bluuebunny/crossref_metadata_2025 huggingface dataset:
Antibacterial Properties of Ag–Cu Alloy Nanoparticles Against Multidrug-Resistant Pseudomonas aeruginosa Through Inhibition of Quorum Sensing Pathway and Virulence-Related Genes
Authors: Pourjafari Mozhgan , Ghane Masood , Kaboosi Hami , Sadeghi Babak , Rezaei Abolhasan
Published: July 2022

Objective: To evaluate the application of Ag–Cu NPs as quorum sensing (QS) inhibitors and attenuate virulence expression to overcome the global crisis of multidrug-resistant (MDR) P. aeruginosa. Methods: Ag–Cu NPs were synthesized by co-reduction of
silver-nitrate and copper-nitrate (Ag:Cu = 1:1 0.75 μM). In this cross-sectional study, a total of eighty clinical strains of P. aeruginosa were collected from patients with burns. The antibacterial and resistance pattern of the clinical isolated was determined using the microdilution
and Kirby Bauer disk methods. The effect of sub-MIC of Ag–Cu NPs on the expression of lasI, exoS and toxA in five clinical isolates of imipenem-resistant P. aeruginosa was performed using qRT-PCR. Results: The characterization methods confirm the formation of the Ag–Cu
alloy NPs with agglomerated spherical morphology and particle sizes of about 30–40 nm. We observed that the MIC and MBC of Ag–Cu alloy NPs against MDR P. aeruginosa was found to be 2.5 and 5 μg ml−1, respectively. The effects of a sub-inhibitory
concentration of Ag–Cu NPs on MDR P. aeruginosa QS and virulence-related genes showed that the expression level of QS regulatory and virulence genes significantly decreased in both MDR P. aeruginosa and reference strain under Ag–Cu sub-MIC treatment. Conclusion:
Ag–Cu NPs could be potentially used as a promising QS inhibitor and anti-virulence compound against P. aeruginosa.
Revisiting U.S. Nocturnal Tornado Vulnerability and Its Influence on Tornado Impacts
Authors: Strader Stephen M. , Ashley Walker S. , Haberlie Alex M. , Kaminski Kristie
Published: July 2022

This research examines tornadoes and their fatalities by light condition (i.e., daytime and nighttime) for the United States. The study has two primary objectives: 1) to catalog and reassess differences in daytime and nighttime, or nocturnal, tornadoes and their fatalities from spatial and temporal perspectives and 2) to employ a spatially explicit Monte Carlo simulation technique to calculate differences in daytime and nocturnal tornado–population impact potential by combining climatological tornado risk data with fine-scale, gridded estimates of day and night population density. Results reveal that nocturnal tornadoes remain a substantial impediment to mitigating tornado casualties despite long-term improvements in detection and warning of these events. Nocturnal tornadoes are nearly 2 times as deadly as daytime events, with fatalities stemming from overnight (i.e., from local midnight to sunrise) tornadoes increasing fourfold since the late nineteenth century. The proportion of all tornado fatalities that occurred during daytime hours has decreased 20% over the last 140 years while the nocturnal fatality proportion has increased 20%. The stall, or even slight growth, in U.S. tornado mortality rates over the last 30 years has, at least in part, been driven by increasing nocturnal tornado fatalities. Overall, nocturnal tornadoes affect 13% more people on average than daytime tornadoes, revealing the importance of time of day in mitigating tornado–population impacts and disasters. Emergency managers, forecasters, first responders, policy makers, and researchers should continue to focus efforts on understanding nocturnal tornadoes, especially with regard to how populations receive warnings and respond to these nocturnal threats.
“Death is as Much Part of Life as Living”: Attitudes and Experiences Preparing for Death from Older Adults with Sickle Cell Disease
Authors: Oyedeji Charity I. , Strouse John J. , Masese Rita , Gray Nathan , Oyesanya Tolu O.
Published: July 2022

The life-limiting and unpredictable nature of sickle cell disease (SCD) is well-established, yet there is limited literature on end-of-life planning. The purpose of this study was to describe perspectives about preparing for death for older adults with SCD. We enrolled 19 older adults with SCD (age ≥ 50 years) into this qualitative descriptive study. Theme 1 was “anticipation of early death,” with sub-themes: (a) informed of early death and (b) making plans for death. Theme 2 was “near death experiences.” Theme 3 was “differences in level of comfort with death” with subthemes: (a) death as a part of life and (b) differences in level of comfort discussing death. Theme 4 was “influence of spirituality” with subthemes: (a) God controls the timing of death and (b) belief in the afterlife. These results will inform interventions to improve the quality of patient-provider communication to provide goal-concordant end-of-life care for adults with SCD.
Using the Data-Based Individualization Framework in Math Intervention
Authors: Powell Sarah R. , Bos Samantha E. , King Sarah G. , Ketterlin-Geller Leanne , Lembke Erica S.
Published: July 2022

Data-based individualization (DBI) is a framework that allows educators to make timely and informed decisions about student progress in academics or behavior. In this article, we focus on the DBI framework as applied to math intervention within a tiered support model for students experiencing math difficulty. We review how DBI starts with an instructional platform paired with progress monitoring. Then, we discuss decision making within a DBI framework and highlight how diagnostic data informs instructional adaptations. Finally, we emphasize the on-going use of DBI to determine the best set of instructional practices in math for each student.
Open Access Exercise Electrocardiography: A Service to Improve Management of Ischaemic Heart Disease by General Practitioners
Authors: Sulke A N , Paul V E , Taylor C J , Roberts R H , Norris ADC
Published: July 2022

An initial study of the use of open access exercise electrocardiography by general practitioners (GPs) in South East Kent showed that patient selection and interpretation of test results was frequently incorrect. After issuing guidelines, modifying the request form and instituting registrar review of all requests, significant improvements in both referral pattern, result interpretation and patient management have resulted.

