bluuebunny/crossref_metadata_2025 huggingface dataset:
Priority setting in the Brazilian emergency medical service: a multi-criteria decision analysis (MCDA)
Authors: Frazão Talita D. C. , Santos Ana F. A. dos , Camilo Deyse G. G. , da Costa Júnior João Florêncio , de Souza Ricardo P.
Published: May 2021

Background

Despite the proven value of multicriteria decision analysis in the health field, there is a lack of studies focused on prioritising victims in the Emergency Medical Service, EMS. With this, and knowing that the decision maker needs a direction on which choice may be the most appropriate, based on different and often conflicting criteria. The current work developed a new model for prioritizing victims of SAMU/192, based on the multicriteria decision methodology, taking into account the scarcity of resources.

Methods

An expert panel and a discussion group were formed, which defined the limits of the problem, and identified the evaluation criteria for choosing a victim, amongst four alternatives illustrated from hypothetical scenarios of emergency situations—clinical and traumatic diseases of absolute priority. For prioritization, an additive mathematical method was used that aggregates criteria in a flexible and interactive version, FITradeoff.

Results

The structuring of the problem led the researchers to identify twenty-five evaluation criteria, amongst which ten were essential to guide decisions. As a result, in the simulation of prioritization of four requesting victims in view of the availability of only one ambulance, the proposed model supported the decision by suggesting the prioritization of one of the victims.

Conclusions

This work contributed to the prioritization of victims using multicriteria decision support methodology. Selecting and weighing the criteria in this study indicated that the protocols that guide regulatory physicians do not consider all the criteria for prioritizing victims in an environment of scarcity of resources. Finally, the proposed model can support crucial decision based on a rational and transparent decision-making process that can be applied in other EMS.
Oxidative stress induced by NOX2 contributes to neuropathic pain via plasma membrane translocation of PKCε in rat dorsal root ganglion neurons
Authors: Xu Jing , Wu Shinan , Wang Junfei , Wang Jianmei , Yan Yi , Zhu Mengye , Zhang Daying , Jiang Changyu , Liu Tao
Published: May 2021

Background

Nicotinamide adenine dinucleotide phosphate oxidase 2 (NOX2)-induced oxidative stress, including the production of reactive oxygen species (ROS) and hydrogen peroxide, plays a pivotal role in neuropathic pain. Although the activation and plasma membrane translocation of protein kinase C (PKC) isoforms in dorsal root ganglion (DRG) neurons have been implicated in multiple pain models, the interactions between NOX2-induced oxidative stress and PKC remain unknown.

Methods

A spared nerve injury (SNI) model was established in adult male rats. Pharmacologic intervention and AAV-shRNA were applied locally to DRGs. Pain behavior was evaluated by Von Frey tests. Western blotting and immunohistochemistry were performed to examine the underlying mechanisms. The excitability of DRG neurons was recorded by whole-cell patch clamping.

Results

SNI induced persistent NOX2 upregulation in DRGs for up to 2 weeks and increased the excitability of DRG neurons, and these effects were suppressed by local application of gp91-tat (a NOX2-blocking peptide) or NOX2-shRNA to DRGs. Of note, the SNI-induced upregulated expression of PKCε but not PKC was decreased by gp91-tat in DRGs. Mechanical allodynia and DRG excitability were increased by ψεRACK (a PKCε activator) and reduced by εV1-2 (a PKCε-specific inhibitor). Importantly, εV1-2 failed to inhibit SNI-induced NOX2 upregulation. Moreover, the SNI-induced increase in PKCε protein expression in both the plasma membrane and cytosol in DRGs was attenuated by gp91-tat pretreatment, and the enhanced translocation of PKCε was recapitulated by H2O2 administration. SNI-induced upregulation of PKCε was blunted by phenyl-N-tert-butylnitrone (PBN, an ROS scavenger) and the hydrogen peroxide catalyst catalase. Furthermore, εV1-2 attenuated the mechanical allodynia induced by H2O2

Conclusions

NOX2-induced oxidative stress promotes the sensitization of DRGs and persistent pain by increasing the plasma membrane translocation of PKCε.
Chronic cholestasis detection by a novel tool: automated analysis of cytokeratin 7-stained liver specimens
Authors: Sjöblom Nelli , Boyd Sonja , Manninen Anniina , Knuuttila Anna , Blom Sami , Färkkilä Martti , Arola Johanna
Published: May 2021

Background

The objective was to build a novel method for automated image analysis to locate and quantify the number of cytokeratin 7 (K7)-positive hepatocytes reflecting cholestasis by applying deep learning neural networks (AI model) in a cohort of 210 liver specimens. We aimed to study the correlation between the AI model’s results and disease progression. The cohort of liver biopsies which served as a model of chronic cholestatic liver disease comprised of patients diagnosed with primary sclerosing cholangitis (PSC).

Methods

In a cohort of patients with PSC identified from the PSC registry of the University Hospital of Helsinki, their K7-stained liver biopsy specimens were scored by a pathologist (human K7 score) and then digitally analyzed for K7-positive hepatocytes (K7%area). The digital analysis was by a K7-AI model created in an Aiforia Technologies cloud platform. For validation, values were human K7 score, stage of disease (Metavir and Nakunuma fibrosis score), and plasma liver enzymes indicating clinical cholestasis, all subjected to correlation analysis.

