bluuebunny/crossref_metadata_2025 huggingface dataset:
Exchange Rate Uncertainty Effects on Domestic Investment in South Africa
Authors: Gidey Hiluf Techane , Nuru Naser Yenus
Published: July 2021

The main goal of this study is to examine the effect of real effective exchange rate uncertainty on domestic investment for the South African economy over the sample period 1985Q1–2019Q2. To address this objective, Jordà’s (2005) local projection method is employed in this study. The generalised impulse response functions indicate that domestic investment decreases between the second and seventh quarters in response to one standard deviation shock in exchange rate uncertainty. Furthermore, high exchange rate uncertainty affects domestic investment negatively while low exchange rate uncertainty affects domestic investment positively. In other words, domestic investment declines due to a rise in exchange rate uncertainty while a drop in exchange rate uncertainty enhances domestic investment. Regarding the effects of control variables, output and export influences domestic investment positively and significantly. Inflation, however, has a negative and significant effect on domestic investment. Lastly, the Diks–Panchenko nonlinear Granger’s causality confirms bidirectional causality between exchange rate uncertainty and domestic investment.

JEL Classification: C32, E22, F31, F41
Beijing Raising the Ante in the Natunas: The Next Flash Point in the South China Sea?
Authors: Majumdar Munmun
Published: July 2021

China’s nine-dash line or U-shape line claim in the South China Sea overlaps with Indonesia’s 200 nautical miles exclusive economic zone (EEZ). There have been several instances where Jakarta and China have entered into skirmishes involving fishing vessels in the Natuna area. The latest encroachment by China into Indonesian Natuna EEZ witnessed a departure of China’s justification for such action when it argued that it has sovereignty over the Nansha (Spratly) Islands and also sovereign rights over relevant waters near the Nansha Islands. Jakarta rejected both the arguments and insisted that under United Nations Convention for the Law of the Sea (UNCLOS) China does not have legal basis to claim either traditional fishing grounds or parts of the Natuna waters and invoked the 2016 UN Arbitral Tribunal’s ruling to back its position. This article examines Indonesia’s response vis-à-vis China and argues that with the rise of nationalism over ownership of the Natunas it is likely to progress into an area of potential conflict between Indonesia and China.
Linking CEO Entrepreneurial Orientation to Firm Performance: The Perspective of Middle Managers’ Cognition
Authors: Liu Yueyue , Xi Meng
Published: July 2021

The influence of chief executive officer (CEO) entrepreneurial orientation (EO) on firm performance and the underlying mediating mechanisms are worth studying because CEO EO may have a double-edged sword effect on firm performance. Drawing on the social information processing theory and social cognitive theory and using multilevel, multi-source data from 198 Chinese firms, this study found that CEO EO affects firm performance by triggering middle managers’ confidence in the organization’s prospects or workplace anxiety, moderated by middle managers’ entrepreneurial self-efficacy. It explicates the CEO EO–performance relationship and the vertical pervasiveness of EO in organizations.
The Adherence to Healthy Lifestyle Among Arab Patients With Cardiovascular Disease: Mixed-Method Review
Authors: Alomari Albara , Alananzeh Ibrahim , Lord Heidi , Fernandez Ritin
Published: July 2021

Introduction

Cardiovascular disease (CVD) accounts for 25% to 45% of deaths among Arab people. The purpose of this review was to investigate the level, predictors, motivators, and barriers to adherence to lifestyle recommendations among Arab patients with CVD.

Method

A systematic search of the literature was conducted and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, EMCARE, CINAHL, Scopus, and the Cochrane Central Register of Controlled Trials were searched. Studies that explored adherence to a healthy lifestyle among Arab adult patients with CVD were included.

Results

Twelve studies were included. Quantitative results showed low adherence among Arab people with CVD. Qualitative synthesized results revealed that internal motivators, personal desire as well as structural drivers impact the patient’s ability to adhere to a healthy lifestyle.

Discussion

Multidimensional solutions that consider religion and culture and include active involvement of families are required to improve adherence.
Prevalence of Injuries Among Medicaid Enrolled Infants Prior to Child Abuse and Neglect
Authors: Shanahan Meghan E. , Austin Anna E. , Berkoff Molly C.
Published: July 2021

Prior research has identified common injuries among children who experience child maltreatment; however, most of this work has focused on inpatient settings and has excluded many cases of neglect. This study examines the prevalence of injuries that occur prior to a diagnosis of child maltreatment, as well as the proportion of children with well-child visits prior to the injury and child maltreatment diagnosis. Based on a secondary analysis of Medicaid data from four states, we found that among infants with 12 months of continuous enrollment ( N = 4817), 30.6% of those diagnosed with maltreatment were previously diagnosed with an injury. Among infants diagnosed with child maltreatment, 88.4% had at least one well-child visit prior to the maltreatment diagnosis. Among children with a maltreatment diagnosis and a prior injury, 84% had at least one well-child visit preceding the injury. These results indicate that most children had at least one well-child visit prior to being diagnosed with child maltreatment or an injury, indicating opportunities for prevention.
Ultra-low-dose radiation treatment for early-stage ocular adnexal MALT lymphoma
Authors: Lee Min Joung , Lee Me Yeon , Choe Ji-Young , Choi Se Hyun , Kim Hyo Jung
Published: July 2021

Purpose:

To investigate the long-term outcomes of ultra-low-dose (4 Gy) radiation treatment (RT) in patients with early-stage ocular adnexal mucosa-associated lymphoid tissue (MALT) lymphoma.

