bluuebunny/crossref_metadata_2025 huggingface dataset:
Playing in the water: an exquisite corpse and found river and underwater poems
Authors: Januchowski-Hartley Stephanie R , Giannoulatou Ioanna D , Sahni Asha
Published: August 2021

This article shares and reflects on Underwater Haiku Exquisite Corpse – a playful approach to writing and enquiry about rivers and their underwater environments. The Underwater Haiku Exquisite Corpse was an adaptation of the Surrealist exquisite corpse concept – a collaborative game in which each participant wrote or drew in response to a prompt and kept their contribution concealed until the end, when the full corpse was revealed to all contributors. We consider how our approach to exquisite corpse fostered playful co-creation and community and contributed to better understanding people’s experiences with and intuitive responses to river environments. This article blends academic writing and found poems (existing words or phrases reframed into a poem) from Underwater Haiku Exquisite Corpse, in response to calls for more creative and entangled ways to write about the world. We applied this technique, using lines of text by different Underwater Haiku Exquisite Corpse contributors and reordering lines into poems that illustrated how contributors intertwined notions of humans, rivers, and what lies below the surface. We hope that by sharing our experiences with the Underwater Haiku Exquisite Corpse, we encourage more playful approaches to geopoetics, to foster conversations across disciplines, as well as within and outside the academy.
Suture Anchor Repair of Pectoralis Major Muscle Dehiscence After Modified Ravitch
Authors: de Loos Erik R. , Daemen Jean H. T. , Janssen Nicky , Hulsewé Karel W. E. , Vissers Yvonne L. J.
Published: August 2021

During repair of pectus excavatum by the modified Ravitch procedure, the major pectoral muscles are detached from their sternal insertion to obtain adequate surgical exposure. Following repair, the muscles are approximated in midline and reinserted through scarring. Dehiscence of the major pectoral muscles after the modified Ravitch procedure is a rare phenomenon, not previously reported in literature. We report on 2 cases and describe an effective treatment method using sternal suture anchors with good long-term results.
Nudgeability: Mapping Conditions of Susceptibility to Nudge Influence
Authors: de Ridder Denise , Kroese Floor , van Gestel Laurens
Published: August 2021

Nudges are behavioral interventions to subtly steer citizens’ choices toward “desirable” options. An important topic of debate concerns the legitimacy of nudging as a policy instrument, and there is a focus on issues relating to nudge transparency, the role of preexisting preferences people may have, and the premise that nudges primarily affect people when they are in “irrational” modes of thinking. Empirical insights into how these factors affect the extent to which people are susceptible to nudge influence (i.e., “nudgeable”) are lacking in the debate. This article introduces the new concept of nudgeability and makes a first attempt to synthesize the evidence on when people are responsive to nudges. We find that nudge effects do not hinge on transparency or modes of thinking but that personal preferences moderate effects such that people cannot be nudged into something they do not want. We conclude that, in view of these findings, concerns about nudging legitimacy should be softened and that future research should attend to these and other conditions of nudgeability.
A ‘never miss’ diagnosis: Ptosis secondary to metastatic breast cancer diagnosed as involutional ptosis and a review of the literature
Authors: Safi Mustafa , Fethat Katayun , Silkiss Rona Z
Published: August 2021

We present a case of ptosis secondary to metastatic lobular carcinoma of the breast which was initially diagnosed as involutional ptosis. A 67-year-old woman previously diagnosed with lobular carcinoma of the breast presented to our clinic with mild restriction of lateral gaze and persistent droopiness of her right eyelid (associated with decreased levator function) despite recent repair of a suspected involutional ptosis. Orbital magnetic resonance imaging revealed a mass in the right orbit which was biopsied and diagnosed as lobular carcinoma of the breast. Poor levator function is rarely present in involutional ptosis. Especially in conjunction with abnormal extraocular motility, other etiologies of acquired ptosis must be considered. This case highlights the importance of patient history and ocular examination in identifying the underlying etiology of ptosis. A review of the literature to evaluate the incidence of signs and symptoms associated with metastatic breast cancer to the orbit is included.
Lingual Behavior in Clarinet Articulation: A Multiple-Case Study Into Single and Double Tonguing
Authors: Slis Anneke , Wolak Kornel , Namasivayam Aravind , van Lieshout Pascal
Published: August 2021

Articulating notes on the clarinet requires the control of many factors, one of which is the behavior of the tongue. It is hypothesized that one of the mechanisms to produce notes in the altissimo (highest) register involves the lowering of the tongue dorsum. The study sought to answer the question of whether different tonguing techniques interfered with the required lowering of the tongue dorsum in this register, making adequate note production difficult. Four professional clarinet players performed diatonic scales across the chalumeau, clarion, and altissimo registers using two techniques—single and double tonguing. Movements of the tongue dorsum and tongue blade were recorded with 3D Electromagnetic Articulography. The movement data revealed that, for all players, a low position of the tongue dorsum was indeed associated with a higher success rate of producing adequate notes in the altissimo register. Single tonguing was the most effective technique due to ability of the tongue dorsum to lower during the highest register. For three of the four players, failed note production in the altissimo register when performing double tonguing related to a high tongue dorsum position; one participant, however, was successful in performing double tonguing in the altissimo register, despite a high tongue dorsum position. This latter finding suggests player-specific strategies to successfully realize double tonguing in the altissimo register.
Risk of Pediatric Cardiac Surgery Increased in Patients Undergoing Tracheal Surgery During the Same Hospitalization
Authors: Riggs Kyle W. , Wells Dennis , Zafar Farhan , Morales David L. S. , Bryant Roosevelt , Tweddell James S.
Published: August 2021

Background

The impact of complex tracheal surgery (TS) on outcomes of children undergoing cardiac surgery has rarely been investigated in large national databases and could impact anticipated outcomes in those patients.

