bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring expectations and perceptions of different manual therapy techniques in chronic low back pain: a qualitative study
Authors: Plank A. , Rushton A. , Ping Y. , Mei R. , Falla D. , Heneghan N. R.
Published: May 2021

Background

Chronic low back pain (CLBP) prevalence has steadily increased over the last two decades. Manual therapy (MT) is recommended within a multimodal management approach to improve pain and disability although evidence investigating the patients’ experience of MT is scarce.

Objective

To explore expectations and perceptions of MT techniques in people with CLBP.

Methods

A qualitative study embedded sequential to an experimental trial using semi-structured interviews (SSI) explored participants’ experiences of thrust, non-thrust and sham technique. Purposive sampling enabled variance in age and CLBP duration. An evidence informed topic guide was used. Data were analysed using thematic analysis (TA). Respondent validation and peer debriefing enhanced trustworthiness. The Consolidating Criteria for Reporting Qualitative Studies (COREQ) reported methodological rigour.

Findings

Ten participants (50% male) with a mean age of 29.1 years (Standard Deviation (SD): 7.9, range: 19–43), a mean pain intensity of 4.5 on a Numeric Rating Scale (NRS) 0–10 (SD: 1.5, range: 2–7), a mean Oswestry Disability Score (ODI) of 9 (SD: 4.6, range: 2–17) and a mean Tampa Scale of Kinesiophobia (TSK) score of 38.6 (SD: 4.8, range: 30–45) participated. Four themes were identified: understanding of pain; forming expectations; perception of care; re-evaluation of body awareness and management. Understanding of CLBP is formed by an individuals’ pain perception and exchange with social environment. This, combined with communication with physiotherapist influenced expectations regarding the MT technique.

Conclusion

Expectations for MT were formed by an individual’s social environment and previous experience. A treatment technique is perceived as positive if its characteristics are aligned with the individual’s understanding of pain and if care is delivered in an informative and reassuring manner.
Does posterior configuration have similar strength as parallel configuration for treating comminuted distal humerus fractures? A cadaveric biomechanical study
Authors: Shih Chien-An , Kuan Fa-Chuan , Hsu Kai-Lan , Hong Chih-Kai , Lin Cheng-Li , Yeh Ming-Long , Su Wei-Ren
Published: May 2021

Background

The posterior plating technique could be used as a clinical alternative to parallel plating for treating comminuted distal humerus fractures (DHFs) successfully with good clinical results. However, the biomechanical characteristics for posterior fixation are still unclear. The purpose of this study is to evaluate the biomechanical properties of the posterior fixation and to make comparisons between the parallel and the posterior fixation systems.

Materials and methods

We performed a cadaveric biomechanical testing with two posterior plating systems (a posterior two plating and a single posterior pre-contoured Y plating system) and one parallel two plating system to treat AO/OTA type-C2.3 DHFs. Among three groups, we compared construct stiffness, failure strength, and intercondylar width changes after 5000-cycle fatigue loading and failure loads and failure modes after destructive tests in both the axial compression and (sagittal) posterior bending directions. The correlations between construct failure loads and bone marrow density (BMD) were also compared.

Results

In axial direction, there were no significant differences in the stiffness and failure load between the posterior and the parallel constructs. However, in sagittal direction, the two-plate groups (posterior two plating and parallel plating group) had significant higher stiffness and failure loads than the one-plate group (single posterior Y plating). There was no fixation failure after 5000-cyclic loading in both directions for all groups. Positive correlation was noted between BMD and failure loads on parallel fixation.

Conclusions

We found that when using two plates for treating comminuted DHFs, there were no significant differences in terms of most biomechanical measurements between posterior and parallel fixation. However, the single pre-contoured posterior Y plate construct was biomechanically weaker in the sagittal plane than the parallel and the posterior two-plate constructs, although there was no fixation failure after the fatigue test for all groups regardless of the fixation methods.

Level of evidence

Biomechanical study
Translation of oncology multidisciplinary team meeting (MDM) recommendations into clinical practice
Authors: Vinod Shalini K. , Wellege Nisali T. , Kim Sara , Duggan Kirsten J. , Ibrahim Mirette , Shafiq Jesmin
Published: May 2021

Background

Multidisciplinary team meeting (MDM) processes differ according to clinical setting and tumour site. This can impact on decision making. This study aimed to evaluate the translation of MDM recommendations into clinical practice across solid tumour MDMs at an academic centre.

Methods

A retrospective audit of oncology records was performed for nine oncology MDMs held at Liverpool Hospital, NSW, Australia from 1/2/17–31/7/17. Information was collected on patient factors (age, gender, country of birth, language, postcode, performance status, comorbidities), tumour factors (diagnosis, stage) and MDM factors (number of MDMs, MDM recommendation). Management was audited up to a year post MDM to record management and identify reasons if discordant with MDM recommendations. Univariate and multivariable regression analyses were performed to assess for factors associated with concordant management.

Results

Eight hundred thirty-five patients were discussed, median age was 65 years and 51.4% were males. 70.8% of patients were presented at first diagnosis, 77% discussed once and treatment recommended in 73.2%. Of 771 patients assessable for concordance, management was fully concordant in 79.4%, partially concordant in 12.8% and discordant in 7.8%. Concordance varied from 84.5% for lung MDM to 97.6% for breast MDMs. On multivariable analysis, breast and upper GI MDMs and discussion at multiple MDMs were significantly associated with concordant management. The most common reason for discordant management was patient/guardian decision (28.3%).

