bluuebunny/crossref_metadata_2025 huggingface dataset:
‘Who Ya Gonna Call …?’ Ethical and legal dilemmas in specialist children centres and district general hospitals
Authors: Avula Harika , Dittborn Mariana , Brierley Joe
Published: August 2021

The field of Paediatric Bioethics, or ethical issues applied to children's healthcare, is relatively new but has recently gained an increased professional and public profile. Clinical ethics support to health professionals and patients who face ethical challenges in clinical practice varies between and within institutions. Literature regarding services available to paediatricians is sparse in specialist tertiary centres and almost absent in general paediatrics. We performed a mixed-methods study using online surveys and focus groups to explore the experiences of ethical and legal dilemmas and the support structures available to (i) paediatric intensive care teams as a proxy for specialist children's centres and (ii) paediatricians working in the general setting in the UK. Our main findings illustrate the broad range of ethical and legal challenges experienced by both groups in daily practice. Ethics training and the availability of ethics support were variable in structure, processes, funding and availability, e.g., 70% of paediatric intensive care consultants reported access to formal ethics advice versus 20% general paediatricians. Overall, our findings suggest a need for ethics support and training in both settings. The broad experience reported of ethics support, where it existed, was good – though improvements were suggested. Many clinicians were concerned about their relationship with children and families experiencing a challenging ethical situation, partly as a result of high-profile recent legal cases in the media. Further research in this area would help collect a broader range of views to inform clinical ethics support's development to better support paediatric teams, children and their families.
Investigation flexural behavior of hybrid-reinforced layered filament wound pipes using experimental tests and numerical model
Authors: Masoumi Mehrdad , Abdellahi Sayyed Behzad , Hejazi Sayyed Mahdi
Published: August 2021

In the present study, filament wound pipes were fabricated by glass and polypropylene (PP) yarns with the three different filament winding angles 55°, 70°, and 82°. Glass and PP yarns were wound around the pipe with two methods; layered and hybrid. Epoxy resin was applied as a matrix to manufacture composite samples. It should be mentioned that composite samples were made in different layers. The three-point bending test was carried out on all samples to investigate the bending behavior of the composites. The experimental results showed that the winding angle 55° is better than other angles in terms of improving the flexural strength of the composite. Moreover, using hybrid yarn to fabricate the composite sample increases the flexural strength and energy absorption of the composite. In the next step, a multi-scale finite element model was applied to predict the flexural behavior of the composites. In this model, a unit-cell of each composite structure was modeled at the meso scale and elastic constants of the composites were extracted by a Python code. In addition, failure parameters for the composites were determined according to micromechanical equations. All elastic and failure parameters were utilized for the macro model and simulation three-point bending test. The numerical results were compared with the experimental and a good agreement could be observed between numerical and experimental results. So, the proposed model is proper to predict the mechanical behavior of the filament wound composite with high accuracy.
Psychometric properties and correlates of Chinese version of Perceived Stress Scale (CPSS-10) in people with common mental disorders with different employment Statuses
Authors: Shih Sam , Chan Ashley , Yeung Eva , Tsang Amily , Chiu Rose , Chu Menza , Poon Magdalene
Published: August 2021

Background/objectives

Several studies have indicated that stress is associated with common mental disorders, and work stress trebles the risk of developing them. However, a validated assessment tool for measuring and establishing psychological stress correlates in this group of clients remains unavailable. The objectives of the present study were to examine the psychometric properties of the Chinese version of the Perceived Stress Scale-10 (CPSS-10) on people with common mental disorders with different employment statuses and explore its correlates.

Methods

Two hundred and fifty-two participants with common mental disorders were recruited. The data were analysed through exploratory factor and confirmatory analyses to investigate construct validity. The convergent and discriminant validities were examined based on their correlation with other measures, while the internal consistency was estimated using Cronbach’s α coefficient. A t-test was used to detect differences between groups. The CPSS-10 correlates were explored using multiple linear regression analysis.

Results

Principal component analysis with varimax rotation yielded two factors, which accounted for 63.82% of the total variance, while confirmatory factor analysis confirmed its factor structure. The CPSS-10 had a positively moderate to strong correlation with other measures, thereby indicating its acceptable convergent and discriminant validities. The internal consistency ranged from acceptable to good for the two subscales and ten overall items, while the item-total correlation was adequate except for the seventh item. There were no group differences in gender nor employment status. Finally, the CPSS-10 predictors were studied.

Conclusion

The CPSS-10 is a reliable and valid instrument for people with common mental disorders with different employment statuses.
Long-short term memory and gas path analysis based gas turbine fault diagnosis and prognosis
Authors: Zhou Hongyu , Ying Yulong , Li Jingchao , Jin Yaofei
Published: August 2021

