted control input
Authors: Liu Ting-Rui , Gong Ai-Ling
Published: February 2021

Vibration and control of cantilever blade with bending-twist coupling (BTC) based on trailing-edge flap (TEF) by restricted control input are investigated. The blade is a thin-walled structure using circumferentially asymmetric stiffness (CAS) configuration, with TEF embedded and hinged into the host composite structure along the entire blade span. The TEF structure is driven by quasi-steady aerodynamic forces. Vibration control is investigated based on linear matrix inequation (LMI) algorithm using restricted control input (LMI/RCI). Flutter suppression of BTC displacements and the angle of TEF (i.e. the practical control input) are illustrated, with apparently controlled effects demonstrated. The restricted control input signals are used to driven the TEF to explore the scope of the feasibility of the practical TEF angle, which is displayed by a virtual simulation platform. The platform verifies the feasibility of the hardware implementation for the control algorithms.
Prison Changed Me—and I Just Work There: Personality Changes Among Prison Officers
Authors: Einat Tomer , Suliman Nina
Published: February 2021

This study examined the impact of prison officers’ time on the job on changes in two personality factors, conscientiousness and agreeableness. The results confirmed the hypotheses that after four years of work, there was a clear interaction effect and significant difference between prison officers and the control group regarding the personality factors examined. A downward trend in conscientiousness and agreeableness was indicated, contrary to the trend that characterized the employees in the control organizations. These findings suggest a unique personality change among prison officers as a result of their work, which could have a negative effect.
“Here We Go Again”: Race and Redevelopment in Downtown Richmond, Virginia, 1977-Present
Authors: Chiles Marvin T.
Published: February 2021

This article examines newspapers, archival collections, interviews, and personal papers to place Richmond, Virginia, at the center of the national debate about public–private revitalization projects. Since World War II, America’s urban leaders, led by interracial coalitions of black politicians and white business elites, have used racial capitalism to promise that tax-funded redevelopment projects would enrich their cities, provide better public services, and reconcile the legacy of racist urban planning. Richmond’s issues with Project One and the Sixth Street Marketplace in the 1980s, as well as recent issues with the Navy Hill Project, reveals the continuum of political and economic peril that comes with using such plans. Because urban revitalization is supremely profit-driven and shaped by the economic thinking that created disparate levels of white corporate wealth and black urban poverty, it is bound to exacerbate systemic racism.
Improving Care for Older Adults in China: Development of Long-Term Care Policy and System
Authors: Wu Bei , Cohen Marc A. , Cong Zhen , Kim Kyungmin , Peng Changmin
Published: February 2021

This special issue covers several important topics related to long-term care (LTC) systems and policy development in China. It provides a good contextual background on the development of the LTC system in China as well as the needs and preferences of LTC from family and older adults’ perspectives. In addition, this issue covers the topic of evaluation of a recently developed long-term care nursing insurance and provides an example of family caregiving for persons with dementia within the Chinese context. The authors in this special issue also provided insights into the impact of the COVID-19 pandemic on older adults’ life and LTC quality, and explored potential strategies to handle the challenges during and post-pandemic.
Heparin-free adventitia pulmonary oxygenation in the treatment of trauma complicated with severe pulmonary infection: a case report
Authors: Qiao Gu , Zeng Xiao-Kang , Yang Xiang-Ying , Diao Meng-Yuan , Zhu Ying , Yang Jing , Hu Wei
Published: February 2021

The application of Venovenous (VV) extracorporeal membrane oxygenation (ECMO) in trauma and patients with severe bleeding tendency has been controversial. However, VV ECMO without anticoagulation contributes to reducing the risk of bleeding during ECMO maintenance. VV ECMO serves critical roles in therapy of patients with severe pulmonary infection and failure in conventional therapy. The common peripheral catheterization approach for VV ECMO is femoral vein-internal jugular vein catheterization, and bilateral femoral vein catheterization can also achieve the purpose of respiratory support for patients with limited cervical catheterization. In this case report, we described a patient with post-traumatic cervical spinal cord injury and severe pulmonary infection who was successfully treated with heparin-free intravenous ECMO.
What we talk about when we talk about information literacy
Authors: Zimmerman Margaret S. , Ni Chaoqun
Published: February 2021

Information literacy skills are requisite to fulfilling one’s potential and are highly connected to a good quality of life. However, the ways in which information literacy is discussed within the academic canon are largely unexplored, particularly as these conversations take place through different cultural lenses. The ways in which such cultures are grouped often rely on traditional methods of geographic clustering that are increasingly complicated by the disparate internal nature of societies. Using text analysis of a large bibliometric data set, this research is an attempt to examine how scholars around the world discuss information literacy in their publications. The authors pulled 3658 records with the exact term “information literacy” from the Scopus database. This data was analyzed for the most frequently employed words and phrases, and grouped by country. The authors then further grouped the countries by their levels of literacy, Human Development Index ranking, the average number of citations per article, and a metric created by the authors that assessed each country’s progress in regard to the Sustainable Development Goals and population health. The results include a discussion of the differences in the ways that scholars from different cultures discuss information literacy, and a number of data visualizations to highlight differences in the data.
Examination of the Validity of the Chinese Version of the Children’s Hope Scale Among Chinese Adolescents
Authors: Ling Yu , Yang Qin , Ge Zixuan , Zhong Mingtian , Zeng Yifang , Huebner Scott E.
Published: January 2021