Conclusion

There was variability in translation of MDM recommendations into clinical practice by tumour site. Routine measurement of implementation of MDM recommendations should be considered as a quality indicator of MDM practice.
Training for outbreak response through the Global Outbreak Alert and Response Network
Authors: Christensen Renee , Fisher Dale , Salmon Sharon , Drury Patrick , Effler Paul
Published: May 2021

For 20 years, the Global Outbreak Response and Alert Network (GOARN) has been a leader in the coordination of international outbreak response. On the premise that no single institution can provide all capacities required to successfully respond to a complex public health emergency or fulfil all outbreak response training needs, GOARN embarked on a capacity building journey that draws on the unique strengths of more than 250 partner institutions. Through extensive engagement and collaboration, GOARN Partners have created a bespoke, multifaceted, 3-tiered training programme which has evolved over the last 15 years and enhanced the competencies of thousands of multidisciplinary outbreak responders around the world.
Outcome of early stage Merkel carcinoma treated by exclusive radiation: a study of 53 patients
Authors: Dubois Manon , Abi Rached Henry , Escande Alexandre , Dezoteux Frédéric , Darloy Franck , Jouin Anaïs , Kyheng Maeva , Labreuche Julien , Dziwniel Véronique , Mirabel Xavier , Mortier Laurent
Published: May 2021

Purpose

Early stage Merkel cell carcinoma (MCC) is a rare and aggressive primary skin cancer. The standard of care for MCC is broad excision and adjuvant external beam radiation therapy (EBRT). However, for some patients, anesthesia is contraindicated, while others run the risk of serious aesthetic sequelae. In such cases, exclusive radiotherapy is an interesting alternative to surgery. Though limited data is available, this study evaluates exclusive radiotherapy for MCC, using data from the largest retrospective study to date.

Methods

All patients who were followed in our center between 1989 and 2019 for histologically proven early stage MCC were included in the study. They were treated either by surgery with a 2-cm clear margin followed by adjuvant radiotherapy (RT) or by exclusive RT. Survival rates with adjuvant and exclusive EBRT were analyzed using Cox model and Fine and Gray model depending on the type of survival. p value < 0.05 was considered significant.

Results

Eighty-four patients treated for MCC were included. Fifty-three of them (63.1%) were treated by exclusive RT, and 31 (36.9%) had surgical excision followed by adjuvant RT. Local relapse rate was 13.7% (95% CI 8.0–43.7) in the RT monotherapy group (group A) and 25.8% (95% CI 10.3–56.2) in the surgery + RT group (group B) (p = 0.42). No statistical difference was found for nodal relapse (p = 0.81), metastatic relapse (p = 0.10), disease free survival (p = 0.83) or overall survival (p = 0.98).

Conclusion

Our study suggests that exclusive radiotherapy for early Merkel cell carcinoma leads to a similar oncological outcome as combined treatment, with fewer aesthetic sequelae. The approach is interesting for elderly patients with comorbidities or patients for whom surgery would cause significant functional or aesthetic sequelae.
Presymptomatic treatment of classic late-infantile neuronal ceroid lipofuscinosis with cerliponase alfa
Authors: Schaefers J. , van der Giessen L. J. , Klees C. , Jacobs E. H. , Sieverdink S. , Dremmen M. H. G. , Spoor J. K. H. , van der Ploeg A. T. , van den Hout J. M. P. , Huidekoper H. H.
Published: May 2021

Background

Neuronal ceroid lipofuscinosis type 2 (CLN2 disease) is a rare rapidly progressive neurodegenerative disorder, resulting in early death. Intracerebroventricular enzyme replacement therapy (ERT) with cerliponase alfa is now available and has shown to delay disease progression in symptomatic patients. It is yet unknown if cerliponase alfa can prevent disease onset in presymptomatic patients.

Results

We evaluated the effect of 2 years of intracerebroventricular ERT in two siblings with CLN2 disease, one symptomatic (age 47 months) and one presymptomatic (age 23 months) at treatment start, using the CLN2 Clinical Rating Scale (CLN2 CRS), Gross Motor Function Measure-66 (GMFM-66) for motor function, Bayley Scales of Infant and Toddler Development, 3rd Edition, Dutch (BSID-III-NL) for neurocognitive development, brain MRI, and visual evoked potentials (VEP), electroretinogram (ERG) and retinoscopy for visual function. On the CLN2 CRS patient 1 showed a decline from 3 to 2 in the combined motor and language score due to regression in language use (CLN2 CRS total score after 2 years of treatment: 8), whereas a decline of 2 or more points in the combined motor and language score would be expected without treatment. Patient 2 retained the maximum score of 3 in all 4 subdomains (CLN2 CRS total score after 2 years of treatment: 12). The GMFM-66 total score declined from 46 to 39 in patient 1 and showed an age-appropriate increase from 66 to 84 in patient 2. Cognitive-developmental age decreased from 24 to 11 months in patient 1, whereas an increase in cognitive-developmental age from 21 to 39 months was seen in patient 2. Cerebral and cerebellar atrophy observed on MRI in patient 1 at age 42 months (before treatment) was not observed in patient 2 at age 48 months (after 2 years of treatment).

Conclusion

We show that cerliponase alfa is able to delay the onset of symptoms when treatment is started in a presymptomatic stage of CLN2 disease. Our results advocate the start of treatment at an early age before symptom onset, but should be confirmed in a larger cohort study.
Pathological drivers of neurodegeneration in suspected non-Alzheimer’s disease pathophysiology
Authors: Wisse L. E. M. , de Flores R. , Xie L. , Das S. R. , McMillan C. T. , Trojanowski J. Q. , Grossman M. , Lee E. B. , Irwin D. , Yushkevich P. A. , Wolk D. A. ,   on behalf of the Alzheimer’s Disease NeuroImaging Initiative
Published: May 2021

Background

Little is known about the heterogeneous etiology of suspected non-Alzheimer’s pathophysiology (SNAP), a group of subjects with neurodegeneration in the absence of β-amyloid. Using antemortem MRI and pathological data, we investigated the etiology of SNAP and the association of neurodegenerative pathologies with structural medial temporal lobe (MTL) measures in β-amyloid-negative subjects.

