bluuebunny/crossref_metadata_2025 huggingface dataset:
The most common disease-causing mutation of factor XIII deficiency is corrected by CRISPR/CAS9 gene editing system
Authors: Dorgalaleh Akbar , Kiani Jafar , Zaker Farhad , Safa Majid
Published: February 2022

Factor XIII (FXIII) deficiency is one of the most severe congenital bleeding disorders, with an estimated incidence of one person per one million. Patients with severe FXIII deficiency present a wide range of clinical manifestations, including umbilical cord bleeding, intracranial haemorrhage and recurrent miscarriages. Due to the high rate of life-threatening bleeding, primary prophylaxis is mandatory from the time of diagnosis. Although replacement therapy is the most common therapeutic choice, gene therapy remains the only curative option. In the present study, we assessed the efficacy of the clustered regularly interspaced short palindromic repeats – CRISPR-associated protein 9 (CRISPR/Cas9) system in the correction of the most common FXIII disease-causing mutation (c.562 T > C). A dermal fibroblast was harvested from the human skin biopsy of a young patient with FXIII deficiency. Sanger sequencing was used to confirm the presence of c.562 T>C mutation in the patient and in the harvested fibroblasts. PX459 vector was digested with BbsI restriction enzyme, and after annealing and ligation of two 20-bp guide-RNAs (g-RNAs) close to the PAM (NGG) sequence, the constructed vectors were amplified in Escherichia coli Top 10. Transfection was performed by a nucleofector device, and DNA extraction was performed after puromycin selection and serial dilution from potentially transfected colonies. A 50-bp template oligonucleotide was used to aid homologous repair for correction of the underlying mutation and synonymous mutation as an internal control. The synonymous mutation (AAT to ACT) near the mutation site was used as internal control. Sanger sequencing was done in order to check the gene correction. The c.562 T > C mutation was detected in homozygote state in the primary fibroblasts of the patient and wild-type alleles were confirmed in the normal individual. Colony PCR and sequencing revealed successful cloning of the designed gRNAs. The detected mutation was corrected from a homozygote mutant state (c.562 T > C) to a homozygote wild type in transfected dermal fibroblasts of the patient. The control mutation, as an internal control, was also corrected in the same fibroblasts in the heterozygote manner. The result of the study shows that the CRISPR/CAS9 gene editing system is an effective tool for correction of point mutations in transfected fibroblasts of patients with congenital FXIII deficiency and represents a new, potentially curative, option.
Comparative Analysis of Type I Keratin Expression By Nail Consistency: An Immunohistochemistry Study
Authors: Mingorance Álvarez Esther , Rodríguez-León Joaquín , Pérez Pico Ana Mª. , Mayordomo Raquel
Published: February 2022

The nail plate is one of the essential structures of the nail apparatus and is highly keratinized, making it difficult to handle this tissue experimentally. Different types of nail consistency were identified by applying distal pressure to the nail plate. To analyze the relationship between the keratins expressed in the nail plate and nail consistency, we chose a sample of 32 adult individuals (age 49.81±3.21 y) with the same number of each sex, who had a similar percentage of nail consistency types (56.25% hard consistency nails and 43.75% soft consistency nails). Immunohistochemical analyses showed that hard consistency nails contain more keratin 17 than soft consistency nails (P=0.026). These novel results allow nail consistency to be defined by the differential expression of keratins in the nail plate, and have potential clinical implications for the diagnosis of possible nail disorders and/or systemic disease.
Children's Hospital Transfers From Referring Emergency Departments
Authors: Baca Jacqueline E. , Foster Carolyn C. , Simon Norma-Jean E. , Lorenz Doug , Gregg Mary E. , Schinasi Dana A.
Published: February 2022

Objectives

Children are increasingly transferred from emergency departments (EDs) to children's hospitals for inpatient care. The existing literature on the use of direct admission (DA) specifically among pediatric patients transferred from referring EDs remains sparse.

The objective of this study was to identify demographic, clinical, and contextual factors associated with the use of direct-to-inpatient versus ED-to-inpatient admission among patients transferred to children's hospitals from EDs.

Methods

This was a retrospective chart review of nontrauma patients admitted to inpatient services at a single tertiary children's hospital after interfacility transfer from EDs between July 1, 2016, and June 30, 2017. Characteristics of the patient population and referring EDs were described; unadjusted associations between rates of DA and the demographic, clinical, and contextual variables of encounters were performed; and a logistic model quantified the relevant associations as odds ratios (ORs).

Results

Of 2939 study encounters, 78% resulted in DA. Among White patients, private insurance was associated with decreased direct admission (OR, 0.5; 95% confidence interval [CI], 0.4–0.8). Younger patients and patients with respiratory diagnoses (OR, 3.9; 95% CI, 2.8–5.3) had increased likelihood of DA. Patients with gastrointestinal diagnoses had decreased likelihood of DA (OR, 0.6; 95% CI, 0.4–0.7).

Conclusions

At a tertiary hospital with a high rate of DA among patients transferred from other EDs, we identified factors that were associated with the use of direct versus ED admission. Our results identify specific populations in which future work could inform admission processes for interfacility transfers.
Emergence of Extended-Spectrum β-Lactamase-Producing Pathogens in Community-Acquired Urinary Tract Infections Among Infants at a Pediatric Emergency Department
Authors: Tamas Vanessa , Shah Seema , Hollenbach Kathryn A. , Kanegaye John T.
Published: February 2022

Background

Extended-spectrum β-lactamase (ESBL)-producing pathogens are common among adults and are associated with extended and multiple hospitalizations. They cause urinary tract infections (UTIs) among children with known risk factors such as urinary tract abnormalities and antimicrobial prophylaxis. The emergence of UTIs caused by ESBL-producing organisms among infants has not been well characterized.

