bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of multiple ınterventions for women at risk for cervical cancer on their health responsibility, beliefs regarding cervical cancer and having screening: a randomized controlled trial
Authors: Altinel B , Akin B
Published: February 2022

This study was intended to analyze the effect of multiple initiations on beliefs about cervical cancer, health responsibility, and screening participation. In total, 134 women aged 40–55 years, who were at risk of cervical cancer and had never had a Pap smear before, were randomly assigned to the experimental (n = 67) and control (n = 67) groups. The 14 weeks of sessions involving the experimental group included group training on cervical cancer, counselling, reminder phone calls and delivery materials, all aimed to increase motivation to be screened regularly for cervical cancer. The control group received the usual care. The study data were collected using an information form, the Health Belief Model Scale, the Healthy Lifestyle Behaviors Scale II and the Assessment Form for Undergoing Pap-Smear Test. After the multiple interventions, there was a significant difference between the experimental and control group’s Health Responsibility, Pap smear benefit and motivation, obstacle and health motivation scores (P < 0,05). The participation rate of women in the experimental group to cervical cancer screening was found to be 93%. Multiple nursing interventions (group training, counselling, reminder phone calls and delivery materials) were effective in increasing participation in cervical cancer screening programs.
The Perceived Impacts of a Bilingual Learner's Dictionary
Authors: Hall Megan , Louw Phillip
Published: February 2022

This paper reports on research into teachers' perceptions of the impact of using a bilingual learner's dictionary. The research, a perceptions of impact study conducted in South Africa from March 2016 to February 2019, investigates the perceptions of teachers on the impact of the dictionary on themselves as teachers, and their perceptions of the dictionary's impact on their pupils. The findings show that teachers perceived dictionary use to have positive impacts on both the language production and language reception skills of pupils in their L2, in line with other studies. However, they also show unexpected teacher perceptions of impacts on content subjects, L1, teaching itself, and attitudes and behaviours (here called the socio-emotional), especially with regard to learning or teaching. The paper situates this research in the literature on dictionary use for production and reception in language learning, and of impact evaluation, as well as highlighting relevant aspects of the South African education system, particularly the use of English as a language of learning and teaching from an early stage. The dictionary in this study was the Oxford Bilingual School Dictionary: isiXhosa and English (De Schryver and Reynolds 2014).
Enhancing pharmacy practice doctoral research with patient and public involvement
Authors: Youssef Essra , Mellor Doug , Walkerly Sujata , Wright David J
Published: February 2022

Evidence shows that patient and public involvement (PPI) can have a positive effect on the quality and relevance of health services research. This article describes the experiences of PPI contributors within a pharmacy practice doctoral research project. This includes practical examples of how PPI contributed to the project and the impact this made. In addition, the PPI contributors and doctoral candidates’ reflections are presented along with learning points to support other doctoral researchers planning PPI in their research.
Sgr A* X-ray flares from non-thermal particle acceleration in a magnetically arrested disc
Authors: Scepi Nicolas , Dexter Jason , Begelman Mitchell C
Published: February 2022

Sgr A* exhibits flares in the near-infrared and X-ray bands, with the luminosity in these bands increasing by factors of 10–100 for ≈60 min. One of the models proposed to explain these flares is synchrotron emission of non-thermal particles accelerated by magnetic reconnection events in the accretion flow. We use the results from particle-in-cell simulations of magnetic reconnection to post-process 3D two-temperature GRMHD simulations of a magnetically arrested disc (MAD). We identify current sheets, retrieve their properties, estimate their potential to accelerate non-thermal particles, and compute the expected non-thermal synchrotron emission. We find that the flux eruptions of MADs can provide suitable conditions for accelerating non-thermal particles to energies γe ≲ 106 and producing simultaneous X-ray and near-infrared flares. For a suitable choice of current-sheet parameters and a simplified synchrotron cooling prescription, the model can simultaneously reproduce the quiescent and flaring X-ray luminosities as well as the X-ray spectral shape. While the near-infrared flares are mainly due to an increase in the temperature near the black hole during the MAD flux eruptions, the X-ray emission comes from narrow current sheets bordering highly magnetized, low-density regions near the black hole, and equatorial current sheets where the flux on the black hole reconnects. As a result, not all infrared flares are accompanied by X-ray ones. The non-thermal flaring emission can extend to very hard (≲ 100 keV) X-ray energies.
Transcriptomic analysis reveals myometrial topologically associated domains linked to the onset of human term labour
Authors: Tyagi Sonika , Chan Eng-Cheng , Barker Daniel , McElduff Patrick , Taylor Kelly A , Riveros Carlos , Singh Esha , Smith Roger
Published: February 2022