Methods:

This retrospective case series includes eight patients with ocular adnexal MALT lymphoma who received ultra-low-dose RT at a single tertiary referral center between March 2016 and February 2018. Response to treatment and the time taken to respond were analyzed.

Results:

Of the eight patients (three men, five women), seven patients had conjunctival lymphoma (T1N0M0), and one patient had orbital lymphoma (T2N0M0). Six patients with T1 disease showed complete response (CR), and the median time to CR was 4.5 months (range 2–5). Partial response was achieved in the remaining two patients (one each with T1 and T2). During the median follow-up period of 44 months (range 30–54), none of the patients had a relapse or needed additional treatment. RT was well-tolerated in all patients with no ocular complications, including cataracts and dry eye.

Conclusion:

This case series suggests that ultra-low-dose RT is effective and well-tolerated in patients with early-stage ocular adnexal MALT lymphoma. Further studies with a larger sample size and long-term follow-up are needed to evaluate the local control rate and disease-free survival precisely.
Sound predictions in an urban context
Authors: Niesten J , Tenpierik MJ , Krimm J
Published: July 2021

Recent studies show that environmental noise in urban environments continues to be a great health risk. This noise is especially further transmitted by the hard materials that are mostly used for façades. To predict these effects it is desirable to have a reliable prediction method. There are already several ways to predict sound levels in an urban context. This paper investigates two while focusing specifically on a practical approach to show that the methods are suitable to use during an actual design project. The impact of changing a façade at a specific location is investigated using both prediction methods. A façade which reflects sound to a location where it has a smaller impact, a sound absorbing façade, and a façade which combines both are taken into consideration. These façade adaptions have the potential to improve the sound levels in the investigated area from 1.7 up to 9.3 dB(A).
Evaluation of Low Molecular Weight Cross Linked Chitosan Nanoparticles, to Enhance the Bioavailability of 5-Flourouracil
Authors: Sethi Aisha , Ahmad Mahmood , Huma Tayyaba , Khalid Ikrima , Ahmad Imtiaz
Published: July 2021

The present study aimed to formulate 5-fluorouracil loaded cross linked chitosan nanoparticles based on chemical cross-linking of low molecular weight chitosan with glutaraldehyde by reverse micelles technique as 5-FU is less hydrophobic, relatively potent, has a shorter half-life, is rapidly metabolized, less tolerated, and has low oral bioavailability; therefore, we aimed to formulate potential nanocarriers of 5-FU for efficient drug delivery to specific targeted areas of action, reduce oral toxicity, improve tolerability and therapeutic outcomes of 5-FU, in a restricted fashion to enhance the bioavailability of 5-FU. Nanoparticles were formulated by the reverse micelle method based on the chemical cross-linking of glutaraldehyde (25% aqueous solution) into a w/o emulsion in different ratios. LMWCH-NPs were characterized for post-formulation parameters by mean particle size, zeta potential, %age yield, loading/entrapment efficiency, Fourier transform infrared spectroscopy (FTIR), DSC/TGA, TEM, PXRD, drug release at pH 1.2, and pH 7.4. 5-FU loaded NPs showed a size range (198 nm-200 nm) and zeta potential (−39mV to −41mV), which ensured mechanical stability and increased retention time in blood vessels by the sustained release properties of biodegradable nanocarrier drug delivery systems. % age yield showed the range 92% to 96% while % LC ranged 2.0% to 3.4% and %EE ranged 40% to 43%. The TEM images showed spherical nanoparticles. FTIR revealed the compatibility between the drug and the cross-linked polymer. DSC/TGA ensured the thermal stability of the drug, while the solid-state stability of the drug-loaded cross-linked chitosan nanoparticles was evaluated by powder X-ray diffraction (PXRD) analysis. Drug release studies were performed using the dialysis bag technique at both pH (1.2 and 7.4) to mimic the gastrointestinal tract. Highly stable NPs displayed targeted release in phosphate buffer pH 7.4 at 37°C. Fickian diffusion was the predominant release with an R2 value of 0.9975-0.9973—and an N value 0.45-0.53. Prepared nanoparticles are inert, biodegradable, and biocompatible drug delivery systems for sustained release of 5-FU with maximum therapeutic efficacy and bioavailability.
Stakeholder views on young adults with intellectual disabilities as a workforce: A qualitative study on students’ performance in upper secondary education and their employment potential
Authors: Karhina Kateryna , Ineland Jens , Vikström Lotta
Published: July 2021