Objective

We sought to describe the incidence and current clinical management of infants who were diagnosed with UTIs caused by ESBL-producing organisms at a pediatric emergency department (ED). In addition, we sought to describe risk factors associated with inpatient hospitalization for UTIs caused by ESBL-producing organisms.

Methods

We retrospectively identified infants who were treated in the ED from 2013 to 2017 and who had positive urinalyses and urine cultures positive for greater than 50,000 colony-forming unit per milliliter of a single ESBL-producing urinary pathogen. We abstracted details of clinical management and known previous risk factors, including prior neonatal intensive care unit hospitalization stay, prior UTI caused by an ESBL-producing organism, and known urologic abnormalities.

Results

Forty-five UTIs caused by ESBL-producing organisms occurred in 43 patients (mean age of 5.9 months and 59% female)—ESBL Escherichia coli represented the majority (42/45). The incidence of UTIs caused by ESBL-producing organisms ranged from 0.9% to 4.5% during the 5-year study period. The 13 patients (26%) admitted from the ED were significantly younger than discharged patients (1.9 vs 6.7 months, P = 0.016) and more likely to have had prior neonatal intensive care unit hospitalizations (50% vs 15.6%, P = 0.0456). Of the 33 visits (77%) resulting in initial outpatient management, 5 were followed by readmission for parenteral antibiotic treatment. Of those who were readmitted, 40% (n = 2) were afebrile at the time of admission. The remainder (28/33) completed outpatient oral antibiotic courses guided by susceptibilities. Two patients (4%) had negative repeat urine cultures despite in vitro resistance to initial antibiotic coverage.

Conclusions

Extended spectrum β-lactamase–producing organisms are an increasing cause of UTIs in infants presenting at a pediatric ED, and outpatient management may be reasonable for infants older than 2 months.
Malrotation With Midgut Volvulus in an Adolescent Male
Authors: Greenbaum Rebecca , Koyama Atsuko
Published: February 2022

Malrotation and midgut volvulus are conditions commonly described in infants, typically diagnosed within the first month of life. We present an unusual occurrence of high-grade obstruction because of malrotation and volvulus in an adolescent male. His symptoms at presentation, abdominal pain and vomiting, were similar to previous episodes in which he had been diagnosed with constipation or viral gastroenteritis and discharged home. His main criteria for admission for this occurrence were related to his degree of dehydration.
The Use of Point-of-Care Ultrasound for the Diagnosis of Müllerian Abnormality in the Pediatric Emergency Department
Authors: Acuña Josie , Cabrera-Ramirez Jacob
Published: February 2022

We present a case of an 18-year-old female patient with a history of primary amenorrhea presenting to a pediatric emergency department with complaint of new-onset vaginal bleeding. Upon the patient's presentation, she received a point-of-care ultrasound (POCUS), which promptly identified the lack of a uterus and led to the diagnosis of a müllerian duct anomaly. This is the first published report of müllerian agenesis identified in the pediatric emergency department using a transabdominal approach to pelvic POCUS. We recommend POCUS as a quick, noninvasive diagnostic approach for pediatric patients presenting with undifferentiated vaginal bleeding to guide further management.
Visualization of Concurrent Epicardial and Microvascular Coronary Artery Disease in a Patient with Systemic Lupus Erythematosus by Magnetic Resonance Imaging
Authors: McGill Liam , Gill Callum , Schoepf U. Joseph , Bayer Richard R. , Suranyi Pal , Varga-Szemes Akos
Published: February 2022

We present a patient with history of systemic lupus erythematosus who presented with acute chest pain. Electrocardiography, invasive coronary angiography, and cardiac MRI were performed during the course of her evaluation. Invasive coronary angiography demonstrated obstructive disease in the diagonal system and cardiovascular MRI confirmed an anterior infarct consistent with the electrocardiographic findings. However, MRI also revealed focal inferoseptal hypoperfusion inconsistent with electrocardiographic and angiographic findings. Rather, these findings indicate the presence of concurrent microvascular coronary artery disease, which has a high prevalence among women with autoimmune disease.
Lateral Tarsoplasty for Managing Ectropion and Laxity of the Lower Eyelid
Authors: Hsieh Meng-Chien Willie , Lai Ya-Wei , Wang Yu-Chi , Ramachandran Savitha , Lin Tzu-Yu , Lai Chung-Sheng
Published: February 2022

Background

The most challenging complication associated with lower blepharoplasty is ectropion, and the traditional lateral canthopexy or canthoplasty procedure may carry the risk of eyelid malposition or subsequent chemosis. We propose lateral tarsoplasty with a detailed description of the techniques to treat and even prevent ectropion by not involving the medial or lateral canthal ligament so as to avoid complications.

