bluuebunny/crossref_metadata_2025 huggingface dataset:
Emergency department mental health presentations before and during the COVID-19 outbreak in Western Australia
Authors: Dragovic Milan , Pascu Viki , Hall Tammy , Ingram Jesse , Waters Flavie
Published: September 2020

Objective:

Coronavirus (COVID-19) has led to high levels of psychological distress in the community. This study aimed to examine whether emergency departments (EDs) also recorded a rise in mental health presentations.

Method:

Changes in the number, and type, of mental health presentations to Western Australia EDs were examined between January and May 2020, and compared to 2019.

Results:

Data showed an unexpected decrease in the number of mental health presentations, compared to 2019, which was temporally coincident with the rise in local COVID-19 cases. Presentations for anxiety and panic symptoms, and social and behavioural issues, increased by 11.1% and 6.5%, respectively, but suicidal and self-harm behaviours decreased by 26%.

Conclusion:

A rise in local COVID-19 cases was associated with a decrease in mental health presentations to EDs. This has important implications for the planning and provision of healthcare services in the current pandemic.
Access Barrier in Rural Older Adults’ Use of Pain Management and Palliative Care Services: A Systematic Review
Authors: Suntai Zainab , Won Cho Rong , Noh Hyunjin
Published: September 2020

Background:

Pain and symptom management is critical in ensuring quality of life for chronically ill older adults. However, while pain management and palliative care have steadily expanded in recent years, many underserved populations, such as rural older adults, experience barriers in accessing such specialty services, in part due to transportation issues. The purpose of this systematic review is to examine the specific types of transportation-related barriers experienced by rural older adults in accessing pain and palliative care.

Methods:

Studies were searched through the following 10 databases: Abstracts in Social Gerontology, Academic Search Premier, CINAHL, MEDLINE, PsycINFO, SocINDEX with Full Text, Cochrane Database of Systematic Reviews, Nursing & Allied Health Database, Sociological Abstracts, and PubMED. Studies were chosen for initial review if they were written in English, full text, included older adults in the sample, and examined pain/palliative care/hospice, rural areas, and transportation. A total of 174 abstracts were initially screened, 15 articles received full-text reviews and 8 met the inclusion criteria.

Results:

Findings of the 8 studies identified transportation-related issues as major access barrier to pain and palliative care among rural older adults: specifically, lack of public transportation; lack of wheelchair accessible vehicles; lack of reliable drivers; high cost of transportation services; poor road conditions; and remoteness to the closest pain and palliative care service providers.

Conclusion:

Results suggest that rural older adults have unique transportation needs due to the urban-centric location of pain and palliative care services. Implications for practice, policy and research with older adults are discussed.
Misinformation Inoculation and Literacy Support Tweetorials on COVID-19
Authors: Graham S. Scott
Published: September 2020

Many expected federal public health agencies to provide timely and accurate information about the COVID-19 pandemic. That did not happen. In response, physicians and epidemiologists have explored new ways to educate the public about COVID-19 and protect against misinformation. One genre that has received significant uptake is the tweetorial, threaded tweets that educate followers on technical matters. This article builds on prior genre studies of the tweetorial to explore how #MedTwitter and #EpiTwitter communities have refashioned the emerging conventions of the tweetorial as part of efforts to protect the public from COVID-19 misinformation.
Determinants of the Higher Prevalence and Severity of Subjective Cognitive Impairment in Cancer Patients Compared to Healthy Subjects: Fatigue and Stress
Authors: Kim Hee-Ju , Abraham Ivo
Published: September 2020

This study examined whether (a) cancer patients in two cohorts reported greater subjective cognitive impairment (SCI) in prevalence and severity than noncancer healthy controls; and (b) selected psychoneurological factors (fatigue, stress, and sleep disturbance) contribute to such differences. Data from 60 prechemotherapy cancer patients, 81 active-chemotherapy cancer patients, and 116 noncancer healthy controls were analyzed using hierarchical regressions. The prevalence rate of SCI was higher in the prechemotherapy cancer cohort (41.6%) and in the active-chemotherapy cancer cohort (46.9%) than in healthy controls (21.5%; p < .001). SCI severity was also higher in two cancer cohorts than noncancer controls ( p < .001). The two cancer cohorts were similar to each other in severity and prevalence of SCI. The two cancer cohorts experienced higher fatigue, stress, and sleep disturbance than healthy controls. After controlling for psychoneurological factors, however, the two cancer cohorts did not differ from healthy controls in experiencing SCI in prevalence and severity. Psychoneurological factors may be a major determinant of the higher prevalence and severity of SCI in cancer patients.
Performance Assessment of a Multifaceted Unfractionated Heparin Dosing Protocol in Adult Patients on Extracorporeal Membrane Oxygenator
Authors: Al-Jazairi Abdulrazaq , Raslan Shahad , Al-mehizia Rayd , Dalaty Hani Al , De Vol Edward B. , Saad Elias , Alanazi Mosleh , Owaidah Tarek
Published: September 2020

Background

The use of extracorporeal membrane oxygenator (ECMO) support devices are associated with complications, including bleeding and thrombosis. Unfractionated heparin (UFH) is the gold standard anticoagulant in ECMO patients. Clinically, UFH is monitored through activated clotting time (ACT), activated partial thromboplastin time (aPTT), and anti–factor Xa assay. It is unknown which assay best predicts anticoagulation effects in adults.