At present, the main purpose of gas turbine fault prediction is to predict the performance decline trend of the whole system, but the quantitative and thorough performance health index (PHI) research of every major component is lacking. Regarding the issue above, a long-short term memory and gas path analysis (GPA) based gas turbine fault diagnosis and prognosis method is proposed, which realizes the coupling of fault diagnosis and prognosis process. The measurable gas path parameters (GPPs) and the health parameters (HP) of every main component of the goal engine are obtained through the adaptive modeling strategy and the gas path diagnosis method based on the thermodynamic model. The predictive model of the Long-Short Term Memory (LSTM) network combines the measurable GPPs and the diagnostic HPs to predict the HPs of each major component in the future. Simulation experiments show that the proposed method can effectively diagnose and predict detailed, quantified, and accurate PHIs of the main components. Among them, the maximum root mean square error (RMSE) of the diagnosed component HPs do not exceed 0.193%. The RMSE of the best prediction model is 0.232%, 0.029%, 0.069%, and 0.043% in the HP prediction results of each component, respectively.
Preparation and properties of a novel polystyrene solid-phase fluorescence pH sensor based on a naphthalimide derivative
Authors: Ling Li , Tian Feng , Zhenghe Guo , Cheng Huang , Yuanyuan Liu , Tao Yu
Published: August 2021

A novel naphthalimide-based solid-phase fluorescence pH sensor (PS-Acyl-II) is prepared by immobilization of a small molecule probe (II) on polystyrene microspheres through an ester bond and is characterized by Fourier-transform infrared spectroscopy, optical microscope, scanning electron microscope, and conductiometric titrations. The sensor can determine the pH of a solution within the pH 4.0–7.0, free from interference of common metal ions, and can be reused several times. The geometries of II, PS-Acyl-II, and its product with H+ are optimized at the B3LYP/6-31G** level by density functional theory. The charge distribution, orbital interactions, and bonding characteristics are analyzed and compared in detail to discuss the recognition mechanism and structure–fluorescence property relationships.
Preoperative chest computed tomography in emergency surgery during COVID-19 pandemic
Authors: Chatzaraki Vasiliki , Kubik-Huch Rahel A , Potempa Anna , Gashi Andi , Friedl Andrée , Heesen Michael , Wiggli Benedikt , Nocito Antonio , Niemann Tilo
Published: August 2021

Background

The COVID-19 pandemic challenges the recommendations for patients’ preoperative assessment for preventing severe acute respiratory syndrome coronavirus type 2 transmission and COVID-19-associated postoperative complications and morbidities.

Purpose

To evaluate the contribution of chest computed tomography for preoperatively assessing patients who are not suspected of being infected with COVID-19 at the time of referral.

Methods

Candidates for emergency surgery screened via chest computed tomography from 8 to 27 April 2020 were retrospectively evaluated. Computed tomography images were analysed for the presence of COVID-19-associated intrapulmonary changes. When applicable, laboratory and recorded clinical symptoms were extracted.

Results

Eighty-eight patients underwent preoperative chest computed tomography; 24% were rated as moderately suspicious and 11% as highly suspicious on computed tomography. Subsequent reverse transcription polymerase chain reaction (RT-PCR) was performed for seven patients, all of whom tested negative for COVID-19. Seven patients showed COVID-19-associated clinical symptoms, and most were classified as being mildly to moderately severe as per the clinical classification grading system. Only one case was severe. Four cases underwent RT-PCR with negative results.

Conclusion

In a cohort without clinical suspicion of COVID-19 infection upon referral, preoperative computed tomography during the COVID-19 pandemic can yield a high suspicion of infection, even if the patient lacks clinical symptoms and is RT-PCR-negative. No recommendations can be made based on our results but contribute to the debate.
Association of anti-thyroid antibodies with radiographic knee osteoarthritis and chondrocalcinosis: a NHANES III study
Authors: Tagoe Clement E , Wang Wanyi , Wang Shudan , Barbour Kamil E
Published: August 2021

Objectives:

To examine the relationships between radiographic knee osteoarthritis (RKOA), symptomatic radiographic knee osteoarthritis (sRKOA), and chondrocalcinosis, as outcome variables, and the autoimmune thyroid disease (AITD) autoantibodies, anti-thyroid peroxidase antibody (TPOAb) and anti-thyroglobulin antibody (TgAb), in the Third National Health and Nutrition Examination Survey (NHANES III) data source.

Methods:

NHANES III provided data on 2291 persons over the age of 60 years that included the osteoarthritis variables of interest RKOA, sRKOA and chondrocalcinosis, and the thyroid autoantibodies TPOAb and TgAb. A log-binomial regression model was fit to examine the relationships between anti-thyroid autoantibodies and RKOA. Modified Poisson regression models were employed for the thyroid autoantibodies compared to sRKOA and chondrocalcinosis.

Results:

Patients with higher levels of TPOAb were more likely to have chondrocalcinosis [prevalence ratio (PR) 1.247, 95% confidence interval (CI) 1.051, 1.479, p = 0.012]. A piecewise regression analysis indicated that this relationship between TPOAb and chondrocalcinosis was only observed when TPOAb was above 35 IU/ml (PR 1.482, 95% CI 1.233, 1.781, p < 0.001). Levels equal to or below 35 IU/ml were not associated with chondrocalcinosis. TPOAb was not associated with RKOA or sRKOA, and TgAb was not significantly related to any of the outcomes.