Materials and Methods

Lower eyelid laxity was analyzed with the snap-back test and distraction test before surgery. Approximately 5 mm medial to the lateral canthus, lateral tarsoplasty is performed through a full-thickness pentagonal tarsal-conjunctival resection according to the “overlapping test” for an accurate measurement of the amount of the tarsus to be resected. Seventy-two eyelids that received either ectropion correction or prevention with lateral tarsoplasty over an 8-year period at a single institution were collected and analyzed for this retrospective review.

Results

Lateral tarsoplasty was performed in 39 patients with a mean age of 63.8 years. Thirteen patients with 20 eyelids presented for ectropion correction, in whom 5 to 10 mm of tarsus was resected, 6.0 mm in average. The other 26 patients with 52 eyelids presented for ectropion prevention, in whom 3 to 7 mm of tarsus was resected, 4.1 mm in average. Apart from temporary mild chemosis, all patients experienced highly satisfactory results without any ectropion or malposition of the involved lower eyelids after a follow-up of 8.1 months in average.

Conclusions

For patients with moderate and severe laxity of lower eyelids, lateral tarsoplasty without involvement of the lateral canthal ligament proves to be an effective way to treat and prevent lower eyelid ectropion.
Accuracy of the Application of 3-Dimensional Printing Models in Orbital Blowout Fractures—A Preliminary Study
Authors: Ma Chun-Yu , Wang Tien-Hsiang , Yu Wen-Chan , Shih Yu-Chung , Lin Chih-Hsun , Perng Cherng-Kang , Ma Hsu , Wang Shyh-Jen , Chen Wei-Ming , Chen Ching-En
Published: February 2022

Background

Application of 3-dimensional (3D) printing technology has grown in the medical field over the past 2 decades. In managing orbital blowout fractures, 3D printed models can be used as intraoperative navigators and could shorten the operational time by facilitating prebending or shaping of the mesh preoperatively. However, a comparison of the accuracy of computed tomography (CT) images and printed 3D models is lacking.

Material and Methods

This is a single-center retrospective study. Patients with unilateral orbital blowout fracture and signed up for customized 3D printing model were included. Reference points for the 2D distance were defined (intersupraorbital notch distance, transverse horizontal, sagittal vertical, and anteroposterior axes for orbital cavity) and measured directly on 3D printing models and on corresponding CT images. The difference and correlation analysis were conducted.

Results

In total, 9 patients were reviewed from June 2017 to December 2020. The mean difference in the intersupraorbital notch measurement between the 2 modules was −0.14 mm (P = 0.67). The mean difference in the distance measured from the modules in the horizontal, vertical, and anteroposterior axes of the traumatic orbits was 0.06 mm (P = 0.85), −0.23 mm (P = 0.47), and 0.51 mm (P = 0.32), whereas that of the unaffected orbits was 0.16 mm (P = 0.44), 0.34 mm (P = 0.24), and 0.1 mm (P = 0.88), respectively. Although 2D parameter differences (<1 mm) between 3D printing models and CT images were discovered, they were not statistically significant.

Conclusions

Three-dimensional printing models showed high identity and correlation to CT image. Therefore, personalized models might be a reliable tool of virtual surgery or as a guide in realistic surgical scenarios for orbital blowout fractures.
Drivers of adaptive evolution during chronic SARS-CoV-2 infections
Authors: Harari Sheri , Tahor Maayan , Rutsinsky Natalie , Meijer Suzy , Miller Danielle , Henig Oryan , Halutz Ora , Levytskyi Katia , Ben-Ami Ronen , Adler Amos , Paran Yael , Stern Adi
Published: February 2022

In some immunocompromised patients with chronic SARS-CoV-2 infection, dramatic adaptive evolution occurs, with substitutions reminiscent of those in variants of concern (VOCs). Here, we searched for drivers of VOC-like emergence by consolidating sequencing results from a set of twenty-seven chronic infections. Most substitutions in this set reflected lineage-defining VOC mutations, yet a subset of mutations associated with successful global transmission was absent from chronic infections. The emergence of these mutations might dictate when variants from chronic infections can dramatically spread onwards. Next, we tested the ability to predict antibody-evasion mutations from patient- and viral-specific features, and found that viral rebound is strongly associated with the emergence of antibody-evasion. We found evidence for dynamic polymorphic viral populations in most patients, suggesting that a compromised immune system selects for antibody-evasion in particular niches in a patient’s body. We suggest that a trade-off exists between antibody-evasion and transmissibility that potentially constrains VOC emergence, and that monitoring chronic infections may be a means to predict future VOCs.
Detection of nervous necrosis virus RGNNV genotype in pearl gentian grouper (Epinephelus lanceolatus ♂ × E. fuscoguttatus ♀) fry imported to Thailand
Authors: Jungi Sumit Vinod , Sangsuriya Pakkakul , Taengphu Suwimon , Phiwsaiya Kornsunee , Sonthi Molruedee , Nuangsaeng Bunlung , Salin Krishna R , Senapin Saengchan , Dong Ha Thanh
Published: February 2022

Nervous necrosis virus (NNV) is a deadly virus that affects more than 120 fish species worldwide, but there is little information about it in Thailand. In August 2019, a population of pearl gentian grouper fry imported to Thailand experienced mass mortality. The diseased fish exhibited darkening, floating on the water surface, ‘sleepy behaviour’, and erratic swimming. We received a set of samples for disease diagnosis. PCR analysis revealed that these samples were positive for NNV but negative for Megalocytivirus ISKNV and Ranavirus. Sequencing the virus’s genome and phylogenetic analysis revealed that it is a member of the red-spotted grouper nervous necrosis virus (RGNNV) genotype. In situ hybridization using an NNV-specific probe revealed localization of the virus in the vacuolation lesions of the central nervous system (brain and spinal cord) and the retina of infected fish. The virus was successfully isolated from tissue homogenate from diseased fish using the E-11 cell line. This study identified NNV (RGNNV genotype) as a virus associated with massive die-offs in imported pearl grouper fry in Thailand. Considering the infectious nature of the virus and its broad host range, appropriate biosecurity measures are needed to prevent any loss to the marine aquaculture industry.

