bluuebunny/crossref_metadata_2025 huggingface dataset:
Regulating language: Territoriality and personality in plurinational Spain
Authors: Morales-Gálvez Sergi , Cetrà Daniel
Published: October 2021

This article examines the regulation of linguistic diversity in Spain from a combined empirical and normative perspective. Spain is a particularly interesting case due to the intersection of linguistic and national diversity and its peculiar combination of territoriality and personality. We first present a conceptual framework which draws on the personality and territoriality distinction as established by political philosophers. Second, we examine the way multilingualism is regulated in Spain. A dual system emerges in which Castilian is the only state language while four other languages – Aranese, Basque, Catalan and Galician – are co-official in six Autonomous Communities. We identify two models concerning the degree of institutionalisation of non-Castilian languages: co-officiality and limited recognition. Finally, we characterise and assess normatively the advantages and disadvantages of the Spanish linguistic regulation. We argue that the Spanish linguistic system may be characterised as an Unequal Personality Linguistic Regime. This regime offers several instrumental advantages related to the prevalence of a shared language as well as a significant degree of territorial accommodation for minority language groups, but it also gives rise to injustices related to unequal treatment and domination. This article contributes to the academic debate about the politics of language by analysing a paradigmatic case of multilingualism and plurinationalism, Spain, and considering the usefulness of the territoriality and personality framework to study specific cases.
The changing self: The impact of dementia on the personal and social identity of women (findings from the Improving the Experience of Dementia and Enhancing Active Life programme)
Authors: Scott Hannah
Published: October 2021

This paper explores the impact of dementia on the selfhood of women, specifically the ways in which changes occur as a result of such a diagnosis. Interviews were conducted with 12 women (recruited from the Improving the Experience of Dementia and Enhancing Active Life programme dataset), and analysed using interpretative phenomenological analysis. Emergent themes concerned the process of receiving and adjusting to a dementia diagnosis, the emotional and psychological impact of dementia, self-presentation and stigma and the self-enforcement of new boundaries. The analysis showed that dementia had a wide-ranging impact on the selfhood and identity of women, with newfound characteristics associated with the disease leading to a loss of self-esteem, sadness and anger. The women subsequently engaged in the modification of their behaviour, as a means of coming to terms with the losses experienced.
Trends in Utilization and Outcomes of Orbital, Laser, and Excisional Atherectomy for Lower Extremity Revascularization
Authors: Bai Halbert , Fereydooni Arash , Zhang Yawei , Tonnessen Britt H. , Guzman Raul J. , Chaar Cassius Iyad Ochoa
Published: October 2021

Purpose:

The aim of this study is to analyze the utilization pattern of atherectomy modalities and compare their outcomes.

Materials and Methods:

All patients undergoing atherectomy in the 2010–2016 Vascular Quality Initiative Database were identified. Utilization of orbital, laser, or excisional atherectomy was obtained. Characteristics and outcomes of patients treated for isolated femoropopliteal and isolated tibial disease by different modalities were compared.

Results:

Atherectomy use increased from 10.3% to 18.3% of all peripheral interventions (n = 122 938). Orbital atherectomy was most commonly used and increased from 59.4% in 2010 to 63.2% of all atherectomies in 2016, while laser atherectomy decreased from 19.2% to 13.1%. Atherectomy was mostly used for treatment of isolated femoropopliteal disease (51.1%), followed by combined femoropopliteal and tibial disease (25.8%) and isolated tibial disease (11.7%). In isolated femoropopliteal revascularization, excisional atherectomy was associated with higher rate of perforation (1.2%) compared with laser (0.4%) and orbital atherectomy (0.5%). The technical success of orbital atherectomy (96.7%) was lower compared with excisional atherectomy (98.7%). Concomitant stenting was significantly higher with laser atherectomy (43.0%) compared with orbital (27.2%) and excisional (26.1%) atherectomy. Nevertheless, there was no difference in 1-year primary patency, reintervention, major amputation, improvement in ambulatory status, or mortality. Multivariable analysis also demonstrated no difference in 1-year primary patency and major ipsilateral amputation among the modalities. In isolated tibial revascularization, there were no differences in perioperative outcomes among the modalities. Excisional atherectomy was associated with the highest 1-year primary patency (88.1%). After adjusting for confounders, excisional atherectomy remained associated with superior 1-year primary patency compared with orbital atherectomy (odds ratio [OR] = 2.59, 95% confidence interval [CI] = [1.18–5.68]), and excisional atherectomy remained associated with a lower rate of 1-year major ipsilateral amputation compared with laser atherectomy (OR = 0.29, 95% CI = [0.09–0.95]).