People with intellectual disabilities are the most disadvantaged group among all disability types when it comes to employment. In Sweden, special needs upper secondary schools prepare students with intellectual disabilities for the labour market using practice periods at workplaces. This study targets stakeholder involved in their school-to-work transition (i.e. teachers, employers, employment agency officials). The aim is to identify how they view: (1) the working capabilities of students during practice periods and (2) their employment potential. We base the analysis on interview data with the stakeholders using Grounded Theory. Our results identify three student types whose preparedness for the labour market differs considerably. One student type performs well during the practice period and represents a high potential to enter the workforce. The other two student types have the lower working capability and employment potential. Our study highlights stakeholders as resources to improve the labour market preparations of students with intellectual disabilities.
Community risk perception and health-seeking behavior in the era of COVID-19 among adult residents of Harari regional state, eastern Ethiopia
Authors: Eyeberu Addis , Mengistu Dechasa Adare , Negash Belay , Alemu Addisu , Abate Degu , Raru Temam Beshir , Wayessa Alemayehu Deressa , Debela Adera , Bahiru Nebiyu , Heluf Helina , Kure Mohammed Abdurke , Abdu Ahmedmenewer , Dulo Amanuel Oljira , Bekele Habtamu , Bayu Kefelegn , Bogale Saron , Atnafe Genanaw , Assefa Tewodros , Belete Rabuma , Muzeyin Mohammed , Asmerom Haftu , Arkew Mesay , Mohammed Anumein , Asfaw Henock , Taddesse Barkot , Alemu Daniel , Yihun Dawit , Amare Shambel Nigussie , Kebira Jemal Yusuf , Adem Siraj Aliyi , Dirirsa Gebisa , Girmay Saba Hailu , Godana Abduro , Dechasa Deribe Bekele , Dessie Yadeta
Published: July 2021

Background:

COVID-19 brought significant challenges to public health. It changed the view of global health and safety, trust in the healthcare system, and clients’ willingness to seek healthcare. To contain the course of the COVID-19 pandemic and its detrimental effects, understanding peoples’ health behavior, especially healthcare-seeking, and determining the community risk perception is very important. Thus, this study aimed to determine the health-seeking behavior, community’s risk perception to COVID-19 pandemics, and factors influencing the community risk perception in Harari regional state, Ethiopia.

Methods:

Community-based cross-sectional study was conducted from 5 to 30 February 2021. A total of 1320 adult (>18 years) participants were selected using systematic random sampling. The data were collected using an online kobo collect toolbox and analyzed using descriptive statistical tests. Chi-square test and multiple binary logistic regression were applied to examine the difference between variables. A p-value < 0.05 was considered to be of statistical significance.

Results:

The study included 1296 respondents >18 years old. The overall prevalence of willingness to seek healthcare in the study area was 35.6% (95% CI: 33%–38.3.0%). The mean cumulative score of risk perception was 30.5 (SD ± 7.25) with the minimum and maximum score of 13 and 63, respectively. A total of 656 (50.6%) of the participants had low-risk perceptions concerning COVID-19. The study found a statistically significant association between risk perception and sociodemographic characteristics (age, educational status, and income), and knowledge of the respondents.

Conclusion:

The overall prevalence of willingness to seek healthcare was 35.6%. Healthcare intervention aimed to contain the COVID-19 pandemic should consider the factors associated with the study area. Similarly, the study found a low-risk perception among the community that needs critical action to manage the COVID-19 pandemic and to protect the community as a whole. Thus, it is necessary to improve community risk perception through health education.
Oriental Cholangiohepatitis in a Caucasian male
Authors: Suarez Laura Suzanne K , Simms Larnelle N , Deeb Khaled , Scott Curtis E
Published: July 2021

Recurrent pyogenic cholangitis (RPC) is a condition found almost exclusively in individuals who lived in Southeast Asia. We report a case of a Caucasian veteran diagnosed with RPC after presenting with a 5-year history of recurrent fevers and abdominal pain 20 years after serving in Japan, South Korea, and Guam. Extensive evaluation led to the diagnosis of RPC with improvement after biliary decompression and antibiotics. Although rare, RPC should be considered in individuals who present with recurrent bouts of abdominal pain and fevers regardless of race.
A Sociological Framework to Reduce Aberrant Behaviour of School Students Through Increasing School Connectedness
Authors: Markham Wolfgang A. , Dolan Alan , Moore Graham F.
Published: July 2021

A framework for understanding relationships between school connectedness and student aberrant behaviors is outlined that is synthesized from Merton’s insights into anomie and Bernstein’s theory of cultural transmission (which focuses on schools’ instructional methods and students’ internalization of schools’ values). A seven-category classification system identifies students’ risk of nonconformist behavior based upon students acceptance/rejection of dominant overarching cultural aspirations (commonly material prosperity); perception of schools’ role in aspiration realization; responses to schools’ instructional methods; and internalization of schools’ values regarding conduct/character. We propose frustration weakens connectedness and is grounded in students’ perceptions regarding their school’s educational outcomes, degree of acceptance at school, and their school’s values. We then consider student dispersal across schools, and how age may affect students’ categorization and the influence of frustration risk factors. Finally, we discuss how initiatives within school organization, curriculum, and pedagogic practice may promote connectedness among different student categories and their potential adverse consequences.
Determinants of Behavioral Intention of the Use of Self-Order Kiosks in Fast-Food Restaurants: Focus on the Moderating Effect of Difference Age
Authors: Na Tae Kyun , Yang Jae Yeon , Lee Sun Ho
Published: July 2021