Methods

Subjects with antemortem MRI and autopsy data were selected from ADNI (n=63) and the University of Pennsylvania (n=156). Pathological diagnoses and semi-quantitative scores of MTL tau, neuritic plaques, α-synuclein, and TDP-43 pathology and MTL structural MRI measures from antemortem T1-weighted MRI scans were obtained. β-amyloid status (A+/A−) was determined by CERAD score and neurodegeneration status (N+/N−) by hippocampal volume.

Results

SNAP reflects a heterogeneous group of pathological diagnoses. In ADNI, SNAP (A−N+) had significantly more neuropathological diagnoses than A+N+. In the A− group, tau pathology was associated with hippocampal, entorhinal cortex, and Brodmann area 35 volume/thickness and TDP-43 pathology with hippocampal volume.

Conclusion

SNAP had a heterogeneous profile with more mixed pathologies than A+N+. Moreover, a role for TDP-43 and tau pathology in driving MTL neurodegeneration in the absence of β-amyloid was supported.
A mathematical model for the spread of COVID-19 and control mechanisms in Saudi Arabia
Authors: Bachar Mostafa , Khamsi Mohamed A. , Bounkhel Messaoud
Published: May 2021

In this work, we develop and analyze a nonautonomous mathematical model for the spread of the new corona-virus disease (COVID-19) in Saudi Arabia. The model includes eight time-dependent compartments: the dynamics of low-risk $S_{L}$

S
L

and high-risk $S_{M}$

S
M

susceptible individuals; the compartment of exposed individuals E; the compartment of infected individuals (divided into two compartments, namely those of infected undiagnosed individuals $I_{U}$

I
U

and the one consisting of infected diagnosed individuals $I_{D}$

I
D

); the compartment of recovered undiagnosed individuals $R_{U}$

R
U

, that of recovered diagnosed $R_{D}$

R
D

individuals, and the compartment of extinct Ex individuals. We investigate the persistence and the local stability including the reproduction number of the model, taking into account the control measures imposed by the authorities. We perform a parameter estimation over a short period of the total duration of the pandemic based on the COVID-19 epidemiological data, including the number of infected, recovered, and extinct individuals, in different time episodes of the COVID-19 spread.
Patient hematology during hospitalization for viral pneumonia caused by SARS-CoV-2 and non-SARS-CoV-2 agents: a retrospective study
Authors: Bai Bingke , Xu Zhe , Hu Yan , Qu Mengmeng , Cheng Juan , Luo Shengdong , Yao Zengtao , Gao Hongyan , Ma Yenv , Gao Rong , Hou Jun , Xin Shaojie , Mao Panyong
Published: May 2021

Background

Hematological comparison of coronavirus disease (COVID-19) and other viral pneumonias can provide insights into COVID-19 treatment.

Methods

In this retrospective case–control single-center study, we compared the data of 126 patients with viral pneumonia during different outbreaks [severe acute respiratory syndrome (SARS) in 2003, influenza A (H1N1) in 2009, human adenovirus type 7 in 2018, and COVID-19 in 2020].

Results

One of the COVID-19 characteristics was a continuous decline in the hemoglobin level. The neutrophil count was related to the aggravation of COVID-19 and SARS. Thrombocytopenia occurred in patients with SARS and severe COVID-19 even at the recovery stage. Lymphocytes were related to the entire course of adenovirus infection, recovery of COVID-19, and disease development of SARS.

Conclusions

Dynamic changes in hematological counts could provide a reference for the pathogenesis and prognosis of pneumonia caused by respiratory viruses in clinics.
A retrospective examination of care pathways in individuals with treatment-resistant depression
Authors: Day Elana , Shah Rupal , Taylor Rachael W. , Marwood Lindsey , Nortey Kimberley , Harvey Jade , McAllister-Williams R. Hamish , Geddes John R. , Barrera Alvaro , Young Allan H. , Cleare Anthony J. , Strawbridge Rebecca
Published: May 2021

Background

Individuals with treatment-resistant depression (TRD) experience a high burden of illness. Current guidelines recommend a stepped care approach for treating depression, but the extent to which best-practice care pathways are adhered to is unclear.

Aims

To explore the extent and nature of ‘treatment gaps’ (non-adherence to stepped care pathways) experienced by a sample of patients with established TRD (non-response to two or more adequate treatments in the current depressive episode) across three cities in the UK.

Method

Five treatment gaps were considered and compared with guidelines, in a cross-sectional retrospective analysis: delay to receiving treatment, lack of access to psychological therapies, delays to medication changes, delays to adjunctive (pharmacological augmentation) treatment and lack of access to secondary care. We additionally explored participant characteristics associated with the extent of treatment gaps experienced.

Results

Of 178 patients with TRD, 47% had been in the current depressive episode for >1 year before initiating antidepressants; 53% had received adequate psychological therapy. A total of 47 and 51% had remained on an unsuccessful first and second antidepressant trial respectively for >16 weeks, and 24 and 27% for >1 year before medication switch, respectively. Further, 54% had tried three or more antidepressant medications within their episode, and only 11% had received adjunctive treatment.