Conclusion:

Atherectomy use has increased, driven primarily by orbital atherectomy. Despite significant variation in perioperative outcomes, there were no differences in 1-year outcomes among the different modalities when used for treating isolated femoropopliteal disease. In isolated tibial disease treatment, excisional atherectomy was associated with higher 1-year primary patency compared with orbital atherectomy and decreased major ipsilateral amputation rates compared with laser atherectomy. These differences warrant further investigation into the comparative effectiveness of atherectomy modalities in various vascular beds.
“No Country Bureaucratised its way to Excellence”: A Content Analysis of Comments on a Petition to Streamline Australian Research Ethics and Governance Processes
Authors: Scott Anna M. , Bryant E. Ann , Byrne Jennifer A. , Taylor Natalie , Barnett Adrian G.
Published: October 2021

We created a petition for a national inquiry into the Australian system of research ethics and governance, to inform the politicians about the problems with the existing system. We analyzed the reasons that signatories offered for why signing the petition was important to them. A total of 409 comments (by 805 signatories) focused on five major themes: (1) views on previous changes to the system of research ethics and governance; (2) drawbacks of the existing system; (3) suggested changes to the system; (4) anticipated impacts of changing the system; and (5) miscellaneous/other comments. Comments ranged from several words to over 400 words in length, and most often focused on the procedural aspects, and commented on theme 2: drawbacks of the existing system.
The Interpersonal Neuroscience of Social Learning
Authors: Pan Yafeng , Novembre Giacomo , Olsson Andreas
Published: October 2021

The study of the brain mechanisms underpinning social behavior is currently undergoing a paradigm shift, moving its focus from single individuals to the real-time interaction among groups of individuals. Although this development opens unprecedented opportunities to study how interpersonal brain activity shapes behaviors through learning, there have been few direct connections to the rich field of learning science. Our article examines how the rapidly developing field of interpersonal neuroscience is (and could be) contributing to our understanding of social learning. To this end, we first review recent research extracting indices of brain-to-brain coupling (BtBC) in the context of social behaviors and, in particular, social learning. We then discuss how studying communicative behaviors during learning can aid the interpretation of BtBC and how studying BtBC can inform our understanding of such behaviors. We then discuss how BtBC and communicative behaviors collectively can predict learning outcomes, and we suggest several causative and mechanistic models. Finally, we highlight key methodological and interpretational challenges as well as exciting opportunities for integrating research in interpersonal neuroscience with social learning, and we propose a multiperson framework for understanding how interpersonal transmission of information between individual brains shapes social learning.
Incidence and associated factors of postdural puncture headache for parturients who underwent cesarean section with spinal anesthesia at Debre Tabor General Hospital, Ethiopia; 2019
Authors: Demilew Basazinew Chekol , Tesfaw Aragaw , Tefera Alemitu , Getnet Bekalu , Essa Keder , Aemro Agazhe
Published: October 2021

Introduction and Objective:

Postdural puncture headache is one of the most frequent late complications of spinal anesthesia. There are different factors that might predispose for postdural puncture headache. Therefore, the main aim of this study was to assess the incidence of postdural puncture headache and its associated factors for parturients who gave birth by cesarean section under spinal anesthesia.

Methods:

Hospital-based longitudinal study was conducted on mothers who underwent cesarean section with spinal anesthesia. Descriptive analysis and chi-square test were employed. Bivariable and multivariable logistic regression were used to measure the association of factors with the presence of postdural puncture headache. A p-value of ⩽0.05 was used to decide statistical significance for multivariable logistic regression.

Result:

A total of 119 parturients were participated in this study. The incidence of postdural puncture headache was 20.2%. According to multivariable logistic regression, having previous spinal anesthesia (adjusted odds ratio = 7.028; 95% confidence interval = 2.377–20.781; p = 0.0001), using 20- and 22-gauge needle (adjusted odds ratio = 4.206; 95% confidence interval = 1.247–14.187; p = 0.021), and repeated attempt (adjusted odds ratio = 4.699; 95% confidence interval = 1.594–13.872; p = 0.05) had statistically significant association with postdural puncture headache.

Conclusion:

Larger gauge needle size, repeated attempt, and previous spinal anesthesia might increase the incidence of postdural puncture headache.
The epidemiology of spinal fractures in a level 2 trauma center in Kuwait
Authors: Alhadhoud Meshal , Alsiri Najla
Published: October 2021

Objectives:

Spinal fractures are a public health issue with high morbidity and mortality, and significant social and economic impact. The burden of disease can be minimized through effective management and preventive strategies based on basic epidemiological figures. Therefore, this study aimed to establish the epidemiological figures for traumatic injuries of the spine, including prevalence and associated risk factors in Kuwait, one of the high-income countries in the Middle East region.