Methods

The Pediatric Health Information System database was reviewed from January 1, 2005 to December 31, 2014, for pediatric (<18 years) patients undergoing select cardiac surgical procedures using International Classification of Disease-9 procedural coding. Patients were divided based upon having TS (excluding tracheostomy) during the same hospitalization. Patients with tracheal and cardiac surgeries (CHS + TS) were propensity matched in a 1 : 2 fashion to patients undergoing isolated cardiac surgeries without TS (CHS) based upon cardiac procedure(s), age at surgery, gender, and discharge year. Hospital mortality and other outcomes were compared between the 2 matched groups.

Results

The 283 CHS + TS patients were similar to the 566 CHS patients in gender, race, age, cardiac procedures, and presence of chromosomal abnormalities, all P > .05. Hospital mortality was 13.8% ( n = 39) for CHS + TS and 5.8% ( n = 33) for CHS patients with an unadjusted 2.58 hazard ratio of death (95% confidence interval: 1.59-4.20; P < .001). CHS + TS was also associated with a greater length of stay (63 days vs 12 days), a higher cost per hospitalization ($322 402 vs $80 273), and more readmissions (64.3% [ n = 182] vs 41.8% [ n = 243]), all P < .001.

Conclusions

Patients undergoing cardiac and TS in the same hospitalization are at greater risk of in-hospital mortality than patients undergoing similar cardiac surgeries alone and incur higher resource utilization thereafter. The increased risk of mortality is currently underappreciated, but it is important to recognize when discussing expectations with families and providers.
How Nissin Represented Naomi Osaka: Race, Gender, and Sport in Japanese Advertising
Authors: Ho Michelle H. S. , Tanaka Hiromi
Published: August 2021

In January 2019, instant noodle giant Nissin Foods released two animated advertisements online featuring Naomi Osaka, which elicited backlash over “whitewashing” the multiracial professional tennis player who represents Japan. Although Nissin has since pulled the advertisements and officially apologized for portraying Osaka as lighter-skinned, underlying these issues are also those of gender, especially its intersections with race/ethnicity, nation, and sport in Japanese media. Employing discourse analysis of these two advertisements, this article examines how Nissin represented Osaka and what ideologies these representations reflect in Japanese society. Drawing on intersectional and transnational feminist cultural studies approaches, we argue that the advertisements’ representation of Osaka and the ensuing controversy reflect racialized and gendered ideologies in an allegedly homogeneous Japanese society, informed by local media and popular cultures that regularly portray “racially neutral” characters, celebrate lighter-skinned hāfu (half; multiracial) women, and diminish sportswomen’s athletic abilities. This article contributes to communication and sport studies by situating Osaka within broader contexts of how hāfu and sporting women are depicted in Japanese media and how elite sportswomen and multiracial athletes are portrayed in international media. Our article concludes by offering two suggestions on how to research multiracial sportswomen in the media.
Putting Sense and Mind into Your Enterprise Systems: A Qualitative Study of IS Assimilation in Large Public Organizations in India
Authors: Chauhan Jitendra Pratap Singh , Gupta Sumeet
Published: August 2021

The purpose of this paper is to investigate the information systems (IS) assimilation level of an enterprise system in the post-implementation phase, through the lens of IS governance mechanisms and IS support structures, impacted by the socio-cognitive processes. The research follows a qualitative approach and builds on semi-structured interviews with enterprise system stakeholders in large public sector organizations in India. The study posits that high levels of IS governance mechanisms and high levels of IS support structures lead to a high level of IS assimilation only in the presence of higher level socio-cognitive processes. A not-so-higher level of socio-cognitive fabric results in low or moderate IS assimilation levels in spite of high levels of IS governance and/or IS support structures.

Despite close to a couple of decades of IS research on enterprise systems, IS assimilation is still an enigma for practitioners and academicians. The generalizability of the results of this study may be applicable to any public organization in a developing country, like India, which are using enterprise system solutions but are yet to reap the potential benefits. The results present a way forward for practitioners to ensure optimal resources and focus for the triad- IS governance, IS support structures and socio-cognitive processes.
Lemierre Syndrome in a Patient With Splenectomy Secondary to Pyruvate Kinase Deficiency, Complicated by Heparin Resistance
Authors: Clark Kiley , Sly Morgan , Chan Pearl , Lai Hobart , Ali Hadi , Contreras David , Sidhu Ramanjeet , Bhandohal Janpreet , Mishra Sikha , Kuran Rasha , Polineni Rahul Dev
Published: August 2021