Conclusions

There appears to be a considerable difference between treatment guidelines for depression and the reality of care received by people with TRD. Future research examining representative samples of patients could determine recommendations for optimising care pathways, and ultimately outcomes, for individuals with this illness.
CAR T-Cell Therapy in Hematologic Malignancies: Clinical Role, Toxicity, and Unanswered Questions
Authors: Gill Saar , Brudno Jennifer N.
Published: May 2021

At the time of writing, five anti-CD19 CAR T-cell products are approved by the U.S. Food and Drug Administration for seven different indications in lymphoid malignancies, including B-cell non-Hodgkin lymphoma, pediatric B-cell acute lymphoblastic leukemia, and multiple myeloma. CAR T cells for chronic lymphocytic leukemia, acute myeloid leukemia, and less common malignancies such as T-cell lymphomas and Hodgkin lymphoma are being tested in early-phase clinical trials worldwide. The purpose of this overview is to describe the current landscape of CAR T cells in hematologic malignancies, outline their outcomes and toxicities, and explain the outstanding questions that remain to be addressed.
Taking Aim at the Undruggable
Authors: Coleman Niamh , Rodon Jordi
Published: May 2021

The term “undruggable” is used to describe a protein that is not pharmacologically capable of being targeted; recently, however, substantial efforts have been made to turn these proteins into “druggable” targets. Thus, “difficult to drug” or “yet to be drugged” are perhaps more appropriate terms. In cancer, a number of elusive targets fall into this category, including transcription factors such as STAT3, TP53, and MYC. Pharmacologically targeting these intractable proteins is now a key challenge of modern drug development, requiring innovation and the development of new technologies. In this article, we discuss some of the recent technologic and pharmacologic advances that have underpinned the erosion of the concept of undruggability. We describe recent successes in drugging the undruggable RAS ( KRAS G12C and HRAS), and discuss the advances that have led to the validation of further targets previously believed to be undruggable, such as HIF-2α, BCL-2, MDM2, and MLL. Finally, we look to the future and describe important advances that are likely to have a major impact on targeting undruggable targets, such as the advent of proteolysis-targeting chimeras and protein-protein modulators, which are leading to considerable excitement surrounding the development of cancer targets.
Very large-scale gap distances of atmospheric pressure dielectric barrier glow discharge using semiconductor materials
Authors: Wang Weiwei , Wang Xue , Fan Zhihui , Liu Feng , Wang Jingquan , Zhao Zhi , Han Haiyan , Huang Yanbin
Published: May 2021

Very large-scale gap distances of atmospheric pressure dielectric barrier discharge (DBD) in glow mode are obtained through semiconductor materials. The maximum value of the gap distance is up to 70 mm. Based on the feature of the cathode sheath, Auger neutralization theory, the trapped electron and the accumulated charge in the DBD system, the secondary electron emission is one of the primary reasons for very large-scale gap distances of the DBD to produce glow discharge. Furthermore, the contribution of the effective capacitance, the gas voltage and the discharge power are also discussed. Significant for the research are the development and the practical applications of atmospheric pressure glow discharge in the DBD with very large-scale gap distances.
Chlamydomonas FAP70 is a component of the previously uncharacterized ciliary central apparatus projection C2a
Authors: Hou Yuqing , Zhao Lei , Kubo Tomohiro , Cheng Xi , McNeill Nathan , Oda Toshiyuki , Witman George B.
Published: May 2021

Cilia are essential organelles required for cell signaling and motility. Nearly all motile cilia have a ‘9+2’ axoneme composed of nine outer doublet microtubules plus two central microtubules; the central microtubules together with their projections are termed the central apparatus (CA). In Chlamydomonas reinhardtii, a model organism for studying cilia, 30 proteins are known CA components, and ∼36 more are predicted to be CA proteins. Among the candidate CA proteins is the highly conserved FAP70 (CFAP70 in humans), which also has been reported to be associated with the doublet microtubules. Here, we determined by super-resolution structured illumination microscopy that FAP70 is located exclusively in the CA, and show by cryo-electron microscopy that its N-terminus is located at the base of the C2a projection of the CA. We also found that fap70-1 mutant axonemes lack most of the C2a projection. Mass spectrometry revealed that fap70-1 axonemes lack not only FAP70 but two other conserved candidate CA proteins, FAP65 (CFAP65 in humans) and FAP147 (MYCBPAP in humans). Finally, FAP65 and FAP147 co-immunoprecipitated with HA-tagged FAP70. Taken together, these data identify FAP70, FAP65 and FAP147 as the first defining components of the C2a projection.
Comparison of British Thyroid Association, American College of Radiology TIRADS and Artificial Intelligence TIRADS with histological correlation: diagnostic performance for predicting thyroid malignancy and unnecessary fine needle aspiration rate
Authors: Watkins Linda , O'Neill Greg , Young David , McArthur Claire
Published: May 2021

Objectives:

To compare diagnostic performance of British Thyroid Association (BTA), American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) and Artificial Intelligence TIRADS (AI-TIRADS) for thyroid nodule malignancy. To determine comparative unnecessary fine needle aspiration (FNA) rates.

Methods:

218 thyroid nodules with definitive histology obtained during 2017 were included. Ultrasound images were reviewed retrospectively in consensus by two subspecialist radiologists, blinded to histopathology, and nodules assigned a BTA, ACR-TIRADS and AI-TIRADS grade. Nodule laterality and size were recorded to allow accurate histopathological correlation and determine which nodules met criteria for FNA.

Results:

77 (35.3%) nodules were malignant. Deeming ultrasound Grade 4–5 as test-positive and 1–2 as test-negative, sensitivity and specificity for BTA was 98.28 and 42.55%, for ACR-TIRADS: 95.24 and 40.57% and for AI-TIRADS: 93.44 and 45.71%. FNA was indicated in 101 (71.6%), 67 (47.5%) and 65 (46.1%) benign nodules utilising BTA, ACR-TIRADS and AI-TIRADS respectively. The unnecessary FNA rate was significantly higher with BTA (46.3%) compared to ACR-TIRADS (30.7%) and AI-TIRADS (29.8%) p < 0.001.