Methods:

Using a retrospective design, the Orthopedic Admission Database of level II trauma center was reviewed from January 2018 to February 2020 for traumatic spinal fractures.

Results:

The study included 564 patients with 788 fractures, and from this sample, 162 patients sustained vertebral fractures at 181 different vertebral anatomical areas, resulting in 28.72% prevalence rate for spinal fractures; the mean age was 37.10 (SD = 18.25) years old; 79.2% were men, and 57.8% were Kuwaitis. The most prevalent mechanism of injury was road traffic accidents at 54.5%, and the lumbar spine was the most prevalent fracture site, followed by the thoracic spine at 47.5% and 31.5%, respectively. The mortality rate associated with spinal fractures is 42.10% from trauma cases admitted to the intensive care unit. Patients’ sex, nationality, fracture anatomical site, and the mechanism of injury were identified as risk factors (p < 0.05).

Conclusion:

The established epidemiological figures for spinal fractures can be used to direct management and preventive strategies and assist health care planning and delivery.

Level of Evidence:

III
Variations in Cost and Readmissions of Patients in the Bundled Payment for Care Improvement Bundle for Hip and Femur Fractures
Authors: Rose Ryan Hunter , Cherney Steven M. , Jensen Hanna K. , Karim Saleema A. , Mears Simon C.
Published: October 2021

Introduction

The Bundled Payment for Care Improvement (BPCI) for hip and femur fractures is an effort to increase care quality and coordination at a lower cost. The bundle includes all patients undergoing an operative fixation of a hip or femur fracture (diagnosis-related group codes 480-482). This study aims to investigate variance in the hospital cost and readmission rates for patients within the bundle.

Materials and Methods

The study is a retrospective analysis of patients ≥65 years old billed for a diagnosis-related groups 480-482 in 2016 in the National Readmission Database. Cost of admission and length of stay were compared between patients who were or were not readmitted. Regression analysis was used to determine the effects of the primary procedure code and anatomical location of the femur fracture on costs, length of stay, and readmission rates.

Results

Patients that were readmitted within 90 days of surgery had an increased cost on initial admission ($18,427 vs $16,844, P < .0001), and an increased length of stay (6.24 vs 5.42, P < .0001). When stratified by procedure, patients varied in readmission rates (20.7% vs 19.6% vs 21.8%), initial cost, and length of stay (LOS). Stratification by anatomical location also led to variation in readmission rates (20.7% vs 18.3% vs 20.6%), initial cost, and LOS.

Conclusion

The hip and femur fractures bundle includes a great number of procedures with variance in cost, readmission, and length of stay. This amount of variation may make standardization difficult and may put the hospital at potential financial risk.
Adolescents Have Twice the Revision Rate of Young Adults After ACL Reconstruction With Hamstring Tendon Autograft: A Study From the Swedish National Knee Ligament Registry
Authors: Thorolfsson Baldur , Svantesson Eleonor , Snaebjornsson Thorkell , Sansone Mikael , Karlsson Jon , Samuelsson Kristian , Senorski Eric Hamrin
Published: October 2021

Background:

Previous studies have identified young age as a risk factor for anterior cruciate ligament (ACL) revision. However, few studies have looked separately at pediatric patients and adolescents with regard to outcomes after ACL reconstruction.

Purpose:

To determine whether patient age at ACL reconstruction affects the risk of undergoing revision surgery in young patients.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

This study was based on data from the Swedish National Knee Ligament Registry. Patients aged 5 to 35 years who underwent a primary ACL reconstruction with a hamstring tendon autograft between January 1, 2005, and December 31, 2015, were included. The cohort was stratified into different age groups of pediatric patients, adolescents, and young adults to estimate patients with open, recently closed, and closed epiphyses, respectively. The primary endpoint was ACL revision. A multivariable Cox regression model was used to assess the ACL revision rate. The results were expressed as hazard ratios (HRs) and 95% CIs.