Given possible developmental and/or cultural differences in the meaning and levels of hope among children, we evaluated the validity, measurement invariance, and latent mean differences for the Chinese version of the Children’s Hope Scale (CHS) across gender. Our sample comprised 2045 Chinese adolescents (46.4% men), with a mean age of 12.94 years. Confirmatory factor analyses (CFAs) supported one-factor and two-factor models. Cronbach’s alphas, mean inter-item correlations, and test–retest coefficients supported their reliability for both models. Also, multigroup CFA for both models indicated measurement invariance across gender. Analyses of latent means revealed no significant gender differences for the CHS total or Agency factor. However, men scored higher than women on the Pathways factor. Such differences suggest consideration of gender when assessing and promoting hope in Chinese adolescents.
Predictors of Sexual Intimate Partner Violence Perpetration Among Men: A Prospective Analysis
Authors: Dunn Hailee K. , Pearlman Deborah N. , Montgomery Madeline C. , Orchowski Lindsay M.
Published: February 2021

Research demonstrates that both peer socialization and underage drinking play a significant role in teen dating violence. However, less is known about the lasting effects of these risk factors on boys’ ability to form healthy romantic relationships as they get older. The present study examined whether boys who perceived their peers would respect them more for having sex and those who engaged in past year heavy alcohol use would be more likely to perpetrate sexual intimate partner violence (IPV) in young adulthood compared to boys who did not endorse perceived peer approval for sex or report past year heavy drinking. Analyses were conducted using a sample of boys ( n = 1,189) from Waves I and III of the National Longitudinal Study of Adolescent to Adult Health (Add Health). A logistic regression was conducted to assess the relationship between perceived peer approval to have sex and heavy alcohol use at Wave I and sexual IPV at Wave III, after adjusting for demographic factors and other correlates of sexual IPV at Wave I, including age, race/ethnicity, sexual initiation in adolescence, parental attachment, annual family income, and neighborhood poverty. Boys who believed they would gain peer respect by having sex and boys who reported getting drunk in the last 12 months, regardless of how often, were significantly more likely to report sexual IPV in young adulthood compared to boys who did not endorse either of these factors. Targeting boys’ perceived peer norms regarding sexual activity and heavy alcohol use may therefore be especially important for preventing sexual IPV later in life.
Forcible, Substance-facilitated, and Incapacitated Sexual Assault Among University Women: A Canadian Sample
Authors: Champion Amanda , Oswald Flora , Pedersen Cory L.
Published: February 2021

This study examined the frequency of sexual assault experiences in a sample of university women to understand the conditions under which sexual assault occurs, and compare alcohol and drug consumption patterns on the likelihood of experiencing sexual victimization. While patterns of victimization have been examined in American contexts, research on contemporary Canadian contexts is scant at present. We found that roughly 58% of the 377 university women in our sample attending one of three large Western Canadian universities in British Columbia reported having been sexually assaulted. These women reported a total of 528 incidents of sexual assault, with 56% of these involving substance-related nonpenetrative sex acts; 312 incidents were substance-related and 216 involved forcible sexual assault. The likelihood of sexual assault victimization was the highest among participants who identified as a sexual minority, consumed marijuana, and reported greater severity of recent alcohol consumption. The present research aims to inform sexual assault prevention and education efforts to reduce occurrences of victimization.
Smartphones and Social Support: Longitudinal Associations Between Smartphone Use and Types of Support
Authors: Lapierre Matthew A. , Zhao Pengfei
Published: February 2021

Smartphones provide users with a vast array of tools to reach out to the world. Smartphones can be used to reach out interpersonally with family, friends, and acquaintances, they can be used to scroll through social networking platforms where one can post comments on a friend’s status update or read about the personal lives of their favorite celebrity, and they can be used to surf the web or read the news. Yet, research has also shown that problematic smartphone use (PSU) can be harmful. Of interest in the current study is whether smartphones can help or harm social bonds longitudinally via social support. Working with a sample of 221 college students who were surveyed twice over a 3-month span, this study explored whether various types of smartphone use (e.g., person-to-person, social networking, and mass-mediated) along with PSU predicted different types of social support over time. The results showed that person-to-person smartphone use was associated with greater belonging support (i.e., feeling accepted by people around you) and tangible support (i.e., feeling that you can find people to help with practical needs) over time. In addition, increased PSU was associated with less tangible support longitudinally. Lastly, there were no effects for social networking or mass-mediated smartphone use on any type of social support. These results offer important insights into how smartphones potentially affect our ability to connect with others along with greater detail about specific kinds of use are implicated.
Pharyngeal gonorrhoea in men who have sex with men
Authors: Richardson Daniel , Pickering Alice , Trotman Daniel , Nichols Kayleigh , Buss Zoe , Devlin John , Finnerty Fionnuala
Published: February 2021