Conclusion:

BTA, ACR-TIRADS and AI-TIRADS had similar diagnostic performance for predicting thyroid nodule malignancy with sensitivity >93% for all systems when considering ultrasound Grade 4–5 as malignant and Grade 1–2 as benign. ACR-TIRADS and AI-TIRADS both had a significantly lower rate of recommended FNA in benign nodules compared to BTA.

Advances in knowledge:

BTA, ACR-TIRADS and AI-TIRADS have comparable diagnostic performance with high sensitivity but relatively low specificity for predicting thyroid nodule malignancy in this cohort using histology as gold-standard. Using Grade 1–2 as benign and 4–5 as malignant there were more false negatives with TIRADS but this improved when taking other features into account while BTA had a significantly higher rate of unnecessary FNA.
Comparing the supine and erect pelvis radiographic examinations: an evaluation of anatomy, image quality and radiation dose
Authors: Flintham Kevin , Alzyoud Kholoud , England Andrew , Hogg Peter , Snaith Beverly
Published: May 2021

Objectives:

Pelvis radiographs are usually acquired supine despite standing imaging reflecting functional anatomy. We compared supine and erect radiographic examinations for anatomical features, radiation dose and image quality.

Methods:

60 patients underwent pelvis radiography in both supine and erect positions at the same examination appointment. Measures of body mass index and sagittal diameter were obtained. Images were evaluated using visual grading analysis and pelvic tilt was compared. Dose–area product values were recorded and inputted into the CalDose_X software to estimate effective dose (ED). The CalDose_X software allowed comparisons using data from the erect and supine sex-specific phantoms (MAX06 & FAX06).

Results:

Patient sagittal diameter was greater on standing with an average 20.6% increase at the iliac crest (median 30.0, interquartile range [26.0 to 34.0] cm), in comparison to the supine position [24.0 (22.3 to 28.0) cm; p < 0.001]. 57 (95%) patients had posterior pelvic tilt on weight-bearing. Erect image quality was significantly decreased with median image quality scores of 78% (69 to 85) compared to 87% for the supine position [81 to 91] (p < 0.001). In the erect position, the ED was 47% higher [0.17 (0.13 to 0.33) mSv vs 0.12 (0.08 to 0.18) mSv (p < 0.001)], influenced by the increased sagittal diameter. 42 (70%) patients preferred the standing examination.

Conclusion:

Patient diameter and pelvic tilt were altered on weightbearing. Erect images demonstrated an overall decrease in image quality with a higher radiation dose. Optimal acquisition parameters are required for erect pelvis radiography as the supine technique is not directly transferable.
The U.S. Food and Drug Administration’s role in improving radiation dose management for medical X-ray imaging devices
Authors: Miller Donald L. , Kakar Smita , Jiang Lu , Spelic David C. , Burk Laurel
Published: May 2021

The U.S. Food and Drug Administration (FDA) has been concerned with minimizing the unnecessary radiation exposure of people for half a century. Manufacturers of medical X-ray imaging devices are important partners in this effort. Medical X-ray imaging devices are regulated by FDA under both its electronic product regulations andits medical device regulations. FDA also publishes guidance documents that represent FDA’s current thinking on a topic and provide a suggested or recommended approach to meet the requirements of a regulation or statute. FDA encourages manufacturers to develop medical devices that conform to voluntary consensus standards. Use of these standards is a central element of FDA’s system to ensure that all medical devices marketed in the U.S. meet safety and effectiveness requirements. FDA staff participate actively in the development and maintenance of these standards, often advancing or introducing new safety and dose management requirements. Use of voluntary consensus standards reduces the amount of time necessary to evaluate a premarket submission and reduces the burden on manufacturers. FDA interacts with industry and other stakeholders through meetings with industry groups, public meetings, public communications, and through the development of voluntary consensus standards. In these interactions, FDA staff introduce new concepts for improving the safety of these devices and provide support for similar initiatives from professional organizations. FDA works with all stakeholders to achieve its mission of protecting and promoting the public health.
PRECURSORES ESQUECIDOS DO DIREITO E LITERATURA NOS ESTADOS UNIDOS: A HISTORICIDADE DOS PARADIGMAS DA EPISTEMOLOGIA JURÍDICA
Authors: Oliveira Amanda Muniz
Published: May 2021

Objetivo: Bucou-se demonstrar que, ao contrário do que frequentemente se afirma, o tema Direito e Literatura não começa a ser estudado nos Estados Unidos com a publicação de The Legal Imagination(em 1973). Procurou-se demonstrar quais os paradigmas epistemológicos vigentes em determinados períodos nas academias estadunidenses, responsáveis por permitir as aproximações e os distanciamentos entre as duas áreas. Buscou-se problematizar porque alguns autores estadunidenses são mencionados de forma mais recorrentes que outros.Metodologia: Partiu-se de uma revisão de literatura de textos escritos em língua inglesa e de análises empíricas documentais de diferentes fontes, como livros, artigos, ensaios e textos publicados em sites. Resultados: Foi possível identificar as relações de direito e literatura no início da república estadunidense, importantes para a construção da identidade nacional daquele país; a emergência do positivismo lógico como uma possível justificativa para a cisão entre as duas áreas; e a permanência de autores que, antes do marco inicial de 1973, continuaram a escrever, com origininalidade, sobre esta empreitada interdisciplinar. Contribuições: Levantaram-se problematizações a respeito do esquecimento de determinados autores e autoras da área, o que auxilia na compreensão da historicidade do direito e da literatura, em específico, e da própria epistemologia jurídica, em geral.
Growth and health status of Pangasionodon hypophthalmus reared under manipulated photoperiod conditions
Authors: Windarti Windarti , Amin Bintal , Simarmata Asmika H.
Published: May 2021

Background: In general, the length of photoperiod affects the physiology of Pangasionodon hypophthalmus. This study aimed to understand the growth and health status of this fish reared under manipulated photoperiods.