Results:

A total of 36,274 ACL reconstructions were registered during the study period. Of these, 2848 patients were included in the study: 47 pediatric patients (mean age, 13.6 years; range, 9-15 years), 522 adolescents (mean age, 17.4; range, 14-19 years), and 2279 young adults (mean age, 27.0; range, 20-35 years). A total of 31 patients (1.1%) underwent ACL revision within 2 years (0 pediatric patients, 9 adolescents [1.7%], and 22 young adults [1.0%]) and a total of 53 patients (2.6%) underwent ACL revision within 5 years (2 pediatric patients [6.9%], 15 adolescents [3.9%], and 36 young adults [2.2%]). The adolescent age group had a 1.91 times higher rate of ACL revision compared with the young adults (HR = 1.91 [95% CI, 1.13-3.21]; P = .015). There were no differences in revision rates between the pediatric age group and the young adults (HR = 2.93 [95% CI, 0.88-9.79]; P = .081).

Conclusion:

Adolescents had almost twice the rate of revision ACL reconstruction compared with young adults.
Democratic Decentralizaton and Socio-Political Inclusion of Marginalized Communities: A Study of Musahar Community in Madhubani District of Bihar, India
Authors: Jha Ashish
Published: October 2021

Democratic decentralization is the process of devolving the state’s roles and resources from the centre to the lower-level elected officials to encourage greater direct participation of people in governance. The 73rd Constitutional Amendment Act (1993), which gave the constitutional mandate to the Panchayati Raj Institutions in India, is considered as an opportunity for historically marginalized groups like women, Dalits (Scheduled Caste) and others to actively engage in the grassroot governance as members of local government institutions. Further, gram panchayats have been mandated for formulating their own annual development plan for economic development and social justice in their area. Although in these 25 years, since the enactment of the Act, various measures have been introduced through Panchayati Raj Institutions for increasing people’s participation and effective implementation of developmental programmes, but there is a little or no evidences—either the theoretical or the empirical, which can give a hint on its performance on social and political inclusion of marginalized communities. Against this backdrop, this empirical research paper attempts to explore the linkages between the democratic decentralization and socio-political inclusion of marginalized, by focussing on the Musahar community in Bihar state of India, using primary data collected from the field. The researchers argue that decentralization has ameliorated the social inclusion to some extent but shows very dismal rate of political inclusion of the Musahar Community.
Toward a uniform earthquake loss model across Central America
Authors: Calderón Alejandro , Silva Vitor , Avilés Matilde , Méndez Rosalín , Castillo Rolando , Carlos Gil José , Alfredo López Manuel
Published: October 2021

This study presents a probabilistic earthquake loss model for Central America, which is used to evaluate the indicators of the Sendai Framework for Disaster Risk Reduction (SFDRR). The exposure, vulnerability, and hazard components of the model were established using a uniform methodology for all the countries. Earthquake risk is expressed according to three indicators: mortality (A-1), population affected (B-1), and economic losses (C-1). Exposure results indicate that over 9.1 million structures (with an economic value of US$635 billion) are exposed to seismic hazard in the region. The risk results indicate an average annual human loss of 0.7 fatalities per 100,000 inhabitants, an average number of 35 people affected per 100,000 inhabitants, and an average annual economic loss of US$990 million. This represents 0.43% and 0.16% of the regional gross domestic product (GDP) and total replacement value, respectively. Guatemala, Nicaragua, and El Salvador present the highest risk, contributing with 75% of the absolute economic losses and 84% of the average annual fatalities in the region.
Transcriptional expression changes during compensatory plasticity in the terminal ganglion of the adult cricket Gryllus bimaculatus
Authors: Prasad Meera P. , Detchou Donald K. E. , Wang Felicia , Ledwidge Lisa L. , Kingston Sarah E. , Wilson Horch Hadley
Published: October 2021

Background

Damage to the adult central nervous system often leads to long-term disruptions in function due to the limited capacity for neurological recovery. The central nervous system of the Mediterranean field cricket, Gryllus bimaculatus, shows an unusual capacity for compensatory plasticity, most obviously in the auditory system and the cercal escape system. In both systems, unilateral sensory disruption leads the central circuitry to compensate by forming and/or strengthening connections with the contralateral sensory organ. While this compensatory plasticity in the auditory system relies on robust dendritic sprouting and novel synapse formation, the compensatory plasticity in the cercal escape circuitry shows little obvious dendritic sprouting and instead may rely on shifts in excitatory and inhibitory synaptic strength.

Results

In order to better understand what types of molecular pathways might underlie this compensatory shift in the cercal system, we used a multiple k-mer approach to assemble a terminal ganglion transcriptome that included ganglia collected one, three, and 7 days after unilateral cercal ablation in adult, male animals. We performed differential expression analysis using EdgeR and DESeq2 and examined Gene Ontologies to identify candidates potentially involved in this plasticity. Enriched GO terms included those related to the ubiquitin-proteosome protein degradation system, chromatin-mediated transcriptional pathways, and the GTPase-related signaling system.