Conclusion:

There was no association of AITD autoantibodies TPOAb and TgAb with RKOA or sRKOA. However, there may be an association of TPOAb with the presence of chondrocalcinosis.
A Multi-Component Transition of Care Improvement Project to Reduce Hospital Readmissions Following Ischemic Stroke
Authors: Leonhardt-Caprio Ann M. , Sellers Craig R. , Palermo Elizabeth , Caprio Thomas V. , Holloway Robert G.
Published: August 2021

Background:

Ischemic stroke (IS) is a common cause of hospitalization which carries a significant economic burden and leads to high rates of death and disability. Readmission in the first 30 days after hospitalization is associated with increased healthcare costs and higher risk of death and disability. Efforts to decrease the number of patients returning to the hospital after IS may improve quality and cost of care.

Methods:

Improving care transitions to reduce readmissions is amenable to quality improvement (QI) initiatives. A multi-component QI intervention directed at IS patients being discharged to home from a stroke unit at an academic comprehensive stroke center using IS diagnosis-driven home care referrals, improved post-discharge telephone calls, and timely completion of discharge summaries was developed. The improvement project was implemented on July 1, 2019, and evaluated for the 6 months following initiation in comparison to the same 6-month period pre-intervention in 2018.

Results:

Following implementation, a statistically significant decrease in 30-day all-cause same-hospital readmission rates from 7.4% to 2.8% ( p = .031, d = 1.61) in the project population and from 6.6% to 3% ( p = .010, d = 1.43) in the overall IS population was observed. Improvement was seen in all process measures as well as in patient satisfaction scores.

Conclusions:

An evidence-based bundled process improvement intervention for IS patients discharged to home was associated with decreased hospital readmission rates following IS.
Intra-arterial nimodipine for severe cerebral vasospasm after aneurysmal subarachnoid haemorrhage – neurological and radiological outcome
Authors: Samuelsson Jennifer , Sunila Merete , Rentzos Alexandros , Nilsson Daniel
Published: August 2021

Objectives

Cerebral vasospasm is a known complication to aneurysmal subarachnoid haemorrhage, which can lead to severe morbidity. Intra-arterial vasodilation therapy is widely used as a last resort treatment in patients with symptomatic refractory cerebral vasospasm but there is limited data about the outcome. The purpose of this study is to evaluate the neurological and radiological outcome in patients treated with intra-arterial nimodipine in relation to cerebral infarction, procedure-related complications and clinical outcome.

Methods

Patients with refractory cerebral vasospasm treated with intra-arterial nimodipine during 2009–2020 at Sahlgrenska University Hospital were retrospectively reviewed. Neurological outcome (modified Rankin Scale) at 30 days and 6 months, development of cerebral infarction after intra-arterial nimodipine treatment and procedure-related complications were studied.

Results

Forty-eight patients were treated with intra-arterial nimodipine. A good outcome (modified Rankin Scale 0–2) was seen in 25% ( n = 12) of the patients after 30 days and in 47% ( n = 22) of the patients after six months. Infarction related to the vasospastic vessel after treatment with intra-arterial nimodipine was seen in 60% ( n = 29) of the patients. A total of 124 procedures with intra-arterial nimodipine were performed where complications were seen in 10 (21%) patients in 10 (8%) procedures. Four (8%) patients died within 30 days.

Conclusions

A majority of patients developed an ischaemic cerebral infarction in spite of intra-arterial nimodipine treatment. However, a good clinical recovery was seen in almost half of the patients after 6 months. Minor complications occurred in one out of five patients.
Risk of occult spinal dysraphism based on lumbosacral cutaneous manifestations
Authors: Shields Lisa BE , Mutchnick Ian S , Daniels Michael W , Peppas Dennis S , Rosenberg Eran
Published: August 2021

Objectives:

Occult spinal dysraphism is a congenital failure of fusion of the posterior vertebral arches with intact skin overlying the defect. Lumbosacral cutaneous manifestations are associated with a variable risk of occult spinal dysraphism. Tethered cord syndrome is a type of occult spinal dysraphism that puts abnormal traction on the spinal cord. This study analyzed neonates and infants who were referred to our pediatric urology practice and had evidence of lumbosacral cutaneous manifestation on physical examination.

Methods:

We reviewed the presence of lumbosacral cutaneous manifestations in neonates and infants evaluated in our pediatric urology clinic at our Institution over a 6-year period (1 March, 2015–28 February, 2021) with no prior diagnosis of lumbosacral cutaneous manifestation. All patients underwent a spinal ultrasound.

Results:

The most common lumbosacral cutaneous manifestations were bifurcated/duplicated gluteal folds (33%), gluteal asymmetry (19%), and sacral dimples (14%). A total of 34 (24%) patients had an abnormal spinal ultrasound; 15 (44%) of these infants underwent a lumbar magnetic resonance imaging. A coccygeal pit was statistically marginally higher in abnormal versus normal spinal ultrasound (p = 0.07). Patients with only one lumbosacral cutaneous manifestation (N = 121) were significantly more likely to have a normal spinal ultrasound compared to those with two or more lumbosacral cutaneous manifestation (N = 17) (79% vs 53%, p = 0.03).