Highlights

This study reports detection of NNV in grouper larvae imported to Thailand

The virus was assigned to the RGNNV genotype, which is the most extensively distributed genotype

Histopathology revealed a pathognomonic lesion of NNV

ISH using an NNV-specific probe revealed localization of NNV in the CNS and retina

The virus was successfully propagated from diseased fish using the E-11 cell line
Effectiveness of the BNT162b2 vaccine among children 5-11 and 12-17 years in New York after the Emergence of the Omicron Variant
Authors: Dorabawila Vajeera , Hoefer Dina , Bauer Ursula E. , Bassett Mary T. , Lutterloh Emily , Rosenberg Eli S.
Published: February 2022

Importance

There is limited evidence on the effectiveness of the BNT162b2 vaccine for children, particularly those 5-11 years and after the Omicron variant’s emergence.

Objective

To estimate BNT162b2 vaccine effectiveness against COVID cases and hospitalizations among children 5-11 years and 12-17 years during December, 2021 and January, 2022.

Design

Analyses of cohorts constructed from linked statewide immunization, laboratory testing, and hospitalization databases.

Setting/Participants

New York State children 5-17 years.

Main outcomes/measures

New laboratory-confirmed COVID-19 cases and hospitalizations. Comparisons were made using the incidence rate ratio (IRR), comparing outcomes by vaccination status, and estimated vaccine effectiveness (VE: 1-[1/IRR]).

Results

From December 13, 2021 to January 30, 2022, among 852,384 fully-vaccinated children 12-17 years and 365,502 children 5-11 years, VE against cases declined from 66% (95% CI: 64%, 67%) to 51% (95% CI: 48%, 54%) for those 12-17 years and from 68% (95% CI: 63%, 72%) to 12% (95% CI: 6%, 16%) for those 5-11 years. During the January 24-30 week, VE for children 11 years was 11% (95%CI -3%, 23%) and for those age 12 was 67% (95% CI: 62%, 71%). VE against hospitalization declined changed from 85% (95% CI: 63%, 95%) to 73% (95% CI: 53%, 87%) for children 12-17 years, and from 100% (95% CI: -189%, 100%) to 48% (95% CI: -12%, 75%) for those 5-11 years. Among children newly fully-vaccinated December 13, 2021 to January 2, 2022, VE against cases within two weeks of full vaccination for children 12-17 years was 76% (95% CI: 71%, 81%) and by 28-34 days it was 56% (95% CI: 43%, 63%). For children 5-11, VE against cases declined from 65% (95% CI: 62%, 68%) to 12% (95% CI: 8%, 16%) by 28-34 days.

Conclusions and Relevance

In the Omicron era, the effectiveness against cases of BNT162b2 declined rapidly for children, particularly those 5-11 years. However, vaccination of children 5-11 years was protective against severe disease and is recommended. These results highlight the potential need to study alternative vaccine dosing for children and the continued importance layered protections, including mask wearing, to prevent infection and transmission.
SARS-CoV-2 Exposures of Healthcare Workers from Primary Care, Long-Term Care Facilities and Hospitals: A Nationwide Matched Case-Control Study
Authors: Belan Martin , Charmet Tiffany , Schaeffer Laura , Tubiana Sarah , Duval Xavier , Lucet Jean-Christophe , Fontanet Arnaud , Birgand Gabriel , Kernéis Solen
Published: February 2022

Objectives

Healthcare workers (HCWs) are at higher risk of contracting coronavirus disease-19 (COVID-19) than the general population. This study assessed the roles of various exposures and personal protective equipment (PPE) use on that risk for HCWs working in primary care, long-term-care facilities (LTCFs) or hospitals.

Methods

We conducted a matched case-control (1:1) study (10 April–9 July 2021). Cases (HCWs with confirmed COVID-19) and controls (HCWs without any COVID-19-positive test or symptoms) recruited by email were invited to complete an online questionnaire on their exposures and PPE use. Questions covered the 10 days preceding symptom onset for cases (or testing if asymptomatic) or inclusion for controls.

Results

A total of 4152 matched cases and controls were included. The multivariable conditional logistic regression analysis retained exposure to an infected person outside work (adjusted odds ratio, 19.9 [95% confidence intervaI, 12.4–31.9]), an infected colleague (2.26 [1.53–3.33]) or COVID-19 patients (2.37 [1.66–3.40]), as independent predictors of COVID-19 in HCWs, while partial or complete immunization was protective. Eye protection (0.57 [0.37–0.87]) and wearing a gown (0.58 [0.34–0.97]) during COVID-19 patient care were protective, while wearing an apron slightly increased the risk of infection (1.47 [1.00–2.18]). N95-respirator protection was comparable to that of surgical masks. Results were consistent across healthcare-facility categories.