Conclusion

Further exploration of these GO terms will provide a clearer picture of the processes involved in compensatory recovery of the cercal escape system in the cricket and can be compared and contrasted with the distinct pathways that have been identified upon deafferentation of the auditory system in this same animal.
Identification of long noncoding RNAs in injury-resilient and injury-susceptible mouse retinal ganglion cells
Authors: Ayupe Ana C. , Beckedorff Felipe , Levay Konstantin , Yon Benito , Salgueiro Yadira , Shiekhattar Ramin , Park Kevin K.
Published: October 2021

Background

Emerging evidence indicates that long noncoding RNAs (lncRNAs) are important regulators of various biological processes, and their expression can be altered following certain pathological conditions, including central nervous system injury. Retinal ganglion cells (RGCs), whose axons form the optic nerve, are a heterogeneous population of neurons with more than 40 molecularly distinct subtypes in mouse. While most RGCs, including the ON-OFF direction-selective RGCs (ooDSGCs), are vulnerable to axonal injury, a small population of RGCs, including the intrinsically photosensitive RGCs (ipRGCs), are more resilient.

Results

By performing systematic analyses on RNA-sequencing data, here we identify lncRNAs that are expressed in ooDSGCs and ipRGCs with and without axonal injury. Our results reveal a repertoire of different classes of lncRNAs, including long intergenic noncoding RNAs and antisense ncRNAs that are differentially expressed between these RGC types. Strikingly, we also found dozens of lncRNAs whose expressions are altered markedly in response to axonal injury, some of which are expressed exclusively in either one of the types. Moreover, analyses into these lncRNAs unraveled their neighboring coding genes, many of which encode transcription factors and signaling molecules, suggesting that these lncRNAs may act in cis to regulate important biological processes in these neurons. Lastly, guilt-by-association analysis showed that lncRNAs are correlated with apoptosis associated genes, suggesting potential roles for these lncRNAs in RGC survival.

Conclusions

Overall, the results of this study reveal RGC type-specific expression of lncRNAs and provide a foundation for future investigation of the function of lncRNAs in regulating neuronal type specification and survival.
Facilitators and barriers in prevention of cardiovascular disease in Limpopo, South Africa: a qualitative study conducted with primary health care managers
Authors: Douglas Mbuyiselo , Kgatla Nancy , Sodi Tholene , Musinguzi Geofrey , Mothiba Tebogo , Skaal Linda , Makgahlela Mpsanyana , Bastiaens Hilde
Published: October 2021

Background

In the Southern African countries, cardiovascular disease burden is increasing and the second most prevalent cause of death after infectious diseases. The sustainable primary prevention of cardiovascular disease is associated with the engagement of facilitators that support it and hindered by barriers that undermine the support of a healthy lifestyle at the community level. The purpose of the study was to investigate facilitators and barriers at the level of primary health care facilities, on prevention of cardiovascular disease in Limpopo Province of South Africa.

Methods

This study is an exploratory and descriptive qualitative design, where open-ended key informant interviews were conducted among 20 primary health care managers conveniently sampled in their respective health care facilities. Coding and analysis were done using the thematic analysis method with the assistance of Atlas ti qualitative software.

Results

Various facilitators for the prevention of CVD were identified in this study. One of such facilitators is the availability and adherence to CVD treatment guidelines in the district. Other facilitators included top-down health education programme; collaboration with schools, traditional and religious leaders; the use of modern technology; and a structured healthcare system. Barriers were also identified as poor infrastructural development; shortage of medical supplies and equipment; lack of health promotion activities; shortage of nurses and other health care personnel; and poor accessibility to primary health care services.

Conclusion

This study has identified barriers and facilitators that may be harnessed to improve cardiovascular disease prevention, care, and management in a rural setting in South Africa. The facilitators should be strengthened, and barriers identified redressed.

Trial registration number: REC-0310111-031.
Shifting from vitamin K antagonists to non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: predictors, patterns and temporal trends
Authors: Shiyovich Arthur , Shalev Varda , Chodick Gabriel , Tirosh Matanya , Katz Amos , Klar Miriam M. , Shuvy Mony , Pereg David , Minha Sa’ar
Published: October 2021

Background

Non-Vitamin K antagonist oral anticoagulants (NOACs) emerged as an alternative with comparable or superior efficacy and safety to vitamin K antagonists (VKAs) for stroke prevention in patients with non-valvular atrial fibrillation (AF).