Results

The K7-AI model results (K7%area) correlated with the human K7 score (0.896; p < 2.2e− 16). In addition, K7%area correlated with stage of PSC (Metavir 0.446; p < 1.849e− 10 and Nakanuma 0.424; p < 4.23e− 10) and with plasma alkaline phosphatase (P-ALP) levels (0.369, p < 5.749e− 5).

Conclusions

The accuracy of the AI-based analysis was comparable to that of the human K7 score. Automated quantitative image analysis correlated with stage of PSC and with P-ALP. Based on the results of the K7-AI model, we recommend K7 staining in the assessment of cholestasis by means of automated methods that provide fast (9.75 s/specimen) quantitative analysis.
ATTR amyloidosis during the COVID-19 pandemic: insights from a global medical roundtable
Authors: Brannagan Thomas H. , Auer-Grumbach Michaela , Berk John L. , Briani Chiara , Bril Vera , Coelho Teresa , Damy Thibaud , Dispenzieri Angela , Drachman Brian M. , Fine Nowell , Gaggin Hanna K. , Gertz Morie , Gillmore Julian D. , Gonzalez Esther , Hanna Mazen , Hurwitz David R. , Khella Sami L. , Maurer Mathew S. , Nativi-Nicolau Jose , Olugemo Kemi , Quintana Luis F. , Rosen Andrew M. , Schmidt Hartmut H. , Shehata Jacqueline , Waddington-Cruz Marcia , Whelan Carol , Ruberg Frederick L.
Published: May 2021

Background

The global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causing the ongoing coronavirus disease 2019 (COVID-19) pandemic has raised serious concern for patients with chronic disease. A correlation has been identified between the severity of COVID-19 and a patient’s preexisting comorbidities. Although COVID-19 primarily involves the respiratory system, dysfunction in multiple organ systems is common, particularly in the cardiovascular, gastrointestinal, immune, renal, and nervous systems. Patients with amyloid transthyretin (ATTR) amyloidosis represent a population particularly vulnerable to COVID-19 morbidity due to the multisystem nature of ATTR amyloidosis.

Main body

ATTR amyloidosis is a clinically heterogeneous progressive disease, resulting from the accumulation of amyloid fibrils in various organs and tissues. Amyloid deposition causes multisystem clinical manifestations, including cardiomyopathy and polyneuropathy, along with gastrointestinal symptoms and renal dysfunction. Given the potential for exacerbation of organ dysfunction, physicians note possible unique challenges in the management of patients with ATTR amyloidosis who develop multiorgan complications from COVID-19. While the interplay between COVID-19 and ATTR amyloidosis is still being evaluated, physicians should consider that the heightened susceptibility of patients with ATTR amyloidosis to multiorgan complications might increase their risk for poor outcomes with COVID-19.

Conclusion

Patients with ATTR amyloidosis are suspected to have a higher risk of morbidity and mortality due to age and underlying ATTR amyloidosis-related organ dysfunction. While further research is needed to characterize this risk and management implications, ATTR amyloidosis patients might require specialized management if they develop COVID-19. The risks of delaying diagnosis or interrupting treatment for patients with ATTR amyloidosis should be balanced with the risk of exposure in the health care setting. Both physicians and patients must adapt to a new construct for care during and possibly after the pandemic to ensure optimal health for patients with ATTR amyloidosis, minimizing treatment interruptions.
Modulating innate immune activation states impacts the efficacy of specific Aβ immunotherapy
Authors: Levites Yona , Funk Cory , Wang Xue , Chakrabarty Paramita , McFarland Karen N. , Bramblett Baxter , O’Neal Veronica , Liu Xufei , Ladd Thomas , Robinson Max , Allen Mariet , Carrasquillo Minerva M. , Dickson Dennis , Cruz Pedro , Ryu Danny , Li Hong-Dong , Price Nathan D. , Ertekin-Taner NIlüfer , Golde Todd E.
Published: May 2021

Introduction

Passive immunotherapies targeting Aβ continue to be evaluated as Alzheimer’s disease (AD) therapeutics, but there remains debate over the mechanisms by which these immunotherapies work. Besides the amount of preexisting Aβ deposition and the type of deposit (compact or diffuse), there is little data concerning what factors, independent of those intrinsic to the antibody, might influence efficacy. Here we (i) explored how constitutive priming of the underlying innate activation states by Il10 and Il6 might influence passive Aβ immunotherapy and (ii) evaluated transcriptomic data generated in the AMP-AD initiative to inform how these two cytokines and their receptors’ mRNA levels are altered in human AD and an APP mouse model.

Methods

rAAV2/1 encoding EGFP, Il6 or Il10 were delivered by somatic brain transgenesis to neonatal (P0) TgCRND8 APP mice. Then, at 2 months of age, the mice were treated bi-weekly with a high-affinity anti-Aβ1–16 mAb5 monoclonal antibody or control mouse IgG until 6 months of age. rAAV mediated transgene expression, amyloid accumulation, Aβ levels and gliosis were assessed. Extensive transcriptomic data was used to evaluate the mRNA expression levels of IL10 and IL6 and their receptors in the postmortem human AD temporal cortex and in the brains of TgCRND8 mice, the later at multiple ages.