Objective

To assess the correlation of UFH dosing and monitoring using an established protocol.

Methods

A pilot, prospective cohort, historically controlled study was conducted at a tertiary care hospital. Patients ≥18 years-old who received ECMO on the multifaceted anticoagulation protocol were included and compared with those on the conventional method of anticoagulation. The primary end point was to assess the correlation between UFH dose and different monitoring methods throughout 72 hours using the new protocol guided by ACT and anti–factor Xa assay.

Results

In each arm, 20 patients were enrolled. The study revealed that anti–factor Xa assay had the largest number of “strong” correlations 11/20 (55%), followed by both aPTT and aPTT ratio 10/20 (50%), and, finally, ACT 2/20 (10%). Concordance between anti–factor Xa assay and the other monitoring parameters in the prospective arm was generally low: 31% with aPTT ratio, 26% with ACT, and 23% with aPTT.

Conclusion and Relevance

The adaption of a multifaceted anticoagulation protocol using anti–factor Xa assay may provide a better prediction of heparin dosing in adults ECMO patients compared with the conventional ACT-based protocol. Further studies are needed to assess the safety and different monitoring modalities.
Performance measurement of a lean product development process
Authors: Hejazi Amir , Bhuiyan Nadia , Othman Mohammed
Published: September 2020

Over the past few years, organizations have faced pressure from stakeholders to implement lean principles in their product development processes. However, the existing methods are not capable of measuring the benefits of adopting lean initiatives in the product development process. This research aims to develop a performance measurement model that can measure the effects of implementing lean in the engineering process. Engineering effort is analyzed in order to identify hidden wastes (e.g. inventory in the form of information about product specifications or engineering errors) in the engineering process. The model has been implemented in a civil design process of an engineering consultant company to validate the general applicability of the new model. The implementation of the model provides visibility on the waste hidden in the engineering process and quantifies that waste. The most significant contribution of this research is the development of new performance metrics and a decomposition chart. Finally, performance metrics are properly linked and the model treats lean as a holistic system, quantitatively measuring performance at different organizational levels.
The Prevalence of Genital Human Papillomavirus Subtypes in a Cohort of Hispanic Women Presenting for Cervical Cancer Screening Along the US-Mexico Border
Authors: Shokar Navkiran K. , Doan Amy , Calderon-Mora Jessica , Lakshmanaswamy Rajkumar , Ramadevi Subramani , Shokar Gurjeet S. , Molokwu Jennifer , Alomari Adam , Dwivedi Alok
Published: September 2020

Introduction : Hispanic women residing along the US-Mexico border have the highest cervical cancer incidence rates in the US. Genital human papillomavirus (HPV) is the major causative agent, but more information is needed about the prevalence and distribution of genital HPV subtypes in this high-risk population. Methods : A population-based cross-sectional study of uninsured Hispanic women along the US-Mexico border was conducted and participants had their cervical specimens undergo DNA extraction followed by HPV genotype testing using the Linear Assay from Roche® Diagnostics, to identify 37 genital HPV subtypes. Results : Among the 585 women aged 21-65 years, 584 self-identfied as Hispanic. Any HPV subtype prevalence was 53.2% (95% CI: 49.0%-57.3%) and of these 52% (i.e. 27.5% of the total) had single infections and 48% (i.e. 25.6% of the total) had multiple infections. High-risk HPV prevalence was 15.6% (95% CI: 24-31.3%). The mean number of subtypes among those testing positive was 2.1 (SD 1.6). The prevalence of any HPV and high-risk HPV showed a U shaped pattern with age; and prevalence of 16/18 and non-16/18 high-risk subtypes (e.g. 31, 33, 35, 39, 45, 51, 52, 58); also varied with age. Forty-one percent of high-risk HPV occurrences were of a subtype not covered by the current nonavalent HPV vaccine. Discussion : Our findings suggest a different high-risk HPV subtype pattern and age distribution among Hispanic women in the USA, which could have implications for future cervical cancer prevention strategies.
It Is Impossible: The Teacher’s Creative Response to the Covid-19 Emergency and Digitalized Teaching Strategies
Authors: Chemi Tatiana
Published: September 2020

My purpose is to investigate what happens to bodies/affects, arts-based education, entangled relationships, diffractive perspectives, and playful dramatizations during a pandemic crisis. The Covid-19 emergency was a tsunami that wiped away all my favored teaching tools. It is impossible I wrote to my study-leader when I had to adjust my creative teaching to digital frames. Still I did it, asking: what if? How did this experimentation transform my thinking, planning, and implementing teaching? The methodology I made use of is autoethnographic where data emerged by means of written or multimedia materials that were part of two collective writing projects.
Of Late Alarms, Long Queues, and Online Attendances: My Experiences of COVID Time
Authors: Sarkar Sucharita
Published: September 2020

This essay has three autoethnographic, interconnected, temporal vignettes that narrate my lived pandemic experiences of mothering a teenage daughter, performing socially isolated housework, and teaching online classes. These personal experiences are located in specific Indian contexts through thick descriptions that accommodate more massive perspectives. Adapting Sarah Sharma’s concepts of power-chronography and temporal politics, I problematize my COVID-enforced slow time, and explore more deeply how my fraught COVID time experiences intersect with the multiple COVID times of others. I use this methodological format—autoethnography, thick description, and theorization—to make sense of my pandemic experiences at both microscopic and massive levels.
Touching Matters: Affective Entanglements in Coronatime
Authors: Bozalek Vivienne , Newfield Denise , Romano Nike , Carette Lieve , Naidu Katharine , Mitchell Veronica , Noble Alex
Published: September 2020