Changes in cell phenotype are thought to occur through the expression of groups of co-regulated genes within topologically associated domains (TADs). In this paper, we allocate genes expressed within the myometrium of the human uterus during the onset of term labour into TADs. Transformation of the myometrial cells of the uterus into a contractile phenotype during term human labour is the result of a complex interaction of different epigenomic and genomic layers. Recent work suggests that the transcription factor (TF) RELA lies at the top of this regulatory network. Using deep RNA sequencing (RNAseq) analysis of myometrial samples (n = 16) obtained at term from women undergoing caesarean section prior to or after the onset of labour, we have identified evidence for how other gene expression regulatory elements interact with TFs in the labour phenotype transition. Gene set enrichment analysis of our RNAseq data identified three modules of enriched genes (M1, M2 and M3), which in gene ontology studies are linked to matrix degradation, smooth muscle and immune gene signatures, respectively. These genes were predominantly located within chromosomal TADs suggesting co-regulation of expression. Our transcriptomic analysis also identified significant differences in the expression of long non-coding RNAs (lncRNA), microRNAs (miRNA) and TFs that were predicted to target genes within the TADs. Additionally, network analysis revealed 15 new lncRNA (MCM3AP-AS1, TUG1, MIR29B2CHG, HCG18, LINC00963, KCNQ1OT1, NEAT1, HELLPAR, SNHG16, NUTM2B-AS1, MALAT1, PSMA3-AS1, GABPB1-AS1, NORAD and NKILA) and 4 miRNA (mir-145, mir-223, mir-let-7a and mir-132) as top gene hubs with three TFs (NFKB1, RELA and ESR1) as master regulators. Together, these factors are likely to be involved in co-regulatory networks driving a myometrial transformation to generate an estrogen-sensitive phenotype. We conclude that lncRNA and miRNA targeting the estrogen receptor 1 and nuclear factor kappa B pathways play a key role in the initiation of human labour. For the first time, we perform an integrative analysis to present a multi-level genomic signature made of mRNA, non-coding RNA and TFs in the myometrium for spontaneous term labour.
Drop-off-reinitiation triggered by EF-G-driven mistranslocation and its alleviation by EF-P
Authors: Tajima Kenya , Katoh Takayuki , Suga Hiroaki
Published: February 2022

In ribosomal translation, peptidyl transfer occurs between P-site peptidyl-tRNA and A-site aminoacyl-tRNA, followed by translocation of the resulting P-site deacylated-tRNA and A-site peptidyl-tRNA to E and P site, respectively, mediated by EF-G. Here, we report that mistranslocation of P-site peptidyl-tRNA and A-site aminoacyl-tRNA toward E and A site occurs when high concentration of EF-G triggers the migration of two tRNAs prior to completion of peptidyl transfer. Consecutive incorporation of less reactive amino acids, such as Pro and d-Ala, makes peptidyl transfer inefficient and thus induces the mistranslocation event. Consequently, the E-site peptidyl-tRNA drops off from ribosome to give a truncated peptide lacking the C-terminal region. The P-site aminoacyl-tRNA allows for reinitiation of translation upon accommodation of a new aminoacyl-tRNA at A site, leading to synthesis of a truncated peptide lacking the N-terminal region, which we call the ‘reinitiated peptide’. We also revealed that such a drop-off-reinitiation event can be alleviated by EF-P that promotes peptidyl transfer of Pro. Moreover, this event takes place both in vitro and in cell, showing that reinitiated peptides during protein synthesis could be accumulated in this pathway in cells.
COVID-19 Outcomes Among Patients With Cancer: Observations From the University of California Cancer Consortium COVID-19 Project Outcomes Registry
Authors: Borno Hala T , Kim Mi-Ok , Hong Julian C , Yousefi Sasha , Lin Amy , Tolstykh Irina , Zhang Sylvia , McKay Rana R , Harismendy Olivier , Cinar Pelin , Rugo Hope , Koshkin Vadim S , Rabow Maya , Wang Christine , Bailey Adina , Small Eric J
Published: February 2022

Background

The risks associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its associated illness, coronavirus disease 2019 (COVID-19), among patients with a cancer diagnosis have not been fully characterized. This study leverages data from a multi-institutional cohort study, the University of California Cancer COVID Consortium, to evaluate outcomes associated with SARS-CoV-2 infection among patients with cancer.

Methods

Clinical data were collected from March to November 2020 and included patient demographics, cancer history and treatment, SARS-CoV-2 exposure and testing, and COVID-19 clinical management and outcomes. Multivariate ordinal logistic regression permitting unequal slopes was used to evaluate the impact of demographic, disease, and treatment factors on SARS-CoV-2 related hospitalization, intensive care unit (ICU) admission, and mortality.

Findings

Among all evaluated patients (n = 303), 147 (48%) were male, 118 (29%) were older adults (≥65 years old), and 104 (34%) were non-Hispanic white. A subset (n = 63, 21%) had hematologic malignancies and the remaining had solid tumors. Patients were hospitalized for acute care (n = 79, 26%), ICU-level care (n = 28, 9%), or died (n = 21, 7%) due to COVID-19. Patients with ≥2 comorbidities were more likely to require acute care (odds ratio [OR] 2.09 [95% confidence interval (CI), 1.23-3.55]). Cough was identified as a significant predictor of ICU hospitalization (OR 2.16 [95% CI, 1.03-4.57]). Importantly, mortality was associated with an active cancer diagnosis (OR 3.64 [95% CI, 1.40-9.5]) or advanced age (OR 3.86 [95% CI, 1.2-12.44]).