Results

Priming TgCRND8 mice with Il10 increases Aβ loads and blocks efficacy of subsequent mAb5 passive immunotherapy, whereas priming with Il6 priming reduces Aβ loads by itself and subsequent Aβ immunotherapy shows only a slightly additive effect. Transcriptomic data shows that (i) there are significant increases in the mRNA levels of Il6 and Il10 receptors in the TgCRND8 mouse model and temporal cortex of humans with AD and (ii) there is a great deal of variance in individual mouse brain and the human temporal cortex of these interleukins and their receptors.

Conclusions

The underlying immune activation state can markedly affect the efficacy of passive Aβ immunotherapy. These results have important implications for ongoing human AD immunotherapy trials, as they indicate that underlying immune activation states within the brain, which may be highly variable, may influence the ability for passive immunotherapy to alter Aβ deposition.
Maternal temperament and character: associations to child behavior at the age of 3 years
Authors: Agnafors Sara , Bladh Marie , Ekselius Lisa , Svedin Carl Göran , Sydsjö Gunilla
Published: May 2021

Background

The influence of maternal temperament on child behavior, and whether maternal temperament impact boys and girls differently is not thoroughly studied. The aim was to investigate the impact of maternal temperament and character on child externalizing and internalizing problems at age 3.

Methods

A birth-cohort of 1723 mothers and their children were followed from birth to age 3. At the child’s age of 3 months, the mothers filled out standardized instruments on their temperament and character using the Temperament and Character Inventory (TCI) and depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS). At the child’s age of 3 years, the mothers reported on child behavior using the Child Behaviour Checklist (CBCL).

Results

Maternal temperamental trait novelty seeking was positively associated with externalizing problems in the total population and in girls. Harm avoidance was positively associated with externalizing problems in the total population and in boys, and with internalizing problems in the total population and boys and girls respectively. Maternal character traits of self-directedness and cooperativeness were negatively associated with both externalizing and internalizing problems in the total population and in boys and girls respectively.

Conclusions

Maternal character traits were more influential on child behavior than were temperamental traits, and thus the opportunities for intervention targeted at parental support are good. Maternal mental health and socioeconomic aspects also increased the risk for child behavior problems, indicating the need for recognition and support in clinical settings.
Correction to: Clinical guidance for podiatrists in the management of foot problems in rheumatic disorders: evaluation of an educational programme for podiatrists using a mixed methods design
Authors: Huijbrechts E. J. , Dekker J. , Tenten‐Diepenmaat M. , Gerritsen M. , van der Leeden M.
Published: May 2021

An amendment to this paper has been published and can be accessed via the original article.
VANET simulators: an updated review
Authors: Weber Julia Silva , Neves Miguel , Ferreto Tiago
Published: May 2021

Research on VANETs (vehicular ad hoc networks) date back to the beginning of the 2000s. The possibility of enabling communication between vehicles through a wireless network stimulated the creation of new protocols, devices, and diverse utilization scenarios. Due to the intrinsic difficulties of using a real testbed to evaluate these research contributions, several simulators were developed at the time. Recently, with the advent of autonomous vehicles and the emergence of novel technologies (e.g., 5G and edge computing), new research challenges on VANETs are coming into sight. Therefore, revisiting VANET simulators is required to identify if they are still capable of evaluating these new scenarios. This paper presents an updated review of VANET simulators, showing their current state and capabilities to assess novel scenarios in VANET research. Based on this analysis, we identify open research challenges that should be addressed in current and future VANET simulators.
Student test-taking effort in low-stakes assessments: evidence from the English version of the PISA 2015 science test
Authors: Pools Elodie , Monseur Christian
Published: May 2021

Background

The idea of using low-stakes assessment results is often mentioned when designing educational system reforms. However, when tests have no consequences for the students, test takers may not make enough effort when completing the test, and their lack of engagement may negatively affect the validity of the conclusions of the studies that use such tests. This article presents analyses of student test-taking engagement in a low-stakes international large-scale assessment, the Programme for International Student Assessment (PISA), and (i) quantifies test-taking effort, (ii) predicts effort by means of expectancy-value proxies and (iii) investigates the relationship between effort and science proficiency.

Methods

Students’ response times on the science items of PISA 2015 were used to derive an index of test-taking effort. Data from six English-speaking countries that administered the computer-based version of the test, were selected. The response time for each item was modelled by means of a two-class finite mixture model, and students’ probabilities of being classified as effortful were combined to derive a global index of effort.

Results

Our findings showed that students’ effort decreased towards the end of the testing sessions. The variance of examinees’ test-taking effort was not substantially explained by the expectancy-value variables. Test-taking effort had a strong relationship with science achievement, with the correlation increasing to more than 0.5 towards the end of the test. Moreover, an important part of the relationship between test-taking effort and achievement is not related to other student characteristics, such as gender, socio-economic and cultural status, attitude towards school or attitude towards science.

Conclusions

This study shows that students put different amounts of effort into test taking, especially towards the end of the assessment, and suggests a possible underestimation of related student achievement that may affect the interpretation of test scores.
Effect of a simple core muscle training program on trunk muscle strength and neuromuscular control among pediatric soccer players
Authors: Kumahara Ryotaro , Sasaki Shizuka , Sasaki Eiji , Kimura Yuka , Yamamoto Yuji , Tsuda Eiichi , Ishibashi Yasuyuki
Published: May 2021

Purpose

The purpose of this study was to examine the effect of simple core muscle training (CMT) program on trunk muscle strength and neuromuscular control among pediatric athletes.