Forty-nine GPs requested 110 exercise tests during 1988/89. Twelve per cent were not undertaken after discussion with the referring practitioner. Eighty-four per cent of those tested would have been referred to the district general hospital cardiology outpatient department in the absence of open access exercise electrocardiography service. Six per cent of patients were referred directly for invasive investigation. Thirty-five per cent were referred to the district general hospital cardiology outpatient department, whilst 42% were spared hospital referral based on the result of the investigation.

Better use of the modified service was suggested by: Referral of fewer patients with non-cardiac chest pains (P= 0.002); more patients with a moderate pre-test probability of ischaemic heart disease (P<0.05); fewer inappropriate requests (P<0.01); and fewer inappropriately undertaken tests (P< 0.001) than in the previous study. All patients with strongly positive test results were appropriately managed.

Open access exercise electrocardiography in the format investigated is potentially a cost-effective and useful tool to improve diagnosis and management of heart disease bv GPs.
Observations on the Intrinsic Blood Supply to the Human Patella: Disruption Correlated with Articular Surface Degeneration
Authors: Slater R N S , Spencer J D , Churchill M A , Bridgeman G P , Brookes M
Published: July 2022

The intrinsic blood supplies of 13 human patellae with varying degrees of articular surface degeneration were studied by perfusion techniques. Disruption of the normal pattern of arterial arcades correlated with increasing surface wear.
Acute Changes in Haematological Parameters on Cessation of Smoking
Authors: Bain B J , Rothwell M , Feher M D , Robinson R , Brown J , Sever P S
Published: July 2022

Cigarette smoking is known to affect many haematological parameters but little is known of their rate of return to normal on withdrawal of cigarettes. Two groups of chronic smokers were studied whilst smoking and in the 2 weeks after cessation. A rapid return towards normal was found in the elevated haemoglobm concentration, packed cell volume, red cell count, white cell count, neutrophil count, lymphocyte count and platelet count, indicating that at least some of the abnormalities in these parameters are an acute, reversible effect of cigarette smoking rather than being a response to tissue damage.
Fluctuations in Perceived Energy and Mood among Patients with Chronic Fatigue Syndrome
Authors: Wood C , Magnello M E , Sharpe M C
Published: July 2022

Patients currently suffering or recently recovered from chronic fatigue syndrome (CFS) were compared with each other and with a group of well-matched controls in a study of diurnal variation in levels of perceived mental and physical energy and positive and negative affect.

Patients who were currently ill showed diurnal variation in patterns of energy, with maximum levels being recorded between 10.00 h and 12.00 h which were significantly higher (P< 0.05) than energy levels recorded on rising or retiring. This pattern was similar to the controls but average energy levels at each time point were lower (P< 0.05) among the ill patients. Recovered patients showed the same pattern, with mean energy levels falling between those of the ill patients and controls. Similar diurnal patterns were found for perceptions ofpositive, though not negative affect.

Correlations between physical and mental energy and between both of these energy variables and positive affect were high (r=0.75 to 0.85) in both controls and CFS patients. However, correlations with negative affect were low (eg r=-0.10) and non-significant.

Total scores on the Hospital Anxiety and Depression Scale (HAD) were significantly higher (P< 0.05) among patients who were still ill than those who had recovered. Scores on the HAD Depression (but not Anxiety) subscale were also significantly higher among those who were still ill (P< 0.01).

These findings may be of value in facilitating programmes of cognitive-behavioural modification intended to aid the recovery of patients with CFS.
A Pilot Study into the Prevalence of Ophthalmic Disease in the Indian Population of Southall
Authors: Rauf Abdul , Ong P S , Pearson Russell V , Wormald Richard P L
Published: July 2022

A pilot study was carried out to determine the prevalence of ophthalmic disease in the Indian community of Southall and to ascertain the best methods applicable for a larger formal study. Three sites were chosen for the study, a Sikh gurdwara, a mosque and a Hindu temple. The subjects were volunteers aged 30 years and over who had visited the appropriate place of worship at least twice in the previous month. A total of 184 subjects were examined. The prevalence of blindness was 2.7% by the World Health Organization (WHO) criteria, while 9.8% had uniocular blindness. The prevalence of glaucoma and ocular hypertension was 2.7% and 7%, respectively. Of the 184 subjects examined, 58% had cataract and 3.8% had age-related maculopathy. The prevalence of visually disabling trachomatous eye disease was 9.7%. The prevalence of diabetes mellitus was 17.9%, and that of hypertension 22.8%. This small study suggests that people with origins from the Indian subcontinent have a higher prevalence of ophthalmic disease than the Caucasian population.
Bleeding Peptic Ulcer: An Audit of Conservative Management
Authors: Mueller X , Rothenbuehler J M , Amery A , Harder F
Published: July 2022