Methods: The study was conducted between June to August 2020[A1] . Three treatments were applied: control (natural photoperiod); 18 hours of darkness (18D6L; tanks were placed under a dark tarp tent for 18 hours); and 24 hours of darkness (24D0L; tanks were placed under a dark tarp tent continuously). Three replications were performed per treatment. At baseline, fish were approx. 7.5 cm  [A2] total length (TL) and 4 g body weight (BW), and were reared in circular plastic tanks (100 L; 30 fish/tank) with aerators and filters, and fed with commercial fish feed pellet (2 times/day to satiation). Fish growth and survival were studied once/week, and blood and tissue samples were taken at the end of the experiment (8 th week). Tissue was formalin fixed and HE stained.

Results: The survival of fish in all treatment was 100%. The fish reared in 24D0L and 18D6L grew better than control, achieving mean TL of 23 cm and BW of 98 g (control = 19 cm TL and 72 g BW). There was no difference in hematology condition or tissue structure between the three groups. Tissue structure of gill, kidney and liver were normal, but light abnormality due to parasites was present in the gill of fish reared in 24D0L. Blood samples for all three groups showed mean red blood cell count of 1,800,000 cells/ml and white blood cell (WBC) count of 55,200 cells/ml. WBC consisted of lymphocyte 65%, monocyte 24%, thrombocyte 6%, neutrophil 3%, eosinophil 1% and basophile 1%.

Conclusion: Data obtained indicate that a short photoperiod improves the growth of P. hypophthalmus fish and does not negatively affects their health.
Evidence for immunity to SARS-CoV-2 from epidemiological data series
Authors: Yubero Pablo , Lavin Alvar A. , Poyatos Juan F.
Published: May 2021

The duration of immunity to SARS-CoV-2 is uncertain. Delineating immune memory typically requires longitudinal serological studies that track antibody prevalence in the same cohort for an extended time. However, this information is needed in faster timescales. Notably, the dynamics of an epidemic where recovered patients become immune for any period should differ significantly from those of one where the recovered promptly become susceptible. Here, we exploit this difference to provide a reliable protocol that can estimate immunity early in an epidemic. We verify this protocol with synthetic data, discuss its limitations, and then apply it to evaluate human immunity to SARS-CoV-2 in mortality data series from New York City. Our results indicate that New York’s mortality figures are incompatible with immunity lasting anything below 105 or above 211 days (90% CI.), and set an example on how to assess immune memory in emerging pandemics before serological studies can be deployed.
Case Report: Spontaneous simultaneous coronary and carotid dissection in a young cannabis user
Authors: Ibn Hadj Amor Hassen , Touil Imen , Boukriba Seif , Bouchnak Skander , Kraiem Salma , Rouabhia Ramzi
Published: May 2021

Due to legalization of its consumption in some countries and its medical use as well as low toxic potential, cannabis remains the most widely used drug around the world and the rate of usage is only increasing. 

Nevertheless, there are several case reports of vascular complications following cannabis use even in young people without cardiovascular risk factors. We report the case of a cannabis smoker presenting to the emergency room for an ischemic stroke associated with an acute coronary syndrome related to a spontaneous simultaneous double dissection of the carotid artery and the left anterior descending artery, with a favourable outcome under medical treatment. This case shows the seriousness of complications due to the cannabis consumption, hence the need to limit or even prohibit its consumption.
The utility of an AMR dictionary as an educational tool to improve public understanding of antimicrobial resistance
Authors: Prapharsavat Ravikanya , Lim Cherry , Sunthornsut Pornpan , Wuthiekanun Vanaporn , Wongsantichon Jantana , Hanpithakpong Warunee , Sonthayanon Piengchan , Jaiyen Yanin , Jeeyapant Atthanee , Ekkapongpisit Maneerat , Bleho John , Chan Xin Hui S , Hernandez-Koutoucheva Anastasia , Ashley Elizabeth A. , Dance David A.B. , Bierhoff Marieke , Kittikongnapang Rattanasiri , Malathum Kumthorn , Kuduvalli Prasad N , Mathew Philip , Mathee Kalai , Kiatying-Angsulee Niyada , Sumpradit Nithima , Hsu Li Yang , Day Nicholas PJ , Cheah Phaik Yeong , Limmathurotsakul Direk
Published: May 2021

Background: Communicating about antimicrobial resistance (AMR) to the public is challenging.  

Methods: We developed a dictionary of terms commonly used to communicate about AMR. For each term, we developed learning points to explain AMR and related concepts in plain language.  We conducted a pilot evaluation in 374 high school students in Ubon Ratchathani, Thailand. In three 50-minute sessions, students were asked to answer five true/false questions using a paper-based questionnaire. The first session assessed their understanding of AMR at baseline, the second after searching the internet, and the third after the provision of the printed AMR dictionary and its web address.   

Results: We developed the AMR dictionary as a web-based application (www.amrdictionary.net). The Thai version of the AMR dictionary included 35 terms and associated learning points, seven figures displaying posters promoting AMR awareness in Thailand, and 66 recommended online videos. In the pretest, the proportion of correct responses to each question ranged from 10% to 57%; 10% of the students correctly answered that antibiotics cannot kill viruses and 57% correctly answered that unnecessary use of antibiotics makes them ineffective. After the internet searches, the proportions of correct answers increased, ranging from 62% to 89% (all p<0.001). After providing the AMR dictionary, the proportions of correct answers increased further, ranging from 79% to 89% for three questions (p<0.001), and did not change for one question (p=0.15). Correct responses as to whether taking antibiotics often has side-effects such as diarrhoea reduced from 85% to 74% (p<0.001). The dictionary was revised based on the findings and comments received.