Methods

Forty-nine male soccer players (mean age, 10.8 years) participated. The CMT program had three components (bench, side bench, and Nordic hamstrings) and was performed at least three times weekly for a year. Trunk flexion/extension muscle strength and the K/H ratio (determined by dividing knee separation distance by hip separation distance during drop-jump test and used as an index of lower limb valgus alignment) were measured, and the Y balance test (YBT) was performed before and after intervention. This study did not include the pure control group among the same team. To consider the effect of CMT on trunk muscle strength due to physical growth, we used the data of trunk muscle strength from the local cohort study previously conducted in our institution. One hundred participants who matched the age, height, body weight, and body mass index of the training group was designated as a control group.

Results

In the training group, the trunk flexion/extension strength significantly increased at 6 months (p < 0.001, p < 0.001, respectively) and 12 months (p < 0.001, p < 0.001, respectively) compared to initial value. The K/H ratio at initial contact and maximum knee flexion phase significantly increased at 6 months (p < 0.001 and p < 0.001, respectively); however, it did not increase at 12 months (p = 0.384 and p = 0.070, respectively) compared to the initial value. In the YBT, the maximized reach distance in each direction significantly increased after intervention on both the dominant and non-dominant sides, except in the posteromedial direction on the non-dominant foot. Compared to the control group, although there was no significant difference in trunk flexion/extension strength at baseline (p = 0.141 and p = 0.390, respectively), the training group showed significantly higher trunk flexion/extension muscle strength at 12 months (p < 0.001 and p < 0.001, respectively).

Conclusion

The CMT program increased trunk muscle strength and improved dynamic balance among pediatric male athletes.

Level of evidence

Level II
The reproduction of working class? Social mobility and the stratification of parenting practice in urban Chinese families
Authors: Tian Felicia F. , Jing Yongchao
Published: May 2021

Parenting practice, an embodied cultural capital, is class based. The findings of this study showed that in urban Chinese families, the middle class was inclined to adopt the practice of concerted cultivation while the working class was inclined to adopt the practice of natural growth. However, those who were born in working-class families but were able to achieve upward mobility to the middle class were more likely to adopt similar practices to those who stayed in the middle class; those who were born in middle-class families but moved downward were able to retain some aspects of parenting practices similar to those who stayed in the middle class. The findings of the unbalanced reproduction of parenting practice do not support the argument that class boundaries have solidified in Chinese society.
In vitro antimalarial activity evaluation of two ethnomedicinal plants against chloroquine sensitive and resistant strains of Plasmodium falciparum
Authors: Gogoi Neelutpal , Gogoi Bhaskarjyoti , Chetia Dipak
Published: May 2021

Background

In this study, we selected two medicinal plants Citrus maxima (Burm.) Merr. and Artemisia nilagirica (C.B. Clarke) Pamp. on the basis of their traditional use in the treatment of fever associated with malaria in Assam (India) and evaluated their antimalarial potential against Plasmodium falciparum strains.

Methods

The properly processed plant parts of C. maxima (Burm.) Merr. and A. nilagirica (C.B. Clarke) Pamp. were extracted with different solvents from nonpolar to polar by cold maceration technique. After that antimalarial activities of the extracts were evaluated against both chloroquine sensitive (3D7) and resistant (RKL-9) strains of P. falciparum using Giemsa staining light microscopy technique. The most active extract(s) was further screened for cytotoxicity potential against murine macrophage RAW264.7 cell line using MTT assay. Then preliminary phytochemical screening and qualitative fingerprint analysis of the active extract(s) were done to check the presence of different secondary metabolites.

Results

From the in vitro study, the hydro-alcoholic extract of C. maxima (Burm.) Merr. and methanol extract of A. nilagirica (C.B. Clarke) Pamp. were found to be the most active against both 3D7 and RKL-9 strains. In the cytotoxicity study, the CC50 values of the active extracts were found to be > 100 μg/ml, which suggested the safety of the extracts. Then phytochemical and fingerprint analysis revealed the presence of various important plant secondary metabolites in both the extracts.

Conclusion

The findings of this study confirmed the presence of antimalarial potential of hydro-alcoholic extract of C. maxima (Burm.) Merr. and methanol extract of A. nilagirica (C.B. Clarke) Pamp without having any toxic effect. Both the extracts showed IC50 values below 5 μg/ml against 3D7 and RKL-9 strains.
Field evaluation of two entomopathogenic fungi; Beauveria bassiana and Metarhizium anisopliae as a biocontrol agent against the spiny bollworm, Earias insulana Boisduval (Lepidoptera: Noctuidae) on cotton plants
Authors: Lotfy Dalia El Sayed , Moustafa Hemat Zakaria
Published: May 2021

Background

The Earias spp. are devastating pests which reduce cotton yield up to 40% as seed cotton. Efficacy of Metarhizium anisopliae and Beauveria bassiana as bio-insecticides were investigated against the spiny bollworm, Earias insulana Boisduval (Lepidoptera: Noctuidae), under field conditions in Egypt throughout two successive seasons 2018 and 2019.