One hundred and twenty-six of 157 consecutive patients (80%) admitted for a bleeding peptic ulcer were treated conservatively and retrospectively analysed. There were 52% duodenal, 41% gastric and 7% combined ulcers. The initial shock index (pulse/systolic blood pressure) was in excess of one in 10%. For 22% of the patients no transfusion was required but 10% had more than 6 units of blood during their hospital stay. Forty-nine per cent were on nonsteroidal anti-inflammatory drugs and 83% had at least one coexisting systemic disease. Six patients (5%) had a further haemorrhage, four of whom died. A total of 10 patients (8%) died. Five of them were related to the peptic ulcer disease but also had terminal or multiple systemic diseases precluding any surgery. Their poor short-term prognosis shows how difficult it will be to effectively reduce the mortality in this particular group of conservatively treated patients, even with the recent advent of endoscopic haemostasis, and stresses the importance of carefully identifying high risk patients in trials mounted to improve on the current mortality figures.
Assessment of the Impact of Cancer on Work, Recreation, Home Management and Sleep Using a General Health Status Measure
Authors: Malone Margaret , Harris Adrian L , Luscombe David K
Published: July 2022

A general health status measure (the UK Sickness Impact Profile) was used to assess health-related quality of life in 212 cancer patients [143 women, mean (SD - standard deviation) age 55.3 (11.7) years] compared to 105 age-sex matched control subjects [71 women, mean (SD) age 54.7 (12.2) years]. The four main areas of impairment in the cancer patient group were work, recreation and pastimes, home management and sleep and rest. The majority of patients were unable to work or working shorter hours due to their disease. A diagnosis of cancer was likewise found to have a major impact on active leisure pursuits and led to reduced participation in social and community activities. Patients had particular problems in carrying out household chores and maintenance or repair work in the house. Many patients had difficulty sleeping at night and tended to sleep during the day or rest for much of the day.

The majority of studies of quality of life in oncology patients concentrate upon alterations in symptoms, such measures would fail to detect impairment in the aspects described above. Greater attention should be directed towards addressing issues such as changes in employment status and the need for help in the home to improve the overall care of cancer patients.
Blood Cholesterol and Coronary Heart Disease: Changing Perspectives
Authors: Temple Norman J , Walker Alexander R P
Published: July 2022

There has been much controversy concerning the value of efforts to reduce blood cholesterol levels. In this contribution, the risks and benefits of interventions are discussed. Lowering cholesterol level by drugs is not recommended except in a small minority of subjects at very high risk of coronary heart disease (CHD), since it causes an excess of non-CHD deaths. Dietary intervention, by contrast, is safe. However, for it to be effective it must be sufficiently vigorous to achieve a drop in blood cholesterol of at least 6%, though considerably more is preferable. This action should be part of a more general effort aimed at the prevention of all Western diseases based on changes in lifestyle.
An Audit of Autopsy Rates in an Inner London General Hospital
Authors: Lazda E J , Brown D C
Published: July 2022

Low autopsy rates are of continuing concern to pathologists. The aim of this study was to investigate the reasons why autopsy did not happen, and to determine whether carrying out the investigation and providing some feedback of the results would have any effect on autopsy rates. The main reasons why autopsy did not happen were that junior doctors considered it unnecessary because the diagnosis and cause of death appeared to be well established, and that patients' relatives declined to give permission for autopsy. No increase in autopsy rates was demonstrated, but possible avenues of approach were suggested and these are being implemented.
The Emergency Department and the Community: A Model for Improved Cooperation
Authors: Hadfield J M , Yates D W , Berry A
Published: July 2022

Improved emergency care may be achieved by closer integration of hospital and community management. This has been promoted in Salford by the appointment of an Emergency Services Practice Manager jointly funded by the Family Health Services Authority and Salford Health Authority. Communication has improved, complementary working relationships developed and health promotion initiatives established.
Low Self-Concept Clarity Inhibits Self-Control: The Mediating Effect of Global Self-Continuity
Authors: Jiang Tonglin , Wang Ting , Poon Kai-Tak , Gaer Wangchu , Wang Xue
Published: July 2022

Whether and how self-concept clarity (SCC) affects self-control has not been sufficiently explored in empirical research. We proposed that low SCC inhibits self-control through a lower sense of global self-continuity. The results of five studies provided converging support for our mediation model ( N = 898). Compared with participants with high SCC, participants with low SCC scored lower on self-control scales (Studies 1 and 2), spent less time practicing to improve their performance on a tedious task (Study 3), and were less likely to stay focused on an ongoing task (Study 4) or to adhere to the exercise plan to stay healthy (Study 5). Global self-continuity mediated the effects of low SCC on self-control (Studies 1–5) even after emotional affect (Study 5) and self-esteem (Studies 4 and 5) were controlled for. These findings highlight the importance of fostering SCC for coping with self-control failures.
Sometimes needs change minds: Interests and values as determinants of attitudes towards state support for the self-employed during the COVID-19 crisis
Authors: Bonoli Giuliano , Fossati Flavia , Gandenberger Mia , Knotz Carlo Michael
Published: July 2022