Conclusion:

Due to the varying risk of certain lumbosacral cutaneous manifestations with occult spinal dysraphism, all patients with a lumbosacral cutaneous manifestation should undergo spinal ultrasound. This study also highlights the importance of urodynamic studies when there are abnormal cutaneous findings. Routine physical examinations of the lumbar region for cutaneous manifestations of occult spinal dysraphism are vital to ensure prompt management of tethered cord syndrome and avoid potentially devastating consequences.
Comparison between bicycle ergometric interval and continuous training in patients early after coronary artery bypass grafting: A prospective, randomized study
Authors: Reer Marco , Rauschenberg Sophie , Hottenrott Kuno , Schwesig Rene , Heinze Viktoria , Huta Dana , Schwark Nadja , Schlitt Axel
Published: August 2021

Objectives:

Continuous and interval training have previously been compared in patients with cardiac diseases. However, data comparing the safety and effectiveness of the two exercise methods are lacking in patients early after coronary artery bypass grafting.

Methods:

In all, 120 patients were prospectively randomized in a 1:1 fashion approximately 17 days after coronary artery bypass grafting to an interval group or continuous group. All patients participated in bicycle ergometric training six times/week for 20 min each during a 3-week inpatient rehabilitation program. The combined primary endpoint was safety as defined by incidence of scar pain and cardiac events related to the exercise intervention. Secondary outcomes included the effect of the interventions on parameters such as heart rate and peak power output.

Results:

Four patients (12.1%) in the interval group reported pain on the saphenectomy scar as a result of the training intervention in comparison to six patients (20.0%) in the continuous group (χ2 (1, n = 63) = 0.73, p = 0.393). No cardiac events were related to exercise intervention. No effect on heart rate was found during the intervention, nor was a difference observed between the groups. Peak power output, as one of the analyzed markers, improved significantly in both groups, but no differences were found between groups.

Conclusion:

Ergometry training performed as interval or continuous training was safe and effective regarding increase in physical fitness early after coronary artery bypass grafting in an inpatient rehabilitation setting, with no differences observed between the groups.
Province-Wide Prevalence Testing for SARS-CoV-2 of In-Center Hemodialysis Patients and Staff in Ontario, Canada: A Cross-Sectional Study
Authors: Sniekers Daphne C. , Jung James K. H. , Blake Peter G. , Cooper Rebecca , Leis Jerome A. , Muller Matthew P. , Padure Vlad , Holm Philip , Yeung Angie , Taji Leena , McFarlane Phil , Oliver Matthew J.
Published: August 2021

Background:

People receiving in-center hemodialysis face a high risk for contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and experience poor outcomes. During the first wave of the coronavirus disease 2019 (COVID-19) pandemic in Ontario (between March and June 2020), it was unclear whether asymptomatic or presymptomatic cases were common and whether widespread testing of all dialysis patients and staff would identify cases earlier and prevent transmission. Ontario has a population of about 14.5 million. Approximately 8900 people receive dialysis across 102 in-center dialysis units.

Objective:

The objective of this study was to determine participation rates for patients and staff in point prevalence testing in dialysis units across the province and to determine the prevalence of asymptomatic or presymptomatic infection.

Design:

Cross-sectional study design.

Setting:

In-center hemodialysis units at 27 renal programs across Ontario.

Participants:

Patients and staff in in-center dialysis units in Ontario.

Measurements:

Participation rates, demographic data, SARS-CoV-2 positivity rates, and COVID-19-related symptom data.

Methods:

From June 8 to 30, 2020, all in-center dialysis patients and staff in the Province of Ontario were requested to undergo a symptom screening assessment and nasopharyngeal swab. Testing was done using polymerase chain reaction to detect SARS-CoV-2. A standardized questionnaire of atypical and typical COVID-19-related symptoms was administered to patients, to assess for new or worsening COVID-19-related symptoms.

Results:

Patient participation was 83% (7155 of 8612) of which 15 tests were positive: less than 5 (<0.07%) were new positive cases, 7 were false positive, and the remaining were recovered positives. Half of the new positive cases had symptoms. Common symptoms reported included fatigue (4%), falls (4%), runny nose (3%), dyspnea (3%), and cough (3%). Staff participation was 49% (2109 of 4325), and less than 5 (<0.24%) were asymptomatic positive.

Limitations:

As point prevalence testing was voluntary, not all patients and staff participated. Lower participation rate may be due to decreasing new cases in Ontario, and testing or pandemic fatigue, among other factors. This study did not use serology to identify prior infections because it was not widely available in Ontario. With respect to the standardized symptom questionnaire, it was only available in English and French and could not be tested due to the urgency of the initiative.

Conclusions:

Participation among patients in point prevalence testing was good, but participation among staff was relatively low. Asymptomatic positivity in the dialysis patient and staff population was rare during the first wave of the COVID-19 pandemic in Ontario.
A comparative Scripture-reading analysis of Latter-day Saint experts and novices
Authors: Rackley Eric D.
Published: August 2021

This study employs an expert--novice research design to examine how five Latter-day Saint scholars and five Latter-day Saint youths read Scripture. Qualitative analyses of semi-structured interviews and verbal protocols point to six practices participants used: theorizing scriptural possibilities, connecting to Scripture, applying Scripture, managing Scripture-reading uncertainties, using self-contained scriptural resources, and situating Scripture in historical contexts. Use of these practices demonstrates the different ways experts and novices read Scripture and where and how their differences are manifest. Findings build a fuller explanation of the nature of Scripture-reading practice and raise questions for religious education research and practice across Christian traditions.
Late-Night Use of Social Media and Cognitive Engagement of Female Entrepreneurs: A Stressor–Strain–Outcome Perspective
Authors: Shahzad Fakhar , Abbas Adnan , Fateh Adnan , Kasim Raja Suzana Raja , Akram Kashif , Ashraf Sheikh Farhan
Published: August 2021