Pharyngeal gonorrhoea is important in the transmission dynamics of gonorrhoea, and generation of antimicrobial resistance and the performing of culture remains vital. We reviewed the notes of men who have sex with men (MSM) presenting to our clinic with a positive pharyngeal NAAT for gonorrhoea between January and December 2019. There were 383 cases of NAAT-positive pharyngeal gonorrhoea, and 28 (7%, 95% CI = 5.11–10.36) reported sore throat at presentation. Pharyngeal cultures were taken from 270/383 (70%), and 73/270 (27%) were culture positive with available antimicrobial sensitivities. Overall, the presence of pharyngeal symptoms was not associated with pharyngeal chlamydia (OR = 1.6, CI = 0.19–13.32, p = 0.7), HIV status (OR = 1.1, CI = 0.47–2.57, p = 0.8), positive cultures (OR = 1.9, CI = 0.78–4.62, p = 0.2) or age ( p = 0.3). Routine screening of MSM for pharyngeal gonorrhoea is important to maintain surveillance and measures need to be taken to improve pharyngeal culture sampling from MSM.
A national audit of the management pathways for new HIV diagnoses
Authors: Kaide Ergul , Curtis Hilary , Freedman Andrew , Croxford Sara , Burns Fiona , Sabin Caroline , Chadwick David R , Sullivan Ann ,   on behalf of the BHIVA Audit and Standards Subcommittee
Published: February 2021

The British HIV Association recommends that new diagnoses be reviewed by an HIV specialist within two weeks. NHS England outcome measures include the proportion of new diagnoses commencing antiretroviral therapy (ART) within 91 days. We aimed to review the extent to which these recommendations were followed, to explore the topics discussed with new diagnoses, and to identify reasons behind delayed ART initiation. UK specialist HIV services were invited to retrospectively review the notes of their last 40 new diagnoses over a 15-month period. One-hundred and thirty-two services provided data for 2281 eligible individuals. Most new diagnoses were reviewed by a specialist within two weeks (67.7%) and were commenced on ART within 91 days (83%), however, there were some concerning delays in those tested at home and in general practice. Partner notification and treatment benefits were discussed with most individuals, unlike the availability of community support and U = U (“undetectable equals untransmittable”). Lengthy delays in ART initiation were mostly due to individuals initially declining ART or missing appointments. Our findings suggest a need for more streamlined pathways into HIV care, review of new diagnoses who have not commenced ART within 8 weeks, and protocol development to ensure discussion of relevant topics.
May Member States’ courts act as catalysts of normalization of the European Union’s Common Foreign and Security Policy?
Authors: Lonardo Luigi
Published: February 2021

This article considers whether national courts may act as catalyst of normalization of Common Foreign and Security Policy, in cases on the merits of which prima facie the Court of Justice of the European Union (CJEU) does not have jurisdiction. First, regardless of the exact scope of the CJEU’s jurisdiction, this contribution surveys arguments in favour (the principle of conferral and of effective judicial protection, expression of the value of the rule of law) and against (the notion of autonomy and consistency of EU law) the jurisdiction of national courts. It concludes in favour of the former option. Second, it considers whether national courts may act as agents of ‘normalization’ of CFSP, where this word means the application of general rules of EU law to this policy even in the absence of express literal provision in the Treaty. It argues that national courts may act as catalyst for the normalization of this policy in so far as they can, through the preliminary ruling procedure, give an opportunity to the CJEU to rule on (at least some) CFSP acts.
Energy analysis and optimization of inerter-based systems
Authors: Zheng Yi-Lin , Li Lu-Yu , Zhang Tian-Jiao
Published: January 2021

This article introduces the basic principles of four kinds of inerters applied for structural vibration control including a traditional inertial mass damper and ideal clutch inerter damper. The clutch inerter damper with all damping (clutch inerter damper_all damped) and clutch inerter damper with partial damping (clutch inerter damper_part damped) are distinguished in detail. First, a series of energy indexes are defined for further analysis. Second, the control effect of displacement for the uncontrolled structure and the four inerter-based single-degree-of-freedom systems are compared. Finally, considering the total input energy ( E1) and the invalid damping energy ( ECID_ric) as the effective indexes, combined with a large number of numerical simulation results, the variation rules of the two energy indexes with respect to two key parameters (inertia mass ratio and additional damping) are summarized, and the optimal parameters are proposed. The effectiveness of the optimal value is verified by displacement comparison.
Investigation on rail corrugation grinding criterion based on coupled vehicle–track dynamics and rolling contact fatigue model
Authors: Liang Hongqin , Li Wei , Zhou Zhijun , Wen Zefeng , Li Shaoguang , An Dong
Published: January 2021