This contribution investigates public attitudes toward providing financial help to the self-employed, a less well-researched area in the otherwise vibrant literature on welfare state attitudes. We analyse to what extent the self-employed themselves soften their general anti-statist stance in times of need, and how the public thinks about supporting those who usually tend to oppose government interventions. To answer these questions, we study public attitudes towards providing financial aid to the self-employed during the lockdowns adopted in response to the COVID pandemic in Switzerland, using survey data collected in the spring and in the autumn of 2020. The results show that most respondents favour the provision of financial support. In addition, the self-employed are the staunchest supporters of the more generous forms of help, like non-refundable payments. We conclude that, when exposed to significant economic risk, need and interests override ideological preferences for less state intervention.
Volcano: Between Structural Vulnerabilities and Collective Defence of Honor in Communities Surrounding an Open Dumpsite
Authors: Luxardo Natalia , Sassetti Fernando , Passerino Leila Martina , Wright Eugenia , Billordo Javier , Kolvenbach Marcel , Bello Julio César
Published: July 2022

This study analyzes the dynamics in which structural vulnerabilities are shaped and expressed in the day-to-day lives of people making a living from a garbage dump in Argentina. It is a mixed methods case study, qualitative driven with a collaborative cycle (2016-2021). The study is embedded in medical anthropology, social epidemiology and Latin America Social Medicine, with the focus on the ways people respond to inequalities locally. The findings contribute to the field of health disparities in three directions: 1) the description of patterns of segregation in South America peripheries, shedding light on cumulative disadvantages and multiple exposures; 2) the experience of living enmeshed in places with strong stigmas, revising the ways this source of discrimination become social suffering; and 3) the detection of the impact of collective action and social capital in providing material and symbolic resources for restoring dignity and honour that challenge depreciated status.
Gender Stereotypes in the UK Primary Schools: Student and Teacher Perceptions
Authors: Gilchrist Ella , Zhang Kaili C.
Published: July 2022

Gender stereotypes are often an unconscious notion, which can unjustly confine individuals’ pathways to that of those deemed acceptable in society. Therefore, this qualitative study aimed to explore whether such ideals are shown by primary school students’ and their teachers. Results showed that gender stereotypes were present, with both students and teachers expressing this. Students indicated that all six professions explored had large stereotypes. Teachers were largely in agreement, noting that although they felt able to challenge such ideals, many of them had no formal training throughout their teaching program. The results offer a rationale for more initial teacher training programs to explore the effects of gender stereotypes, preparing teachers to challenge these early on while children are developing their long-term beliefs, to avoid unjust bias.
High-dose methotrexate-related pneumonitis in a child with acute lymphoblastic leukemia
Authors: Rakez Rim , Boufrikha Wiem , Cheffaï Areej , Boukhriss Sarra , Laatiri Mohamed Adnene
Published: July 2022

Introduction

Methotrexate is administered through different routes to treat childhood acute lymphoblastic leukemia. Toxicities of low, intermediate, or high doses of methotrexate have been described in the literature. Methotrexate-induced or related pneumonitis is a rare complication that leads, in most cases, to discontinuing this drug.

Case report

We report a case of a 17-year-old female patient with newly diagnosed B-acute lymphoblastic leukemia who received a high-dose methotrexate on an induction course. Eight days after methotrexate infusion, she developed fever, dyspnea, hypoxemia, and dry cough. Chest computed tomography showed mosaic attenuation of lung parenchyma and bilateral interstitial infiltrate in favor of hypersensitivity pneumonitis with no evidence of bacterial or fungal infections.

Management and outcome

Methotrexate-related pneumonitis was diagnosed and corticosteroids were prescribed. Improvement of the symptomatology was noted within four days. Given the importance of methotrexate in the treatment of acute lymphoblastic leukemia, intrathecal methotrexate was administered without incident and high-dose methotrexate was re-introduced successfully two and a half months after the pneumonitis episode while using corticosteroids. According to Naranjo's algorithm, the reaction to the drug was found to be probable with a score of 6.

Discussion

Methotrexate is the backbone of acute lymphoblastic leukemia treatment, but numerous adverse reactions have been published of which methotrexate pneumonitis can be fatal in some cases. In this case, we concluded that this drug can be successfully reintroduced after methotrexate-related pneumonitis.
Level of Hand Hygiene Compliance and Its Associated Factors Among Health Care Workers at Eka Kotebe General Hospital, Addis Ababa, Ethiopia
Authors: Tadesse Muluken , Shimelash Alebachew , Tegegne Eniyew
Published: July 2022

Background:

Poor hand hygiene is an important source of infection, but maintaining hand hygiene is the most important measure to prevent infections. Hand hygiene compliance and its associated factors are not well recognized in Ethiopia. Therefore, this study was intended to determine hand hygiene compliance and its associated factors among health care workers in Eka Kotebe General Hospital.

Methods:

A cross-sectional study was conducted among health care workers at Eka Kotebe General Hospital. A self-administered questionnaire supplemented by a World Health Organization Hand Hygiene Technical Reference Manual was used to collect data. Data was entered using Epi Info 7.2.0.1 and exported to SPSS 23 for analysis. The data were analyzed using descriptive and inferential statistics. Statistical significance was determined using a P-value of ⩽.05 with a 95% confidence interval.