The excessive use of social media is an emerging phenomenon with several negative consequences in an entrepreneurial context. Based on the stressor–strain–outcome paradigm, this research aims to unveil the following: that social media late-night usage can affect two psychological strains (life invasion and technostress) among female entrepreneurs and thus influence their behavioral outcome (cognitive engagement). This study empirically tested the proposed mediation model using an online survey of 225 female entrepreneurs from the small- and medium-sized enterprise sector. A partial least squares structural equation modeling (PLS-SEM) was implemented to obtain the results. The findings indicate that late-night social media usage significantly raises life invasion and technostress among female entrepreneurs. Moreover, internal strains (life invasion and technostress) reduce female entrepreneurs’ cognitive engagement and significantly mediate the association between late-night use of social media and entrepreneurial cognitive engagement. This study draws associated practical and theoretical contributions based on findings, which were not previously discussed.
Integrative Medicine in General Practice in Australia: A Mixed-Methods Study Exploring Education Pathways and Training Needs
Authors: Ee Carolyn , Templeman Kate , Forth Amy , Kotsirilos Vicki , Singleton Gillian , Deed Gary , Dubois Shamieka , Pirotta Marie , Harnett Joanna , Myers Stephen , Hunter Jennifer
Published: August 2021

Background

Globally, a substantial proportion of general practitioners (GPs) incorporate integrative medicine (IM) into their clinical practice.

Objective

This study aimed to map the IM education and training pathways and needs of a cohort of Australian GPs who are members of the Royal Australian College of General Practitioners’ IM Specific Interest Network, which is a group of GPs with interest in IM.

Methods

We conducted a mixed-methods study comprising of an online, cross-sectional survey supplemented with in-depth semi-structured interviews. Data from the survey and interviews were initially analysed separately and then combined.

Results

Eighty-three (83) of 505 eligible GPs/GPs in training (16.4%) participated in the survey, and 15 GPs were interviewed. Results from the two datasets either converged or were complementary. Almost half (47%) of survey respondents had undertaken formal undergraduate or postgraduate IM education, a short course (63%), informal education (71%) or self-education (54%), in at least one of 20 IM modalities listed. Interviewees affirmed there was no single education pathway in IM. Survey respondents who identified as practicing IM were significantly more likely to have IM education, positive attitudes towards IM, particularly natural products, and higher self-rated IM knowledge and competencies. However, knowledge gaps were identified in professional skills domains of population health and context, and organisational and legal dimensions of applied IM practice. Interviewees also highlighted a range of professional and systemic barriers to the practice of IM, education, and training. There was broad support for recognition of IM as a sub-specialty through formalised post-graduate training and accreditation. Most survey respondents (62%) expressed interest in post-fellowship recognition of GPs with advanced skills in IM.

Conclusion

Our findings demonstrate that it is important to define best practice in IM for GPs in Australia and provide a standardised pathway towards recognition of advanced skills in IM.
Comparison of Pelvis and Trunk Kinematics Between Youth and Collegiate Windmill Softball Pitchers
Authors: Wasserberger Kyle W. , Friesen Kenzie B. , Downs Jessica L. , Bordelon Nicole M. , Oliver Gretchen D.
Published: August 2021

Background:

The windmill softball pitch is a dynamic sporting movement that places softball pitchers at high risk of injury. Unlike baseball, there is limited research into the mechanical differences between softball pitchers of varying skill levels.

Purpose/Hypothesis:

The purpose of this study was to compare pelvis and trunk kinematics between youth and collegiate softball pitchers. It was hypothesized that there would be significant differences in pelvis and trunk kinematics between these 2 groups.

Study Design:

Descriptive laboratory study.

Methods:

The pelvic and trunk kinematics of 90 softball pitchers were collected during full-effort pitching using a 3-dimensional motion capture system. Participants were grouped based on their age at the time of data collection (35 youth [mean age, 11 ± 1 years]; 55 collegiate [mean age, 20 ± 2 years]). We compared between-group differences in pelvic posterior tilt, lateral tilt, axial rotation, and axial rotation velocity as well as trunk extension, lateral flexion, axial rotation, and axial rotation velocity during the pitching phase between start of pitch and ball release (BR) using 1-dimensional statistical parametric mapping. Statistical significance was determined using Holmes-Šidák stepdown correction–adjusted P values ( P ′).

Results:

Compared with youth pitchers, collegiate pitchers exhibited a more posteriorly tilted pelvis from the moment of start of pitch until 94% of the way between start of pitch and BR ( P ′ = .002) and a more laterally flexed trunk toward the glove side from the moment of start of pitch until 71% of the way between start of pitch and BR ( P ′ = .010).

Conclusion:

Collegiate pitchers displayed a more posteriorly tilted pelvis and more laterally flexed trunk toward the glove side during the windmill pitching motion when compared with youth pitchers.