Interpretation

This study observed that patients with active cancer or advanced age are at an increased risk of death from COVID-19. These study observations can inform risk counseling related to COVID-19 for patients with a cancer diagnosis.
Physical properties of the molecular cloud, N4, in SS 433: Evidence for an interaction of molecular cloud with the jet from SS 433
Authors: Yamamoto Hiroaki , Okamoto Ryuji , Murata Yasuhiro , Nakanishi Hiroyuki , Imai Hiroshi , Kurahara Kohei
Published: February 2022

We conducted observations and analyses of the molecular cloud, N4, which is located at ∼40 pc from SS 433 and the same line of sight as that of the radio shell, in 12CO(J = 1–0), 12CO(J = 3–2), 13CO(J = 3–2), and grand-state OH emissions. N4 has a strong gradient of the integrated intensity of 12CO(J = 1–0, 3–2) emission at the northern, eastern, and western edges. The main body of N4 also has a velocity gradient of ∼0.16 km s−1 (20″)−1. A velocity shift by up to 3 km s−1 from the systemic velocity at ∼49 km s−1 is detected at only the northwestern part of N4. The volume density of the molecular hydrogen gas and the kinematic temperature are estimated at eight local peaks of 12CO(J = 1–0) and 13CO(J = 3–2) emissions by the RADEX code. The calculated $n_{\rm (H_2)}$ is an order of 103 cm−3, and Tk ranges from ∼20 to ∼56 K. The mass of N4 is estimated to be ∼7300 M⊙. The thermal and turbulent pressures in N4 are estimated to be ∼105 K cm−3 and ∼107 K cm−3, respectively. The relation of the thermal and turbulent pressures in N4 tends to be similar to that of the molecular clouds in the Galactic plane. However, these values are higher than those in the typical molecular clouds in the Galactic plane. Several pieces of circumstantial evidence representing the physical properties of N4 and comparison with the data of infrared and X-ray radiation suggest that N4 is interacting with a jet from SS 433. However, no gamma-ray radiation is detected toward N4. Compared to the previous study, it is hard to detect the gamma-ray radiation by cosmic-ray proton origin due to the low sensitivity of the current gamma-ray observatories. No OH emission was detected toward N4 due to the low sensitivity of the observation and antenna beam dilution.
Ammonia mapping observations toward the Galactic massive star-forming region Sh 2-255 and Sh 2-257
Authors: Kohno Mikito , Omodaka Toshihiro , Handa Toshihiro , Chibueze James O , Nagayama Takumi , Burns Ross A , Murase Takeru , Matsusaka Ren , Nakano Makoto , Sunada Kazuyoshi , Yamada Rin I , Bieging John H
Published: February 2022

We performed NH3 (J, K) = (1, 1), (2, 2), and (3, 3) mapping observations toward the Galactic massive star-forming region Sh 2-255 and Sh 2-257 using the Nobeyama 45 m telescope as a part of the KAGONMA (KAgoshima Galactic Object survey with the Nobeyama 45 metre telescope by Mapping in Ammonia lines) project. NH3 (1, 1) has an intensity peak at the cluster S255 N, is distributed over 3 pc × 2 pc, and is located between two H ii regions. The kinetic temperature derived from the NH3 (2, 2)/(1, 1) ratio was ∼35 K near the massive cluster S255 IR. These clusters also show emission with a large line width of ∼3–4 km s−1. Based on the reported data, we suggest that NH3 gas in these regions is affected by stellar feedback from embedded youn stellar object (YSO) clusters in S255 IR and S255 N. We also detected NH3 (1, 1) emission in a region west of the main gas clump at the location of a concentration of Class II YSOs adjacent to the H ii regions Sh 2-254. The presence of Class II YSOs implies ∼2 Myr of star formation, younger than Sh 2-254 (∼5 Myr), thus we suggest that star formation in the western region could be influenced by the older H ii region Sh 2-254.
Ghana Must Go: Nativism and the Politics of Expulsion in West Africa, 1969–1985
Authors: Daly Samuel Fury Childs
Published: February 2022

Beginning in the late 1960s, the Nigerian and Ghanaian governments staged a series of massive forced removals of one another’s nationals. The first was in Ghana in 1969, and the largest was Nigeria’s 1983 deportation of over one million Ghanaians. A further expulsion from Nigeria happened in 1985, and smaller ones took place in the years that followed. Each was an enactment of the state’s sovereign right to define its national community — and a devastating blow to the principle of free movement in Africa. Using records from Nigeria and elsewhere, ‘Ghana Must Go’ places the expulsions in the longer history of law and nationality policy in the British Empire. Mass expulsions were made possible by colonial-era jurisprudence that tied political membership to indigeneity, often through codified, neo-traditional ‘customary’ laws. The mass deportations of the 1960s–1980s were underwritten by this jurisprudence, even though their immediate causes lay in economic resentment, the failure of regional co-operation, and Ghana and Nigeria’s rocky diplomatic relationship.
The Effects of Combined Respiratory-Gated Auricular Vagal Afferent Nerve Stimulation and Mindfulness Meditation for Chronic Low Back Pain: A Pilot Study
Authors: Meints Samantha M , Garcia Ronald G , Schuman-Olivier Zev , Datko Michael , Desbordes Gaelle , Cornelius Marise , Edwards Robert R , Napadow Vitaly
Published: February 2022

Objective

Respiratory-gated Auricular Vagal Afferent Nerve stimulation (RAVANS) is a safe nonpharmacological approach to managing chronic pain. The purpose of the current study was to examine (1) the feasibility and acceptability of RAVANS, combined with mindful meditation (MM) for chronic low back pain (CLBP), (2) the potential synergy of MM+RAVANS on improving pain, and (3) possible moderators of the influence of MM+RAVANS on pain.

Design

Pilot feasibility and acceptability study.

Setting

Pain management center at large academic medical center.

Subjects

Nineteen adults with CLBP and previous MM training.