Results:

Hand hygiene compliance among healthcare workers was 22.2%. Hand hygiene training (AOR = 2.9, 95% CI: 1.13-7.52), presence of hand hygiene indication poster (AOR = 3.38, 95% CI: 1.18-9.66), hand hygiene promotion by IPC team (AOR = 4.2, 95% CI: 2.53-8.58)), working experience ⩾5 years of a health care providers (AOR = 3.96, 95% CI: 1.12-13.9), being midwife (AOR = 17.1, 95% CI: 2.8-10), being nurse (AOR = 5.3, 95% CI: 2.09-7.8) by profession, and presence of water (AOR = 2.50, 95% CI: 2.20-11.78) were significantly associated factors to hand hygiene compliance.

Conclusion:

The level of hand hygiene compliance among health care providers was found to be low. Training about hand hygiene, the presence of hand hygiene indication posters, hand hygiene promotion by the IPC team, working experience of health care providers, being a nurse and midwife, and the presence of water were independent predictors of hand hygiene compliance. Health care workers need to be given training on hand hygiene as well as hand hygiene facilities shall be installed and supplied by the hospital in a sustained manner.
No increase of serum neurofilament light in relapsing-remitting multiple sclerosis patients switching from standard to extended-interval dosing of natalizumab
Authors: Johnsson Magnus , Farman Helen H , Blennow Kaj , Zetterberg Henrik , Malmeström Clas , Axelsson Markus , Lycke Jan
Published: July 2022

Background:

Accumulating evidence supports the efficacy of administering natalizumab (NZ) with extended-interval dosing (EID) in patients with relapsing-remitting multiple sclerosis (RRMS).

Objectives:

We switched NZ dosing from 4-week to 6-week intervals in patients with RRMS, and investigated the effect on serum neurofilament light chain (sNfL) concentrations.

Methods:

We included two cohorts of patients with RRMS treated with NZ: one received the standard-interval dosing (4 weeks) at baseline, and were switched to 6-week intervals (EID4–6, N = 45). The other cohort received EID (5- or 6-week intervals) both at baseline and during follow-up (EID5/6, N = 25). Serum samples were collected in the EID4–6 cohort at every NZ infusion, for 12 months. The primary outcome was the change in sNfL concentrations after switching to EID.

Results:

The baseline mean sNfL concentration in the EID4–6 cohort was 10.5 ng/L (standard deviation (SD) = 6.1), and it remained unchanged at 12 months. Moreover, individual sNfL concentrations did not change significantly after extending the NZ dosing intervals. In addition, the EID4–6 and EID5/6 cohorts had similar baseline sNfL concentrations.

Conclusion:

We concluded that extending the NZ dosing interval did not increase axonal damage, as determined with sNfL, in patients with RRMS.
Ruination in the ring: Habitus in the making of a professional “opponent”
Authors: Wacquant Loïc
Published: July 2022

Backed by 3 years of apprenticeship in a boxing gym of Chicago’s hyperghetto and in-depth life-story interviews with fifty professional boxers, this article reconstructs the social biography and ring career of a professional “opponent” as a living analyzer of the social, economic, mental, and emotional wheels and cogs of prizefighting careers. An “opponent” like Jake “The Snake” Valliance is a boxer determined and skilled enough to give a good account of himself in the ring, but willing to travel for quick money and be overmatched to serve as a stepping stone in the careers of rising fighters. He fights often, loses nearly as often, but maintains enough occupational pride that he keeps going, always hoping to turn his ship around, thus playing a key role in the pugilistic market. The article dissects the genesis, feeding, and fading of the libido pugilistica that explains the opponent's continued investment in the economy of pain, love, and deceit that is professional boxing. It throws light on the material and symbolic logics of a skilled bodily craft and, beyond it, on the workings of habitus as cognitive cog, trained capacity and socialized desire driving social action.
Ranked-Choice Voting and Democratic Attitudes
Authors: Gutiérrez Manuel , Simmons Alan J. , Transue John
Published: July 2022

Ranked-Choice voting is an electoral system that has become a subject of analysis after its implementation across multiple municipalities and two states. An electoral system can affect several aspects of the election, including how voters perceive the system. Our research addresses the impact of RCV on voters’ attitudes towards democracy. In this study, we develop a theory of why ranked-choice voting will increase support for democracy and candidates, even if their preferred choice does not win. With a survey experiment, we find some support for the claim that participating in an RCV election affects how respondents perceive democracy. With the ongoing polarization and partisanship, RCV may provide an avenue for improving assessments and attitudes towards democracy.
Not All Paths are Equal: Stimulating Specific Cerebellar Outputs Inhibits Hippocampal Seizures
Authors: Buchanan Gordon F.
Published: July 2022

[Box: see text]
Epidemiology of Distal Forearm Fracture: A Population-Based Study of 5426 Fractures
Authors: Soerensen Soeren , Larsen Peter , Korup Lærke R. , Ceccotti Adriano A. , Larsen Mia B. , Filtenborg Jonas T. , Weighert Karen P. , Elsoe Rasmus
Published: July 2022

Background:

Despite intensive research into the epidemiology of adult distal forearm fractures, the literature is limited. This study aimed to provide a full overview of adult distal forearm fracture epidemiology, including incidence, fracture classification, mode of injury, and trauma mechanism in patients sustaining a distal forearm fracture, based on an accurate at-risk population with manually validated data leading to a high quality in data.