Clinical Relevance:

These findings add to the growing body of softball research and help elucidate mechanical differences between youth and collegiate softball pitchers.
To Be or No B2: A Rare Cause of Stridor and Weakness in a Toddler
Authors: Frederick Aliya L. , Yang Jennifer H. , Schneider Sarah , Quade Alexis , Guidugli Lucia , Wigby Kristen , Cameron Melissa
Published: August 2021

We present a case of a young child with a rare metabolic disorder whose clinical presentation resembled that of autoimmune myasthenia gravis. The differential diagnosis was expanded when autoantibody testing was negative and the patient did not respond to standard immunomodulatory therapies. Rapid whole genome sequencing identified 2 rare variants of uncertain significance in the SLC52A3 gene shown to be in compound heterozygous state after parental testing. Biallelic mutations in SLC52A3 are associated with Riboflavin Transporter Deficiency, which in its untreated form, results in progressive neurodegeneration and death. Supplementation with oral riboflavin has been shown to limit disease progression and improve symptoms in some patients. When the diagnosis is suspected, patients should be started on supplementation immediately while awaiting results from genetic studies.
Management of Suprachoroidal Hemorrhage in a Patient With Boston Type I Keratoprosthesis
Authors: Wagley Sushant , Brandner Dieter D. , Hou Joshua H. , Montezuma Sandra R.
Published: August 2021

Purpose:

Suprachoroidal hemorrhage (SCH) is a rare but vision-threatening complication in patients with keratoprosthesis devices (KPro), particularly in the setting of concurrent glaucoma tube shunts. Although there are many approaches to draining an SCH, surgery can be especially challenging in these patients because a crowded anterior chamber, and frequent anterior extension of the SCH.

Methods:

A case report is discussed.

Results:

We describe a novel approach to surgical drainage of SCH in a 64-year-old monocular patient with a Type I Boston KPro, an Ahmed valve, and aphakia.

Conclusion:

Successful repair of appositional SCH in the context of KPro can be safely and effectively achieved by injecting viscoelastic through the backplate holes of the KPro, thereby providing internal tamponade within the vitreous compartment while liquefied hemorrhage is drained by sclerotomy.
Tildrakizumab Inadequate Responders Switching to an Alternative IL-23 Inhibitor: A Case Series
Authors: Song Eingun James , Wong Audrey Jia Shin
Published: August 2021

Background:

Biologic switching is not uncommon in the treatment of psoriasis and is most often due to inadequate response of adverse events. Staying within or switching out of the class is still based on expert opinion but there are published data on intra-class switching with TNF-alpha and IL-17 inhibitors. Less is known about the IL-23 inhibitors because of their limited time in the market. We would like to present our experience with inadequate responders to tildrakizumab, a selective IL23 inhibitor, who were switched to an alternative IL-23 inhibitor.

Case Description:

This is a case series of 6 patients at a single institution considered inadequate responders to tildrakizumab, which included primary failures, secondary failures, and intermediate responders, who were subsequently switched to another IL-23 inhibitor.

Conclusion:

All 6 patients who were inadequate responders to tildrakizumab showed significant improvement after switching to another IL-23 inhibitor, with 5/6 reaching IGA 0/1 after 16 weeks of treatment.
Genotypes of European and Iranian patients with type 3 von Willebrand disease enrolled in 3WINTERS-IPS
Authors: Baronciani Luciano , Peake Ian , Schneppenheim Reinhard , Goodeve Anne , Ahmadinejad Minoo , Badiee Zahra , Baghaipour Mohammad-Reza , Benitez Olga , Bodó Imre , Budde Ulrich , Cairo Andrea , Castaman Giancarlo , Eshghi Peyman , Goudemand Jenny , Hassenpflug Wolf , Hoorfar Hamid , Karimi Mehran , Keikhaei Bijan , Lassila Riitta , Leebeek Frank W. G. , Lopez Fernandez Maria Fernanda , Mannucci Pier Mannuccio , Marino Renato , Nikšić Nikolas , Oyen Florian , Santoro Cristina , Tiede Andreas , Toogeh Gholamreza , Tosetto Alberto , Trossaert Marc , Zetterberg Eva M. K. , Eikenboom Jeroen , Federici Augusto B. , Peyvandi Flora
Published: August 2021