Results

Results showed E. insulana population reduction during both seasons after bio-insecticidal applications. M. anisopliae strains (S1, S2) treatments showed significant reductions in the mean numbers of infested bolls with E. insulana after 14 days from the 1st spray. Reduction percentages of E. insulana infestation reached to 77.74 and 76.51% respectively, after application of M. anisopliae strains (S1, S2) treatments; then, the infestation reduction percentages increased to 88.48 and 85.41% after the 2nd spray by the same fungal strains; then, the infestation reduction percentages increased to 90.16 and 90.84% after 3rd spray of the same fungal strains in season 2018. In 2019 season, the infestation reduction percentages of E. insulana was 85.48 and 80.75%, after the 1st spray of M. anisopliae strains (S1, S2), respectively, which increased to 92.40 and 89.87%, after 14 days from the 2nd spray by the two fungal strains respectively, and then increased to 94.12 and 93.73%, after 14 days from the 3rd spray of M. anisopliae (S1 and S2) respectively. In season 2018, the infestation reduction percentage of E. insulana by B. bassiana strains (S1, S2) recorded 73.09 and 71.89%, respectively and 81.04 and 82.89% respectively, in season 2019, after 14 days of the 1st spray. While after the 2nd spray of the two tested B. bassiana strains, the infestation reduction percentage of E. insulana was 85.41 and 85.41% respectively, in season 2018, whereas it was 89.16 and 89.16% respectively, in season 2019. Then after 14 days of the 3rd spray by the same fungus strains, the reduction percentage of E. insulana increased to 86.56 and 85.35%, respectively, in season 2018, and 90.83 and 90.83% in season 2019.

Conclusions

Tested strains of B. bassiana and M. anisopliae fungi proved their potential for decreasing E. insulana infestation percentages through 2–3 spray treatments under field conditions.
Evaluation of level I neck nodes involvement in advanced malignancy of the larynx and the hypopharynx
Authors: Hassan Osama Mohamed , Mansour Hisham , Metwaly Osama , Salah Mohamed
Published: May 2021

Background

Advanced cancer larynx and hypopharynx has high potentiality to nodal spread. Level of lymph node metastasis highly depends on site and stage of laryngopharyngeal carcinoma. Level I cervical lymph node dissection was performed to advanced laryngeal and/or hypopharyngeal tumors in this study.

Results

According to our statistical analysis and data, none of those thirty patients had pathologically positive level I neck lymph nodes after dissection with only one patient suffered from marginal mandibular nerve affection and three patients complained of dry mouth post-operatively, confirming the result that there is no need for prophylactic level I neck dissection in the absence of clinically palpable suspicious lymph nodes.

Conclusion

Although it carries relative low morbidity, there is no need for prophylactic level I neck dissection in advanced laryngeal and/or hypopharyngeal cancer patients without clinically detectable nodal metastases “N0 neck.”
Clinical, societal and personal recovery in schizophrenia spectrum disorders across time: states and annual transitions
Authors: Castelein Stynke , Timmerman Marieke E. ,   PHAMOUS investigators, van der Gaag Mark , Visser Ellen
Published: May 2021

Background

Recovery in schizophrenia is a complex process, involving clinical, societal and personal recovery. Until now, studies analysed these domains separately, without examining their mutual relations and changes over time.

Aims

This study aimed to examine different states of recovery and transition rates between states.

Method

The Pharmacotherapy Monitoring and Outcome Survey (2006–2017) yearly assesses patients with schizophrenia in the Northern Netherlands. Data from 2327 patients with one up to 11 yearly measurements on clinical, societal and personal recovery were jointly analysed with a mixture latent Markov model (MLMM).

Results

The selected MLMM had four states that differed in degree and pattern of recovery outcomes. Patients in state 1 were least recovered on any domain (16% of measurements), and partly recovered in states 2 (25%; featured by negative symptoms) and 3 (21%; featured by positive symptoms). Patients in state 4 (38%) were most recovered, except for work, study and housekeeping. At the subsequent measurement, the probability of remaining in the same state was 77–89%, transitioning to a better state was 4–12% and transitioning to a worse state was 4–6%; no transitions occurred between states 1 and 4. Female gender, shorter illness duration and less schizophrenia were more prevalent in better states.

Conclusions

Quite a high recovery rate was present among a substantial part of the measurements (38%, state 4), with a high probability (89%) of remaining in this state. Transition rates in the other states might increase to a more favourable state by focusing on adequate treatment of negative and positive symptoms and societal problems.
When the World Throws You a Curve Ball: Lessons Learned in Breast Cancer Management
Authors: Obeng-Gyasi Samilia , Coles Charlotte E. , Jones Jade , Sacks Ruth , Lightowlers Sara , Bliss Judith M. , Brunt A. Murray , Haviland Joanne S. , Kirby Anna M. , Kalinsky Kevin
Published: May 2021

In the care of patients with operable breast cancer, there has been a shift toward increasing use of neoadjuvant therapy. There are benefits to neoadjuvant therapy, such as monitoring for response, as well as an increased rate of breast conservation and reduction of potential morbidity associated with breast surgery, including axillary management. Among patients with highly proliferative tumors, such as HER2-positive or triple-negative breast cancer, those with residual disease are at higher risk of recurrence, which informs the recommended systemic therapy in the adjuvant setting. For instance, in patients with residual disease after neoadjuvant chemotherapy and HER2-targeted therapy, there is a role for adjuvant trastuzumab emtansine for those with residual disease at the time of surgery. The same holds true regarding the role of adjuvant capecitabine in patients with residual disease after neoadjuvant chemotherapy. With the added complexities of treating patients in the era of the COVID-19 outbreak, additional considerations are critical, including initiation of surgery within an appropriate time from completion of neoadjuvant therapy. National consensus guidelines on time to surgery must be developed to improve measurement and comparison across systems. In addition, there is emerging radiation treatment management research addressing a number of factors, including hypofractionation, role of proton beam therapy, safe omission of radiotherapy, and preoperative radiotherapy with or without drug combination. In this article, the multidisciplinary approach of treating patients with operable breast cancer is highlighted, with updates and future considerations described.
Predictive Performance of Oximetry to Detect Sleep Apnea in Patients Taking Opioids
Authors: Waseem Rida , Wong Jean , Ryan Clodagh , Chung Frances
Published: May 2021