Objectives

The aim of the current study was to investigate the patterns, predictors, timelines and temporal trends of shifting from VKAs to NOACs.

Methods

In this retrospective observational study, the computerized database of a large healthcare provider in Israel, Maccabi Healthcare Services, was searched to identify patients with AF for whom either a VKA or NOAC was prescribed between 2012 and 2015. Time from diagnosis to therapy initiation and to shifting between therapies was evaluated.

Results

Out of 6987 eligible AF incident patients, 2338 (33.4%) initiated treatment with a VKA and 2221 (31.7%) with a NOAC. In addition, 5259 prevalent patients were analyzed. During the study period, NOAC prescriptions proportion among the newly diagnosed cases increased from 32 to 68.4% (pfor trend <  0.001). The median time from diagnosis to first dispensing was greater in NOAC than VKA and decreased among patients treated with NOAC during the study period (2012: 1.9 and 0.3 months, 2015: 0.7 and 0.2 months, respectively). During follow-up, 3737 (49%) patients (54.3% and 47.1% of the incident and prevalent cases, respectively), shifted from a VKA to a NOAC, after a median of 22 months and 39 months in the incident and prevalent cases, respectively, decreasing throughout the study period. Female gender, younger age, southern district, higher CHADS2and CHA2DS2-VASC score, non-smoking, and treatment with antiplatelets were associated with a greater likelihood for therapy shift. Shifting from a NOAC to a VKA decreased over time from 8 to 4.5% in 2012 to 0.5% and 0.7% in 2015 in the incident and prevalent groups,p <  0.001 respectively.

Conclusions

Shifting from VKA to NOAC occurred in 50% of the cases, more frequently among incident cases, and younger patients with greater stroke risk. Shifting from a NOAC to a VKA was much less frequent, yet it occurred more often in incident cases and decreased over time. A socially and economically sensitive program to optimize the initiation of OAC therapy upon diagnosis is warranted.
Pain-related health care costs for long-term care residents
Authors: Guliani Harminder , Hadjistavropoulos Thomas , Jin Shan , Lix Lisa M.
Published: October 2021

Background

We tested for differences in direct health care costs among long-term care (LTC) residents age 65 and older with clinically significant pain (CSP) and with no pain or non-daily mild pain (NP/NDMP). We are not aware of any other large scale investigation that examined the cost of pain in LTC environments.

Methods

Population-based administrative health data from Saskatchewan, Canada for 2004 to 2015 were used to compare direct health care costs for CSP and NP/NDMP groups up to one year after admission to LTC. Total accumulated costs for hospitalization, physician services, LTC, and prescription drugs were calculated in 2015 Canadian dollars. Group differences were tested using generalized linear models with generalized estimating equations.

Results

Amongst 24,870 LTC residents, 8289 (33.3%) were censored due to death or discharge in the 365-day study observation period. Of the 16,581 (66.7%) observed residents, 5683 (34.3%) had CSP at admission. Residents (66.3% female) had a mean age of 85 years (SD = 7.4). The mean annual total direct health care cost per resident was higher among the CSP group (CAD $8063) than the NP/NDMP group (CAD $6455). This difference was found even after including LTC costs, and for each cost component (i.e., CSP residents had higher hospitalization, physician, and prescription drug costs). Similar results were obtained after controlling for demographics, comorbidities, physical and cognitive impairment, prior health care costs, and facility characteristics.

Conclusion

The higher costs incurred by CSP residents compared to NP/NDMP residents are likely underestimated because pain problems are often missed in residents with dementia, who comprise a large portion of the LTC population. Improved pain care can reduce such costs and improve quality of life.
Preferences and priorities to manage clinical uncertainty for older people with frailty and multimorbidity: a discrete choice experiment and stakeholder consultations
Authors: Tunnard India , Yi Deokhee , Ellis-Smith Clare , Dawkins Marsha , Higginson Irene J. , Evans Catherine J.
Published: October 2021

Background

Clinical uncertainty is inherent for people with frailty and multimorbidity. Depleted physiological reserves increase vulnerability to a decline in health and adverse outcomes from a stressor event. Evidence-based tools can improve care processes and outcomes, but little is known about priorities to deliver care for older people with frailty and multimorbidity. This study aimed to explore the preferences and priorities for patients, family carers and healthcare practitioners to enhance care processes of comprehensive assessment, communication and continuity of care in managing clinical uncertainty using evidence-based tools.