The aim of this study was to derive determinants that affect the behavior associated with using self-order kiosks among fast-food restaurant consumers through the Unified Theory of Acceptance and Use of Technology model, and to analyze the moderating effect of consumers’ difference age (difference between individuals’ cognitive age and chronological age) among the variables. From December 1 to 30, 2019, a survey was conducted on 316 customers using four different fast-food restaurants in the Seoul Station. The results showed that the higher the price value, social influence, performance expectancy, and hedonic motivation, the higher the behavioral intention of ordering through the kiosk; furthermore, the higher the difference age, the higher the behavioral intention of using a kiosk. Therefore, fast-food restaurant operators need to ensure that customers who are unfamiliar with using kiosks can order and make payments through kiosks with minimal effort and reasonable price value.
Democratization and Authoritarianism in the Information Age
Authors: Kim Elvis H
Published: July 2021

The outbreak of the Arab Spring in the Middle East and North Africa reignited the debate over the possibilities of democratization, with much attention paid to the roles of the internet. This paper attempts to answer the questions of whether the expansion of the internet leads to democratization and how calls for democratization during the Arab Spring produced contrasting results in Tunisia and China. The time-series cross-sectional analysis based on data of 166 countries suggests that the annual change of internet penetration is positively associated with a country’s Polity score and that the existing level of the penetration has a slightly negative effect on democratization, though the inclusion of the internet does not visibly improve the explanatory power of the models. The case study comparing Tunisia and China closely examines the multifaceted relationship between the internet and democratization and shows that the internet alone cannot determine the direction of political change. Rather, it is spatially and temporally situated state and societal actors who collectively determine the process and outcome of politics.
Does Land Still Matter? Gender and Land Reforms in Zimbabwe
Authors: Ossome Lyn , Naidu Sirisha C.
Published: July 2021

The Fast Track Land Reform Program (FTLRP) in Zimbabwe effected changes in the racial, class, and gender structure of land ownership. However, while changes in the racial and class structure have been well explored in existing literature, their articulation to gender in the agrarian structure is not yet well understood. This is because the literature has mainly accounted for gender in relation to the formal redistribution of land to women through titling, and not as a structural element of agrarian reform that locates women within the labor and capital nexus of land ownership. This article aims to fill this gap in our understanding of the gendered agrarian component of FTLRP by locating gender within the political economy of the agrarian reform and by evaluating gender in relation to the capitalist accumulation structure which the land reform sought to alter.
Updates on Guidelines for Mobile Health Applications
Authors: Abts Natalie A. , Barnes Janey
Published: July 2021

The prevalence of mobile health (mHealth) applications has already been on a steady upswing, and home health considerations are being influenced by other factors such as the global COVID-19 pandemic. It is more critical now than ever before that mHealth is well-designed, user-centered, and, even when apps are unregulated, meet a minimum set of requirements to be considered acceptable. There has been an ongoing industry effort to establish these minimum requirements so that developers have a consolidated reference point. Through efforts by a working group and topic domain teams, this set of Guidelines has been iterated and improved over the past several years. The domain team for the Usability portion of the Guidelines set out make the requirements practical, actionable, and measurable throughout the app development process.
In Situ Interprofessional Simulation in the Congenital Cardiac Intensive Care Unit Using the PEARLS Framework for Systems Integration
Authors: Parker Amy , Rice Amy , Cohen Tara , Berndsen Nicole , Wong Robert , Kim Rick , Barnum Jeffery , Metcalfe Smith Russell , Nawathe Pooja
Published: July 2021

We developed an in-situ interprofessional simulation program to study system factors to establish a congenital cardiac arrest activation tree and test it using human factors engineering principles. We used the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model to understand the structure, processes, and outcomes related to the congenital cardiac arrest activation tree (CCCAT) and discuss the Promoting Excellence and Reflective Learning in Simulation (PEARLS) for systems integration framework for our systems focused debriefing (SFD).
LinkIt: A Tool for Assessing and Providing Formative Feedback for Structural Knowledge
Authors: Branaghan Russell J. , Schvaneveldt Roger W. , Winner Jennifer L.
Published: July 2021

It is challenging to assess the effectiveness of learning and training. Most evaluators rely on multiple choice, fill-in-the-blank, and essay questions. These are time-consuming, provide little formative value, and provide no visualization of the knowledge domain. LinkIt uses constrained concept mapping to elicit, score, represent visually, and provide immediate feedback on student knowledge networks by comparing them to expert networks.
Considerations for Translating Medical Devices Under Development From the Clinic to the Home: A Case Study in Providing Chronic Wound Care
Authors: Bass Ellen J. , Sefcik Justine S. , McLaurin Elease , DiMaria-Ghalili Rose Ann
Published: July 2021