BACKGROUND:

Long-term use of opioids for treatment of chronic pain is associated with significant risks including worsening unrecognized or untreated sleep apnea that may increase morbidity and mortality. Overnight oximetry has been validated for predicting sleep apnea in surgical and sleep clinic patients. The objective of the study was to assess the predictive accuracy of oxygen desaturation index (ODI 4%) from home overnight oximetry when compared to apnea hypopnea index (AHI) from polysomnography for predicting sleep apnea in patients taking opioids for chronic pain.

METHODS:

This was a planned post hoc analysis of a prospective cohort study conducted at 5 pain clinics. Patient characteristics and daily morphine milligram equivalent (MME) dose were recorded. All consented patients underwent home overnight oximetry (PULSOX-300i, Konica Minolta Sensing, Inc, Osaka, Japan) and in-laboratory polysomnography. The predictive performance of ODI 4% from oximetry was assessed against AHI from polysomnography.

RESULTS:

Among 332 consented patients, 181 with polysomnography and overnight oximetry data were analyzed. The mean age and body mass index of 181 patients were 52 ± 13 years and 29 ± 6 kg/m2, respectively, with 40% men. The area under the receiver operating curve for ODI to predict moderate-to-severe sleep apnea (AHI ≥15 events/h) and severe sleep apnea (AHI ≥30 events/h) was 0.82 (95% confidence interval [CI], 0.75-0.88) and 0.87 (95% CI, 0.80-0.94). ODI ≥5 events/h had a sensitivity of 85% (95% CI, 74-92) and specificity of 57% (95% CI, 52-61) to predict moderate-to-severe sleep apnea. ODI ≥15 events/h had a sensitivity of 71% (95% CI, 55-83) and specificity of 88% (95% CI, 84-91) to predict severe sleep apnea.

CONCLUSIONS:

Overnight home oximetry has a high predictive performance in predicting moderate-to-severe and severe sleep apnea in patients on opioids for chronic pain. It is a useful additional tool for health care providers for the screening of sleep apnea in this high-risk group.
Navigational strategies underlying temporal phototaxis in Drosophila larvae
Authors: Zhu Maxwell L. , Herrera Kristian J. , Vogt Katrin , Bahl Armin
Published: May 2021

Navigating across light gradients is essential for survival for many animals. However, we still have a poor understanding of the algorithms that underlie such behaviors. Here, we developed a novel closed-loop phototaxis assay for Drosophila larvae in which light intensity is always spatially uniform but updates depending on the location of the animal in the arena. Even though larvae can only rely on temporal cues during runs, we find that they are capable of finding preferred areas of low light intensity. Further detailed analysis of their behavior reveals that larvae turn more frequently and that heading angle changes increase when they experience brightness increments over extended periods of time. We suggest that temporal integration of brightness change during runs is an important – and so far largely unexplored – element of phototaxis.
Near-infrared reflection at 780 nm for detection of early proximal caries in posterior permanent teeth in vitro
Authors: Heck Katrin , Litzenburger Friederike , Geitl Thomas , Kunzelmann Karl-Heinz
Published: May 2021

Objectives:

The aim of this in vitro study was to evaluate the diagnostic potential of near-infrared reflection at 780 nm (NIRR780nm) for early proximal caries detection on the occlusal, buccal and oral surfaces of molars and premolars under simulated, clinically relevant conditions. The findings were validated by micro-computed tomography (µCT).

Methods:

Bitewing radiography (BWR) was used as a comparative diagnostic method. 250 sound or decayed permanent teeth were examined using NIRR780nm and BWR. The NIRR780nm findings were evaluated using yes/no decisions depending on the presence of caries lesions, as the enamel-dentin junction was not detectable in the majority of samples. All NIRR780nm, BWR and µCT findings were obtained twice by two trained examiners. NIRR780nm images were evaluated both occlusally alone and combined occlusally, lingually and buccally. All findings were presented in a cross-table. Sensitivity, specificity and area under the curve (AUC) values were calculated. Reliability assessment was performed using κ statistics.

Results:

Underestimation of caries was observed for NIRR780nm in 26.0% of all surfaces and for BWR in 32.8% of all surfaces. Overestimation was 10.0% for NIRR780nm and 0.4% for BWR. Trilateral NIRR780nm assessment exhibited an overall accuracy of 67.2 %, an underestimation of 13.6% and an overestimation of 19.2%. Trilateral NIRR780nm exhibited 63.0% sensitivity and 69.6% specificity, while BWR exhibited 26.7% sensitivity but 100% specificity for proximal caries detection.