Conclusions: Understanding of AMR among Thai high school students is limited. The AMR dictionary can be a useful supportive tool to increase awareness and improve understanding of AMR. Our findings support the need to evaluate the effectiveness of communication tools in the real-world setting.
The relationship between panic disorder and hypertension. A review of literature
Authors: Bladowski Maciej , Mazur Grzegorz , Małyszczak Krzysztof
Published: May 2021

Na nadciśnienie tętnicze choruje około 1/4 światowej populacji dorosłych. Ze względu na szerokie rozpowszechnienie, wpływ na śmiertelność i powodowane koszty socjoekonomiczne, ważne jest poszukiwanie modyfikowalnych przyczyn rozwoju tej choroby. W pracy tej został przeprowadzony przegląd piśmiennictwa w poszukiwaniu odpowiedzi na pytanie, czy w populacji dorosłych pacjentów (≥18r.ż) chorujących na nadciśnienie tętnicze częściej występuje zaburzenie lękowe z napadami lęku, niż w populacji ogólnej?
W przeglądzie literatury znaleziono 10 badań przekrojowych opisujących związek pomiędzy nadciśnieniem tętniczym, a zespołem lęku panicznego. Iloraz szans współchorobowości tych dwóch jednostek chorobowych wynosił między OR = 3,31 (2,99-3,67), a AOR 1,19 (0,87–1,62). Natomiast częstość współwystępowania wahała się od 4,2%, do 18,75%. W badaniach prospektywnych wykazano zależność między zaburzeniem lękowym z napadami lęku, a następczym rozwinięciem się nadciśnienia tętniczego w ciągu życia jako OR= 1,7 (1,4–2,0). Z drugiej strony ryzyko rozwinięcia się zaburzenia lękowego z napadami lęku u badanych z nadciśnieniem tętniczym w czasie 12-miesięcznej obserwacji wynosiło OR= 3,23 (1,51–6,93), a z 3-letnim okresem obserwacji było nieistotne statystycznie OR= 1,12 (0,80–1,57). Na podstawie przeglądu literatury, ze względu na różnice w metodologii oraz małą ilość badań prospektywnych można jedynie sugerować klinicystom, by w niektórych przypadkach poszukiwali zaburzeń lękowych z napadami lęku u pacjentów z nadciśnieniem tętniczym, szczególnie przy obserwacji niekontrolowanych i krótkotrwałych wzrostów ciśnienia tętniczego.
Mental health of patients suffering from connective tissue diseases. Negative and positive concept and selected correlates
Authors: Zabłocka-Żytka Lidia , Wiśniewski Michał
Published: May 2021

Cel pracy

Celem badań była ocena zdrowia psychicznego, zarówno w ujęciu negatywnym, czyli obecność zaburzeń, jak i pozytywnym- dobrostan osób chorujących na choroby tkanki łącznej. Ze względu na specyfikę chorób tkanki łącznej, m.in. ich nieprzewidywalny przebieg, często towarzyszący pacjentom ból do analiz włączono wybrane zmienne kliniczne oraz socjodemograficzne.

Metoda

W badaniu wzięło udział 101 osób, w tym 81 kobiet i 20 mężczyzn w wieku od 18 do 57 lat chorujących na różne choroby tkanki łącznej. Część osób wypełniało kwestionariusze podczas spotkania grup wsparcia (38, 6%), pozostałe z wykorzystaniem Internetu. Wykorzystano kwestionariusz HADS-M do badania wskaźników zdrowia psychicznego w ujęciu negatywnym, Kwestionariusz PERMA-Profil do oceny dobrostanu (wskaźnik zdrowia psychicznego w ujęciu pozytywnym) oraz ankietę własną dotyczącą danych klinicznych i socjodemograficznych.

Wyniki

Badani chorujący na choroby tkanki łącznej charakteryzują się wysokim nasileniem objawów lęku i depresji. Zaobserwowano związki między zdrowiem psychicznym a wybranymi zmiennymi klinicznymi i socjodemograficznymi np. większy ból wiąże się z wyższymi wskaźnikami lęku i depresji oraz niższym dobrostanem; z wiekiem zwiększa się dobrostan.

Wnioski

Istotne jest monitorowanie zdrowia psychicznego osób przewlekle chorujących somatycznie, w tym na choroby tkanki łącznej, szczególnie osób młodych, w początkowym okresie choroby, odczuwających silny ból, mieszkańców wsi i małych miejscowości, gdzie ograniczony jest dostęp wsparcia.
Mediating effect of coping strategies on the relation between social support and depressive symptoms among patients after cardiac transplantation
Authors: Milaniak Irena , Wilczek Rużyczka Ewa , Przybyłowski Piotr
Published: May 2021

Cel pracy

Celem niniejszego badania była ocena roli różnego rodzaju strategii radzenia sobie jako czynnika pośredniczącego pomiędzy wsparciem społecznym a symptomami depresji wśród pacjentów po przeszczepieniu serca

Metoda

W badaniu udział wzięło 123 pacjentów po przeszczepieniu serca. Wszyscy uczestnicy badania wypełnili kwestionariusze samooceny z użyciem następujących standaryzowanych narzędzi: skróconej wersji Skali Depresji Becka (Beck Depression Inventory Short Form, BDI SF), Berlińskich Skali Wsparcia Społecznego (Berlin Social Support Scales, BSSS) oraz Wielowymiarowego Inwentarza do Pomiaru Radzenia Sobie ze Stresem (Coping Orientation to Problems Experienced, skrócona wersja COPE).