This article troubles touch as requiring embodied proximity, through an affective account of virtual touch during coronatime. Interested in doing academia differently, we started an online Barad readingwriting group from different locations. The coronatime void was not a vacuum, but a plenitude of possibilities for intimacy, pedagogy, learning, creativity, and adventure. Although physically apart, we met daily through Zoom, and we touched and were touched by each other and the texts we read. A montage of writing fragments and a collective artwork, based on the Massive_Micro project, highlight virtual touching. Undone, redone, and reconfigured, we became a diffractive human/nonhuman multiplicity.
Combined modified atmosphere packaging and guar gum edible coatings to preserve blackberry (Rubus glaucus Benth)
Authors: Pérez Diego A , Gómez José M , Castellanos Diego A
Published: September 2020

Blackberry fruits are fresh products with wide market possibilities but of very limited shelf life (3–6 days). To develop preservation alternatives, the effect and interaction of a modified atmosphere packaging and an edible coating based on guar gum were determined on the shelf life and quality properties of blackberry cv. Castilla stored at 5 ℃. Three types of packaging were evaluated: (1) perforated polyethylene terephthalate clamshells, (2) sealed polyethylene terephthalate clamshells, and (3) sealed polyethylene terephthalate clamshells with a polylactic acid film on top. In turn, two types of coating were evaluated: coatings of guar gum solutions at (1) 0.3% and (2) 0.4% in water. During storage, an index of deterioration and different quality properties were evaluated. In the polyethylene terephthalate packages with polylactic acid, an equilibrium modified atmosphere packaging was formed. Weight loss was much lower for the sealed polyethylene terephthalate and polyethylene terephthalate + polylactic acid (<2%) compared to fruits in perforated clamshells, with no significant differences between these two types of packaging. It was possible to observe the treatment with an edible coating of 0.3% gum guar and perforated clamshells (guar gum 0.3/N) presented the lowest deterioration rate and preserve the fruit longer time (13 days) although with a high weight loss (23.23%) while the treatment with polyethylene terephthalate and polylactic acid film + edible coating of gum guar (guar gum 03/polylactic acid) kept the samples during 12 days with a lower weight loss (1.75%). This latter combination of equilibrium modified atmosphere packaging with a biodegradable film and the guar gum edible coating can be an interesting treatment from a commercial point of view.
A Class of Indices and a Graphical Tool to Monitor Temperature Anomalies
Authors: Bárcena-Martín Elena , Molina Julian , Hueso Paloma , Ruiz-Sinoga José Damián
Published: September 2020

We propose a graphical device—Three I’s of Anomalies (TIA) curves—that provides information on the incidence, intensity, and inequality (variability) of air temperature anomalies. We also propose a class of indices that help to compare different TIA curves when visual inspection alone is inconclusive. This class of indices identifies the 3 dimensions of anomalies and can be decomposed to evaluate air temperature anomalies according to different characteristics. Moreover, the results from this class of indices are consistent with the graphical device. We calculated TIA curves and a class of indices to analyze temperature anomalies in Málaga, Spain, from 2000 to 2017. Comparison of sequential 5-year periods indicated that maximum and minimum temperature anomalies have generally increased in frequency and intensity over time. The proposed index, which considers all dimensions, indicated that maximum and minimum temperature anomalies have increased. Analysis of different geographical areas indicated that inland areas had the greatest anomalies for minimum temperatures and mountainous areas had the greatest anomalies for maximum temperatures. Inland areas also had a stronger pattern of increasing anomalies. The coastline, especially in the western region, had weaker maximum and minimum temperature anomalies.
Evaluation of Drinking Water Quality in Schools in a District Area in Hanoi, Vietnam
Authors: Hung Dang The , Thi Cuc Vu , Thi Bich Phuong Vu , Thi Thanh Diu Dao , Thi Huyen Trang Nguyen , Phuong Thoa Nguyen , Thi Tuyet Chinh Do , Manh Hung Ta , Manh Linh Chu , Van Long Nguyen
Published: September 2020

Background:

Drinking water quality affects directly human health. Assessment and prevention of water-borne diseases are crucial for primary prevention, especially for children.

Objective:

The main aim of this study was to investigate the quality of drinking water from tap water in preschools and primary schools in a district area in Hanoi City, Vietnam.

Methods:

A cross-sectional study was performed from August to October 2019. Water samples from tap water of 154 schools in a district area of Hanoi were collected to determine the quality of drinking water. From each school, at least 2 bottles of water samples were collected on the basis of a standard operating procedure (SOP). Each water sample was analyzed for microbial and physicochemical parameters, including Color, Taste and Odor, Turbidity, pH, Nitrite, Nitrate, Ammonium, Total Iron, Permanganate, Chloride, Hardness, Total Manganese, Sulfate, Arsenic, Coliform, and E.coli, by analytical methods. The obtained values of each parameter were compared with the standard values set by WHO and National Technical Regulation on Domestic Water Quality of Vietnam.