Methods

A parallel mixed method observational study in four inpatient intermediate care units (community hospitals) for patients in transition between hospital and home. We used a discrete choice experiment (DCE) to examine patient and family preferences and priorities on the attributes of enhanced services; and stakeholder consultations with practitioners to discuss and generate recommendations on using tools to augment care processes. Data analysis used logit modelling in the DCE, and framework analysis for consultation data.

Results

Thirty-three patients participated in the DCE (mean age 84 years, SD 7.76). Patients preferred a service where family were contacted on admission and discharge (β 0.36, 95% CI 0.10 to 0.61), care received closer to home (β − 0.04, 95% CI − 0.06 to − 0.02) and the GP is fully informed about care (β 0.29, 95% CI 0.05–0.52).

Four stakeholder consultations (n = 48 participants) generated 20 recommendations centred around three main themes: tailoring care processes to manage multiple care needs for an ageing population with frailty and multimorbidity; the importance of ongoing communication with patient and family; and clear and concise evidence-based tools to enhance communication between clinical teams and continuity of care on discharge.

Conclusion

Family engagement is vital to manage clinical uncertainty. Both patients and practitioners prioritise engaging the family to support person-centred care and continuity of care within and across care settings. Patients wished to maximise family involvement by enabling their support with a preference for care close to home. Evidence-based tools used across disciplines and services can provide a shared succinct language to facilitate communication and continuity of care at points of transition in care settings.
The association between chronic venous disease and measures of physical performance in older people: a population-based study
Authors: Sinikumpu Suvi-Päivikki , Keränen Maija-Helena , Jokelainen Jari , Keinänen-Kiukaanniemi Sirkka , Huilaja Laura
Published: October 2021

Background

Muscle pump dysfunction is an essential component of chronic venous disease (CVD) pathology. Aging reduces muscle strength which further weakens the venous return. However, the epidemiology of CVD and its relationship with the physical performance in older persons is poorly studied. We studied the prevalence of CVD in subjects aged over 70 years and its association primarily with the Short Physical Performance Battery (SPPB) and 10 m walk test.

Methods

An accurate clinical leg examination was performed and the Clinical-Etiological-Anatomical-Pathophysiological-classification (CEAP, clinical classification of chronic venous disorders, C1-C6) determined by dermatologists in 552 subjects aged between 70 and 93 years belonging to the Northern Finland Birth Cohort 1966 – Parents’ Study (NFBC-PS). Linear regression analyses were used to examine the association between CVD and functional tests and anthropometric measurements.

Results

The prevalence of CVD (C1-C6) was 54.3%. C1 was diagnosed in 22.1% (n=84), C2 in 15.2% (n=45), C3 in 8.2% (n=45), C4 in 7.8% (43), C5 in 0.4% (n=2) and C6 in 0.5% (n=3). The prevalence and severity of CVD increased with increasing age (p<0.05). Males presented more with severe stages of CVD (C4-C6) (p<0.001). Subjects with CVD had significantly lower total SPPB scores and longer times in the 10 m walk test (p<0.001). The association between CVD severity and SPPB remained statistically significant in females after adjusting for age, body mass index (BMI) and number of children. The 10 m walk test times were associated with CVD when adjusted for sex and age but not after adjusting for BMI.

Conclusions

It is recommended that detailed skin examination of legs should be performed by physicians treating older subjects in order to improve early diagnosis of CVD. We highlight the importance of physical activity in older persons - lower limb activation of older persons with CVD may improve venous return and therefore prevent progression of CVD. We found an association between CVD and gait speed, however, there may exist bidirectional relationship.
High rates of culture conversion and low loss to follow-up in MDR-TB patients managed at Regional Referral Hospitals in Uganda
Authors: Martin Mbonye Kayitale , Paul Otuba John , Sara Riese , Hilary Alima , Frank Mugabe , Augustin Muhwezi K. , Stavia Turyahabwe , Christopher Wandera , van Zanten Tisna Veldhuijzen , Gladys Tugume
Published: October 2021

Background

Multi-drug resistant—tuberculosis (MDR-TB) is an emerging public health concern in Uganda. Prior to 2013, MDR-TB treatment in Uganda was only provided at the national referral hospital and two private-not-for profit clinics. From 2013, it was scaled up to seven regional referral hospitals (RRH). The aim of this study was to measure interim (6 months) treatment outcomes among the first cohort of patients started on MDR-TB treatment at the RRH in Uganda.

Methods

This was a cross-sectional study in which a descriptive analysis of data collected retrospectively on a cohort of 69 patients started on MDR-TB treatment at six of the seven RRH between 1st April 2013 and 30th June 2014 and had been on treatment for at least 9 months was conducted.