Wyniki

Wyniki pokazały, że w odniesieniu do obecności symptomów depresji, aktualnie otrzymywane wsparcie społeczne oraz spostrzegane dostępne wsparcie społeczne (zarówno emocjonalne, jak i instrumentalne) okazały się mieć istotny bezpośredni wpływ. Strategie radzenia sobie miały pośredniczący efekt w korelacji między aktualnie otrzymywanym wsparciem społecznym, spostrzeganym dostępnym wsparciem społecznym a symptomami depresji. Osoby z niskim spostrzeganym dostępnym wsparciem społecznym oraz aktualnie otrzymywanym wsparciem społecznym (zarówno emocjonalnym, jak i instrumentalnym), jak również osoby stosujące strategie radzenia sobie polegające na unikaniu i wyparciu okazały się być podatne na doświadczanie symptomów depresji.
Istotny efekt pośredniczący wobec symptomów depresji określono dla związku między aktywnym radzeniem sobie, planowaniem, pozytywnym przewartościowaniem, obwinianiem siebie oraz rzeczywiście otrzymywanym wsparciem

Wnioski

Wszystkie rodzaje wsparcia społecznego okazały się bezpośrednio skorelowane z symptomami depresji. Strategie radzenia sobie okazały się mieć pośredniczący efekt w korelacji między postrzeganym wsparciem społecznym a depresją.
Plumbing of Securities Markets: The Impact of Post-trade Fees on Trading and Welfare
Authors: Degryse Hans , Van Achter Mark , Wuyts Gunther
Published: May 2021

We analyze how market design choices about counterparty information and costs related to the “plumbing” (i.e., clearing, settlement, and custody) of securities markets affect market quality and welfare. Our model compares two post-trade fee structures for allocating these costs. One charges a uniform fee for all trades and the other, marginal cost–based structure a reduced fee for internalized trades (which, both traders being from the same broker, is less costly to process). Both market design and fee structure affect quote aggressiveness and trading volume and its composition. With marginal cost–based fees and counterparty information being available, traders decide which counterparties to target through quote aggressiveness, trading off execution probability against fee. A social planner can maximize welfare by requiring marginal cost–based fees and providing traders the choice to disclose counterparty information.

This paper was accepted by Gustavo Manso, finance.
Knockout-Tournament Procedures for Large-Scale Ranking and Selection in Parallel Computing Environments
Authors: Zhong Ying , Hong L. Jeff
Published: May 2021

On one hand, large-scale ranking and selection (R&S) problems require a large amount of computation. On the other hand, parallel computing environments that provide a large capacity for computation are becoming prevalent today, and they are accessible by ordinary users. Therefore, solving large-scale R&S problems in parallel computing environments has emerged as an important research topic in recent years. However, directly implementing traditional stagewise procedures and fully sequential procedures in parallel computing environments may encounter problems because either the procedures require too many simulation observations or the procedures’ selection structures induce too many comparisons and too frequent communications among the processors. In this paper, inspired by the knockout-tournament arrangement of tennis Grand Slam tournaments, we develop new R&S procedures to solve large-scale problems in parallel computing environments. We show that no matter whether the variances of the alternatives are known or not, our procedures can theoretically achieve the lowest growth rate on the expected total sample size with respect to the number of alternatives and thus, are optimal in rate. Moreover, common random numbers can be easily adopted in our procedures to further reduce the total sample size. Meanwhile, the comparison time in our procedures is negligible compared with the simulation time, and our procedures barely request for communications among the processors.
Sylvia Plath: um olhar crítico sob “Olmo”
Authors: Da Silva Mariana Soletti
Published: May 2021

O presente trabalho busca analisar os estratos de significação do poema "Olmo", publicado por Sylvia Plath em seu mais célebre livro de poesias, "Ariel" (2007). Para tal, foi montada uma linha do tempo acerca do que significa poesia e, evidentemente, as transformações do significado de seu conceito. Foca-se em especial na poesia confessional, cuja principal expoente é Sylvia Plath. Procuram-se inferências sobretudo sobre a finalidade do sujeito poético do poema e como ele se comporta frente às complexidades expostas.
O “mito indígena” da formação social da Amazônia no conto “O rebelde”, de Inglês de Sousa
Authors: Monteiro Alef
Published: May 2021

No artigo analiso o conto “O rebelde”, de Inglês de Sousa. Meu objetivo é identificar e descrever as representações acerca da formação social da Amazônia contidas na obra, com atenção ao “mito indígena”. A metodologia utilizada foi a análise dialética do texto literário, conforme propõe George Lukács, e os dados foram analisados sob uma perspectiva pós-colonial. Concluí que no conto não há diferença substancial entre indígenas e caboclos, estes nada mais são do que indígenas destribalizados e ambos formariam a maior parte da população amazônica. No conto, Inglês de Sousa não rompe com as representações do imaginário romântico acerca do indígena e da Amazônia, mas apenas as reforça com uma linguagem histórica e cientificista típica do Naturalismo. “O rebelde” é fundamentado no / e fundamenta o “mito indígena”.
Estudo dos recursos estilísticos presentes no prólogo (prefácio) do livro Úrsula, obra literária de Maria Firmina dos Reis
Authors: Fernandes Tânia Regina Santos
Published: May 2021

Este estudo tem como objetivo apresentar uma reflexão sobre o estilo da linguagem verbal empregada na elaboração do texto que apresenta a obra ficcional Úrsula, de Maria Firmina dos Reis. Uma análise que partirá da observação de vocábulos utilizados para configurar a ornamentação dos recursos estilísticos evidenciados pela linguagem figurada empregada pela escritora para apresentar a própria narrativa ficcional. Para isso, serão considerados estudos sobre o uso da expressividade linguística já desenvolvidos por Guiraud, M. R. Lapa, Cressot, Nilce Sant’Anna e Azeredo, visando uma aplicação para o trabalho feito com a leitura em salas de aula dos anos finais do Ensino Fundamental.