Results:

All of the schools employed community water system as a main source for drinking water. The results showed that all tested samples were found to be within the standards for some physicochemical properties, including Color, Taste and Odor, Hardness, Chloride, Total Iron (Fe2+ và Fe3+), Total Manganese (Mn), Nitrate (NO3–), Sulfate (SO42–), and Total Arsenic (As). On the other hand, some samples did not meet the allowable limits of the national standard, due to pH (3.9%), Turbidity (0.6%), Nitrite (3.2%), Permanganate (6.5%), and Ammonium (5.8%). Furthermore, the microbial data revealed that the substandard water samples from municipal water systems were contaminated by Coliform (9.7%) and/or E.coli (7.8%).

Conclusions and recommendations:

Contaminants such as bacterial and chemical agents in to drinking water could be occurred during transport, storage and handling before using by the consumer without regular surveillance. A periodic treatment procedure and monitoring system to keep the level of microbial and chemical contamination of drinking water in schools under control should be performed.
Party (de)institutionalization in times of political uncertainty: The case of the Justice and Development Party in Turkey
Authors: Yardımcı-Geyikçi Şebnem , Yavuzyilmaz Hakan
Published: September 2020

Recently many polities around the world as different as Hungary, Turkey, Venezuela, Thailand suffer from autocratization. This has led to a growing scholarly interest in the process of autocratization. Yet, despite this emerging generation of studies on democratic setbacks, we still do not know much about the changing nature of party politics in the process of autocratization. We argue, in this article, that during autocratization, the incumbent party follows the path of internal and external party deinstitutionalization in response to the changing nature and intensity of political uncertainties. Using the case of the Justice and Development Party in Turkey, we address three questions: (1) How can the concept of party de-institutionalization be revised and used to understand party transformation during autocratization? (2) What explains party deinstitutionalization in transitional contexts? (3) What is the relationship between party de-institutionalization and autocratization? In doing so, this article increases our understanding of party transformation in transitional contexts and more specifically incumbent party change in the process of autocratization by providing a causal theory of party deinstitutionalization.
Shedding light on isomeric FAHFA lipid structures using 213 nm ultraviolet photodissociation mass spectrometry
Authors: Buenger Edgar White , Reid Gavin E
Published: September 2020

Fatty Acid Esters of Hydroxy Fatty Acids (FAHFAs) are a recently discovered class of biological active lipids with anti-diabetic and anti-inflammatory functions. Given that structure and function are intimately related, we report here the use of direct infusion multi-stage hybrid tandem mass spectrometry involving sequential Collisional Activated Dissociation (CAD) and 213 nm UltraViolet PhotoDissociation (UVPD), as a novel technique for the unambiguous denovo identification and detailed structural characterisation of FAHFA lipid ions, including determination of the esterified fatty acid identity, the hydroxy fatty acid identity and position of esterification, and localization of the site(s) of endogenous unsaturations, without need for chromatographic separation or authentic reference standards. The utility of this approach is demonstrated for the identification of individual FAHFA lipids introduced to the mass spectrometer in positive ionization mode as their lithiated adducts, as well as from mixtures containing isomeric FAHFA species with differing esterification sites, including those that are not resolved by current liquid chromatography methods.
How Does the Super Bowl Affect Host City Tourism?
Authors: Heller Lauren R. , Stephenson E. Frank
Published: September 2020

This paper uses a unique dataset containing more than eight years of daily data to examine the effect of the Super Bowl on hotel room rentals, rates, and room revenue in four recent host cities. The findings include (1) the net gain in rentals is considerably fewer than the gross number of rooms rented, (2) benefits are heterogeneous across cities, (3) the areas that benefit are not always those located close to stadiums, and (4) nearly 90% of hotel room revenue gained is because of increased room rates which means concerns about leakages from host cities’ regional economies are salient.
Optimizing the physical parameters of polycaprolactone-gelatin-polydimethylsiloxane composite nanofiber scaffold for tissue engineering application
Authors: Dehghan Mahdieh , Nikukar Habib , Mehrizi Mohammad Khajeh
Published: September 2020

A lot of research has already been conducted on tissue engineering as it can have the potential for organ and tissue regeneration and repair. Research on the proliferation of cells on the scaffolds, which are material-based structures in the extracellular matrix, increased efficiency of 3D cultures. In this study, the stages of preparing a nanofiber scaffold with different ratios of three polymers of Polycaprolactone/Gelatin/Polydimethylsiloxane (PCL/G/PDMS) which is biodegradable, non-toxic and biocompatible are explained for tissue engineering and then fibroblast cells cultivation are discussed. The morphology, porosity and hydrophilicity of the prepared scaffolds were evaluated by scanning electron microscope (SEM), the liquid displacement method, water contact-angle measurements respectively. The cell growth and proliferation on scaffolds were counted by Digimizer© software. Then morphology, porosity and hydrophilicity of scaffolds and cell growth and proliferation on scaffolds were optimized by Response Surface Methodology (RSM). The results show that PCL/G/PDMS electrospun nanofibers can be used for tissue engineering applications. The purpose of this scaffold is design a scaffold for elastic tissue engineering, especially uterine tissue, which will be discussed in the following articles.
The Dual GLP-1/GIP Receptor Agonist DA4-JC Shows Superior Protective Properties Compared to the GLP-1 Analogue Liraglutide in the APP/PS1 Mouse Model of Alzheimer’s Disease
Authors: Maskery Mark , Goulding Elizabeth Mary , Gengler Simon , Melchiorsen Josefine Ulrikke , Rosenkilde Mette Marie , Hölscher Christian
Published: September 2020