Methods

Participants attended two sessions during which they completed quantitative sensory testing (QST), rated pain severity, and completed a MM+stimulation session. Participants received RAVANS during one visit and sham stimulation during the other, randomized in order. Following intervention, participants repeated QST.

Results

MM+RAVANS was well tolerated, acceptable, and feasible to provide relief for CLBP. Both MM+stimulation sessions resulted in improved back pain severity, punctate pain ratings, and pressure pain threshold. Individuals with greater negative affect showed greater back pain improvement from MM+RAVANS while those with greater mindfulness showed greater back pain improvement from MM+sham.

Conclusions

Results suggest that for CLBP patients with prior MM training, the analgesic effects of MM may have overshadowed effects of RAVANS given the brief single session MM+RAVANS intervention. However, those with greater negative affect may benefit from combined MM+RAVANS.
Enabling Policing to Be Better: Lessons from Two Case Studies in Police Collaboration
Authors: Zaghloul Fatema , Partridge Justin
Published: February 2022

In the UK, the introduction of austerity measures for public services has intensified the thinking around inter-organizational collaboration between emergency services and other public and/or private sector organizations. Theoretically, while collaborative benefits are held up as beacons that drive organizations to participate in inter-organizational arrangements, a high number of such arrangements fail. In this paper, we explored the factors that influenced the collaboration process in the context of developing ‘collaborative information infrastructures’, from an organizational and collaboration level perspective, via a multiple case study approach. Our findings offer insights into how policymakers and public managers could improve their practices by considering their approach towards, and impact of, these factors when implementing collaborative projects in information technology and information systems.
Police and the Pandemic Response in India—Findings from Kerala
Authors: Kumar T K Vinod
Published: February 2022

The spread of COVID-19 is a challenge the likes of which the world has not witnessed in recent times. Response to the pandemic has both medical and non-medical facets. The non-medical response includes measures such as social distancing, quarantine, and lockdown. The police have a significant role in the implementation of these measures. Using time-series analyses, the data from one district and the state of Kerala were examined to ascertain whether the police efforts had an impact on the spread of the disease. The study concludes that the interventions by the police had a significant effect in reducing the spread of the disease.
On the Distribution of the Number of Lattice Points in Norm Balls on the Heisenberg Groups
Authors: Gath Yoav A
Published: February 2022

We investigate the fluctuations in the number of integral lattice points on the Heisenberg groups which lie inside a Cygan–Korányi ball of large radius. Let $$ \mathcal{E}_{q}(x)=\big|\mathbb{Z}^{2q+1}\cap\delta_{x}\mathcal{B}\big|-\textit{vol}\big(\mathcal{B}\big)x^{2q+2}\,, $$ be the error term which occurs for this lattice point counting problem on the $(2q + 1)$-dimensional Heisenberg group $\mathbb{H}_{q}$, where $\mathcal{B}=\{\mathbf{u}\in\mathbb{R}^{2q+1}:|\mathbf{u}|_{{Cyg}}\leq\,1\}$ is the unit ball with respect to the Cygan–Korányi norm $$ |\mathbf{u}|_{{Cyg}}=\Big(\Big(u^{2}_{1}+\cdots+u^{2}_{2q}\Big)^{2}+u^{2}_{2q+1}\Big)^{1/4}\,, $$ and $\big\{\delta_{x}\big\}_{x\gt0}$ are the Heisenberg dilations given by $\delta_{x}\mathbf{u}=(xu_{{1}},\ldots, xu_{{2q}},x^{2}u_{{2q+1}})$.

For $q\geq\,3$, we prove that the suitably normalized error term $\mathcal{E}_{q}(x)/x^{2q-1}$ has a limiting value distribution in the sense that there exists a probability density $\mathcal{P}_{q}(\alpha)$ such that for any interval $\mathcal{I}$, $$ \lim_{X\to\infty}\frac{1}{X}\textit{meas}\Big\{x\in[X,2X]:\mathcal{E}_{q}(x)/x^{2q-1}\in\mathcal{I}\Big\}=\int\limits_{\mathcal{I}}\mathcal{P}_{q}(\alpha)\textit{d}\alpha\,. $$ The density $\mathcal{P}_{q}(\alpha)$ is an entire function of α which satisfies, for any non-negative integer $j\geq\,0$ and any real α, $|\alpha|$ sufficiently large in terms of j and q, the upper bound $$ \begin{split} \big|\mathcal{P}^{(j)}_{q}(\alpha)\big|\leq\exp{\Big(-|\alpha|^{4-\beta/\log\log{|\alpha|}}\Big)}\,, \end{split} $$ where β > 0 is an absolute constant. In addition, we prove that $\int_{-\infty}^{\infty}\alpha\mathcal{P}_{q}(\alpha)\textit{d}\alpha=0$ and $\int_{-\infty}^{\infty}\alpha^{3}\mathcal{P}_{q}(\alpha)\textit{d}\alpha\lt0$, and we derive an explicit formula for the j-th integral moment of the density $\mathcal{P}_{q}(\alpha)$ for any integer $j\geq\,1$.
Spirits and Skins: The Sceapheord of Exeter Book Riddle 13 and Holy Labour
Authors: Burns Rachel A
Published: February 2022