Based on the measured spectra of rail roughness and track structures longitudinal roughness, the rail grinding limit is studied with the help of an established coupled dynamic metro vehicle–track model and a rolling contact fatigue model. The results indicate that metro rail grinding control should be regulated according to corrugation wavelength range and operating speed. Based on the rolling contact fatigue model, longer wavelength of rail corrugation has less influence on the wheel rolling contact fatigue. For the metro lines with a maximum operating speed of 80 km/h, the average levels of rail corrugation in the wavelength ranges of 30–65 mm, 65–125 mm, and 125–250 mm should be less than 5.4, 24.8, and 33.8 dB re 1 μm, respectively; for the ones with the operating speed of 80–120 km/h, the corresponding average corrugation levels in the three wavelength ranges should be less than 4.4, 9.8, and 29.8 dB re 1 μm, respectively.
Managing COVID-19 Lockdown Impacts: Sustaining GLP Compliance and Man Material Medium (MMM) Strategy for Augmenting Prevention of Workplace Infections
Authors: Wangikar Pralhad , Giridhar T. R. , Shanmugam Prakash Srinivasan Timiri
Published: February 2021

Good Laboratory Practices (GLP) is a well-established global system that encompass a set of principles or a framework for defining how laboratory studies are planned, performed, monitored, recorded, reported, and stored for future reference. It is important that compliance with the principles of GLP continues to be maintained. Coronavirus disease 2019 (COVID-19) pandemic lockdowns in various countries, including India, have been sudden and over an extended duration. Although every GLP laboratory has Standard Operating Procedure for disaster management, the sudden lockdown due to COVID-19 created specific emergency procedures related to this situation such as travel bans, safe distancing, and work from home notifications. Good Laboratory Practice compliances in the context of animal experimentation during and post lockdown period need effective managerial responses that are not just flexible and innovative but can ensure they are well-calibrated to the challenges of business continuity and maintenance of health directives. On-the-ground realities suggest there may still be practical challenges to compliance, and guidelines may not always be complied with. This article discusses the issues that may be encountered due to COVID-19 that could potentially impact the GLP status of a study and suggests ways to manage them so as to minimize or prevent infection with COVID-19. We propose an MMM (Man, Material, and Medium) strategy to ensure compliance with health directives and guidelines that will help staff to keep themselves and others safe in the workplace while endeavoring to comply with GLP requirements.
Multimodal imaging of two cases of retinal vein occlusion secondary to Waldenstrom macroglobulinemia
Authors: Remolí Sargues Lidia , Montero Hernández Javier , Navarro Palop Catalina , Monferrer Adsuara Clara , Castro Navarro Verónica , Cervera Taulet Enrique
Published: February 2021

Purpose:

To report multimodal imaging characteristics of two cases of retinal vein occlusion (RVO) secondary to Waldenstrom macroglobulinemia (WM).

Case report:

Case 1: An 82-year-old woman presented with vision loss. She had a history of WM. Best-corrected visual acuity (BCVA) was 20/100 Snellen equivalent in the right eye (OD) and 20/63 in the left eye (OS). Fundoscopy showed bilateral hemorrhages in posterior pole and along superotemporal arcade. Fluorescein angiography illustrated no macular leakage. Optical coherence tomography (OCT) revealed macular edema (ME). Optical coherence tomography angiography (OCTA) demonstrated abnormalities in choriocapillaris. A diagnosis of bilateral branch RVO was made and ME was treated with intravitreal dexamethasone, achieving stability. Case 2: A 65-year-old man presented with venous dilation, tortuosity, and intraretinal hemorrhages. BCVA was 20/20 in both eyes (OU). OCT showed ME and hyperreflective dots in choroid. A diagnosis of bilateral central RVO was made. Laboratory evaluation and bone narrow biopsy confirmed a diagnosis of WM. After that, our patient consulted because of vision loss. BCVA was 20/400 in OU. Fundoscopy and OCT demonstrated a worsening of the intraretinal hemorrhages and the ME. OCTA showed damage of choriocapillaris. Thus, intravitreal dexamethasone and plasmapheresis was advised. Two months after, BCVA was 20/40 in the OD and 20/32 in the OS. Also, fundoscopy and OCT improved.

Conclusion:

Early treatment of WM is truly important, with the aim of achieving a decrease in IgM levels in order to avoid toxic effect over the RPE that results in refractory ME.
The socioeconomic concentration of intensive production interest: Lessons from the tiny home community
Authors: Summers Nik
Published: January 2021