Alzheimer’s disease (AD) is a neurodegenerative disorder for which there is no cure. Here, we test a dual GLP-1/GIP receptor agonist (DA4-JC) that has a cell penetrating sequence added to enhance blood-brain barrier penetration. We show in a receptor activity study that DA4-JC has balanced activity on both GLP-1 and GIP receptors but not on GLP-2 or Glucagon receptors. A dose-response study in the APP/PS1 mouse model of AD showed both a dose-dependent drug effect on the inflammation response and the reduction of amyloid plaques in the brain. When comparing DA4-JC with the GLP-1 analogue liraglutide at equal doses of 10nmol/kg bw ip. once-daily for 8 weeks, DA4-JC was more effective in reversing memory loss, enhancing synaptic plasticity (LTP) in the hippocampus, reducing amyloid plaques and lowering pro-inflammatory cytokine levels in the brain. The results suggest that DA4-JC may be a novel treatment for AD.
emagnification: A tool for estimating effect-size magnification and performing design calculations in epidemiological studies
Authors: Miller David J. , Nguyen James T. , Bottai Matteo
Published: September 2020

Artificial effect-size magnification (ESM) may occur in underpowered studies, where effects are reported only because they or their associated p-values have passed some threshold. Ioannidis (2008, Epidemiology 19: 640–648) and Gelman and Carlin (2014, Perspectives on Psychological Science 9: 641–651) have suggested that the plausibility of findings for a specific study can be evaluated by computation of ESM, which requires statistical simulation. In this article, we present a new command called emagnification that allows straightforward implementation of such simulations in Stata. The commands automate these simulations for epidemiological studies and enable the user to assess ESM routinely for published studies using user-selected, study-specific inputs that are commonly reported in published literature. The intention of the command is to allow a wider community to use ESMs as a tool for evaluating the reliability of reported effect sizes and to put an observed statistically significant effect size into a fuller context with respect to potential implications for study conclusions.
Uniform nonparametric inference for time series using Stata
Authors: Li Jia , Liao Zhipeng , Gao Mengsi
Published: September 2020

In this article, we introduce a command, tssreg, that conducts nonparametric series estimation and uniform inference for time-series data, including the case with independent data as a special case. This command can be used to nonparametrically estimate the conditional expectation function and the uniform confidence band at a user-specified confidence level, based on an econometric theory that accommodates general time-series dependence. The uniform inference tool can also be used to perform nonparametric specification tests for conditional moment restrictions commonly seen in dynamic equilibrium models.
Study on the Fingerprints and Quality Evaluation of Angelica Sinensis Radix by HPLC Coupled With Chemometrics Based on Traditional Decoction Process of ACPTCM
Authors: Qian Zhang , Yiyang Chen , Lixia Ma , Yue Jiang , Jun Chen , Jie Dong , Yifan Ma , Jingjing Zhang , Guojun Yan
Published: September 2020

Objective:

To establish a HPLC fingerprints evaluation method for Angelica Sinensis Radix (ASR) based on traditional decoction process of Ancient Classical Prescriptions of Traditional Chinese Medicine (ACPTCM).

Methods:

The fingerprints of 10 batches of ASR were further evaluated by chemometrics methods. The similarity analyzed with “Similarity Evaluation System for Chromatographic Fingerprint of Traditional Chinese Medicine 2004A,” and hierarchical clustering analysis (HCA) and principal component analysis (PCA) were performed by SPSS (version 22.0, SPSS Inc., Chicago, IL, USA).

Results:

There were 12 common peaks, and the similarity degrees of 10 batches of samples were more than 0.923 and showed that all the samples from different origins were of good consistency. The samples were divided into 4 clusters by HCA. The results of PCA showed that the 3 factors were chosen, the quality of samples could be evaluated basically. The comprehensive score results show that the ASR with Lot.Nos.DG-18007, DG-18008 in Weiyuan County, Gansu and DG-18009 produced in Minle County, Gansu Province rank among the top 3 in all samples.

Conclusions:

These results demonstrated that the combination of HPLC chromatographic fingerprint and chemometrics offers an efficient and reliable approach for quality evaluation of ASR from different sources as Ancient Classical Prescriptions ingredients.
Immunomodulation Through Low-Dose Radiation for Severe COVID-19: Lessons From the Past and New Developments
Authors: Hanekamp Yannic N. , Giordano James , Hanekamp Jaap C. , Khan Mohammad K. , Limper Maarten , Venema Constantijn S. , Vergunst Samuel D. , Verhoeff Joost J. C. , Calabrese Edward J.
Published: September 2020

Low-dose radiation therapy (LD-RT) has historically been a successful treatment for pneumonia and is clinically established as an immunomodulating therapy for inflammatory diseases. The ongoing COVID-19 pandemic has elicited renewed scientific interest in LD-RT and multiple small clinical trials have recently corroborated the historical LD-RT findings and demonstrated preliminary efficacy and immunomodulation for the treatment of severe COVID-19 pneumonia. The present review explicates archival medical research data of LD-RT and attempts to translate this into modernized evidence, relevant for the COVID-19 crisis. Additionally, we explore the putative mechanisms of LD-RT immunomodulation, revealing specific downregulation of proinflammatory cytokines that are integral to the development of the COVID-19 cytokine storm induced hyperinflammatory state. Radiation exposure in LD-RT is minimal compared to radiotherapy dosing standards in oncology care and direct toxicity and long-term risk for secondary disease are expected to be low. The recent clinical trials investigating LD-RT for COVID-19 confirm initial treatment safety. Based on our findings we conclude that LD-RT could be an important treatment option for COVID-19 patients that are likely to progress to severity. We advocate the further use of LD-RT in carefully monitored experimental environments to validate its effectiveness, risks and mechanisms of LD-RT.
Test the Effectiveness of Quantitative Linear-Quadratic-Based (qLQB) Model on Evaluating Irradiation-Induced Liver Injury (ILI) Against Normal Tissue Complication Probability (NTCP)
Authors: Bai Han , Wang Li , Li Wenhui , Liu Xuhong , Xia Yaoxiong , Chang Li
Published: September 2020