Methods:

This was a population-based cohort study with a manual review of X-rays and charts. The primary outcome measure was the incidence of adult distal forearm fractures. The study was based on an average at-risk population of 522 607 citizens. A total of 5426 adult distal forearm fractures were included during the study period. Females accounted for 4199 (77%) and males accounted for 1227 (23%) of fractures.

Results:

The overall incidence of adult distal forearm fractures was 207.7/100 000/year. Female incidence was 323.4/100 000/year, and male incidence was 93.3/100 000/year. A marked increase in incidence with increasing age was observed for females after 50 years of age. The incidence of distal radius fractures was 203.0/100 000/year, and the incidence of isolated ulna fractures was 3.8/100 000/year. The most common fracture type was an extra-articular AO type 2R3A (69%), and the most common mode of injury was a fall from own height (76%). A small non-trending year-to-year variation was observed during the 5-year study period.

Conclusion:

Results show that adult distal forearm fractures are very common in women after the postmenopausal period. The overall incidence of adult distal forearm fractures was 207.8/100 000/year. Female incidence was 323.4/100 000/year.
Single-Pass Albumin Dialysis as Rescue Therapy for Pediatric Calcium Channel Blocker Overdose
Authors: Essink Jenna , Berg Sydney , Montange Jaka , Sankey Andrew , Taylor Veronica , Salomon Jeffrey
Published: July 2022

Calcium channel blocker ingestions remain one of the leading causes of death related to cardiovascular medication ingestion in both adults and pediatric patients. We report a case of a 17-year-old, 103 kg female presenting after an intentional polypharmacy ingestion, including 500 to 550 mg of amlodipine. She presented with profound vasoplegia and cardiovascular collapse requiring high-dose inotropes and eventual life support with extracorporeal membrane oxygenation (ECMO). Current available treatments, designed for adults, including lipid emulsion and methylene blue, provided no sustained clinical improvement. This resulted in the initiation of single-pass albumin dialysis (SPAD). We aim to describe the clinical implications, amlodipine toxic dose effects, and clinical challenges associated with large pediatric patients and high-dose medications. We also discuss several challenges encountered related to dosing and concentration of medications, which led to fluid overload. Given the ongoing obesity epidemic, we routinely see pediatric patients of adult size. This will continue to challenge pediatric use of adult dosing and concentrations to avoid excessive fluid administration for high-dose medications, such as insulin and vasoactive agents. To our knowledge, this is the first successful case of using SPAD in conjunction with ECMO for salvage therapy after refractory life-threatening calcium channel blocker toxicity.
Geopolitics of security and surveillance in Nepal and Afghanistan: A comparative analysis
Authors: Shrestha Rupak , Fluri Jennifer L
Published: July 2022

This article examines the geopolitics and geo-economics of security and surveillance. We comparatively focus on the effects of geopolitically powerful states – China and the United States – and their influence over the use of surveillance technologies in the name of spatial security in relatively weaker states – Nepal and Afghanistan. We use these two areas of comparison to address the similarities in security logics across disparate spaces and to highlight the everyday experiences and responses to both outside influence from powerful states and national security regimes. Through interview data from our respective qualitative research in Afghanistan and Nepal, we show how the logics of security situates particular racialized and gendered bodies as suspicious and examine how individuals living in these spaces experience, understand, and challenge these security regimes. We conclude by arguing for more comparative studies of security technologies and surveillance regimes. Additionally, we view these spaces of heightened security as potential sites for increased violence, rather than security.
Histidine-rich glycoprotein as a novel predictive biomarker of postoperative complications in intensive care unit patients: a prospective observational study
Authors: Oiwa Masahiko , Kuroda Kosuke , Kawanoue Naoya , Morimatsu Hiroshi
Published: July 2022

Background

Decrease in histidine-rich glycoprotein (HRG) was reported as a cause of dysregulation of the coagulation-fibrinolysis and immune systems, leading to multi-organ failure, and it may be a biomarker for sepsis, ventilator-associated pneumonia, preeclampsia, and coronavirus disease 2019. However, the usefulness of HRG in perioperative management remains unclear. This study aimed to assess the usefulness of HRG as a biomarker for predicting postoperative complications.

Methods

This was a single-center, prospective, observational study of 150 adult patients who were admitted to the intensive care unit after surgery. Postoperative complications were defined as those having a grade II or higher in the Clavien–Dindo classification, occurring within 7 days after surgery. The primary outcome was HRG levels in the patients with and without postoperative complications. The secondary outcome was the ability of HRG, white blood cell, C-reactive protein, procalcitonin, and presepsin to predict postoperative complications. Data are presented as number and median (interquartile range).

Results

The incidence of postoperative complications was 40%. The HRG levels on postoperative day 1 were significantly lower in patients who developed postoperative complications (n = 60; 21.50 [18.12–25.74] µg/mL) than in those who did not develop postoperative complications (n = 90; 25.46 [21.05–31.63] µg/mL). The Harrell C-index scores for postoperative complications were HRG, 0.65; white blood cell, 0.50; C-reactive protein, 0.59; procalcitonin, 0.73; and presepsin, 0.73. HRG was independent predictor of postoperative complications when adjusted for age, the presence of preoperative cardiovascular comorbidities, American Society of Anesthesiologists Physical Status Classification, operative time, and the volume of intraoperative bleeding (adjusted hazard ratio = 0.94; 95% confidence interval, 0.90–0.99).