While the unnamed creatures of Exeter Book Riddle 13 have been read as ‘chickens’ since the early twentieth century, this solution has never fully satisfied either the narrative description or the cryptic puzzles of this short verse text. In this article, I propose a new solution, the Old English word SCEAPHEORD (‘flock of sheep’), which fulfils the various clues of the riddle and fits more satisfactorily among the quadruped cluster of neighbouring Riddles 12, 14 and 15. Far from settling the meaning of the text, this new solution opens the riddle to a range of interpretative possibilities. Following previous critical work on the role of medieval riddles in teaching interpretative practice, I will demonstrate that the riddle invites readings of the wandering sceapheord on several discrete levels, in a process analogous to fourfold biblical exegesis: the literal (a flock of sheep), the historical (allusions to biblical Eden, following Patrick Murphy) and the anagogical (images of renewal and salvation). A fourth, moral level of interpretation is revealed through attention to the riddle’s letter-games and etymological puns, which, in the Isidorean tradition, portray human language as reflective of material reality. By emphasizing this relationship between the textual and the real, the poem encourages monks to apply their skills of exegetical analysis to their daily labour (represented by the ubiquity of sheep-rearing in the early medieval English economy). While celebrating the spiritual meaning of individual acts of manual labour, Riddle 13 also reinforces the moral and theological importance of collective monastic work.
Learning the Ropes of Tatparya: Revival of the Mimansa Rules of Interpretation
Authors: Agarwal Krishna
Published: February 2022

The primary task of the judiciary while interpreting the statute is to ascertain the true intention of the legislature. Maxwell on the interpretation of Statutes, setting out the principles evolved by the English Courts, is of immense help in the interpretation of statutes. An indigenous alternative that has been used by the Indian judiciary time and again is the Mimansa Rules which are the traditional rules of interpretation laid down by Jaimini to interpret Brahmanas. Despite dating back to the 5th century BC, these principles are considered scientific to an extent that they can be used to interpret the modern statutes and judgments. The Indian judiciary has adopted the principles of Mimansa to adjudicate several disputes about statutory interpretation. In light of these judgments, the researcher examines the scientific nature and application of the Mimansa Rules of Interpretation in contemporary times in parallel with the Maxwell’s Principles.
The nature of a beneficiary’s interest under a Jersey law trust: Kea Investments v Watson in its historical context
Authors: Williams Sam
Published: February 2022

In Kea Investments v Watson [2021] JRC 009, the Royal Court of Jersey considered for the first time whether a beneficiary’s interest under a discretionary trust could be the subject of distraint by a judgment creditor. This article places the decision in its historical context and argues that it reflects the inherent difficulty in reconciling a system of property law which in Jersey has its roots in the customary law of Normandy, and the quintessentially English law concept of the trust as transposed to the island.
Coronavirus disease 2019 and pediatric asthma: friend or foe?
Authors: Abrams Elissa M.
Published: February 2022

Purpose of review

The interplay of asthma and coronavirus disease 2019 (COVID-19) in children is yet unknown. The purpose of this review is to determine the interplay of asthma and asthma therapeutics and COVID-19.

Recent findings

There is no evidence to date that asthma is a risk factor for more severe COVID-19 outcomes, especially in children. There is actually some basis to suggest that children with atopic asthma may be at reduced risk of asthma exacerbations during COVID-19. The impact of asthma therapeutics on COVID-19 outcomes is unclear, but guidance is relatively uniform in recommending that those with asthma remain on current asthma medications. A focus on social determinants of health may be increasingly important during the pandemic and beyond.

Asthma in children appears to be more friend, than foe, during COVID-19.
Predicting the course of asthma from childhood until early adulthood
Authors: Koefoed Hans Jacob L. , Vonk Judith M. , Koppelman Gerard H.
Published: February 2022

Purpose of review

To communicate recent insights about the natural history of childhood asthma, with a focus on prediction of persistence and remission of childhood asthma, up to early adulthood.

Recent findings

Lung function around the age of 8–9 years is the strongest predictor: obstructive lung function predicts asthma persistence up to early adulthood, whereas normal lung function predicts remission. The ability to predict asthma remission improves when lung function is combined with blood eosinophil levels and degree of bronchial hyperresponsiveness. Interventions, such as inhaled corticosteroids and immunotherapy do not appear to alter the course of asthma. Epigenetic studies have revealed potential novel biomarkers of asthma remission, such as micro-RNA patterns in blood. Specifically, lower serum levels of mi-R221-5p, which is associated with lower IL-6 release and eosinophilic inflammation, predict remission. Higher levels of blood DNA-methylation of a CpG site in Peroxisomal Biogenesis Factor 11 Beta were associated with asthma remission.

Lung function, allergic comorbidity and polysensitization in childhood predict the course of asthma. Recent epigenetic studies have provided a better understanding of underlying pathological processes in asthma remission, which may be used to improve prediction or develop novel treatments aimed at altering the course of asthma.
Current strategies for phenotyping and managing asthma in preschool children
Authors: Feleszko Wojciech , Jartti Tuomas , Bacharier Leonard B.
Published: February 2022

Purpose of review

Half of all children will experience an episode of wheezing by 6 years. Recurrent preschool wheezing is associated with early lung function loss and has a lifelong impact on airway health, so deciding which children should be treated to prevent exacerbations while also avoiding irreversible health consequences is crucial. The purpose of this review is to provide a practical approach to the pediatric patient under 5 years of age with asthma, with particular attention to the recent enhanced identification of wheeze phenotypes.