Conclusions

HCWs were more likely to get COVID-19 in their personal sphere than during occupational activities. Our results suggest that eye protection for HCWs during patient care should be actively promoted.
Impact of migration on household consumption expenditures in Bangladesh using the coarsened exact matching (CEM) approach
Authors: Hossain Aktar , Gani Mohammad Osman
Published: February 2022

Purpose

The study aims to examine the impact of migration on household consumption expenditures in Bangladesh.

Design/methodology/approach

The paper uses coarsened exact matching methods to examine the causal impact between migration and household welfare using the dataset on Bangladesh Household Income and Expenditure Survey 2010 on 12,213 households.

Findings

The study reveals that migration has a positive impact on household welfare improvement through increases in their consumption expenditures. Households with migration status are found to spend more on food, non-food (housing, durable goods, fuel, cosmetics, cleaning, transport, clothing, taxes, insurance, recreation) items and medical. However, the authors do not find any evidence of impacts on education expenditures.

Research limitations/implications

The availability of panel data and the use of other variables (e.g. household investment expenditures, household budget allocation for agricultural input expenses, etc.) would have been able to provide vivid results.

Originality/value

This paper adds to the Bangladeshi migration literature by offering a novel empirical assessment of the Bangladeshi migrants and its impact on household welfare by drawing upon a recently published, nationally representative sample of Bangladeshi households.
Ethical challenges in an evolving digital communication era: coping resources and ethics trainings in corporate communications
Authors: Meng Juan , Kim Solyee , Reber Bryan
Published: February 2022

Purpose

This study is motivated to investigate the ethical challenges facing public relations professionals in today's digital communication environment. Specifically, the authors focused the research on the new ethical challenges in digital practice, the resources relied on when encountering ethical challenges and public relations professionals' efforts in seeking trainings on communication ethics.

Design/methodology/approach

An international online survey was designed and conducted in Canada and the USA. The final sample includes 1,046 respondents working full time in the profession of public relations and communication. In addition, the authors prespecified several demographic quotas in sampling design in order to recruit a more representative sample.

Findings

The research found nearly 60% of surveyed professionals reported that they faced ethical challenges in their day-to-day work, and there is a wide range of ethical challenges in digital practices. Results also revealed that professionals use various resources to deal with ethical issues. Those resources include ethical codes of practice of professional associations, ethical guidelines of their organizations and their personal values and beliefs. As common as experiencing ethical challenges, over 85% of surveyed professionals reported that they have participated in communication ethics training. However, only 30% of participants indicated that their ethics training took place in the past year.

Originality/value

The research provides solid evidence that the digital communication environment generates more ethical challenges, while it creates new ways of delivering content in corporate communications. Professional associations and organizations shall dedicate efforts in providing timely ethics training to PR professionals at all levels of leadership within and beyond corporate communications.
A PCA-based variable ranking and selection approach for electric energy load forecasting
Authors: Bezerra Francisco Elânio , Grassi Flavio , Dias Cleber Gustavo , Pereira Fabio Henrique
Published: February 2022

Purpose

This paper aims to propose an approach based upon the principal component analysis (PCA) to define a contribution rate for each variable and then select the main variables as inputs to a neural network for energy load forecasting in the region southeastern Brazil.

Design/methodology/approach

The proposed approach defines a contribution rate of each variable as a weighted sum of the inner product between the variable and each principal component. So, the contribution rate is used for selecting the most important features of 27 variables and 6,815 electricity data for a multilayer perceptron network backpropagation prediction model. Several tests, starting from the most significant variable as input, and adding the next most significant variable and so on, are accomplished to predict energy load (GWh). The Kaiser–Meyer–Olkin and Bartlett sphericity tests were used to verify the overall consistency of the data for factor analysis.

Findings

Although energy load forecasting is an area for which databases with tens or hundreds of variables are available, the approach could select only six variables that contribute more than 85% for the model. While the contribution rates of the variables of the plants, plus energy exchange added, have only 14.14% of contribution, the variable the stored energy has a contribution rate of 26.31% being fundamental for the prediction accuracy.

Originality/value

Besides improving the forecasting accuracy and providing a faster predictor, the proposed PCA-based approach for calculating the contribution rate of input variables providing a better understanding of the underlying process that generated the data, which is fundamental to the Brazilian reality due to the accentuated climatic and economic variations.
Using Lean Six Sigma to improve timeliness of clinical laboratory test results in a university hospital in Egypt
Authors: Ibrahim Islam , Sultan Magda , Yassine Omaima Gaber , Zaki Adel , Elamir Hossam , Guirguis Wafaa
Published: February 2022

Purpose

Healthcare environments are highly complex and full of variation and inefficiency. However, variation and inefficiency can be measured and improved, providing better quality care at a lower cost. This study aims to report the application of Lean Six Sigma (LSS) in a haematology laboratory in a university hospital in Egypt.

Design/methodology/approach

The authors used case study research. Applying the define, measure, analyse, improve and control phases of the DMAIC methodology together with lean tools, the problem was identified, the process mapped, the causes analysed and improvements implemented.

Findings

Results show that LSS can be successfully implemented in challenging public sector healthcare settings. Management commitment, generating and implementing ideas from frontline staff, using a variety of quality tools and previous LSS training were all key to success. This is evidence that the LSS methodology is adaptable to any process, people or place.