Objectives:

To test the effectiveness of quantitative linear-quadratic-based (qLQB) model on evaluating irradiation-induced liver injury (ILI) and establish the relation between the damaged ratio/percent (DRP) in qLQB model and normal tissue complication probility (NTCP).

Materials and Methods:

We established the qLQB model to calculate the ratio/percent (RP) between damaged cell/functional subunit (FSU) and entire cell/FSU of liver for radiation dose response, tested the qLQB against the Lyman-Kutcher-Burman (LKB) model, and established relation between the RP and NTCP through analyzing the dose of 32 patients with cancer of abdominal cavity who were treated with radiation therapy at our department. Based on varied α/β and varied parameters for NTCP, we put the calculated results into varied arrays for the next analysis. We named the 2 groups of RPs: RP1 (α/β = 3.0, α = 0.03) and RP2 (α/β = 8.0, α = 0.26), and named the 2 groups of NTCPs: NTCP1 (n = 0.32, m = 0.15, TD50(1) = 4000 cGy) and NTCP2 (n = 1.10, m = 0.28, TD50(1) = 4050 cGy).

Results:

Spearman correlation analysis was used to analyze the correlations among the groups, the results were as follows: RP1 vs NTCP1, rs = 0.83827, p < 0.0001; RP1 vs NTCP2, rs = 0.83827, p < 0.0001; RP2 vs NTCP2, rs = 0.79289, p < 0.0001; and RP2 vs NTCP1, rs = 0.79289, p < 0.0001.

Conclusions:

There is a significant correlation between RP value and NTCP for evaluating ILI, and there is no difference between qLQB model and LKB model on evaluating ILI.
Citrulline, A Potential Biomarker of Radiation-Induced Small Intestine Damage
Authors: Ye Fei , Ning Jing , Fardous Zeenath , Katsube Takanori , Li Qiang , Wang Bing
Published: September 2020

Radiation damage assessment of the small intestine is important in nuclear accidents or routine radiotherapy of abdominal tumors. This article reviews the clinical symptoms and molecular mechanisms of radiation-induced small intestinal damage and summarizes recent research on biomarkers of such damage. Citrulline is the most promising biomarker for the evaluation of radiation-induced small intestinal damage caused by radiotherapy and nuclear accidents. This article also summarizes the factors influencing plasma citrulline measurement investigated in the latest research, as well as new findings on the concentration of citrulline in saliva and urine after different types of radiation.
Setting performance benchmarks for stroke care delivery: Which quality indicators should be prioritized in quality improvement; an analysis in 500,331 stroke admissions
Authors: Li Xi , Wang Chao , Rehman Shazia , Wang Xinyu , Zhang Wei , Su Shaofei , Bao Xiaoqiang , Li Jingkun , Liu Meina , Wang Yongchen
Published: September 2020

Background and aim

Benchmarking is a management approach for implementing best medical practices at the lowest cost. The objectives of this study were to set achievable performance benchmarks for individual quality indicators to determine the predicted quality achievement related to better adherence, and to select optimal quality indicators for improving the quality of acute ischemic stroke care.

Methods

We analyzed data on 500,331 patients diagnosed with acute ischemic stroke who were treated at 518 hospitals in China from January 2011 to May 2017. The primary outcome was independence (modified Rankin Scale score ≤2) at discharge. Data-driven achievable benchmarking used the “pared-mean” approach to set objective performance targets. Hierarchical logistic regression models were employed to evaluate the process–outcome association, as well as the predicted quality improvement if all hospitals were to operate at the benchmark level.

Results

Of the overall population, 64.01% were independent patients at discharge. The performance benchmarks were >90% for most of the quality indicators. After adjusting for patient-level and hospital-level characteristics and unifying hospital performance to the benchmark level, the quality indicators with high increase in both overall adherence rate and independence rate were thrombolytic therapy, anticoagulant therapy, venous thrombosis prophylaxis.

Conclusions

Performance targets for three acute treatments, including thrombolytic therapy, anticoagulant therapy, venous thrombosis prophylaxis, could best motivate improvements in both overall adherence rate and independence rate at discharge. The finding suggests that the above three types of acute treatment should be given priority to improve the quality of acute ischemic stroke care.
A Post-Infectious Steroid-Responsive Brainstem Lesion Associated With COVID-19
Authors: Chang Philip , Tasch Edwin S. , Rapoport Lisa N. , Bakhadirov Khamidulla
Published: September 2020