A prototype medical device and protocol that work well in a clinic would not necessarily work reliably in the home setting. The goal of this work is to identify factors to consider when translating a device evaluated in a clinic for use by home caregivers providing chronic wound care for persons living with dementia. One must consider the current device, the associated bundle, the protocol and how they may need to be modified. Semi-structured interviews with the research assistants who have applied a prototype device were conducted to generate a list of known issues with the current clinical protocol in terms of ultrasound application The researchers performed a set of specified tasks by following the current device protocol and explaining any difficulties with use\execution. They embellished the descriptions with details about what had happened with actual patients in the clinic. Using thematic analysis, analysts identified themes and subthemes. Issues potentially relevant to translating medical devices to the home are discussed.
Exploring Older Adults’ Internalizations And Misconceptions Regarding Antihypertensive Medication Management
Authors: Blocker Kenneth A. , Rogers Wendy A.
Published: July 2021

Hypertension, or high blood pressure, is an asymptomatic cardiovascular condition common with increasing age that must be controlled with proper management behaviors, such as adherence to prescribed antihypertensive medications. Unfortunately, older adults may struggle with consistent and effective management of this medication specifically and the disease generally, which can lead to poorer health outcomes. The goal of the study was to investigate older adults’ antihypertensive medication management using the Illness Representation Model as a lens to identify potential misconceptions that may contribute to medication management. We conducted semi-structured interviews with 40 older adults regarding management routines, hypertension knowledge, perceived nonadherence contributors, and perspectives related to their illness. We identified numerous misconceptions regarding hypertension knowledge, disease severity, as well as perceived adherence performance that may contribute to challenges older adults face with maintaining antihypertensive medication adherence. Moreover, these findings inform the need for and design of effective educational tools for improving antihypertensive medication adherence.
Exploring the Differences in Macrocognition Between Experts and Non-CHD Experts Managing Congenital Heart Disease (CHD)
Authors: Assadi Azadeh , Laussen Peter C. , Trbovich Patricia
Published: July 2021

Background and aims: Children with congenital heart disease (CHD) are at risk of deterioration in the face of common childhood illnesses, and their resuscitation and acute management is often best achieved with the guidance of CHD experts. Access to such expertise may be limited outside specialty heart centers and the fragility of these patients is cause for discomfort among many emergency medicine physicians. An understanding of the differences in macrocognition of these clinicians could shed light on some of the causes of discomfort and facilitate the development of a sociotechnological solution to this problem. Methods: Cardiac intensivists (CHD experts) and pediatric emergency medicine physicians (non-CHD experts) in a major academic cardiac center were interviewed using the critical decision method. Interview transcripts were coded deductively based on Klein’s macrocognitive framework and inductively to allow for new or modified characterization of dimensions. Results: While both CHD-experts and non-CHD experts relied on the macrocognitive functions of sensemaking, naturalistic decision making and detecting problems, the specific data and mental models used to understand the patients and course of therapy differed between CHD-experts and non-CHD experts. Conclusion: Characterization of differences between the macrocognitive processes of CHD experts and non-CHD experts can inform development of sociotechnological solutions to augment decision making pertaining to the acute management of pediatric CHD patients.
The Case for Human-Centered Research on the Complex Patient Journey of Deprescribing
Authors: Hill Jordan R. , Russ-Jara Alissa L. , Campbell Noll L. , Holden Richard J.
Published: July 2021

Current models of the deprescribing process are largely clinician driven and limited to a single point in time. Our objective with this work was to investigate the effects of these existing models on interventions targeting older adults. Studies identified in an existing systematic literature review were examined and classified in terms of who within the deprescribing process the intervention targeted (target classification) and when in the process they were targeted (temporal classification). It was found that the vast majority of interventions targeted clinicians and focused on actions taken before or during the deprescribing touchpoint. Additionally, older adults with dementia and their caregivers were often excluded from these studies. We argue that the deprescribing process needs to be reframed as a patient journey that unfolds over time in order to address these gaps.
Race, School Discipline, and Magnet Schools
Authors: Kitchens Karin , Brodnax NaLette
Published: July 2021

School environment plays an important role in student outcomes. Increasingly, research has also highlighted the role school environment plays in the White–Black suspension gap. We test whether magnet schools reduce the White–Black suspension gap using data from Tulsa Public Schools. Using student-level and incident-level data from Tulsa, Oklahoma, we explore whether Black students receive exclusionary discipline at lower rates in magnet schools than in traditional schools compared with White students. Using matching techniques to minimize selection bias, we find that magnet schools in Tulsa are associated with a reduction in the racial suspension gap. In magnet schools in Tulsa, we do not find a racial gap in severity of incident or days assigned.
Using an ICU Diary to Communicate With Family Members of COVID-19 Patients in ICU: A Case Report
Authors: Haruna Junpei , Tatsumi Hiroomi , Kazuma Satoshi , Kuroda Hiromitsu , Goto Yuya , Aisaka Wakiko , Terada Hirofumi , Masuda Yoshiki
Published: July 2021