Conclusions

The HRG levels on postoperative day 1 could predict postoperative complications. Hence, HRG may be a useful biomarker for predicting postoperative complications.
How does safety netting for lung cancer symptoms help patients to reconsult appropriately? A qualitative study
Authors: Black Georgia B. , van Os Sandra , Renzi Cristina , Walter Fiona M. , Hamilton Willie , Whitaker Katriina L.
Published: July 2022

Background

Safety netting in primary care is considered an important intervention for managing diagnostic uncertainty. This is the first study to examine how patients understand and interpret safety netting advice around low-risk potential lung cancer symptoms, and how this affects reconsultation behaviours.

Methods

Qualitative interview study in UK primary care. Pre-covid-19, five patients were interviewed in person within 2–3 weeks of a primary care consultation for potential lung cancer symptom(s), and again 2–5 months later. The general practitioner (GP) they last saw was interviewed face-to-face once. During the covid-19 pandemic, an additional 15 patients were interviewed only once via telephone, and their GPs were not interviewed or contacted in any way. Audio-recorded interviews were transcribed verbatim and analysed using inductive thematic analysis.

Results

The findings from our thematic analysis suggest that patients prefer active safety netting, as part of thorough and logical diagnostic uncertainty management. Passive or ambiguous safety netting may be perceived as dismissive and cause delayed reconsultation. GP safety netting strategies are not always understood, potentially causing patient worry and dissatisfaction. Telephone consultations and the diagnostic overshadowing of COVID-19 on respiratory symptoms impacted GPs’ safety netting strategies and patients’ appetite for active follow up measures.

Conclusions

Safety netting guidelines do not yet offer solutions that have been proven to promote symptom vigilance and timely reconsultation for low-risk lung cancer symptoms. This may have been affected by primary care practices during the COVID-19 pandemic. Patients prefer active or pre-planned safety netting coupled with thorough consultation techniques and a comprehensible diagnostic strategy, and may respond adversely to passive safety netting advice.
Uses and perceptions of medications among French older adults: results from the 2020 French Health Barometer survey
Authors: Tran Anh Thi-Quynh , Soullier Noémie , Ankri Joël , Herr Marie , Carcaillon-Bentata Laure
Published: July 2022

Background

There are few studies reporting on self-medication, perceptions or difficulties older adults have with their medications. This study aimed to describe the uses and the perceptions of medications among older adults in France and to identify patient groups based on that information.

Methods

We used data from the 2020 ‘French Health Barometer’ – a nationally-representative cross-sectional survey. We assessed polypharmacy (five or more medications), self-medication, and patient perceptions of medications. Robust Poisson regression was used to investigate socio-demographic and health-related factors associated with the outcomes. Latent class analysis was used to identify patient groups classified by the use and the perceptions of medications. Factors associated with group assignment were investigated by multinomial logistic regression. All analyses were weighted.

Results

The study sample comprised 1,623 respondents aged 70–85 years. Polypharmacy and self-medication were reported in 23.5 and 48.7% of the older population, respectively. Polypharmacy was associated with increasing age, low education, and impaired health status. Self-medication was associated with female sex and high education. Among individuals taking at least 1 medication, 8.2% reported not to understand all their medications, and 9.7% having difficulty taking medications as prescribed. Among individuals taking at least 2 medications, 23.2% thought that they took too many medications. Three patient groups were identified: ‘Non-polypharmacy, positive perceptions’ (62.5%), ‘Polypharmacy, positive perceptions’ (28.0%), and ‘Negative perceptions’ (9.5%).

Conclusions

Polypharmacy and self-medication are common in French older adults. One segment of people reported negative perceptions of their medications regardless of their polypharmacy status. This underlines the difference between the objective and perceived measures of polypharmacy.
ArTisaN trial protocol: a single Centre, open-label, phase II trial of the safety and efficacy of TheraSphere selective internal radiation therapy (SIRT) in the treatment of inoperable metastatic (liver) neuroendocrine neoplasia (NENs)
Authors: Sharma Rohini , Slater Susanna , Evans Joanne , Martinez Maria , Ward Caroline , Izadi Hooshang , Wernig Florian , Thomas Rob
Published: July 2022

Background

Neuroendocrine neoplasias (NENs) are a rare type of malignancy that arise from the cells of the neuroendocrine system. Most patients present with advanced, unresectable disease, typically with metastases to the liver. The presence of liver metastases dictates prognosis and there has been a number of studies investigating therapies that reduce the burden of liver disease. Selective Internal Radiation Therapy (SIRT) allows the delivery of targeted high dose radiation directly to tumours, with relative sparing of the surrounding liver tissue. Here, we describe the design and rationale of ArtTisaN, a phase II study to assess efficacy and tolerability of SIRT using TheraSpheres for the management of liver metastases secondary to NENs.

Methods

Twenty-four eligible participants will be recruited to receive SIRT with TheraSpheres. The primary objective is to determine the objective response rate to treatment, defined as the rate of best overall response in the treated liver volume. In addition, total hepatic response and overall response will be assessed according to RECIST 1.1. The second co-primary objective is to determine the incidence of adverse and serious adverse device events. The secondary objectives are progression free survival, overall survival and quality of life. Additional exploratory objectives include investigation of circulating biomarkers of response and identification of a radiomic signature of response.