Recent findings

Here, we note the difficulty of defining ‘asthma’ for this age group and advocate that it be determined by the set of respiratory symptoms presented, without assumptions about the underlying mechanisms of the disease. In addition, we propose a forward-looking approach, what treatment to apply to particular phenotypes, which child should be treated, and, if so, which treatment strategy to choose. No clear recommendation exists for the management of nonallergic preschool wheezing, a substantial clinical and research gap.

We recommend an empathetic approach to parent anxiety and considering objective markers: timing, severity, and frequency of symptoms, along with an assessment of other biomarkers, including viral etiology, aeroallergen sensitization, and blood eosinophils, that contribute to successful decision-making.
MRI Predictors of Residual Dysplasia in Developmental Dysplasia of the Hip Following Open and Closed Reduction
Authors: Johnson Mitchell A. , Gohel Shivani , Nguyen Jie C. , Sankar Wudbhav N.
Published: February 2022

Background:

Following open or closed reduction for children with developmental dysplasia of the hip, there remains a significant risk of residual acetabular dysplasia which can compromise the long-term health of the hip joint. The purpose of this study was to use postoperative in-spica magnetic resonance imaging (MRI) data to determine factors predictive of residual acetabular dysplasia at short-term follow-up.

Methods:

We retrospectively reviewed 63 hips in 48 patients which underwent closed or open reduction and spica casting for developmental dysplasia of the hip. MRI performed in-spica at ∼3-week follow-up were used to assess 11 validated metrics and 2 subjective factors. Acetabular index (AI) was measured on anteroposterior pelvic radiographs at 2-year postoperative follow-up. Binary logistic regression was then used to identify variables predictive of residual dysplasia, defined as an AI greater than the 90th percentile for age based on historic normative data.

Results:

Average age at surgical reduction was 9.3±3.2 months. 58.7% (37/63) of reductions were open. A total of 43 (68.3%) hips demonstrated residual acetabular dysplasia at 2 years postoperatively based on normative values. In those with persistent dysplasia, patients were on average older at the time of reduction (10.0 mo±3.2 vs. 8.0 mo±2.8, P=0.010) and more likely female (88.4% vs. 60.0%, P=0.010). Patients with residual dysplasia were more likely to have mild subluxation on postoperative MRI (40.0% vs. 10.5%, P=0.022). Hips with a cartilaginous acetabular index (CAI) of >23 degrees were 7.6 times more likely to develop residual dysplasia. Type of reduction (ie, closed vs. open) did not appear to influence the rate of residual dysplasia (P=0.682).

Conclusion:

In this series, the rate of residual dysplasia after surgical reduction was higher than most previous reports, with no appreciable difference between closed and open reductions. Older age, female sex, and a higher CAI were associated with a greater risk of persistent radiographic dysplasia. In particular, hips with a CAI >23 degrees were 7.6 times more likely to be dysplastic at 2-year follow-up.

Level of Evidence:

Level III.
Appropriate Telemedicine Utilization in Spine Surgery
Authors: Iyer Sravisht , Bovonratwet Patawut , Samartzis Dino , Schoenfeld Andrew J. , An Howard S. , Awwad Waleed , Blumenthal Scott L. , Cheung Jason P.Y. , Derman Peter B. , El-Sharkawi Mohammad , Freedman Brett A. , Hartl Roger , Kang James D. , Kim Han Jo , Louie Philip K. , Ludwig Steven C. , Neva Marko H. , Pham Martin H. , Phillips Frank M. , Qureshi Sheeraz A. , Radcliff Kris E. , Riew K. Daniel , Sandhu Harvinder S. , Sciubba Daniel M. , Sethi Rajiv K. , Valacco Marcelo , Zaidi Hasan A. , Zygourakis Corinna C. , Makhni Melvin C.
Published: February 2022

Study Design.

Delphi expert panel consensus.

Objective.

To obtain expert consensus on best practices for appropriate telemedicine utilization in spine surgery.

Summary of Background Data.

Several studies have shown high patient satisfaction associated with telemedicine during the COVID-19 peak pandemic period as well as after easing of restrictions. As this technology will most likely continue to be employed, there is a need to define appropriate utilization.

Methods.

An expert panel consisting of 27 spine surgeons from various countries was assembled in February 2021. A two-round consensus-based Delphi method was used to generate consensus statements on various aspects of telemedicine (separated as video visits or audio visits) including themes, such as patient location and impact of patient diagnosis, on assessment of new patients. Topics with ≥75% agreement were categorized as having achieved a consensus.

Results.

The expert panel reviewed a total of 59 statements. Of these, 32 achieved consensus. The panel had consensus that video visits could be utilized regardless of patient location and that video visits are appropriate for evaluating as well as indicating for surgery multiple common spine pathologies, such as lumbar stenosis, lumbar radiculopathy, and cervical radiculopathy. Finally, the panel had consensus that video visits could be appropriate for a variety of visit types including early, midterm, longer term postoperative follow-up, follow-up for imaging review, and follow-up after an intervention (i.e., physical therapy, injection).

Conclusion.

Although telemedicine was initially introduced out of necessity, this technology most likely will remain due to evidence of high patient satisfaction and significant cost savings. This study was able to provide a framework for appropriate telemedicine utilization in spine surgery from a panel of experts. However, several questions remain for future research, such as whether or not an in-person consultation is necessary prior to surgery and which physical exam maneuvers are appropriate for telemedicine.