Lemierre syndrome was first documented in the literature in 1936, and is defined as septic thrombophlebitis of the internal jugular vein. It is typically a result of oropharyngeal infection causing local soft tissue inflammation, which spreads to vasculature, and promotes formation of septic thrombi within the lumen, persistent bacteremia, and septic emboli. We present the case of a 24-year-old incarcerated man, who presented with leukocytosis and a right-sided tender, swollen neck after undergoing left mandibular molar extraction for an infected tooth. Computed tomography revealed a persistent thrombus in the transverse and sigmoid sinuses bilaterally, extending downwards, into the upper jugular veins. He was started on empiric intravenous vancomycin, zosyn, and heparin, but subsequently demonstrated heparin resistance, and was thus anticoagulated with a lovenox bridge to warfarin. Throughout his hospital course, hemocultures demonstrated no growth, so antibiotic treatment was deescalated to oral metronidazole and ceftriaxone. On discharge, the patient was transitioned to oral amoxicillin and metronidazole for an additional 4 weeks with continuation of anticoagulation with warfarin for a total of 3 to 6 months. This case report details a unique presentation of Lemierre syndrome with bilateral transverse sinus, sigmoid sinus, and internal jugular vein thrombosis that was presumably secondary to an odontogenic infectious focus.
Revisiting recent findings on gated communities and racial homogeneity
Authors: Scheller Daniel S
Published: August 2021

This paper seeks to determine the propensity of racial minorities to live in gated communities. A recent study by Plaut in this journal finds that nonwhites are more likely to live in gated communities than whites for both renters and homeowners. Such a finding would indicate a major change in housing patterns. I replicate and build upon her study by including multiple years of data, disaggregating the nonwhite variable into its important racial components, and then interacting race with specific housing type (multi-family units vs. single family units). I find that her potentially innovative results are statistical artifacts. For homeowners, the results generally indicate that nonwhite individuals are not more likely to own a home in a gated community, especially for single family detached units. At best, they are no more or no less likely than white residents to own a home in a gated community. Minority renters are sometimes more likely to indicate that they live in a gated community, but generally only for multi-family rental units. Differences between African American and Latino gating patterns are also discussed.
Participatory Democracy of Women in Rural India: A Field-based Experience of Palli Sabha from Odisha
Authors: Malik Gayadhar , Nayak Smita
Published: August 2021

Participatory democracy has gained special attention in India in recent years as it leads to transparent governance by means of decentralization and participation of citizens. The 73rd Constitutional Amendment Act, 1992 provided a new space for democratic participation at the village level called Gram Sabha. In Odisha, it is called Palli Sabha (PS). The 73rd Amendment aims at providing better governance and promotes democratic participation of the downtrodden people, especially women and people belonging to the Scheduled Caste (SC) and Scheduled Tribe (ST). This study examines women’s participation in PS and their general perceptions about it in rural Odisha. In-depth interviews were conducted with 60 women respondents in six villages under the panchayat of Remuna Block in Balasore District of Odisha for that purpose. The findings of the study revealed that participation of women in PS is not satisfactory. Women have great apathy for participation and many of them are unaware of the usefulness of PS meetings and the flow of funds from government. Patriarchal society and low level of education lead to low interest among women members in panchayats.
Zebrafish: A Promising Real-Time Model System for Nanotechnology-Mediated Neurospecific Drug Delivery
Authors: Saleem Suraiya , Kannan Rajaretinam Rajesh
Published: August 2021

Delivering drugs to the brain has always remained a challenge for the research community and physicians. The blood–brain barrier (BBB) acts as a major hurdle for delivering drugs to specific parts of the brain and the central nervous system. It is physiologically comprised of complex network of capillaries to protect the brain from any invasive agents or foreign particles. Therefore, there is an absolute need for understanding of the BBB for successful therapeutic interventions. Recent research indicates the strong emergence of zebrafish as a model for assessing the permeability of the BBB, which is highly conserved in its structure and function between the zebrafish and mammals. The zebrafish model system offers a plethora of advantages including easy maintenance, high fecundity and transparency of embryos and larvae. Therefore, it has the potential to be developed as a model for analysing and elucidating the permeability of BBB to novel permeation technologies with neurospecificity. Nanotechnology has now become a focus area within the industrial and research community for delivering drugs to the brain. Nanoparticles are being developed with increased efficiency and accuracy for overcoming the BBB and delivering neurospecific drugs to the brain. The zebrafish stands as an excellent model system to assess nanoparticle biocompatibility and toxicity. Hence, the zebrafish model is indispensable for the discovery or development of novel technologies for neurospecific drug delivery and potential therapies for brain diseases.
Montmorillonite colloid plates with adsorbed cytochrome c: in vitro cytotoxic effect on colon cancer cell culture
Authors: Hristova Svetlana H. , Zhivkov Alexandar M.
Published: August 2021

Background

The apoptosis (a cascade of biochemical reactions leading to suicide of damaged biological cells) is blocked in the cancer cells because of impossibility of cytochrome c (cytC) go out from the mitochondria. However, the apoptosis can be started by introducing of exogenous cytC into cytoplasm using colloid particles as a protein carrier due to ability of the cancer cells to phagocytize extracellular particles with submicron size.

Results

The clay mineral montmorillonite (MM) were used to prepare aqueous suspension of protein/mineral composite particles by electrostatic adsorption of the positively charged cytC globules on the negatively charged MM colloid plates, and then added to colon cancel culture. The results shows out that separately cytC and MM have no effect but the composite cytC-MM particles kill 95% of the cancer cells after 96 h treatment using equine cytC which is 97% structurally identical with the human cytC. To reach this high cytotoxicity we have formulated requirements to: (a) bare colloid particles (electric charge, form and size), (b) conditions for protein adsorption (concentrations, pH, ionic strength), and (c) suspension with the composite particles (positive total charge and optimal concentration). Due to satisfying these requirements we have reached cytotoxicity which is 1/3 higher than the reached by other authors using different artificial particles. The cytotoxicity rapidly increases with concentration of the cytC-MM particles but further it shows tendency to saturation.