A 51-year-old man developed coma, bilateral pupillary dilation, ophthalmoplegia and quadriplegia 4 weeks after testing positive for COVID-19. MRI demonstrated a symmetric midline pontine non-enhancing T2-FLAIR hyperintense lesion. The patient was treated with intravenous methylprednisolone, which resulted in improvement of his Glasgow Coma Scale (GCS) from 3 to 15 over the next 5 days. To our knowledge, this is the first case of a post-infectious steroid-responsive brainstem lesion associated with COVID-19. The clinical picture best fits in the family of a steroid-responsive encephalopathy and reminds us that COVID-19 may cause severe post-infectious neurological complications.
Convalescent Blood Products in COVID-19: A Narrative Review
Authors: Chua Vi Long Keegan , Sayed Abida , Karki Priyanka , Acharya Yogesh
Published: September 2020

The coronavirus disease 2019 (COVID-19) pandemic has left the world in a state of desolation with overburdening public health systems in a short period. Finding possible preventative and therapeutic measures to counter severe respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19, has been the priority. A possible solution is convalescent blood products (CBP), primarily convalescent plasma (CP) and immunoglobulins, as an adjunctive therapy. CBP has been tried on the previous coronavirus epidemics with severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Therefore, we reviewed the clinical utility of CBP and available evidence in COVID-19. We found some of the current anecdotal studies demonstrate promising therapeutic potential, but many of these studies do not meet the academic rigours to substantiate its use with confidence. However, the compassionate use of CBP in critically ill COVID-19 patients can be an option while we await a definitive answer from ongoing randomised clinical trials.
Failure to protect the frailest old from Covid-19: Safety in the light of person-centered care
Authors: Hallberg Ingalill Rahm
Published: September 2020

The end results of the Covid-19 pandemic are as yet unknown. However, even at this stage there are outcomes that command the attention of the nursing profession, both the research side and the practice side. By 14 July 2020, 5455 people in Sweden had died infected with Covid-19 and, of those, 2505 lived in what would internationally be regarded as nursing homes (45.9%). In addition, another 1316 individuals, living at home with the support of public home care and services, died. The reports were a shock to the public and rightfully received a lot of attention in the Covid-19 debate. This scenario is not perhaps unique to Sweden; reports from other countries provide similar information. The statistics raise many questions: How could this happen? Where is the voice of the nursing profession? What is happening in nursing research? Is it focusing on what is going on in practice?
Therapeutic strategy for severe COVID-19 pneumonia from clinical experience
Authors: Ogawa Fumihiro , Kato Hideaki , Nakajima Kento , Nakagawa Tomoki , Matsumura Reo , Oi Yasufumi , Sakai Kazuya , Uchiyama Munehito , Ohyama Yutaro , Abe Takeru , Takeuchi Ichiro
Published: September 2020

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first identified in December 2019 in Wuhan, China, and has resulted in global pandemic. There is currently no effective therapeutic strategy for the management of mechanical ventilation or antiviral drugs for the treatment of this disease. As such, the development of a therapeutic strategy is urgently needed and should be established as soon as possible. In this case series, a therapeutic strategy was initially developed based on previous treatment methods used for the treatment of SARS and MERS in the absence of treatment options for COVID-19 due to a lack of information. During the search for a potential treatment, clinical findings were obtained from patients with severe COVID-19, and one therapeutic strategy was established. This therapeutic strategy was then applied to severe COVID-19 patients. In addition, we can require some interesting clinical features and characteristics of COVID-19 from blood analysis and physical findings. Here, we reported on the clinical features and characteristics of a therapeutic strategy for the treatment of severe COVID-19 pneumonia at our institution.
Comparison of the Safety of Outpatient Cervical Disc Replacement With Inpatient Cervical Disc Replacement: A Systematic Review and Meta-Analysis
Authors: Wang Xiaofei , Meng Yang , Liu Hao , Hong Ying , Wang Beiyu , Ding Chen , Yang Yi
Published: September 2020

Study Design:

A systematic review and meta-analysis.

Objectives:

Outpatient cervical disc replacement (CDR) has been performed with an increasing trend in recent years. However, the safety profile surrounding outpatient CDR remains insufficient. The present study systematically reviewed the current studies about outpatient CDR and performed a meta-analysis to evaluate the current evidence on the safety of outpatient CDR as a comparison with the inpatient CDR.

Methods:

We searched the PubMed, Embase, Web of Science, and Cochrane Library databases comprehensively up to April 2020. Patient demographic data, overall complication, readmission, returning to the operation room, operating time were analyzed with the Stata 14 software and R 3.4.4 software.

Results:

Nine retrospective studies were included. Patients underwent outpatient CDR were significantly younger (mean difference [MD] = −1.97; 95% CI −3.80 to −0.15; P = .034) and had lower prevalence of hypertension (OR = 0.68; 95% CI 0.53-0.87; P = .002) compared with inpatient CDR. The pooled prevalence of overall complication was 0.51% (95% CI 0.10% to 1.13%) for outpatient CDR. Outpatient CDR had a 59% reduction in risk of developing complications (OR = 0.41; 95% CI 0.18-0.95; P = .037). Outpatient CDR showed significantly shorter operating time (MD = −18.37; 95% CI −25.96 to −10.77; P < .001). The readmission and reoperation rate were similar between the 2 groups.