Level of Evidence: 4
The Impact of Spinopelvic Parameters on Hip Degeneration After Spinal Fusion
Authors: Kawai Toshiyuki , Shimizu Takayoshi , Goto Koji , Kuroda Yutaka , Okuzu Yaichiro , Otsuki Bungo , Fujibayashi Shunsuke , Matsuda Shuichi
Published: February 2022

Study Design.

Retrospective cohort study.

Objective.

This study aimed to investigate the effects of spinopelvic alignment parameters after spinal fusion on the rate of joint space narrowing in nonarthritic hips.

Summary of Background Data.

Spinal fusion affects the forces on the adjacent hip joint. Therefore, hip joint narrowing may be increased after spinal fusion surgery. However, the relationship between spinal alignment and hip degeneration remains unclarified.

Methods.

We retrospectively reviewed data from patients who underwent lumbar spinal fusion from 2011 to 2018 at our institute. Patients with hip osteoarthritis (Kellgren-Lawrence grade ≥II) or hip dysplasia were excluded. The rate of hip joint space narrowing after spinal fusion was measured in 191 patients (382 hips). We assessed the effects of the following spinopelvic alignment parameters on the joint narrowing rate: pelvic tilt, sacral slope (SS), pelvic incidence (PI), lumbar lordosis (LL), PI-LL, sagittal vertical axis, and distance between the C7 plumb line, and the central sacral vertical line (C7-CSVL).

Results.

The hip joint narrowing rate was greater when four or more levels were fused compared with single-level fusion. After adjusting for the effects of patient-related factors, the alignment parameters significantly associated with the hip joint narrowing rate were the PI (P = 0.0002), SS (P = 0.047), and PI-LL (P = 0.0022). A subgroup analysis of patients who underwent long fusion (four or more levels combined with iliac screws) also indicated that the PI (P = 0.013), SS (P = 0.0054), and PI-LL (P = 0.046) were associated with the hip joint narrowing rate.

Conclusion.

The PI, SS, and PI-LL were associated with the progression of hip joint narrowing after spinal fusion, especially after fusion of four or more levels. Surgeons need to be aware of the risk of increased hip joint narrowing in patients with a large PI, SS, and PI-LL after fusion surgery.
Racial and Gender Differences in Patient Satisfaction Scores Among Oncologists
Authors: Odei Bismarck C. , Pan Xueliang , Bello-Pardo Erika , Mitchell Darrion , Thomas Charles R. , Diaz Dayssy A.
Published: February 2022

Background:

Patient satisfaction scores (PSS) have been adopted in health care reimbursement and faculty promotion metrics. Oncology patients face a challenging prognosis, where PSS may be perceived differently. We hypothesized that PSS differed based on gender and racial demographics of oncologists.

Materials and Methods:

This was an institutional review board exempt cross-sectional study utilizing PSS data for outpatient oncologists within a large comprehensive cancer center. Patient demographics included age, gender, race/ethnicity, geographical residence, and disease site. Characteristics of oncologists included gender and race/ethnicity. We used PSS ≥95 to make comparisons. The association between patient and physician characteristics were evaluated using the t test and χ2 test.

Results:

A total of 15,849 oncology patients were identified between 2011 and 2020. Survey respondents were predominantly female (53.2%), white (93.4%), between 50 and 70 years of age (55.3%), and living in an urban setting (63.6%). There were 303 oncologists with the majority being male (64.4%) and white (58.1%). Compared with white oncologists, Asian and Hispanic oncologists received lower PSS (P=0.001 and 0.0085, respectively). On subset analysis, these differences were significant among patients older than 50 years, living in rural counties, and reporting white or non-Hispanic race/ethnicity, or among patients of either gender (all P<0.05). Patients with genitourinary malignancies provided lower PSS for female oncologists (P=0.005).

Conclusions:

Asian and Hispanic oncologists were more likely to receive lower PSS. In addition, female oncologists treating genitourinary malignancies received lower PSS. Appropriate statistical adjustments are needed for PSS among oncologists to account for race, gender, and physician subspecialization to allow for equitable professional opportunities across demographics.
Associations Between Social Determinants of Health and Adolescent Contraceptive Use
Authors: Maness Sarah B. , Thompson Erika L. , Lu Yu
Published: February 2022

This research assessed social determinants of contraceptive use among a nationally representative sample of adolescents. This study analyzed nationally representative, publicly available data from the 2013-2015 National Survey of Family Growth (NSFG). The sample consisted of sexually active males and females between the ages of 15 and 19 (n = 775). Independent variables were social determinant questions asked on the NSFG, selected based on the Healthy People Social Determinants of Health Framework. We tested associations between adolescents' social determinants of health and 2 outcomes, use of any contraceptive at last sex, and effectiveness level of contraceptive method at last sex. Results indicated high contraceptive use at last intercourse (91.5%) and a significant association between any use of contraceptive and family structure (adjusted odds ratio [AOR] = 2.05, 95% confidence interval [CI] = 1.04-4.03), employment (AOR = 2.00, 95% CI = 1.06-3.77), and education (AOR = 3.43, 95% CI = 1.06-11.13). Few participants reported use of a highly effective method of pregnancy prevention (4.3%). In regression analyses, access to health care (AOR = 0.34, 95% CI = 0.14-0.84) and language and literacy (AOR = 2.92, 95% CI = 1.03-8.26) were found to be associated with using moderately effective contraceptive method to prevent pregnancy compared with not using any method. Although adolescents report overall high rates of contraceptive use, not all contraceptives have the same rates of effectiveness, and adolescents are often choosing those with lower effectiveness. This study found low rates of highly effective contraceptives to prevent pregnancy use (ie, intrauterine device and implant). It is also important to further explore the associations between family structure (measured in this study as intact childhood family) and distal links to contraceptive use. Future research should also further distinguish pathways to adolescent decision-making to use contraceptive methods to protect against STIs and pregnancy.
Racial/Ethnic Differences in the Application and Receipt of Services to Address Social Needs
Authors: Dean Caress
Published: February 2022