Originality/value

There are no publications on LSS implementation in health care in Egypt. This study demonstrates the successful use of LSS in a university hospital (public sector) in a developing country, sharing insight into the facilitators and barriers in a real context with others in the healthcare field.
The impact of uncertainty-fear against COVID-19 on corporate social responsibility and labor practices issues
Authors: Kholaif Moustafa Mohamed Nazief Haggag Kotb , Ming Xiao
Published: February 2022

Purpose

The research aims to profoundly investigate the correlation between uncertainty-fear against COVID-19, corporate social responsibility (CSR) and labor practices issues based on ISO 26000.

Design/methodology/approach

Partial least squares structural equation modeling (PLS-SEM) was adopted for data analysis and hypotheses testing on a sample of 304 managers and employees in the Egyptian small and medium enterprises (SMEs).

Findings

Preliminary results indicate that the uncertainty-fear against COVID-19 positively affects CSR practices in SMEs. CSR positively impacts labor practices dimensions. However, CSR has an insignificant effect on the social protection and work condition dimension. Also, CSR has a significant mediating role in the association between uncertainty-fear toward the pandemic and labor practices. But, this relation is insignificant regarding social protection and work condition dimension.

Practical implications

Managers could develop a consistent strategy for applying CSR practices, providing clear information and focusing on their procedures to protect their workforce during COVID-19. Governments should impose policies to guarantee that all employees have the same opportunities and not discriminate directly or indirectly in any labor practice.

Originality/value

Based on both the “stakeholder” and “social-cognitive” theories, this study shed light on the optimistic side of the COVID-19 pandemic, as it also brings the concepts of social responsibility, sustainability and green practices back into the light, which helps in solving labor issues.
Forging a new corporate engagement
Authors: Hirsch Peter Buell
Published: February 2022

Purpose

This paper aims to highlight the need for corporations to engage politically to create a more functional capitalist system.

Design/methodology/approach

Selective review of relevant economic and sociopolitical developments is presented in this paper.

Findings

There is a growing movement among economists and commentators to hold corporations accountable for political engagement which they ignore at their peril.

Originality/value

While individual strands of this story have been discussed before, the subject has never been handled from the perspective of corporate reputation in a comprehensive manner.
Crystal structure optimization approach to problem solving in mechanical engineering design
Authors: Talatahari Babak , Azizi Mahdi , Talatahari Siamak , Tolouei Mohamad , Sareh Pooya
Published: February 2022

Purpose

In this paper, the authors aim to examine and comparatively evaluate a recently-developed metaheuristic called crystal structure algorithm (CryStAl) – which is inspired by the symmetries in the internal structure of crystalline solids – in solving engineering mechanics and design problems.

Design/methodology/approach

A total number of 20 benchmark mathematical functions are employed as test functions to evaluate the overall performance of the proposed method in handling various functions. Moreover, different classical and modern metaheuristic algorithms are selected from the optimization literature for a comparative evaluation of the performance of the proposed approach. Furthermore, five well-known mechanical design examples are utilized to examine the capability of the proposed method in dealing with challenging optimization problems.

Findings

The results of this study indicated that, in most cases, CryStAl produced more accurate outputs when compared to the other metaheuristics examined as competitors.

Research limitations/implications

This paper can provide motivation and justification for the application of CryStAl to solve more complex problems in engineering design and mechanics, as well as in other branches of engineering.

Originality/value

CryStAl is one of the newest metaheuristic algorithms, the mathematical details of which were recently introduced and published. This is the first time that this algorithm is applied to solving engineering mechanics and design problems.
Plant foliar nutrient response to active layer and water table depth in warming permafrost soils
Authors: Jasinski Briana L. , Hewitt Rebecca E. , Mauritz Marguerite , Miller Samantha N. , Schuur Edward A. G. , Taylor Meghan A. , Walker Xanthe J. , Mack Michelle C.
Published: February 2022

Thawing permafrost in northern latitudes has led to deepening active soil layers and fluctuating water tables. This could increase plant access to permafrost‐derived nitrogen (N), phosphorus (P) and other nutrients such as calcium (Ca) and magnesium (Mg), and subsequently increase plant productivity and ecosystem carbon storage and nutrient cycling. We hypothesized that deepening permafrost thaw and water table fluctuations would alter species‐specific foliar N:P ratios. Since there is often more P, Ca and Mg available in the deeper mineral soil layers and more N available in the shallow organic layers, we expected that deeply rooted species would decrease foliar N:P ratios due to root proximity to thawing mineral soil, and plants with shallower rooting systems mostly in the organic layer would increase foliar N:P ratios.

We assessed foliar and canopy nutrient responses of seven vascular plant species in moist acidic tussock tundra vegetation in the northern foothills of the Alaska Range to variable soil thaw depths and water table levels induced by either a natural thermokarst gradient or a winter warming snow fence experiment.

In both the natural thermokarst gradient and the warming experiment, wet or deeply thawed areas generally led to an increase in foliar nutrient concentrations and greater canopy mass and canopy nutrients. For the majority of species, foliar N:P ratios remained proportional or decreased in deciduous species in wet sites, with the exception of one shallowly rooted species that increased foliar N:P ratio in deeply thawed sites. Overall, plant acquisition of P was more related to water table level than to thaw depth, and water table modulated the canopy biomass response of the species at the warming experiment.