Since the middle of the 1970s, the cost of higher education, childcare, healthcare, and housing have all risen relative to median earnings, threatening the balance sheets of many middle-income households. A large number of these households have maintained their lifestyles and aspirations by taking on debt, leaving them highly leveraged and living paycheck to paycheck. Whether voluntarily or forced, many have responded to these economic pressures by reducing spending where they can, in ways large and small. Seeking “financial freedom,” one “large” response has been attempts to reduce the costs of housing, typically the largest regular expense that households face. People have done this in a variety of ways, including moving into tiny homes, the focus of this paper. Due to the association between homeownership and middle-class achievement norms, a move into an unconventional tiny home on wheels requires use of an alternative cultural vocabulary to support positive identity construction, meaning-making, and sociability, as well as claims for class status and distinction. In this paper, I draw on an original study of the tiny home community to exhibit and analyze that symbolic vocabulary. I find that an emphasis on the biography of production is at the center of a coherent system of meaning that helps tiny home enthusiasts negotiate their middling position in rental and housing markets, as well as in the larger stratification system. I close by discussing the implications of these findings for scholarly understanding of “alternative” consumption behaviors, including so-called “ethical” or “conscientious” consumption, and preferences for craft, artisanal, and local production. To foreshadow my central argument, I believe that “simple affluence” arguments are incomplete, and that these behaviors are instead concentrated among those with high levels of education but low or modest earnings.
Dementia stigma reduction (DESeRvE) through education and virtual contact in the general public: A multi-arm factorial randomised controlled trial
Authors: Kim Sarang , Richardson Alice , Werner Perla , Anstey Kaarin J
Published: January 2021

Objective

To examine the efficacy of the Dementia Stigma Reduction (DESeRvE) programme, aimed at reducing the general public dementia-related stigma utilising ‘education’ and ‘contact’ approaches.

Methods

A total of 1024 Australians aged between 40 and 87 years (M = 60.8, SD = 10.1) participated in a factorial randomised controlled trial. This trial examined four conditions: online education programme (ED), contact through simulated contact with people with dementia and carers (CT), education and contact (ED+CT) and active control. Cognitive, emotional and behavioural aspects of dementia-related stigma were measured with a modified Attribution Questionnaire, and dementia knowledge was measured with the Dementia Knowledge Assessment Scale at the baseline, immediately and 12 weeks after the completion of the intervention.

Results

All four groups improved (reduction in scores) significantly from baseline to week 12 in dementia-related stigma, and the effects were stronger for those with higher baseline stigma scores. Intervention groups also improved significantly from baseline in dementia knowledge. Especially, the ED (β = .85, SE = .07; p < .001) and ED+CT (β = .78, SE = .08; p < .001) groups at immediate follow-up and CT (β = .21, SE = .09; p < .05) and ED+CT (β = .32, SE = .09; p < .001) at 12-week follow-up showed significant effects.

Conclusions

Findings suggest that DESeRvE can be a valuable tool to enhance public’s dementia knowledge and reduce dementia-related stigma, especially for those with higher levels of stigma. Reduction in stigma, however, may take a longer time to achieve, whereas improvement in dementia knowledge is instant.
Characterizing dementia caregiver style in managing care challenges: Cognitive and behavioral components
Authors: Leggett Amanda N , Bugajski Benjamin C , Gitlin Laura N , Kales Helen C
Published: January 2021

Background

Caring for a person living with dementia can take a physical and emotional toll, but understudied is the process by which family caregivers actually provide care. Caregiver management styles may vary and affect care decision-making, experiences, receptivity to and participation in interventions, and outcomes for the caregiver and person living with dementia.

Methods

Participants included 100 primary family caregivers for persons with dementia who were on average 64 years old and had been providing care for 55 months, 74% women, and 18% nonwhite. Participants were interviewed in Michigan and Ohio regarding their cognitive and behavioral management of a recent care challenge and values guiding their decision-making. The rigorous and accelerated data reduction technique was used to analyze qualitative data leading to the identification of caregiving styles. Styles were compared across sample characteristics using chi-square and ANOVA tests.

Findings

Five distinct styles emerged: “Externalizers” (superficial understanding, self-focused, and frequent expressions of anger or frustration), “Individualists” (provide care by going alone, emotionally removed, and lack management strategies), “Learners” (recognize need to change their approach but are stuck and emotionally turbulent), “Nurturers” (positive affect and empathy toward care and reflect natural mastery), and “Adapters” (arsenal of acquired management strategies and adapt to challenges). Style groups differed significantly in terms of age and use of formal care supports.

Discussion

We identified five distinct styles by which caregivers addressed care challenges using a robust qualitative methodology. Styles may be important to identify in order to better tailor interventions to needs and abilities.
Safety of Transcatheter Arterial Embolization for Visceral Artery Pseudoaneurysms: Incidence of Intraprocedural Rupture
Authors: Shimohira Masashi , Nagai Keiichi , Ohta Kengo , Sawada Yusuke , Nakayama Keita , Shibamoto Yuta
Published: February 2021

Introduction:

Transcatheter arterial embolization is the first-line treatment for visceral artery pseudoaneurysms (VAPAs); however, the intraprocedural rupture of pseudoaneurysms is an important complication. The present study was performed to evaluate the safety of embolization for VAPAs, including the incidence of intraprocedural rupture.