Black and Hispanic Americans are disproportionately affected by COVID-19, which impacts their social needs. The objective of this study was to examine differences in white, Black, and Hispanic adults' application and receipt of services to address their social needs during COVID-19. Utilizing weeks 1, 2, and 3 from the COVID Impact Survey, descriptive statistics analyzed covariates and the 12 social services by participants' race/ethnicity. Unweighted frequencies and weighted percentages were computed for the services score by race/ethnicity. Forward stepwise binary logistic regression analyses examined the relationship between services needed and race/ethnicity. All analyses were conducted using STATA MP 14. Among 20 533 participants, unemployment insurance was a common service participants reported applying for or trying to apply for. Compared with white participants, Hispanic participants had higher adjusted odds of needing unemployment insurance services (adjusted odds ratio [AOR] = 1.58; 95% confidence interval [CI], 1.18-2.11). Black (AOR = 3.25; 95% CI, 2.49-4.25) and Hispanic (AOR = 1.55; 95% CI, 1.14-2.10) participants had higher adjusted odds of needing Supplemental Nutrition Assistance Program services than white participants. It is important for Black and Hispanic Americans to have access to these social services. Research and evaluation studies are warranted to inform policies that sustain/modify social services for future use. These studies must include a representative sample of Black and Hispanic Americans.
Interweaving Adult Fitness Classes Into Community Settings Via Stronger Austin's Community Partnership Model
Authors: Springer Andrew E. , Castro Vanessa , Ruiz Felisa , Luna Elena , Martinez Karla , McGhee Shelby , Ranjit Nalini , Bjornaas Davin , Sturrup Adrienne , McNeely Kimberly , McGeady Amy , Harrell Baker
Published: February 2022

The lack of environmental supports for healthy lifestyles is a potent factor in the high prevalence of noncommunicable diseases among communities experiencing economic disadvantage. Stronger Austin aimed to increase access to free physical activity (PA) and fitness programming (eg, Zumba) in underserved communities in Austin, Texas, via a partnership and interweaving into context approach in which classes are interwoven into settings with widespread access for residents, including clinics, city-supported housing, parks, recreation centers, and schools. We aimed to better understand the PA-related benefits and opportunities for improvement when adult fitness classes are interwoven into community settings. A mixed-methods design guided the study, which included SOFIT (Structured Observation of Fitness Instruction Time) assessments of class PA (n = 160 participants) and qualitative assessment of highlights and recommendations for class improvement via participant focus groups (n = 24), open-ended questionnaires (n = 258), and instructor interviews (n = 6). Findings indicated high levels of class PA (76.9%-86.9% of 1-hour class spent in moderate-to-vigorous PA; mean of 18 participants per class), with positive social connectedness cited as a key benefit. Challenges and best practices of community-based fitness classes are explored. Stronger Austin's partnership and interweaving into context approach represents a promising model for increasing access to fitness classes in underserved communities.
Usage Patterns of an mHealth Symptom Monitoring App Among Adolescents With Acute Mild Traumatic Brain Injuries
Authors: Schmidt Matthew , Babcock Lynn , Kurowski Brad G. , Cassedy Amy , Sidol Craig , Wade Shari L.
Published: February 2022

Objective:

To understand usage patterns of SMART (Self-Monitoring Activity Regulation and Relaxation Treatment) mHealth app among adolescents with acute mild traumatic brain injuries (mTBIs) and to identify individual characteristics that influenced app usage.

Methods:

Setting:

Emergency departments of tertiary care children's medical center.

Participants:

Children aged 11 to 18 years with mTBI in the past 2 weeks, English-speaking, no evidence of severe TBI, and no preexisting neurological impairment.

Design:

Nested cohort of the intervention arm of a randomized clinical trial (n = 34).

mHealth App Intervention:

SMART was a month-long educational program on mTBI designed to promote self-monitoring and management of recovery. SMART included digital symptom and activity self-monitoring surveys, feedback on symptom changes, and 8 modules providing psychoeducation, strategies for symptom management, and training in active problem solving.

Main Measures:

App usage time, navigation, and interaction data were automatically collected. Usage involved inputting symptom ratings/activities and reviewing modules. Patterns of symptom/activity reporting and completion of learning modules data were analyzed. Predictors of app utilization, including individual characteristics, resilience (Connor-Davidson Resilience Scale), and coping (Coping Strategies Inventory-Short Form), were analyzed using Spearman correlations.

Results:

Participants completed symptom monitoring an average of 9 days over the month. Participants completed an average of 1.87 learning modules out of 7. Parent income and education, comorbid attention-deficit/hyperactivity disorder (ADHD), and emotional engagement coping style predicted symptom monitoring. Parental income, comorbid ADHD, and greater reliance on emotional engagement coping predicted module completion.

Significant Adverse Events:

None.

Conclusion:

Adolescents of higher socioeconomic status and those who manage their emotions using active engagement spent more time on both components of the SMART program.