Methods

The optimal pH 6.5 and the 10:3 mg/mg cytC/MM concentration ratio at adsorption were found out by employing computer (protein electrostatics) and physicochemical methods (microelectrophoresis and colloid electrooptics) to prepare cytC-MM suspension. The anticancer capability of cytC-MM nanoplates were investigated using cell culture of metastasizing colon cancer.

Conclusion

The in vitro experiments with colon cancer cell culture disclose that cytC-MM composite particles have potential for application in anticancer therapy of superficial neoplasms of the skin and the alimentary system (mouth cavity, esophagus, stomach, jejunum and colon).

Graphic abstract
Induction of amylase and protease as antibiofilm agents by starch, casein, and yeast extract in Arthrobacter sp. CW01
Authors: Solihin Jeffrine , Waturangi Diana Elizabeth , Purwadaria Tresnawati
Published: August 2021

Background

In unfavourable environment, such as nutrient limitation, some bacteria encased themselves into a three dimensional polymer matrix called biofilm. The majority of microbial infections in human are biofilm related, including chronic lung, wound, and ear infections. The matrix of biofilm which consists of extracellular polymeric substances (EPS) causes bacterial colonization on medical implanted device in patients, such as catheter and lead to patient’s death. Biofilm infections are harder to treat due to increasing antibiotic resistance compared to planktonic microbial cells and escalating the antibiotic concentration may result into in vivo toxicity for the patients. Special compounds which are non-microbicidal that could inhibit or destroy biofilm formation are called antibiofilm compounds, for example enzymes, anti-quorum sensing, and anti-adhesins. Arthrobacter sp. CW01 produced antibiofilm compound known as amylase. This time our preliminary study proved that the antibiofilm compound was not only amylase, but also protease. Therefore, this research aimed to optimize the production of antibiofilm agents using amylase and protease inducing media. The five types of production media used in this research were brain heart infusion (BHI) (Oxoid), BHI with starch (BHIS), casein with starch (CS), yeast extract with starch (YS), and casein-yeast extract with starch (CYS). Biofilm eradication and inhibition activities were assayed against Pseudomonas aeruginosa (ATCC 27,853) and Staphylococcus aureus (ATCC 25,923).

Results

The results showed that different production media influenced the antibiofilm activity. Addition of starch, casein and yeast extract increased the production of amylase and protease significantly. Higher amylase activity would gradually increase the antibiofilm activity until it reached the certain optimum point. It was shown that crude extracts which contained amylase only (BHI, BHIS and YS) had the optimum eradication activity against P. aeruginosa and S. aureus biofilm around 60–70 %. Meanwhile, CS and CYS crude extracts which contained both amylase and protease increased the biofilm eradication activity against both pathogens, which were around 70–90 %.

Conclusions

It was concluded that the combination of amylase and protease was more effective as antibiofilm agents against P. aeruginosa and S. aureus rather than amylase only.
TPMT and NUDT15 polymorphisms in thiopurine induced leucopenia in inflammatory bowel disease: a prospective study from India
Authors: Grover Narinder , Bhatia Prateek , Kumar Antriksh , Singh Minu , Lad Deepesh , Mandavdhare Harshal S. , Samanta Jayanta , Prasad Kaushal K. , Dutta Usha , Sharma Vishal
Published: August 2021

Background

Polymorphisms in thiopurine methyltransferase (TPMT) and Nudix hydrolase-15 (NUDT15) have been implicated as the predominant cause of thiopurine induced leukopenia in the Western countries and East Asia respectively. Exact role of these polymorphisms in South Asian population with inflammatory bowel disease (IBD) is uncertain.

Methods

We included consecutive patients with IBD who were initiated on thiopurines at a center in North India. The dosage of thiopurines was titrated using regular monitoring of hemogram and liver function tests. Three TPMT polymorphisms (c.238 G > C, c.460 G > A, and c.719A > G) and one NUDT15 polymorphism (c.415 C > T) were assessed. Comparison regarding incidence of leukopenia and maximum tolerated thiopurine dosage was performed between those with wild polymorphism and those with TPMT and NUDT15 polymorphisms, respectively.

Results

Of the 119 patients (61 males, mean age 36.8 ± 13.5 years), 105 (88.2%) had ulcerative colitis and 14 (11.8%) had Crohn’s disease. Leukopenia was noted in 33 (27.7%), gastrointestinal intolerance in 5 (4.2%) and pancreatitis in 2 (1.6%). TPMT polymorphisms were detected amongst five patients of whom 1 developed leukopenia. NUDT15 polymorphism was noted in 13 patients of whom 7 had leukopenia. The odds of developing leukopenia in TPMT polymorphism were non-significant (0.77, 95% CI:0.0822 to 7.2134,P = 0.819) but were significantly higher in those with NUDT15 polymorphism (3.5933, 1.1041 to 11.6951, P value: = 0.0336).