Methods:

Among 56 consecutive patients with 57 VAPAs who underwent treatment between April 2009 and October 2020, 46 patients with 47 VAPAs underwent embolization. Complications related to embolization including intraprocedural rupture, the technical success rate, and clinical outcomes were evaluated. Complications that required extended hospitalization, an advanced level of care, or resulted in permanent adverse sequelae or death were classified as major complications, while the remainder were considered to be minor. Technical success was defined as the completion of embolization.

Results:

The intraprocedural rupture of pseudoaneurysms occurred in 3 out of 47 VAPAs treated with embolization (6%) and resulted in minor complications. One liver abscess requiring drainage was regarded as a major complication (2%). Focal infarction after embolization was observed as a minor complication in 20 cases. Complications occurred in 24 out of 47 cases (51%), comprising one major complication (2%) and 23 minor complications (48%). The technical success rate was 100% (47/47). Fifty-three out of 56 patients (95%) were alive in a median follow-up period of 18 months (range: 2 days-137 months).

Conclusions:

Embolization is safe and useful for the treatment of VAPAs; however, the intraprocedural rupture of pseudoaneurysms may occur, and, thus, care is needed during this procedure.
Visualization of Fluoroscopic Imaging in Orthopedic Surgery: Head-Mounted Display vs Conventional Monitor
Authors: Johnson Alex A. , Reidler Jay S. , Speier William , Fuerst Bernhard , Wang Jiangxia , Osgood Greg M.
Published: January 2021

Purpose. See-through head-mounted displays (HMDs) can be used to view fluoroscopic imaging during orthopedic surgical procedures. The goals of this study were to determine whether HMDs reduce procedure time, number of fluoroscopic images required, or number of head turns by the surgeon compared with standard monitors. Methods. Sixteen orthopedic surgery residents each performed fluoroscopy-guided drilling of 8 holes for placement of tibial nail distal interlocking screws in an anatomical model, with 4 holes drilled while using HMD and 4 holes drilled while using a standard monitor. Procedure time, number of fluoroscopic images needed, and number of head turns by the resident during the procedure were compared between the 2 modalities. Statistical significance was set at P < .05. Results. Mean (SD) procedure time did not differ significantly between attempts using the standard monitor (55 [37] seconds) vs the HMD (56 [31] seconds) ( P = .73). Neither did mean number of fluoroscopic images differ significantly between attempts using the standard monitor vs the HMD (9 [5] images for each) ( P = .84). Residents turned their heads significantly more times when using the standard monitor (9 [5] times) vs the HMD (1 [2] times) ( P < .001). Conclusions. Head-mounted displays lessened the need for residents to turn their heads away from the surgical field while drilling holes for tibial nail distal interlocking screws in an anatomical model; however, there was no difference in terms of procedure time or number of fluoroscopic images needed using the HMD compared with the standard monitor.
Experiences of Stereotyping and Tracking in Appalachia: A Case in Consolidation and Social Class
Authors: Fewell Connor J. , Hess Michael E. , Lowery Charles , Gervason Madeleine , Ahrendt Sarah , Giglio Marija
Published: February 2021

This case explores the complexities of how consolidation perpetuates stereotypes among different social classes in a rural Appalachian school setting. Examined are the experiences at the intersection of social class in rural U.S. school districts when two communities—one affluent and one underresourced—are consolidated. We present a nuanced critical incident that focuses on how school leaders perceive and address students’ experiences with tracking and stereotyping—particularly at a middle school level where elementary schools from diverse backgrounds attend school together for the first time.
Considerations in the provision of teleconsultations for outpatient obstetric anaesthesia care during the Covid-19 pandemic
Authors: Loh Leonard Wei Wen , He Yingke , Abdullah Hairil Rizal , Ng Kai Lee , Mok Un Sam
Published: February 2021

Evidence has emerged that pregnant women who contract coronavirus disease 2019 (Covid-19) are at increased risk of certain forms of severe illness as well as complications requiring intensive care unit admission and resultant mortality. Teleconsultations can facilitate continuing care for obstetric patients during the Covid-19 pandemic while reducing their risk of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this short report, we share our experience in the provision of teleconsultations for ambulatory obstetric anaesthesia patients in our high-risk obstetric anaesthesia clinic during the Covid-19 pandemic. Appropriate labour analgesia or anaesthesia plans were able to be formulated and communicated to the patients by teleconsultation, resulting in no delay or compromise in their peripartum care. Both patients and clinicians reported satisfaction with the teleconsultation process and outcome. The considerations and challenges in setting up a teleconsultation service as well as the factors in favour of teleconsultation are also explored.
Safety and efficacy of rituximab as first- and second line treatment in multiple sclerosis – A cohort study
Authors: Torgauten Hilde Marie , Myhr Kjell-Morten , Wergeland Stig , Bø Lars , Aarseth Jan H , Torkildsen Øivind
Published: January 2021

Background

Rituximab is increasingly used as off-label therapy in multiple sclerosis (MS). More data are needed on safety and efficacy of rituximab, particularly in cohorts of de novo patients and patients in early therapy escalation.

Objective

To investigate the safety and efficacy of off-label treatment with rituximab in an MS-cohort of predominantly de novo patients or as therapy escalation.