Discussion

This trial will provide prospective evidence on the efficacy of SIRT using TheraSpheres for the management of liver metastases.

Trial registration

NCT04362436.
Screening of BRCA1/2 variants in Mauritanian breast cancer patients
Authors: Brahim Selma Mohamed , Zein Ekht Elbenina , Bonnet Crystel , Hamed Cheikh Tijani , Salame Malak , Zein Mohamed Vall , Khyatti Meriem , Tolba Ahmedou , Houmeida Ahmed
Published: July 2022

Background and study aim

Carrying a pathogenic BRCA1/2 variant increases greatly young women’s risk of developing breast cancer (BC). This study aimed to provide the first genetic data on BC in Mauritania.

Methods

Using NGS based screening; we searched for BRCA1/2 variants in DNA samples from 137 patients diagnosed for hereditary BC.

Results

We identified 16 pathogenic or likely pathogenic (PV) variants carried by 38 patients. Two predominant BRCA1 PV variants were found: c.815_824dup and c.4986 + 6 T > C in 13 and 7 patients, respectively. Interestingly, three novels BRCA1/2 predicted pathogenic variants have also been detected. Notably, no specific distribution of BRCA1/2 variants was observed regarding triple negative breast cancer (TNBC) or patient gender status.

Conclusions

In this first genetic profiling of BC in Mauritania, we identified a substantial number of BRCA1/2 pathogenic variants. This finding could be important in the future diagnosis and prevention policy of hereditary BC in Mauritania.
Reliability levels of motor competence in youth athletes
Authors: Silva Ana Filipa , Nobari Hadi , Badicu Georgian , Ceylan Halil Ibrahim , Lima Ricardo , Lagoa Maria João , Luz Carlos , Clemente Filipe Manuel
Published: July 2022

This study aimed to analyze the reliability of the tests included in the motor competence assessment (MCA) battery and compare the effects of the number of trials per test. Thirty female volleyball players (14.6 ± 1.3 years of age) were tested. The participants performed two or three trials of each test. Intra-class correlation (ICC) was calculated, and a paired sample t-test analyzed the variations between trials (1st vs. 2nd vs. 3rd). Results revealed a significant difference between the first and the second trials for jumping sideways [t(29) = -4.108, p < 0.01], standing long jump [t(29) = -3.643, p < 0.01], and shuttle run [t(29) = -3.139, p < 0.01]. No significant result was registered in the shifting platforms, ball throwing and kicking between the first and second trials. Hence, any difference was recorded between the second and third trial. High ICC values were registered in lateral jumps, among the three repetitions of ball kicking and ball throwing, and between the last two repetitions of shuttle run. Almost perfect values were recorded for the shifting platforms and standing long jump. Nevertheless, there seems to be a learning effect between the first and the second repetition—no differences were registered only considering the two manipulative tests. In conclusion, except for jumping sideways, the MCA tests are reliable and only need to be performed two times instead of three.
Acute mania following COVID-19 in a woman with no past psychiatric history case report
Authors: Sprenger Steven , Bare J. Pilar , Kashyap Rahul , Cardella Luigi
Published: July 2022

Background

The COVID-19 pandemic that began in late 2019 is caused by infection with the severe acute respiratory syndrome coronavirus-2. Since that time, many neuropsychiatric sequelae including psychosis, neurocognitive disorders, and mood disorders have been observed. The mechanism underlying these effects are currently unknown, however several mechanisms have been proposed.

Case presentation

A 47-year-old woman with past medical history including hypertension and premenstrual syndrome but no psychiatric history presented to the psychiatric hospital with new onset mania. She had developed symptoms of COVID-19 and was later diagnosed with COVID pneumonia. During quarantine, she reported high levels of stress, grief, and anxiety. Seventeen days into her illness, she developed altered mental status, sleeplessness, elevated mood, talkativeness, and preoccupations. Her spouse was concerned for her safety and contacted emergency medical services who brought her to the psychiatric hospital. She had not slept for five days prior to her arrival and exhibited flight of ideas, talkativeness, and grandiose ideas. She reported a family history of bipolar disorder but no past manic or depressive episodes. She was diagnosed with acute mania and stabilized using antipsychotics, a mood stabilizer, and a short course of a benzodiazepine. Many of her symptoms improved, including her elevated mood, increased activity level, and flight of ideas though she continued to have decreased need for sleep as her benzodiazepine was tapered. She and her partner were agreeable to transitioning to outpatient care after her mood stabilized.

Conclusions

This report emphasizes the link between COVID-19 and neuropsychiatric symptoms. Acute mania has no recognized association with COVID-19, but similar presentations have been reported. The patient’s age and time to onset of psychiatric symptoms is consistent with previous reports. Given the growing body of evidence, this association warrants further investigation. Severe acute respiratory syndrome coronavirus-2 causes systemic inflammation and has been shown to be neurotropic. In addition, patients undergoing quarantine experience anxiety related to the disease in addition to social isolation. Psychiatric practitioners should be aware of these effects and advocate for psychiatric evaluation following COVID-19 infection. Understanding the sequelae of infectious disease is crucial for responding to future pandemics.