Conclusion

NUDT15 polymorphism was more frequent than TPMT polymorphisms and was associated with thiopurine induced leukopenia. However, the tested polymorphisms account for only 24.2% of the risk of thiopurine induced leukopenia.
Intensive surveillance endoscopy for multiple gastrointestinal tumors in a patient with constitutional mismatch repair deficiency: case report
Authors: Ando Takayuki , Nakajima Takahiko , Fukuda Rei , Nomura Keiko , Niida Yo , Sakumura Miho , Motoo Iori , Mihara Hiroshi , Nanjo Sohachi , Kajiura Shinya , Fujinami Haruka , Hojo Shojo , Fujii Tsutomu , Yasuda Ichiro
Published: August 2021

Background

Constitutional mismatch repair deficiency (CMMRD) is an extremely rare autosomal recessive hereditary disease characterized by the absence of mismatch repair gene activity from birth, which results in brain tumors, colonic polyposis, gastrointestinal cancers, and lymphomas later in life. An aggressive approach, including colectomy or proctocolectomy, is recommended for the treatment of colorectal cancer. Additionally, partial colectomy with subsequent endoscopic surveillance may be an alternative strategy due to poor patient’s condition, although there is no evidence of surveillance endoscopy after partial colectomy for CMMRD.

Case presentation

A 13-year-old male patient with a history of T-lymphoblastic lymphoma underwent total gastrointestinal endoscopy, which revealed rectal cancer, colorectal polyposis, and duodenal adenoma. Differential diagnosis included constitutional mismatch repair deficiency according to its scoring system and microsatellite instability, and subsequent germline mutation testing for mismatch repair genes confirmed the diagnosis of constitutional mismatch repair deficiency based on a homozygous mutation in mutS homolog 6 (MSH6). The patient and his family refused colectomy due to the high risk of malignancies other than colorectal cancer, which could require radical surgery. Therefore, the patient underwent low anterior resection of the rectosigmoid colon for rectal cancer and intensive surveillance endoscopy for the remaining colon polyposis. During the 3-year period after initial surgery, 130 polyps were removed and the number of polyps gradually decreased during 6-months interval surveillance endoscopies, although only one polyp was diagnosed as invasive adenocarcinoma (pT1).

Conclusions

Our experience of short surveillance endoscopy illustrates that this strategy might be one of options according to patient’s condition.
Correlation between cardiopulmonary metabolic energy cost and lower-limb muscle activity during inclined treadmill gait in older adults
Authors: Kim Jihye , Lee Hwang-Jae , Lee Su-Hyun , Lee Jungsoo , Chang Won Hyuk , Ryu Gyu-Ha , Kim Yun-Hee
Published: August 2021

Background

Inclined walking requires more cardiopulmonary metabolic energy and muscle strength than flat-level walking. This study sought to investigate changes in lower-limb muscle activity and cardiopulmonary metabolic energy cost during treadmill walking with different inclination grades and to discern any correlation between these two measures in older adults.

Methods

Twenty-four healthy older adults (n = 11 males; mean age: 75.3 ± 4.0 years) participated. All participants walked on a treadmill that was randomly inclined at 0% (condition 1), 10% (condition 2), and 16% (condition 3) for five minutes each. Simultaneous measurements of lower-limb muscle activity and cardiopulmonary metabolic energy cost during inclined treadmill walking were collected. Measured muscles included the rectus abdominis (RA), erector spinae (ES), rectus femoris (RF), biceps femoris (BF), vastus medialis (VM), tibialis anterior (TA), medial head of the gastrocnemius (GCM), and soleus (SOL) muscles on the right side.

Results

As compared with 0% inclined treadmill gait, the 10% inclined treadmill gait increased the net cardiopulmonary metabolic energy cost by 22.9%, while the 16% inclined treadmill gait increased the net cardiopulmonary metabolic energy cost by 44.2%. In the stance phase, as the slope increased, activity was significantly increased in the RA, RF, VM, BF, GCM, and SOL muscles. In the swing phase, As the slope increased activity was significantly increased in the RA, RF, VM, BF, and TA muscles. SOL muscle activity was most relevant to the change in cardiopulmonary metabolic energy cost in the stance phase of inclined treadmill walking. The relationship between the increase in cardiopulmonary metabolic energy cost and changes in muscle activity was also significant in the VM, GCM, and RF.

Conclusion

This study demonstrated that changes in SOL, VM, GCM, and RA muscle activity had a significant relationship with cardiopulmonary metabolic energy cost increment during inclined treadmill walking. These results can be used as basic data for various gait-training programs and as an indicator in the development of assistive algorithms of wearable walking robots for older adults.

Trial registration

Clinical trials registration information:ClinicalTrials.govIdentifier:NCT04614857(05/11/2020).
Febrile infants without respiratory symptoms or sick contacts: are chest radiographs or RSV/influenza testing indicated?
Authors: Ozcan Ali , Laskowski Evelyn , Sahai Shashi , Levasseur Kelly
Published: August 2021

Background

Serious bacterial infection rates in febrile infants < 60 days are about 8–11%. Less than 1% of febrile infants with no respiratory symptoms will have pneumonia however, chest radiography (CXR) rates remain between 30 and 60%. Rapid Respiratory Syncytial Virus (RSV) and influenza (flu) testing is common, however, there is not enough data to determine if febrile infants without any respiratory symptoms should be tested. The goal of this study is to determine the rate of positive CXR and RSV/flu results in febrile infants with no respiratory symptoms and no sick contacts.

Methods

Well-appearing febrile infants between 7 and 60 days of age who presented to the pediatric emergency department (PED) from September 1st, 2015 through October 30th, 2017 were enrolled. Demographic data, respiratory symptoms, CXR findings and RSV/flu results were collected. SAS statistical software was used for analysis.