Conclusions:

There is a lack of prospective studies on the safety of outpatient CDR. However, current evidence shows outpatient CDR can be safely performed under careful patient selection. High-quality, large prospective studies are needed to demonstrate the generalizability of this study.
Heat shock factor 1 (HSF1-pSer326) predicts response to bortezomib-containing chemotherapy in pediatric AML: a COG report
Authors: Hoff Fieke W. , van Dijk Anneke D. , Qiu Yihua , Ruvolo Peter P. , Gerbing Robert B. , Leonti Amanda R. , Jenkins Gaye N. , Gamis Alan S. , Aplenc Richard , Kolb E. Anders , Alonzo Todd A. , Meshinchi Soheil , de Bont Eveline S. J. M. , Bruggeman Sophia W. M. , Kornblau Steven M. , Horton Terzah M.
Published: September 2020

Bortezomib (BTZ) was recently evaluated in a randomized phase 3 clinical trial by the Children’s Oncology Group (COG) that compared standard chemotherapy (cytarabine, daunorubicin, and etoposide [ADE]) vs standard therapy with BTZ (ADEB) for de novo pediatric acute myeloid leukemia (AML). Although the study concluded that BTZ did not improve outcome overall, we examined patient subgroups benefiting from BTZ-containing chemotherapy using proteomic analyses. The proteasome inhibitor BTZ disrupts protein homeostasis and activates cytoprotective heat shock responses. Total heat shock factor 1 (HSF1) and phosphorylated HSF1 (HSF1-pSer326) were measured in leukemic cells from 483 pediatric patients using reverse phase protein arrays. HSF1-pSer326 phosphorylation was significantly lower in pediatric AML compared with CD34+ nonmalignant cells. We identified a strong correlation between HSF1-pSer326 expression and BTZ sensitivity. BTZ significantly improved outcome of patients with low-HSF1-pSer326 with a 5-year event-free survival of 44% (ADE) vs 67% for low-HSF1-pSer326 treated with ADEB (P = .019). To determine the effect of HSF1 expression on BTZ potency in vitro, cell viability with HSF1 gene variants that mimicked phosphorylated (S326A) and nonphosphorylated (S326E) HSF1-pSer326 were examined. Those with increased HSF1 phosphorylation showed clear resistance to BTZ vs those with wild-type or reduced HSF1-phosphorylation. We hypothesize that HSF1-pSer326 expression could identify patients who benefit from BTZ-containing chemotherapy.
Machine learning demonstrates that somatic mutations imprint invariant morphologic features in myelodysplastic syndromes
Authors: Nagata Yasunobu , Zhao Ran , Awada Hassan , Kerr Cassandra M. , Mirzaev Inom , Kongkiatkamon Sunisa , Nazha Aziz , Makishima Hideki , Radivoyevitch Tomas , Scott Jacob G. , Sekeres Mikkael A. , Hobbs Brian P. , Maciejewski Jaroslaw P.
Published: September 2020

Morphologic interpretation is the standard in diagnosing myelodysplastic syndrome (MDS), but it has limitations, such as varying reliability in pathologic evaluation and lack of integration with genetic data. Somatic events shape morphologic features, but the complexity of morphologic and genetic changes makes clear associations challenging. This article interrogates novel clinical subtypes of MDS using a machine-learning technique devised to identify patterns of cooccurrence among morphologic features and genomic events. We sequenced 1079 MDS patients and analyzed bone marrow morphologic alterations and other clinical features. A total of 1929 somatic mutations were identified. Five distinct morphologic profiles with unique clinical characteristics were defined. Seventy-seven percent of higher-risk patients clustered in profile 1. All lower-risk (LR) patients clustered into the remaining 4 profiles: profile 2 was characterized by pancytopenia, profile 3 by monocytosis, profile 4 by elevated megakaryocytes, and profile 5 by erythroid dysplasia. These profiles could also separate patients with different prognoses. LR MDS patients were classified into 8 genetic signatures (eg, signature A had TET2 mutations, signature B had both TET2 and SRSF2 mutations, and signature G had SF3B1 mutations), demonstrating association with specific morphologic profiles. Six morphologic profiles/genetic signature associations were confirmed in a separate analysis of an independent cohort. Our study demonstrates that nonrandom or even pathognomonic relationships between morphology and genotype to define clinical features can be identified. This is the first comprehensive implementation of machine-learning algorithms to elucidate potential intrinsic interdependencies among genetic lesions, morphologies, and clinical prognostic in attributes of MDS.
Neutrophils promote clearance of nuclear debris following acid-induced lung injury
Authors: Oved Joseph H. , Paris Andrew J. , Gollomp Kandace , Dai Ning , Rubey Kathryn , Wang Ping , Spruce Lynn A. , Seeholzer Steven H. , Poncz Mortimer , Worthen G. Scott
Published: September 2020

Neutrophils are critical mediators of host defense in pathogen-induced and sterile inflammation. Excessive neutrophil activation has been associated with increased host pathology through collateral organ damage. The beneficial aspects of neutrophil activation, particularly in sterile inflammation, are less well defined. We observed accumulation of nuclear debris in the lungs of neutropenic mice exposed to acid-induced injury compared with wild type. Size analysis of DNA debris showed that neutropenic mice were unable to degrade extracellular DNA fragments. In addition, we found that neutrophils are able to differentially express DNA-degrading and repair-associated genes and proteins. Once neutrophils are at sites of lung inflammation, they are able to phagocytose and degrade extracellular DNA. This neutrophil-dependent DNA degradation occurs in a MyD88-dependent pathway. The increased DNA debris in neutropenic mice was associated with dysregulated alveolar repair and the phenotype is rescued by intratracheal administration of DNase I. Thus, we show a novel mechanism as part of the inflammatory response, in which neutrophils engulf and degrade extracellular DNA fragments and allow for optimal organ repair.