Visitation restrictions for family members are problematic in intensive care management due to the COVID-19 pandemic. We analyzed the usefulness of an intensive care unit (ICU) diary about the experiences of family members of critical COVID-19 patients. Four family members of 2 COVID-19 patients participated in this report. Both patients were transferred to our ICU after 2 weeks of treatment at another ICU. An ICU diary was given to their family members post-transfer. The family members were interviewed before and after the patients’ discharge; the recorded interviews were analyzed and categorized into several clusters using a text mining method. Five categories regarding their anxious feelings were classified before the use of the ICU diary, and 3 categories were based on their positive feelings after the use of the ICU diary. Intensive care unit diaries may be beneficial for disclosing patients’ information when visitation restrictions are exercised due to the COVID-19 pandemic.
CEBPA mutations in 4708 patients with acute myeloid leukemia: differential impact of bZIP and TAD mutations on outcome
Authors: Taube Franziska , Georgi Julia Annabell , Kramer Michael , Stasik Sebastian , Middeke Jan Moritz , Röllig Christoph , Krug Utz , Krämer Alwin , Scholl Sebastian , Hochhaus Andreas , Brümmendorf Tim H. , Naumann Ralph , Petzold Andreas , Mulet-Lazaro Roger , Valk Peter J. M. , Steffen Björn , Einsele Hermann , Schaich Markus , Burchert Andreas , Neubauer Andreas , Schäfer-Eckart Kerstin , Schliemann Christoph , Krause Stefan W. , Hänel Mathias , Noppeney Richard , Kaiser Ulrich , Baldus Claudia D. , Kaufmann Martin , Herold Sylvia , Stölzel Friedrich , Sockel Katja , von Bonin Malte , Müller-Tidow Carsten , Platzbecker Uwe , Berdel Wolfgang E. , Serve Hubert , Ehninger Gerhard , Bornhäuser Martin , Schetelig Johannes , Thiede Christian ,   for the Study Alliance Leukemia (SAL)
Published: July 2021

Biallelic mutations of the CEBPA gene (CEBPAbi) define a distinct entity associated with favorable prognosis; however, the role of monoallelic mutations (CEBPAsm) is poorly understood. We retrospectively analyzed 4708 adults with acute myeloid leukemia (AML) who had been recruited into the Study Alliance Leukemia trials, to investigate the prognostic impact of CEBPAsm. CEBPA mutations were identified in 240 patients (5.1%): 131 CEBPAbi and 109 CEBPAsm (60 affecting the N-terminal transactivation domains [CEBPAsmTAD] and 49 the C-terminal DNA-binding or basic leucine zipper region [CEBPAsmbZIP]). Interestingly, patients carrying CEBPAbi or CEBPAsmbZIP shared several clinical factors: they were significantly younger (median, 46 and 50 years, respectively) and had higher white blood cell (WBC) counts at diagnosis (median, 23.7 × 109/L and 35.7 × 109/L) than patients with CEBPAsmTAD (median age, 63 years, median WBC 13.1 × 109/L; P < .001). Co-mutations were similar in both groups: GATA2 mutations (35.1% CEBPAbi; 36.7% CEBPAsmbZIP vs 6.7% CEBPAsmTAD; P < .001) or NPM1 mutations (3.1% CEBPAbi; 8.2% CEBPAsmbZIP vs 38.3% CEBPAsmTAD; P < .001). CEBPAbi and CEBPAsmbZIP, but not CEBPAsmTAD were associated with significantly improved overall (OS; median 103 and 63 vs 13 months) and event-free survival (EFS; median, 20.7 and 17.1 months vs 5.7 months), in univariate and multivariable analyses. Additional analyses revealed that the clinical and molecular features as well as the favorable survival were confined to patients with in-frame mutations in bZIP (CEBPAbZIP-inf). When patients were classified according to CEBPAbZIP-inf and CEBPAother (including CEBPAsmTAD and non-CEBPAbZIP-inf), only patients bearing CEBPAbZIP-inf showed superior complete remission rates and the longest median OS and EFS, arguing for a previously undefined prognostic role of this type of mutation.
CACNA1A-p.Thr501Met mutation associated with familial hemiplegic migraine: a family report
Authors: Romozzi Marina , Primiano Guido , Rollo Eleonora , Travaglini Lorena , Calabresi Paolo , Servidei Serenella , Vollono Catello
Published: July 2021

Background and aims

Hemiplegic migraine (HM) is a rare form of migraine characterized by the presence of a motor and other types of aura. HM can be sporadic or familial. Familial hemiplegic migraine (FHM) is an autosomal dominant disorder, classified into 3 subtypes, based on the gene involved (CACNA1A in FHM1, ATP1A2 in FHM2 and SCN1A in FHM3). The clinical presentation is highly heterogeneous and some attacks may be severe.

We report the clinical characteristics and genetic analysis of 12 patients belonging to a family with CACNA1A-p.Thr501Met gene mutation.

Methods

We screened for mutations in CACNA1A gene 15 patients belonging to the same family. The exonic sequences of CACNA1A were analyzed using a Tru-seq® Custom Amplicon (TSCA) (Illumina Inc., San Diego, CA) targeted capture and paired end library kit. Sanger sequencing was used to confirm CACNA1A variants and segregation analysis.

Results

CACNA1A-p.Thr501Met mutation was found in 12 of the 15 patients screened, which was compatible with the diagnosis of FHM1.

Attacks of hemiplegic migraine were reported by 10 of the 12 subjects (83.33%). Only one subject developed persistent mild cerebellar symptoms and none of the subjects developed cerebellar atrophy.

Discussion

The variant p.Thr501Met was described previously in association with episodic ataxia and rarely with FHM related to cerebellar symptoms. FHM1 has a broad clinical spectrum and about half of the families have cerebellar involvement. In our study, only one patient developed persistent cerebellar deficits.