Type 3 von Willebrand disease (VWD3) is a rare and severe bleeding disorder characterized by often undetectable von Willebrand factor (VWF) plasma levels, a recessive inheritance pattern, and heterogeneous genotype. The objective of this study was to identify the VWF defects in 265 European and Iranian patients with VWD3 enrolled in 3WINTERS-IPS (Type 3 Von Willebrand International Registries Inhibitor Prospective Study). All analyses were performed in centralized laboratories. The VWF genotype was studied in 231 patients with available DNA (121 [115 families] from Europe [EU], and 110 [91 families] from Iran [IR]). Among 206 unrelated patients, 134 were homozygous (EU/IR = 57/77) and 50 were compound heterozygous (EU/IR = 43/7) for VWF variants. In 22 patients, no or only one variant was found. A total of 154 different VWF variants (EU/IR = 101/58 [5 shared]) were identified among the 379 affected alleles (EU/IR = 210/169), of which 48 (EU/IR = 18/30) were novel. The variants p.Arg1659*, p.Arg1853*, p.Arg2535*, p.Cys275Ser, and delEx1_Ex5 were found in both European and Iranian VWD3 patients. Sixty variants were identified only in a single allele (EU/IR = 50/10), whereas 18 were recurrent (≥3 patients) within 144 affected alleles. Nine large deletions and one large insertion were found. Although most variants predicted null alleles, 21% of patients carried at least 1 missense variant. VWD3 genotype was more heterogeneous in the European population than in the Iranian population, with nearly twice as many different variants. A higher number of novel variants were found in the Iranian VWD3 patients.
Anti-inflammatory effect of essential oil extracted from Pinus densiflora (Sieb. et Zucc.) wood on RBL-2H3 cells
Authors: Yang Jiyoon , Choi Won-Sil , Jeung Eui-Bae , Kim Ki-Joong , Park Mi-Jin
Published: August 2021

The aim of this study is to identify the active compounds of the essential oil extracted from the Pinus densiflora (Sieb. et Zucc.) wood using the hydrodistillation method and evaluate their anti-inflammatory activity. The chemical composition of the oil was identified by GC–MS analysis, and its anti-inflammatory activity was assessed by investigating its effect on the expression of interleukin-4 (IL-4), interleukin-13 (IL-13), and β-hexosaminidase in lipopolysaccharide (LPS)-stimulated RBL-2H3 cells. Treatment of the LPS-stimulated RBL-2H3 cells with the oil and its fractions downregulated the production of pro-inflammatory cytokines such as IL-4 and IL-13 and further attenuated the secretion of β-hexosaminidase out of the cells to a significant level. Among the five obtained fractions, fraction E exhibited the best anti-inflammatory activity, and its main constituent, longifolene, was considered as the active compound. Moreover, the inhibitory effect of longifolene on the expression levels of IL-4 and IL-13 and the β-hexosaminidase secretion was similar to that of the P. densiflora wood oil, indicating longifolene as the active constituent of the P. densiflora wood oil with immunosuppressive effects on inflammation.
The transcriptomic blueprint of molt in rooster using various tissues from Ginkkoridak (Korean long-tailed chicken)
Authors: Charton Clémentine , Youm Dong-Jae , Ko Byung June , Seol Donghyeok , Kim Bongsang , Chai Han-Ha , Lim Dajeong , Kim Heebal
Published: August 2021

Background

Annual molt is a critical stage in the life cycle of birds. Although the most extensively documented aspects of molt are the renewing of plumage and the remodeling of the reproductive tract in laying hens, in chicken, molt deeply affects various tissues and physiological functions. However, with exception of the reproductive tract, the effect of molt on gene expression across the tissues known to be affected by molt has to date never been investigated. The present study aimed to decipher the transcriptomic effects of molt in Ginkkoridak, a Korean long-tailed chicken. Messenger RNA data available across 24 types of tissue samples (9 males) and a combination of mRNA and miRNA data on 10 males and 10 females blood were used.

Results

The impact of molt on gene expression and gene transcript usage appeared to vary substantially across tissues types in terms of histological entities or physiological functions particularly related to nervous system. Blood was the tissue most affected by molt in terms of differentially expressed genes in both sexes, closely followed by meninges, bone marrow and heart. The effect of molt in blood appeared to differ between males and females, with a more than fivefold difference in the number of down-regulated genes between both sexes. The blueprint of molt in roosters appeared to be specific to tissues or group of tissues, with relatively few genes replicating extensively across tissues, excepted for the spliceosome genes (U1,U4)and the ribosomal proteins (RPL21,RPL23). By integrating miRNA and mRNA data, when chickens molt, potential roles of miRNA were discovered such as regulation of neurogenesis, regulation of immunity and development of various organs. Furthermore, reliable candidate biomarkers of molt were found, which are related to cell dynamics, nervous system or immunity, processes or functions that have been shown to be extensively modulated in response to molt.

Conclusions

Our results provide a comprehensive description at the scale of the whole organism deciphering the effects of molt on the transcriptome in chicken. Also, the conclusion of this study can be used as a valuable resource in transcriptome analyses of chicken in the future and provide new insights related to molt.
Hemodynamic, renal and hormonal effects of lung protective ventilation during robot-assisted radical prostatectomy, analysis of secondary outcomes from a randomized controlled trial
Authors: Høyer Sidse , Mose Frank H. , Ekeløf Peter , Jensen Jørgen B. , Bech Jesper N.
Published: August 2021

Background

Lung protective ventilation with low tidal volume (TV) and increased positive end-expiratory pressure (PEEP) can have unfavorable effects on the cardiovascular system. We aimed to investigate whether lung protective ventilation has adverse impact on hemodynamic, renal and hormonal variables.

Methods

In this randomized, single-blinded, placebo-controlled study, 24 patients scheduled for robot-assisted radical prostatectomy were included. Patients were equally randomized to receive either ventilation with a TV of 6 ml/IBW and PEEP of 10 cm H2O (LTV-h.PEEP) or ventilation with a TV of 10 ml/IBW and PEEP of 4 cm H2O (HTV-l.PEEP). Before, during and after surgery, hemodynamic variables were measured, and blood and urine samples were collected. Blood samples were analyzed for plasma concentrations of electrolytes and vasoactive hormones. Urine samples were analyzed for excretions of electrolytes and markers of nephrotoxicity.