Methods

We retrieved safety and efficacy data from the Norwegian MS-registry and biobank for all MS-patients treated with rituximab at Haukeland University Hospital, Bergen, Norway, during a four year period.

Results

In the 365 MS-patients (320 relapsing-remitting MS (RRMS), 23 secondary progressive MS (SPMS), and 22 primary progressive MS (PPMS)), the overall annualized relapse rate (ARR) was 0.03 and annualized drug discontinuation rate (ADDR) was 0.05. NEDA-3 was achived in 79% of patients with available data (n=351). Sixty-one patients experienced infusion-related adverse events of which two were serious (CTCAE grade 3–4). Eighteen patients experienced serious non-infusion related adverse events, of which 16 were infections. Infections (n = 34; 9.3%, CTCAE grade 2-5), hypogammaglobulinemia (n = 19, 5.2%) and neutropenia (n = 16; 4.4%) were the most common non-infusion-related adverse events.

Conclusion

Rituximab was a safe and highly efficient disease modifying therapy in this cohort of MS-patients; however, infections and neutropenia need to be monitored.
Using the PEPPA framework to develop the nurse practitioner role in emergency care: Critical reflections
Authors: Boman Erika , Gaarde Kim , Levy-Malmberg Rika , Wong Frances Kam Yuet , Fagerström Lisbeth
Published: February 2021

In this article, we describe and critically reflect on how the PEPPA framework, a Participatory Evidence-based Patient-focused Process for Advanced Practice Nursing, was used to develop a new model of care including the nurse practitioner (NP) role in an emergency department in Norway, where the role is in its infancy. While there is limited earlier research on the applicability of the PEPPA framework, it was here found to be useful. Supported by the framework, we mapped the current model of care, identified stakeholders and participants, determined the need for a new model of care, identified priority problems and goals, and defined the new model of care and the NP role. The PEPPA framework is recommended to develop new models of care including the NP role. Nonetheless, the process has not been straightforward. It is noted that to communicate and establish the new role in a setting as demanding as an emergency department takes time. Support from the management team is essential to succeed in developing and establishing new models of care and new nursing roles, such as the nurse practitioner role.
Lifeline Express: Hospital Train in Rural India
Authors: Ahmed Jashim Uddin , Siddiqui Saima , Ahmed Asma , Mim Kazi Pushpita
Published: February 2021

India’s medical service industry is an emerging force in Southeast Asia, which should be recognized. A large portion of the country’s GDP is being earned through this sector. Paradoxically, India’s rural sphere has always been highly deprived of medical facilities even in rudimentary level. This huge imbalance was previously an issue for India to reach to a footing through innovation. India still being a developing country has majority of people living in rural areas where quality healthcare is not only difficult to avail but sometimes even hard to access. In such circumstances, an initiative like Lifeline Express (LLE) has provided the people with access to quality healthcare which has been crucially needed. It is a very simple idea but incredibly complex in terms of execution throughout the whole region. The LLE is a hospital which moves throughout rural India in a form of a fully equipped train. Since 1991, this initiative in India has generated some commendable projects through which it has served many rural Indians. Through this case, it will be comprehensible of how the train and the medical team function and will show the limitations and challenges healthcare in India is facing and how LLE has proved its fantastic ability to fight with the constraints and make healthcare reach the doorsteps of the rural people. Despite the challenges and limitations, it is also been revealed how the journey of LLE has grown from a three-coach train to seven-coach train where patients get treatment of many diseases from the early 1990s to this day.
All Cause Mortality and Causes of Death in People with Hemophilia: A Systematic Review and Meta Analysis
Authors: Alam Arafat Ul , Karkhaneh Mohammad , Wu Cynthia M. , Sun Haowei
Published: February 2021

Background: There have been many improvements in hemophilia treatment over the last 30 years. Complications and resulting causes of death will be impacted by these changes. We aimed to conduct a systematic review and meta-analysis on all cause mortality and causes of death among people with hemophilia.

Methods: Using a predefined search strategy, we systematically searched EMBASE, MEDLINE, Web of Science, CINAHL, Cochrane central register of controlled trials and Google Scholar from inception through November 6, 2019. Studies that reported standardized mortality ratio (SMR) of hemophilia patients compared with the general population and/or reported causes of death were included. Random-effects meta-analysis with inverse variance method was used to obtain pooled estimates. We further stratified the analysis by the year of cohort entry (before 2000 vs after 2000).

Results: Of the 4072 studies identified , 16 studies from 10 different countries met the eligibility criteria. The pooled SMR for all-cause mortality among people with hemophilia, compared with the general population was 1.93 (95% CI 1.38-2·70; I²=97%) (Figure: 1). The pooled SMR before and after the year 2000 were 2.40 (95% CI 1.92-3·00; I²=87%) and 1.20 (95% CI 1.03-1·40; I²=62%) respectively. Causes of mortality were extracted for 5808 deaths. Before the year 2000, 34% deaths occurred due to AIDS followed by hemorrhage (28%) cardiovascular disease (20%) , liver disease (11%) and cancer (9%) (Table: 1). Fewer (18%) deaths were attributable to AIDS after the year 2000 without any notable difference due to other causes.