Results

129 infants met enrollment criteria. Of the 129 infants, 58 (45.0%) had no respiratory symptoms and no sick contacts. Of these 58, 36 (62.1%) received a CXR and none of them had any abnormal findings, 48 (82.8%) had RSV/flu testing, no patients tested positive for RSV and only one patient tested positive for flu. Costs of CXR and RSV/flu testing for this cohort was $19,788.

Conclusion

The absence of positive CXRs in this patient population reinforces the current recommendations that CXR is not indicated. The low incidence of RSV/flu indicate that routine testing may not be necessary in this population especially outside of the flu season. Reduced testing could decrease overall costs to the healthcare system as well as radiation exposure to this population.
Clinical prediction rules for the diagnosis of neuritis in leprosy
Authors: Giesel Louise Mara , Hökerberg Yara Hahr Marques , Pitta Izabela Jardim Rodrigues , Andrade Lígia Rocha , Moraes Debora Bartzen , da Costa Nery José Augusto , Sarno Euzenir Nunes , Jardim Marcia Rodrigues
Published: August 2021

Background

Diagnosing neuritis in leprosy patients with neuropathic pain or chronic neuropathy remains challenging since no specific laboratory or neurophysiological marker is available.

Methods

In a cross-sectional study developed at a leprosy outpatient clinic in Rio de Janeiro, RJ, Brazil, 54 individuals complaining of neural pain (single or multiple sites) were classified into two groups (“neuropathic pain” or “neuritis”) by a neurological specialist in leprosy based on anamnesis together with clinical and electrophysiological examinations. A neurologist, blind to the pain diagnoses, interviewed and examined the participants using a standardized form that included clinical predictors, pain features, and neurological symptoms. The association between the clinical predictors and pain classifications was evaluated via the Pearson Chi-Square or Fisher’s exact test (p < 0.05).

Results

Six clinical algorithms were generated to evaluate sensitivity and specificity, with 95% confidence intervals, for clinical predictors statistically associated with neuritis. The most conclusive clinical algorithm was: pain onset at any time during the previous 90 days, or in association with the initiation of neurological symptoms during the prior 30-day period, necessarily associated with the worsening of pain upon movement and nerve palpation, with 94% of specificity and 35% of sensitivity.

Conclusion

This algorithm could help physicians confirm neuritis in leprosy patients with neural pain, particularly in primary health care units with no access to neurologists or electrophysiological tests.
The development and validation of a diagnostic scoring system to differentiate pulmonary tuberculosis from non-tuberculosis pulmonary infections in HIV-infected patients with severe immune suppression
Authors: Ouyang Jing , Yuan Jing , Chen Yaling , Zeng Yanming , Harypursat Vijay , Lu Yanqiu , Chen Hui , Chen Yaokai
Published: August 2021

Background

It remains challenging to differentiate tuberculosis (TB) from non-TB pulmonary infections in HIV-infected patients. Herein, we developed a scoring system aimed to rapidly determine the likelihood of TB or non-TB pathology in HIV-infected patients presenting with pulmonary infections.

Methods

We collected and collated data of hospitalized HIV-infected patients with pulmonary infections, followed by univariate and multivariate data analyses to determine risk variables that were significantly different between HIV/TB patients and HIV/non-TB patients. Subsequently, a regression coefficient was calculated for each variable, and a score was assigned to each variable in line with its regression coefficient. The sum of the scores for each variable in our scoring model was used to predict the likelihood of TB or non-TB pulmonary infection in each patient. Finally, we tested the diagnostic accuracy of the scoring system in our retrospective cohort, as well as in a prospective cohort.

Results

A total of 598 HIV-infected patients were enrolled in our retrospective cohort, among whom 288 had TB and 310 had non-TB pulmonary infections. Eight variables, including fever, highest body temperature, erythrocyte sedimentation rate (ESR), cervical lymphadenopathy, hilar and/or mediastinum lymphadenopathy, pulmonary cavitation, pleural effusion, and miliary nodules, were found to be mathematically significantly different via univariate analysis and multivariate logistic regression analysis. After regression coefficient calculation followed by score assignment, a receiver operating characteristic (ROC) curve was plotted, and the area under the curve (AUC) was calculated to be 0.902. When the total score for a patient is > 12, the sensitivity and specificity for TB prediction using our scoring system were 76.4% and 87.7% respectively in the retrospective cohort, and its diagnostic accuracy was 82.7% in the prospective cohort.

Conclusions

Our results demonstrate that our proposed diagnostic scoring system could be helpful in differentiating pulmonary TB from non-TB pulmonary infections in HIV-infected patients.
Effectiveness of mobile text reminder in improving adherence to medication, physical exercise, and quality of life in patients living with HIV: a systematic review
Authors: Ibeneme Sam Chidi , Ndukwu Sandra C. , Myezwa Hellen , Irem Franklin Onyedinma , Ezenwankwo Fortune Elochukwu , Ajidahun Adedayo Tunde , Ezuma Amarachi D. , Nnamani Amaka , Onodugo Obinna , Fortwengel Gerhard , Uwakwe Victor C.
Published: August 2021

Background

Mobile text reminder (SMS) system is considered a viable strategy for targeting/facilitating healthy behavioural change including adherence to prescribed physical exercises (PE) and medication (antiretroviral therapy-ART) which should improve the quality of life (Qol) in people living with HIV/AIDS(PLWHA). Thus, the literature was appraised for evidence of SMS effectiveness in improving ART and PE adherence behaviours and QoL in PLWHA.