These data suggest that CACNA1A-p.Thr501Met mutation can occur prevalently as hemiplegic migraine.
Combination chemoradiotherapy with temozolomide, vincristine, and interferon-β might improve outcomes regardless of O6-methyl-guanine-DNA-methyltransferase (MGMT) promoter methylation status in newly glioblastoma
Authors: Asano Kenichiro , Fumoto Toshio , Matsuzaka Masashi , Hasegawa Seiko , Suzuki Naoya , Akasaka Kenichi , Katayama Kosuke , Kamataki Akihisa , Kurose Akira , Ohkuma Hiroki
Published: July 2021

Background

This investigator-initiated, open-label, single-arm, single-institute study was conducted to investigate the effectiveness of induction combination chemoradiotherapy and long-term maintenance therapy with temozolomide (TMZ) plus interferon (IFN)-β for glioblastoma.

Methods

The initial induction combination chemoradiotherapy comprised radiotherapy plus TMZ plus vincristine plus IFN-β. Maintenance chemotherapy comprised monthly TMZ, continued for 24–50 cycles, plus weekly IFN-β continued for as long as possible. The primary endpoint was 2-year overall survival (2y-OS). The study protocol was to be considered valid if the expected 2y-OS was over 38% and the lower limit of the 95% confidence interval (CI) was no less than 31.7% compared with historical controls, using Kaplan-Meier methods. Secondary endpoints were median progression-free survival (mPFS), median OS (mOS), 5-year OS rate (5y-OS), and mPFS and mOS classified according to MGMT promoter methylation status.

Results

Forty-seven patients were analyzed. The 2y-OS was 40.7% (95%CI, 27.5–55.4%). The mPFS and mOS were 11.0 months and 18.0 months, respectively, and 5y-OS was 20.3% (95%CI, 10.9–34.6%). The mPFS in groups with and without MGMT promoter methylation in the tumor was 10.0 months and 11.0 months (p = 0.59), respectively, and mOS was 24.0 months and 18.0 months (p = 0.88), respectively. The frequency of grade 3/4 neutropenia was 19.1%.

Conclusions

The 2y-OS with induction multidrug combination chemoradiotherapy and long-term maintenance therapy comprising TMZ plus IFN-β tended to exceed that of historical controls, but the lower limit of the 95%CI was below 31.7%. Although the number of cases was small, this protocol may rule out MGMT promoter methylation status as a prognostic factor.

Trial registration

University Hospital Medical Information Network (number UMIN000040599).
Cancer cell line microarray as a novel screening method for identification of radioresistance biomarkers in head and neck squamous cell carcinoma
Authors: Routila Johannes , Suvila Karri , Grénman Reidar , Leivo Ilmo , Westermarck Jukka , Ventelä Sami
Published: July 2021

Background

Currently, no clinically useful biomarkers for radioresistance are available in head and neck squamous cell carcinoma (HNSCC). This study assesses the usefulness of Cell Line Microarray (CMA) method to enhance immunohistochemical screening of potential immunohistochemical biomarkers for radioresistance in HNSCC cell lines.

Methods

Twenty-nine HNSCC cell lines were cultured, cell pellets formalin-fixed, paraffin-embedded, and arrayed. Radioresistance features of the cell lines were combined to immunohistochemical stains for p53, NDFIP1, EGFR, stem cell marker Oct4, and PP2A inhibitor CIP2A.

Results

Expression of p53, EGFR or CIP2A did not indicate intrinsic radioresistance in vitro. Stem cell marker Oct4 nuclear positivity and NDFIP1 nuclear positivity was correlated with increased intrinsic radioresistance.

Conclusion

The usefulness of CMA in analysis of HNSCC cell lines and discovery of biomarkers is demonstrated. CMA is very well adapted to both testing of antibodies in a large panel of cell lines as well as correlating staining results with other cell line characteristics. In addition, CMA-based antibody screening proved an efficient and relatively simple method to identify potential radioresistance biomarkers in HNSCC.
Perceptions, emotional reactions and needs of adolescent psychiatric inpatients during the COVID-19 pandemic: a qualitative analysis of in-depth interviews
Authors: Giannakopoulos George , Mylona Savvina , Zisimopoulou Anastasia , Belivanaki Maria , Charitaki Stella , Kolaitis Gerasimos
Published: July 2021

Background

The new coronavirus pandemic (COVID-19) has been accompanied by severe psychological pressure on the entire population. However, little is known about how this pandemic could affect the more vulnerable population with severe mental illness.

Aims

To explore adolescent psychiatric inpatients’ perceptions, emotional reactions and needs during the first wave of the COVID-19 pandemic.

Methods

Individual in-depth interviews were conducted with nine psychiatric inpatients aged 12–17 years. Through open-ended questions, interviewers initiated five themes: (a) knowledge about coronavirus pandemic, (b) changes in everyday routine due to the pandemic, (c) adolescents’ feelings about the pandemic, (d) adolescents’ positive thoughts and behaviors, and (e) how the social environment can help adolescents deal with the pandemic-related situation. A thematic analysis was conducted using line-by-line open coding.