Conclusion:

NIRR780nm is not suitable for reliable detection of early proximal caries, even with the application of an ideal setup and optimized in vitro conditions.
Comparable exposure to SARS-CoV-2 in young children and healthcare workers in Zambia
Authors: Laban Natasha Makabilo , Bosomprah Samuel , Musukuma-Chifulo Kalo , Simuyandi Michelo , Iyer Shilpa , Ng'ombe Harriet , Muchimba Mutinta , Chauwa Adriace , Tigere Sekayi , Chisenga Caroline Cleopatra , Chibuye Mwelwa , Chilyabanyama Obvious Nchimunya , Goodier Martin , Chilengi Roma
Published: May 2021

Background:Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an ongoing global health crisis that has caused large scale morbidity and mortality. We aimed to determine the exposure to SARS-CoV-2 among young children and healthcare workers by measurement of anti-S1 antigen (spike protein) specific immunoglobulin G (IgG) using an in-house optimized indirect enzyme-linked immunosorbent assay (ELISA) method.

Methods:Plasma samples were collected from cohorts of healthcare workers (n = 287) and young children aged from 6 weeks to 2 years old (n = 150) pre-COVID-19 pandemic between September 2018 and November 2019 and post-COVID-19 pandemic between August and December 2020 were simultaneously tested for anti-SARS-CoV-2 S1 specific IgG. The arithmetic mean of natural logarithm-transformed ELISA relative absorbance reading + (3 x standard deviation) of pre-pandemic plasma was used as the cut-off to determine SARS-CoV-2 IgG seropositivity of post-pandemic plasma.

Results:There was no reactivity to SARS-CoV-2 S1 antigen detected in pre-pandemic plasma but in post pandemic plasma an 8.0% (23/287) IgG seropositivity in healthcare workers’ and 6.0% (9/150) seropositivity in children aged 2 years old was detected.

Conclusions:Comparable levels of SARS-CoV-2 IgG seropositivity in healthcare workers and children suggest widespread exposure to SARS-CoV-2 in Zambia during the first wave of the pandemic. This finding has implications for continued acquisition and transmission of infection in the healthcare setting, household, and wider community.
Bumper-Car Moments and Relationship Recovery: Leveraging Strengths in Building Inclusive Cultures
Authors: Wasserman Ilene
Published: May 2021

A ‘bumper-car moment’ is the jolt when we discover that the rules and norms we take for granted are not necessarily the same for others. In real life, the effects of the jolt can linger, affecting relationships. A triggering event, or bumper-car moment, provides an opening for learning and change.
The True-Colours Phenomenon: Turning the Imposter Syndrome Upside Down
Authors: Shaked David , Hau Viven
Published: May 2021

The term ‘Imposter Syndrome’ is a powerful name to a challenging phenomenon that is experienced by many. Through the lens of Appreciative Inquiry, the authors of this article reframed the challenge into a new term – the True- Colours Phenomenon with the hope to unlock people’s unique potential. This life-giving term opens up many possibilities to expand our awareness and develop ourselves more authentically.
Pivot & Thrive: Supporting Small Business Success as an Agent of Positive Change
Authors: McCarthy Carin
Published: May 2021

Faced with strict lockdown regulations in the response to the Covid-19 pandemic, small business owners enlisted new technology to come together and make better decisions about operating businesses in a difficult market. Using applied Appreciative Inquiry practices, the Pivot & Thrive community uses collaboration to create market opportunities. With the success of co-creation amongst members in Vermont, the Pivot & Thrive community is now opening its doors to invite participation from entrepreneurs across borders.
A weighty issue: The implications of an ultrasound prediction of a large baby in pregnancy
Authors: Baddington Cara , Parker George
Published: May 2021

Introduction: The assessment of fetal growth in Aotearoa New Zealand is governed by a largely medical model of care which highly values the purported objectivity of sonographic assessment. Ultrasound scans are an increasingly normalised part of pregnancy care, and expectant parents may advocate strongly for access to them. It could be questioned whether the increasing number of scans is aligned with clinical need. This paper presents a literature review that explores the implications of an ultrasound diagnosis of a large baby during pregnancy. Method: Databases searched were CINAHL, PubMed, Proquest, and Google Scholar. Search terms used were “macrosomia”, “large for dates” and “large for gestational age”. This search was first undertaken in May 2019, and then repeated in November 2020. Findings: Sonographic assessment of fetal size can be inaccurate and the existence of a predicted fetal weight on scan increases the likelihood of birth interventions, regardless of the baby’s actual size. While there are potentially negative outcomes associated with a larger baby, it is unclear whether birth interventions will significantly reduce the occurrence of these outcomes. There is limited research that focuses on the parents’ experience of having a predicted large baby, offering contradictory insights, which suggests the influence of conflicting meanings applied to large babies and ignoring the experiences of women whose babies were predicted to be large but were born “normal” sized. Discussion: Midwives are encouraged to openly discuss with women the limitations in available evidence in this area. Midwives can consider the context of the woman and whānau (wider family), and how they may assess risk uniquely. Finally, midwives can honour the woman and whānau as the decision-makers in their own experience. There are further opportunities for research to provide a counter-narrative to medicalising discourses about large babies, grounded in a midwifery belief in normal birth. Conclusion: Midwives and women are drawn into a risk-centric paradigm that pathologises large babies for questionable benefit. To support informed decision-making within the midwifery partnership, midwives need to critically evaluate existing research and communicate its limitations and risk-centric orientation.
DESIGN INCLUSIVO DE INTERFACE DE APLICATIVOS DIRIGIDOS A ANALFABETOS FUNCIONAIS.
Authors: Rodrigues Martins Darlan , Santana dos Santos Garcia Marilene , Heliamara Herarth Helbe , Cláudia Maciel Ana
Published: May 2021