Results

Comparable variables were found among the two groups, except for significantly higher postoperative levels of plasma brain natriuretic peptide (p = 0.033), albumin excretion (p = 0.012) and excretion of epithelial sodium channel (p = 0.045) in the LTV-h.PEEP ventilation group compared to the HTV-l.PEEP ventilation group. In the combined cohort, we found a significant decrease in creatinine clearance (112.0 [83.4;126.7] ml/min at baseline vs. 45.1 [25.4;84.3] ml/min during surgery) and a significant increase in plasma concentrations of renin, angiotensin II, and aldosterone.

Conclusion

Lung protective ventilation was associated with minor adverse hemodynamic and renal effects postoperatively. All patients showed a substantial but transient reduction in renal function accompanied by activation of the renin-angiotensin-aldosterone system.

Trial registration

ClinicalTrials, NCT02551341. Registered 13 September 2015.
Predictors of COVID-19 vaccine hesitancy among Egyptian healthcare workers: a cross-sectional study
Authors: El-Sokkary Rehab H. , El Seifi Omnia S. , Hassan Hebatallah M. , Mortada Eman M. , Hashem Maiada K. , Gadelrab Mohamed Rabie Mohamed Ali , Tash Rehab M. Elsaid
Published: August 2021

Background

Coronavirus disease 2019 (COVID-19) vaccination has raised concerns about vaccine hesitancy in general and COVID-19 vaccine hesitancy in particular. Understanding the factors driving the uncertainty regarding vaccination against COVID-19 is crucial.

Methods

This cross-sectional study was designed to identify the perceptions and attitudes of healthcare workers (HCWs) towards COVID-19 vaccines and determine the predictive factors that affect their willingness to receive the COVID-19 vaccine. An online survey was distributed among HCWs to collect data assessing demographic and general characteristics of the participants and vaccine-related characteristics, including source of information about the vaccine. In addition to items assessing the perception of COVID-19, there were items on COVID-19 vaccines and attitude towards vaccination in general and towards COVID-19 vaccines in particular.

Results

The participants were classified according to their willingness to take the COVID-19 vaccine as follows: hesitant (41.9%), refusing (32.1%), and willing (26%). Statistically significant differences were observed among the three groups for the perception of COVID-19 vaccines, attitude towards vaccination in general, and COVID-19 vaccines in particular (p < 0.01).

Conclusions

Although the participants adequately perceived COVID-19 severity, prevention, and COVID-19 vaccine safety, they were widely hesitant or refused to be vaccinated. A multidimensional approach is required to increase the vaccine acceptability rate. Higher income and increased years of work experience are positive predictors of willingness to receive a vaccine. Thus, further studies addressing the scope of COVID-19 vaccine hesitancy are warranted as an initial step to build trust in COVID-19 vaccination efforts with continuous monitoring of attitudes and practices of HCWs towards COVID-19 vaccines in the future.
The associations between fasting blood glucose levels and mortality of SFTS in patients
Authors: Zhang Yin , Zhang Yu , Xu Yuanhong , Huang Ying
Published: August 2021

Objective

To identify the correlation between the level of at-admission fasting blood glucose (FBG) with poor outcomes in hospitalized patients suffering from severe fever with thrombocytopenia syndrome (SFTS).

Methods

Between April 1 and December 1, 2020, the list of hospitalized patients affected with SFTS infection was provided by the Infectious Disease Department at First Affiliated Hospital of Anhui Medical University, followed by the collection of information I.e., gender, age, diabetic history and the level of FBG on admission.

Results

In this study, a total of 77 patients were included and were categorized into three groups (< 5.6, 5.6–6.9, and ≥ 7.0 mmol/l) on the basis of their glucose level in the blood. The obtained results revealed that among three groups considerable variations were observed in leukocytes, FBG, D-Dimer, aspartate aminotransferase (AST), tumor necrosis factor-α (TNF-α), fibrin degradation products (FDP), and interleukin (IL)-10 level. Correlation analysis indicated a linear negative correlation between PLT and FBG (r = − 0.28, P = 0.01), however, a linear positive correlation was observed between AST, IL10, D-Dimer, and FDP levels and FBG (P-value < 0.05). Multivariate statistical analysis results shown that there was significant difference between group comparison (F = 17.01, P < 0.001) and interaction between group and time (F = 8.48, P < 0.05); but there was no significant difference between time point comparison (F = 0.04, P = 0.96). With the prolongation of time, the changes of FBG were different between survivor group and non-survivor group. The FBG in survival group shown a downward trend; The non-survivor group shown an upward trend.

Conclusions

Elevated level of FBG has been correlated with hypercoagulability, inflammation, and lower PLT in SFTS patients. The measurement of FBG level can help in evaluating the inflammatory process, hypercoagulability, and prognosis of patients suffering from SFTS. FBG can predict the prognosis of SFTS. It is necessary to pay attention to the role of FBG in the process of treatment in patients with SFTS.