Methods

Eight databases–AMED, CINAHL, Cochrane Library, EMBASE, EMCARE, Ovid MEDLINE, PsycINFO, and PubMed-were searched up to December 2020, using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocol.This review included only randomised control trials (RCTs) investigating the effectiveness of SMS in improving QoL or PE or ART adherence behaviour or a combination of these variables in PLWHA >18 years. Two independent reviewers determined the eligibility of the studies. Data were extracted and the quality of the study was assessed with the Physiotherapy Evidence Database (PEDro) tool. The primary outcomes were ART and PE adherence behaviours while the secondary outcome was QoL.

Result

A pooled estimate of effect was not calculated due to the heterogeneity of methods and outcome measures. Therefore, a narrative synthesis of ten studies that met the inclusion criteria (n = 1621 participants at study completion) comprising males/females, aged ≥ 18 years, was done. There was a significant improvement in ART adherence behaviour except in three underpowered studies. Only the SMS interventions that were developed using the Starks 3-steps Adherence model was associated with positive outcome. The only study that evaluated QoL was underpowered and reported no significant change while there were no RCTs on PE.

Conclusion

Effects of SMS intervention trends towards a significant improvement in ART adherence behaviour in PLWHA. It is plausible that SMS reminders developed using the broader framework of the interpersonal health behaviour theory(ies) may have positive outcome. Nevertheless, the observed heterogeneity in the methods/outcome measures warrants a cautious interpretation of the findings. There is a lack/paucity of RCTs and therefore no evidence in support of the effectiveness of SMS intervention in improving PE adherence and QoL. Registration number NPLASY202060016.
Development and clinical evaluation of a rapid antibody lateral flow assay for the diagnosis of SARS-CoV-2 infection
Authors: Li Kesheng , Tong Chongxiang , Ha Xiaoqin , Zeng Chaoning , Chen Xia , Xu Feifei , Yang Jinhong , Du Huifen , Chen Yuxin , Cai Jing , Yang Zengwei , Jiang Zhongyi , Chai Dandan , Zhang Xueliang , Li Xun , Li Junfeng , Yao Liqiong
Published: August 2021

Background

The novel coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has quickly spread worldwide since its outbreak in December 2019. One of the primary measures for controlling the spread of SARS-CoV-2 infection is an accurate assay for its diagnosis. SARS-CoV-2 real-time PCR kits suffer from some limitations, including false-negative results in the clinic. Therefore, there is an urgent need for the development of a rapid antibody test kit for COVID-19 diagnosis.

Methods

The nuclear capsid protein (N) and spike protein 1 (S1) fragments of SARS-CoV-2 were expressed in Escherichia coli, and rapid antibody-based tests for the diagnosis of SARS-CoV-2 infection were developed. To evaluate their clinical applications, the serum from COVID-19 patients, suspected COVID-19 patients, recovering COVID-19 patients, patients with general fever or pulmonary infection, doctors and nurses who worked at the fever clinic, and health professionals was analyzed by the rapid antibody test kits. The serum from patients infected with Mycoplasma pneumoniae and patients with respiratory tract infection was further analyzed to test its cross-reactivity with other respiratory pathogens.

Results

A 47 kDa N protein and 67 kDa S1 fragment of SARS-CoV-2 were successfully expressed, purified, and renatured. The rapid antibody test with recombinant N protein showed higher positive rate than the rapid IgM antibody test with recombinant S1 protein. Clinical evaluation showed that the rapid antibody test kit with recombinant N protein had 88.56 % analytical sensitivity and 97.42 % specificity for COVID-19 patients, 53.48 % positive rate for suspected COVID-19 patients, 57.14 % positive rate for recovering COVID-19 patients, and 0.5−0.8 % cross-reactivity with other respiratory pathogens. The analytical sensitivity of the kit did not significantly differ in COVID-19 patients with different disease courses (p < 0.01).

Conclusions

The rapid antibody test kit with recombinant N protein has high specificity and analytical sensitivity, and can be used for the diagnosis of SARS-CoV-2 infection combined with RT-PCR.
Prognostic analysis of different therapeutic regimens in patients with acute cardiogenic cerebral embolism
Authors: Hu Lan , Duan Guangxin , Xu Yuan , Cao Yongjun
Published: August 2021

Background

Few studies focused on the functional outcomes of patients at 3 months after receiving intravenous thrombolysis, anticoagulation, or antiplatelet therapy within 4.5 h of onset of the cardiogenic cerebral embolism (CCE) subtype.

Methods

The purpose of this retrospective study was to analyse the clinical data of patients with acute CCE and compare the 3-month functional prognoses of patients after administration of different antithrombotic therapies within 4.5 h of stroke onset. A total of 335 patients with CCE hospitalized in our institution were included in this study. The patients were stratified according to the hyperacute treatment received, and baseline clinical and laboratory data were analysed. A 3-month modified Rankin scale (mRS) score of 0–2 was defined as an excellent functional outcome.