Synthesis. Foliar N:P ratios suggest that plant species in this tussock tundra ecosystem are either remaining or becoming more N‐limited as thaw depth deepens and water table level rises, indicating that P is not likely to become the primary limiting nutrient with the progression of permafrost thaw. However, the amount of deeply thawed, wet areas that develop on the landscape as permafrost thaws will be important contributors in the total movement of nutrients above‐ground.
3D‐3D facial registration method applied to personal identification: Does it work with limited portions of faces? An experiment in ideal conditions
Authors: Gibelli Daniele , Palamenghi Andrea , Poppa Pasquale , Sforza Chiarella , Cattaneo Cristina , De Angelis Danilo
Published: February 2022

Personal identification of faces represents a challenging issue, especially for what concerns the quantification of the comparison. The 3D‐3D superimposition approach proved to distinguish between matches and mismatches. However, the potential of this procedure applied to cases where only parts of faces are visible still has to be verified. This study aimed at verifying the applicability of a 3D‐3D procedure to faces divided into three thirds. 3D models of fifty male subjects acquired through stereophotogrammetry were used. The 3D facial models were divided into upper, middle, and lower thirds and registered onto other models belonging to the same and different individuals according to the least point‐to‐point distance. In total, 50 matches and 50 mismatches were analyzed. RMS value (root mean square) of point‐to‐point distance between the two facial surfaces was calculated through VAM® software. Statistically significant differences between matches and mismatches in each facial third were assessed through Mann–Whitney test (p < 0.05). On average, RMS value in matches was 0.32 ± 0.12 mm in upper third, 0.36 ± 0.15 mm in middle third, and 0.40 ± 0.20 mm in lower third, respectively; in mismatches, RMS value was 1.40 ± 0.32 mm in upper third, 1.96 ± 0.58 mm in middle third, and 2.39 ± 0.90 mm in lower third, respectively. Differences in RMS values between matches and mismatches were significantly different for all facial thirds, without superimpositions (p < 0.01). This study shows that the existing 3D‐3D superimposition methods may be useful also when only a limited portion of face is visible in ideal conditions. Their application to forensic cases of identification still needs to be verified.
A comprehensive look at explicit screening tools for potentially inappropriate medication: A systematic scoping review
Authors: Schiavo Geovana , Forgerini Marcela , Lucchetta Rosa Camila , Mastroianni Patrícia de Carvalho
Published: February 2022

Objective

To map explicit screening tools to identify potentially inappropriate medication (PIMs), and the characteristics and limitations of these tools. Including PIMs–interactions, therapeutic alternatives and the clinical management of PIMs.

Methods

A systematic scoping review was conducted in PubMed and Scopus (until May 2021). The number of PIMs listed as essential drugs was identified in Model List of Essential Medicines by the World Health Organization (WHO) and National List of Essential Medicines (Brazil). In addition to reporting the therapeutic alternatives and clinical management proposed by explicit screening tools to identify PIMs, we suggested our own alternatives for the PIMs most frequently reported.

Results

Fifty‐eight tools reported 614 PIMs and 747 PIMs–interactions. Limited overlap between the tools was observed: 123 (69.1%) of 178 therapeutic alternatives proposed by the tools were considered inappropriate by other tools, and 222 (36.1%) of the 614 PIMs identified were named as being inappropriate only once. Only 21 tools were developed by a Delphi panel technique associated with systematic review. The PIMs listed as essential medication in Brazil and by the WHO were 30.6% and 23.3% of the total reported, respectively. For the most‐cited PIMs, such as non‐steroidal anti‐inflammatory drugs, tricyclic antidepressants and benzodiazepines, we suggested the use of non‐opioid and opioid analgesics; agomelatine, bupropion or moclobemide; and melatonin, respectively.

Conclusions

The next stages in the development of explicit screening tools to identify PIMs include achieving more consensus between them and improving their applicability across countries. Further, it is recommended that tools include PIMs risks and advice on therapeutic alternatives.
GIPR gene expression in testis is mouse specific and can impact male mouse fertility
Authors: Killion Elizabeth A. , Hussien Rajaa , Shkumatov Artem , Davies Rhian , Lloyd David J. , Véniant Murielle M. , Lebrec Herve , Fort Madeline M.
Published: February 2022

Background

Glucose‐dependent insulinotropic polypeptide receptor (Gipr) gene expression has been reported in mouse spermatids and Gipr knockout male mice have previously been reported to have decreased in vitro fertilization, although the role of Gipr signaling in male mouse fertility is not well understood.

Objectives

The purposes of these studies were to determine the role of glucose‐dependent insulinotropic polypeptide receptor in male fertility using Gipr knockout mice and anti‐glucose‐dependent insulinotropic polypeptide receptor antibody‐treated wild‐type mice and to determine if the expression of Gipr in mouse testes is similar in non‐human and human primates.

Methods and materials

Adiponectin promoter‐driven Gipr knockout male mice (GiprAdipo–/–) were assessed for in vitro and in vivo fertility, sperm parameters, and testicular histology. CD1 male mice were administered an anti‐glucose‐dependent insulinotropic polypeptide receptor antibody (muGIPR‐Ab) prior to and during mating for assessment of in vivo fertility and sperm parameters. Expression of Gipr/GIPR mRNA in the mouse, cynomolgus monkey, and human testes was assessed by in situ hybridization methods using species‐specific probes.