In this article, we highlight aspects of an investigation that seeks to build an inclusive design, which can support the development of an application prototype aimed at improving the writing and reading levels of functional illiterates - from the rudimentary level. This study is the result of the actions carried out in the Study Group “Hybrid Education, methodologies and objects of digital learning in mobility environments”, of the Master in Education and New Technologies - of a Brazilian private institution of higher education. The idea is to elaborate inclusion design assumptions that can direct the creation of an application with functions that cover the profile and condition of functional illiterates, who have lack of reading skills, have low self-esteem to face the challenge of learning, and present operational deficiencies for the use of mobile devices and their applications. The methodology applied in this study is based on the survey of personal narratives of this target audience, which reveals verbal communication needs, which can be planned in interactive ways in the application design. The authors who support this study have worked with gamification concepts, instructional design, cognition, learning mediated by mobile interfaces, among others, such as Concepción (2016), Santana et al. (2012) and Garcia (2016).
PUBLIC RELATIONS AND EVENTS: THE ORGANIZATION OF FESTIVALS AS A TOOL FOR CULTURAL PROMOTION.
Authors: Pulido Marta , Vazquez González Jose , Vazquez González Jose
Published: May 2021

Festivals not only fulfill their traditional role as an institution that allows to present, spread or preserve the culture of a society, but also stand out for their ability to generate wealth in the cities where they are celebrated, for their contribution to the diversification of the tourism product or the improvement of the image of the place (Devesa, Báez, Figueroa and Herrero, 2012). Specifically, film festivals have a much greater importance playing a fundamental, but not recognized, role for the development of the industry and the history of cinema (Vallejo, 2014, p.14). Under this perspective, the main objective of this work is to observe the organization of the SCC Express Short Film Festival, in order to propose a sequenced model for the organization of events as a tool for communication and promotion of the cultural industry. The application of the methodological design designed for the application of the proposed case study allows to establish a 9-phase model for the organization of festivals as a technique of promotion and cultural development at the local level.
Taxa de morbimortalidade entre homens e mulheres com diagnóstico de infarto agudo do miocárdio
Authors: Sant Anna Maria Fernanda Barossi , Paula Carla Fernanda Batista , Mendonça Rita de Cássia Helú Ribeiro , Beccaria Lucia Marinilza , Contrin Ligia Marcia , Werneck Alexandre Lins
Published: May 2021

Objetivo: verificar se existe diferença na taxa de morbimortalidade entre homens e mulheres com diagnóstico de infarto agudo do miocárdio em um hospital de ensino. Método: estudo transversal, descritivo e quantitativo, com amostra de 647 prontuários, comparando-se fatores de risco, dados sociodemográficos e referentes à internação hospitalar. Resultados:  de 647 pacientes, 415 eram homens e 232 mulheres, com idade variando entre 61 e 80 anos.  Dos fatores de risco, 74,96% eram hipertensos em ambos os sexos, sendo que o percentual de hipertensão, diabetes e dislipidemia foi maior no sexo feminino. A taxa de mortalidade foi de 17,24% nas mulheres e 9,64% nos homens. Dentre os fatores de risco relacionados ao óbito, o mais significante foi a hipertensão arterial, seguido de diabetes e dislipidemia. Conclusão: houve maior prevalência de infarto do miocárdio no sexo masculino, entretanto, a taxa de morbidade e mortalidade foi maior no sexo feminino.
Estado de exceção permanente pós 11/09: as implicações da legislação de emergência estadunidense | permanent state of exception post 11/09: implications of the american emergency legislation
Authors: Junqueira Karina , Moreira Ana Camila
Published: May 2021

Este artigo analisa as medidas de exceção instauradas pelo poder executivo dos Estados Unidos da América (EUA), após os ataques terroristas perpetrados em Nova York e Washington no dia 11 de setembro de 2001. Tais reações governamentais culminaram em um estado de emergência permanente no país, devido à sua irrevogabilidade desde então. À luz da perspectiva da securitização e da teoria do estado de exceção, analisamos as implicações dos principais decretos de emergência instaurados no país ao longo das duas últimas décadas para as políticas de vigilância em massa e determinados grupos sociais. Observa-se, sobretudo, a perpetuação da legislação excepcional, ao pressupor maior autonomia estatal e menor restrição de regras na arena política, sob a lógica de salvaguarda da segurança nacional em detrimento das liberdades civis.Palavras-chave: Estado de exceção. 11/09. Estados Unidos.ABSTRACTThis article analyses the exception measures installed by the United States of America (USA) executive powers after the terrorist attacks in New York and Washington on September 11th. Those governamental reactions culminated in a permanent state of exception in the country, for being irrevocable since then. In the light of the securitization theory and the theory of state of exception we analyse the implications of the main emergency decrees established in the country in the last two decades for the mass surveillance politics and some social groups. It’s observed especially the perpetuation of exceptional legislation in the next government, for presuppose greater autonomy from the State and less restriction of rules in the political field, under the logic of protection of national security at the expense of civil liberties.Keywords: State of Exception. 9/11. United States. Recebido em: 25 ago. 2020 | Aceito em: 27 mar. 2021.