Results

Regarding their knowledge of the impact of the current pandemic, almost all adolescents focused on information about the nature of coronavirus and on existing crisis management practices. Almost all patients identified predominantly negative changes due to the quarantine state, including restrictions on both social life and personal freedom as well as excessive contact with family members during home isolation. As far as their emotions were concerned, adolescents did acknowledge anxiety about self-harm and harming their loved ones as well as mood swings within the family nucleus; anxiety was also manifested about the unknown and the management of the pandemic in other countries. Avoidance of thought rumination about the coronavirus and its consequences, positive thinking and looking towards the future were reported as constructive strategies for coping with challenging emotions. Additionally, a sense of belongingness seems to have been playing a pivotal role in the adolescents coping strategies. Trust in the authorities and the community was another quite noteworthy point that emerged during the interviews. Lastly, our findings indicated adolescents’ benefit from receiving balanced health messaging coupled with balanced thinking within their social and family environment.

Conclusions

Enhanced comprehension of possible mediating psychological pathways is needed to help clinicians, researchers, and decision-makers to avert the deterioration of mental disorders and overall functioning, as well as additional stress-related disorders.
Mental health and wellbeing coordinators in primary schools to support student mental health: protocol for a quasi-experimental cluster study
Authors: Darling S. , Dawson G. , Quach J. , Smith R. , Perkins A. , Connolly A. , Smith A. , Moore C. L. , Ride J. , Oberklaid F.
Published: July 2021

Background

Half of mental health disorders begin before the age of 14, highlighting the importance of prevention and early-intervention in childhood. Schools have been identified globally by policymakers as a platform to support good child mental health; however, the majority of the research is focused on secondary schools, with primary schools receiving very little attention by comparison. The limited available evidence on mental health initiatives in primary schools is hindered by a lack of rigorous evaluation. This quasi-experimental cluster study aims to examine the implementation and effectiveness of a Mental Health and Wellbeing Co-ordinator role designed to build mental health capacity within primary schools.

Methods

This is a primary (ages 5–12) school-based cluster quasi-experimental study in Victoria, Australia. Before baseline data collection, 16 schools selected by the state education department will be allocated to intervention, and another 16 matched schools will continue as ‘Business as Usual’. In intervention schools, a mental health and well-being coordinator will be recruited and trained, and three additional school staff will also be selected to receive components of the mental health training. Surveys will be completed by consenting staff (at 2-, 5-, 10- and 17-months post allocation) and by consenting parents/carers (at 3-, 10- and 17-months post allocation) in both intervention and business as usual schools. The primary objective is to assess the change in teacher’s confidence to support student mental health and wellbeing using the School Mental Health Self-Efficacy Teacher Survey. Secondary objectives are to assess the indirect impact on systemic factors (level of support, prioritisation of child mental health), parent and teachers’ mental health literacy (stigma, knowledge), care access (school engagement with community-based services), and student mental health outcomes. Implementation outcomes (feasibility, acceptability, and fidelity) and costs will also be evaluated.

Discussion

The current study will examine the implementation and effectiveness of having a trained Mental Health and Wellbeing Coordinator within primary schools. If the intervention increases teachers’ confidence to support student mental health and wellbeing and builds the capacity of primary schools it will improve student mental health provision and inform large-scale mental health service reform.

Trial registration

The trial was retrospectively registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) on July 6, 2021. The registration number is ACTRN12621000873820.
Preprints in times of COVID19: the time is ripe for agreeing on terminology and good practices
Authors: Ravinetto Raffaella , Caillet Céline , Zaman Muhammad H. , Singh Jerome Amir , Guerin Philippe J. , Ahmad Aasim , Durán Carlos E. , Jesani Amar , Palmero Ana , Merson Laura , Horby Peter W. , Bottieau E. , Hoffmann Tammy , Newton Paul N.
Published: July 2021

Over recent years, the research community has been increasingly using preprint servers to share manuscripts that are not yet peer-reviewed. Even if it enables quick dissemination of research findings, this practice raises several challenges in publication ethics and integrity. In particular, preprints have become an important source of information for stakeholders interested in COVID19 research developments, including traditional media, social media, and policy makers. Despite caveats about their nature, many users can still confuse pre-prints with peer-reviewed manuscripts. If unconfirmed but already widely shared first-draft results later prove wrong or misinterpreted, it can be very difficult to “unlearn” what we thought was true. Complexity further increases if unconfirmed findings have been used to inform guidelines. To help achieve a balance between early access to research findings and its negative consequences, we formulated five recommendations: (a) consensus should be sought on a term clearer than ‘pre-print’, such as ‘Unrefereed manuscript’, “Manuscript awaiting peer review” or ‘’Non-reviewed manuscript”; (b) Caveats about unrefereed manuscripts should be prominent on their first page, and each page should include a red watermark stating ‘Caution—Not Peer Reviewed’; (c) pre-print authors should certify that their manuscript will be submitted to a peer-review journal, and should regularly update the manuscript status; (d) high level consultations should be convened, to formulate clear principles and policies for the publication and dissemination of non-peer reviewed research results; (e) in the longer term, an international initiative to certify servers that comply with good practices could be envisaged.