Results

GiprAdipo–/– male mice are infertile in vitro and in vivo, despite normal testis morphology, sperm counts, and sperm motility. In contrast, administration of muGIPR‐Ab to CD1 male mice did not impact fertility. While Gipr mRNA expression is detectable in the mouse testes, GIPR mRNA expression is not detectable in monkey or human testes.

Discussion

The infertility of GiprAdipo–/– male mice correlated with the lack of Gipr expression in the testis and/or adipocyte tissue. However, as administration of muGIPR‐Ab did not impact the fertility of adult male mice, it is possible that the observations in genetically deficient male mice are related to Gipr deficiency during development.

Conclusion

Our data support a role for Gipr expression in the mouse testis during the development of sperm fertilization potential, but based on gene expression data, a similar role for glucose‐dependent insulinotropic polypeptide receptor in non‐human primate or human male fertility is unlikely.
Following targeted routine antenatal anti‐D prophylaxis, almost half of the pregnant women had undetectable anti‐D prophylaxis at delivery
Authors: Sørensen Kirsten , Stjern Helena Eriksson , Karlsen Bente Anita Grande , Tomter Geir , Ystad Inger , Herud Ida , Bævre Mette Silihagen , Llohn Abid Hussain , Akkök Çiğdem Akalın
Published: February 2022

Introduction

In September 2016, a nationwide targeted routine antenatal anti‐D prophylaxis program was implemented in Norway. The prophylaxis (anti‐D immunoglobulin) aims to cover the whole third trimester and is administered in gestational week 28 to RhD‐negative women who carry RhD‐positive fetuses. However, in many women, antibody screening at delivery does not detect anti‐D immunoglobulin. The goal of this study was to investigate the presumable role of dose and timing of antenatal anti‐D immunoglobulin administration in non‐detectable prophylaxis at the time of delivery.

Material and methods

In this retrospective observational study, RhD‐negative pregnant women who gave birth at Oslo University Hospital and Akershus University Hospital between January 2017 and December 2019 were analyzed. Women who received antenatal anti‐D immunoglobulin (1500 IU at Oslo University Hospital and 1250 IU at Akershus University Hospital) when fetal RHD genotyping at gestational week 24 predicted an RhD‐positive fetus were included if an antibody screen at delivery was available. Data from the blood bank, maternity information systems, and electronic patient records were used.

Results

Analysis of the 984 RhD‐negative women at the two hospitals revealed that 45.4% had non‐detectable anti‐D at delivery. A significant difference between the two hospitals was observed: 40.5% at Oslo University Hospital (n = 509) and 50.7% at Akershus University Hospital (n = 475) (p = 0.001). The proportion with non‐detectable anti‐D increased to 56.0 and 75.3%, respectively (p = 0.008) in the group of women who gave birth 12 weeks after routine antenatal anti‐D prophylaxis. Significantly fewer women had detectable anti‐D at delivery when the lower anti‐D immunoglobulin dose (1250 IU) was administered antenatally. Multiple logistic regression indicated that the time interval between routine antenatal anti‐D prophylaxis and delivery, in addition to anti‐D dose, were significantly associated with detectable anti‐D at delivery (p < 0.001).

Conclusions

We do not know which RhD‐negative pregnant women, despite antenatal anti‐D prophylaxis, are at risk of RhD alloimmunization, when antibody screening is negative at delivery. Administration of antenatal prophylaxis should probably be moved closer to delivery, since the risk of fetomaternal hemorrhage is higher during the last weeks of the third trimester.
Diaphragm pacing in spinal cord injury can significantly decrease mechanical ventilation in multicenter prospective evaluation
Authors: Onders Raymond P. , Khansarinia Saeid , Ingvarsson Páll E. , Road Jeremy , Yee John , Dunkin Brian , Ignagni Anthony R.
Published: February 2022

Background

Cervical spinal cord injury (SCI) can lead to dependence on mechanical ventilation (MV) with significant morbidity and mortality. The diaphragm pacing system (DPS) was developed as an alternative to MV.

Methods

We conducted a prospective single‐arm study of DPS in MV‐dependent patients with high SCI and intact phrenic nerves. Following device acclimation, pacing effectiveness to provide ventilation was evaluated. The primary endpoint was the number who could use DPS to breathe for 4 continuous hours without MV. Secondary endpoints included the number of patients that could use DPS 24 h/day free of MV and the ability of DPS to maintain clinically acceptable tidal volume (Vt). In addition, we conducted a meta‐analysis that included the prospective study along with data from four recently published studies to evaluate DPS hourly use.

Results

Fifty‐three patients were implanted in the prospective study. Most were male (77.4%) with a median time from injury to treatment of 28.3 (IQR: 12.1, 83.3) months. Four‐ and 24‐h use occurred in 96.2% (95% CI: 87.0%, 99.5%) and 58.5% (95% CI: 44.1%, 74.9%), respectively. Four and 24‐h results in the meta‐analysis cohort (n = 196) exhibited similar results 92.2% (95% CI: 82.6%, 96.7%) and 52.7% (95% CI: 36.2%, 68.6%) using DPS for 4 and 24 h, respectively. DPS use significantly exceeded the calculated basal tidal volume requirements by a mean of 48.4% (95% CI: 37.0, 59.9%; p < 0.001).

Conclusions

This study demonstrates that in most ventilator‐dependent patients, diaphragm pacing can effectively supplement or completely replace the need for MV and support basal metabolic requirements.