Conclusion: : With advancement of treatments, mortality in hemophilia patients have declined over the last few decades. Particularly, effective prevention and treatment of HIV has made an impact. However, hemorrhage and cardiovascular disease still rank as leading causes of death.

Disclosures

Wu: Servier: Other: advisory board; BMS-pfizer: Honoraria, Other: advisory board; leo pharma: Other: advisory board; Pfizer: Honoraria. Sun:Octapharma: Research Funding; Sanofi: Other: Advisory board; Pfizer: Other: Advisory board; Octapharma: Other: Advisory board; Novo Nordisk: Other: Advisory board.
Myeloma Induce Fapα+ Macrophage to Remodel Immune Microenvironment Which Lead to Anti-PD-1 Dilemma
Authors: Gu Huiyao , He Jingsong , Zhang Enfan , Cai Zhen
Published: February 2021

Background: Multiple myeloma (MM) is a hematologic cancer which is characterized by clonal immune globulin. In recent years, FAPα+ fibroblast has been found in many tumor microenvironments, and play an important role in tumor immune escape. Furthermore, we find monocyte-derived macrophages can also express FAPα+ under existence of MM cell line.

Objective Explore the impact of FAPα+ Macrophage in MM immune microenvironment.

Methods Western blot(WB) and flow cytometry(FCM) was used to detect the expression of FAPα+ on macrophages. WB was used to detect the PDL1 altering. FCM was used to detect FAPα+ PDL1+macrophages in patient with myeloma. FCM was used to detect apoptosis of CD4+/CD8+ T cells and MM cells.

Results: 1.MM cell line can induce FAPα+ expression on Macrophage through TGFβ1 or CSF1. 2.Over-expression FAPα on macrophage can promote the expression of PDL1 and knock-down FAPα can reduce PDL1. 3.FAPα can increases mRNA PDL1 and partially inhibits ubiquitination mediating autophagy of PDL1. 4.Over-expression FAPα on macrophage can induce CD4+/CD8+T cell apoptosis and knock-down FAPα can reduce T cell apoptosis. 5. FAPα inhibitor combined with anti-PDL1 or anti-PD1 monoclonal antibody can promote CD138+MM cell apoptosis.

Conclusions: MM can induce macrophage expressing FAPα to further promote PDL1 expression and mediate MM immune escape. Combination of FAPα inhibitor with anti-PDL1 or anti-PD1 monoclonal antibody may facilitate immunotherapy effect in MM treatment.

Key words: FAPα, Macrophage, PDL1, T cell, Immunotherapy

Disclosures

No relevant conflicts of interest to declare.
Intermittent concurrent use of clopidogrel and proton pump inhibitors did not increase risk of adverse clinical outcomes in Chinese patients with coronary artery disease
Authors: He Wanbing , Shu Xiaorong , Zhu Enyi , Deng Bingqing , Lin Yongqing , Wu Xiaoying , Zhou Zenan , Wang Jingfeng , Nie Ruqiong
Published: February 2021

Background

Proton pump inhibitors (PPIs) are frequently prescribed to patients with coronary heart disease (CHD) under antiplatelet therapy to prevent gastrointestinal (GI) bleeding. However, its clinical impact is still under debate, especially in Asian population. This study was undertaken to explore the effects of concurrent use of clopidogrel and PPIs on the clinical outcomes in Chinese patients with CHD in secondary prevention.

Methods

A single-center retrospective study was conducted in 638 patients with CHD on consecutive clopidogrel therapy for at least 1 year. After 18-month follow-up, adverse clinical events were collected. Cox regression was used to calculate hazard ratios (HR) and 95% confidence interval (CI) for the effect of PPI use on the outcomes. A total of 638 patients were recruited from 2014 to 2015 in this study, among whom 201 were sustained PPI users, 188 were intermittent PPI users and the remaining 249 were non-PPI users.

Results

Compared with sustained PPI users, intermittent use of PPIs was associated with a lower risk of stroke, major adverse cardiac events (MACE) and net adverse clinical event (NACE) (stroke: adjusted HR: 0.109, 95% CI 0.014–0.878, p = 0.037; MACE: adjusted HR: 0.293, 95% CI 0.119–0.722; p = 0.008; NACE: adjusted HR: 0.357, 95% CI 0.162–0.786, p = 0.011). Subgroup analysis further revealed the benefit of intermittent PPI use was significant in male CHD patients over 60 years old, with hypertension or chronic kidney disease, and undergoing percutaneous coronary intervention during hospitalization.

Conclusion

The current findings suggest that the intermittent concurrent use of PPIs and clopidogrel is not associated with an increased risk of 18-month adverse clinical outcomes, and intermittent use of PPIs is associated with a lower rate of MACE and NACE.