Results

A total of 335 patients were divided into thrombolytic (n = 78), anticoagulant (n = 88), and antiplatelet therapy groups (n = 169). A total of 164 patients had a good prognosis at 3 months (mRS ≤ 2). After adjustments were made for age and National Institute of Health Stroke Scale (NIHSS) score, each group comprised 38 patients, and there were no significant differences in sex composition, complications, lesion characteristics, or Oxfordshire Community Stroke Project (OSCP) classification among the three groups. The plasma D-dimer level (µg/ml) in the thrombolytic group was significantly higher than those in the anticoagulant and antiplatelet groups [3.07 (1.50,5.62), 1.33 (0.95,1.89), 1.61 (0.76,2.96), P < 0.001]. After one week of treatment, the reduction in NIHSS in the thrombolytic group was significantly greater than those in the other two groups [3.00 (1.00, 8.00), 1.00 (0.00, 5.00), 1.00 (0.00, 2.00), P = 0.025]. A total of 47 patients (41.2 %) had an mRS score of ≤ 2 at 3 months, and 23 patients died (20.2 %). There was no significant difference in the proportion of patients with a good prognosis or the mortality rate among the three groups (P = 0.363, P = 0.683).

Conclusions

Thrombolytic therapy is effective at improving short-term and 3-month prognoses. Anticoagulant therapy may be a safe and effective treatment option for patients with the cardiac stroke subtype who fail to receive intravenous recombinant tissue plasminogen activator (r-tPA) thrombolysis within 4.5 h in addition to antiplatelet therapy, as recommended by the guidelines.
Does second-look endoscopy reduce the bleeding after gastric endoscopic submucosal dissection for patients receiving antithrombotic therapy?
Authors: Uozumi Takeshi , Sumiyoshi Tetsuya , Tomita Yusuke , Tokuchi Kaho , Sakano Hiroya , Yoshida Masahiro , Fujii Ryoji , Minagawa Takeyoshi , Okagawa Yutaka , Morita Kotaro , Yane Kei , Ihara Hideyuki , Hirayama Michiaki , Kondo Hitoshi
Published: August 2021

Background

In patients with average risk of bleeding, second-look endoscopy does not reportedly reduce bleeding after gastric endoscopic submucosal dissection. However, effectiveness of second-look endoscopy for patients with a high risk of bleeding, such as those who are taking antithrombotic agents, is unclear. Hence, this study aims to clarify the effectiveness of second-look endoscopy for patients with antithrombotic therapy.

Methods

We studied 142 consecutive patients with 173 gastric epithelial neoplasms who were routinely taking antithrombotic agents and were treated by endoscopic submucosal dissection at Tonan Hospital between November 2013 and December 2019. They were classified into two groups: those with second-look endoscopy (SLE group, 69 patients with 85 lesions) and those without second-look endoscopy (non-SLE group, 73 patients with 88 lesions). The incidence of post-endoscopic submucosal dissection bleeding was compared between the SLE and non-SLE groups.

Results

There were no statistical differences in the rate of patients undergoing single antiplatelet therapy, single anticoagulant therapy, and multiple therapy between the SLE and non-SLE groups (SLE group vs. non-SLE group; 32 [46.4%], 16 [23.2%], and 21 [30.4%] patients vs. 37 [50.7%], 20 [27.4%], and 16 [21.9%] patients, respectively; p = 0.50). Post-endoscopic submucosal dissection bleeding incidence was 21.7% (15/69) and 21.9% (16/73) in the SLE and non-SLE groups, respectively, and did not significantly differ between the two groups (p = 0.98).

Conclusions

For patients taking antithrombotic agents, the incidence of post-endoscopic submucosal dissection bleeding was not reduced by second-look endoscopy.
Examining equity in the utilisation of psychiatric inpatient care among patients with severe mental illness (SMI) in Ontario, Canada
Authors: de Oliveira Claire , Mason Joyce , Jacobs Rowena
Published: August 2021

Background

Severe mental illness (SMI) comprises a range of chronic and disabling conditions, such as schizophrenia, bipolar disorder and other psychoses. Despite affecting a small percentage of the population, these disorders are associated with poor outcomes, further compounded by disparities in access, utilisation, and quality of care. Previous research indicates there is pro-poor inequality in the utilisation of SMI-related psychiatric inpatient care in England (in other words, individuals in more deprived areas have higher utilisation of inpatient care than those in less deprived areas). Our objective was to determine whether there is pro-poor inequality in SMI-related psychiatric admissions in Ontario, and understand whether these inequalities have changed over time.

Methods

We selected all adult psychiatric admissions from April 2006 to March 2011. We identified changes in socio-economic equity over time across deprivation groups and geographic units by modeling, through ordinary least squares, annual need-expected standardised utilisation as a function of material deprivation and other relevant variables. We also tested for changes in socio-economic equity of utilisation over years, where the number of SMI-related psychiatric admissions for each geographic unit was modeled using a negative binomial model.

Results

We found pro-poor inequality in SMI-related psychiatric admissions in Ontario. For every one unit increase in deprivation, psychiatric admissions increased by about 8.1%. Pro-poor inequality was particularly present in very urban areas, where many patients with SMI reside, and very rural areas, where access to care is problematic. Our main findings did not change with our sensitivity analyses. Furthermore, this inequality did not change over time.

Conclusions

Individuals with SMI living in more deprived areas of Ontario had higher psychiatric admissions than those living in less deprived areas. Moreover, our findings suggest this inequality has remained unchanged over time. Despite the debate around whether to make more or less use of inpatient versus other care, policy makers should seek to address suboptimal supply of primary, community or social care for SMI patients. This may potentially be achieved through the elimination of barriers to access psychiatrist care and the implementation of universal coverage of psychotherapy.