Results

Of the 69 patients, 21 (30.4%) were female, 39 (56.5%) HIV-negative, 30 (43.5%) resistant to both isoniazid and rifampicin and 57 (82.6%) category 1 or 2 drug susceptible TB treatment failures. Median age at start of treatment was 35 years (Interquartile range (IQR): 27–45), median time-to-treatment initiation was 27.5 (IQR: 6–89) days and of the 30 HIV-positive patients, 27 (90.0%) were on anti-retroviral treatment with a median CD4 count of 206 cells/microliter of blood (IQR: 113–364.5). Within 6 months of treatment, 59 (85.5%) patients culture converted, of which 45 (65.2%) converted by the second month and the other 14 (20.3%) by the sixth month; one (1.5%) did not culture convert; three (4.4%) died; and six (8.8%) were lost-to-follow up. Fifty (76.8%) patients experienced at least one drug adverse event, while 40 (67.8%) gained weight. Mean weight gained was 4.7 (standard deviation: 3.2) kilograms.

Conclusions

Despite MDR-TB treatment initiation delays, most patients had favourable interim treatment outcomes with majority culture converting early and very few getting lost to follow-up. These encouraging interim outcomes indicate the potential for success of a scale-up of MDR-TB treatment to RRH.
A transferrable IncL/M plasmid harboring a gene encoding IMP-1 metallo-β-lactamase in clinical isolates of Enterobacteriaceae
Authors: Mori Nobuyoshi , Tada Tatsuya , Oshiro Satoshi , Kuwahara-Arai Kyoko , Kirikae Teruo , Uehara Yuki
Published: October 2021

Background

The worldwide spread of carbapenemase-producing Enterobacteriaceae (CPE) has reduced the clinical utility of carbapenems. Plasmids often play an important role in the spread of genes encoding drug-resistance factors, especially in the horizontal transfer of these genes among species of Enterobacteriaceae. This study describes a patient infected with three species of CPE carrying an identical transferrable IncL/M plasmid.

Methods

Clinical isolates of CPE were collected at St. Luke’s International Hospital, Tokyo, Japan, from 2015 to 2019. Three species of CPE isolates, Enterobacter cloacae, Klebsiella aerogenes and Serratia marcescens, were isolated from a patient who developed severe gallstone pancreatitis associated with bloodstream infection, with all three isolates producing IMP-1 metallo-β-lactamase. The complete sequences of the plasmids of the three isolates were determined by both MiSeq and MinION. The medical chart of this patient was retrospectively reviewed conducted to obtain relevant clinical information.

Results

The three CPE species carried an IncL/M plasmid, pSL264, which was 81,133 bp in size and harbored blaIMP-1. The genetic environment surrounding blaIMP-1 consisted of int1-blaIMP-1-aac(6’)-IIc-qacL-qacEdelta1-sul1-istB-IS21. Conjugation experiments showed that S. marcescens could transmit the plasmid to E. cloacae and K. aerogenes. In contrast, pSL264 could not transfer from E. cloacae or K. aerogenes to S. marcescens.

Conclusion

The IncL/M plasmid pSL264 harboring blaIMP-1 was able to transfer among different species of Enterobacteriaceae in a patient receiving long-term antimicrobial treatment. The worldwide emergence and spread of IncL/M plasmids harboring carbapenemase-encoding genes among species of Enterobacteriaceae is becoming a serious public health hazard.
FXTAS is difficult to differentiate from neuronal intranuclear inclusion disease through skin biopsy: a case report
Authors: Toko Megumi , Ohshita Tomohiko , Kurashige Takashi , Morino Hiroyuki , Kume Kodai , Yamashita Hiroshi , Sobue Gen , Iwasaki Yasushi , Sone Jun , Kawakami Hideshi , Maruyama Hirofumi
Published: October 2021

Background

Both fragile X-associated tremor/ataxia syndrome (FXTAS) and late-onset neuronal intranuclear inclusion disease (NIID) show CGG/GGC trinucleotide repeat expansions. Differentiating these diseases are difficult because of the similarity in their clinical and radiological features. It is unclear that skin biopsy can distinguish NIID from FXTAS. We performed a skin biopsy in an FXTAS case with cognitive dysfunction and peripheral neuropathy without tremor, which was initially suspected to be NIID.

Case presentation

The patient underwent neurological assessment and examinations, including laboratory tests, electrophysiologic test, imaging, skin biopsy, and genetic test. A brain MRI showed hyperintensity lesions along the corticomedullary junction on diffusion-weighted imaging (DWI) in addition to middle cerebellar peduncle sign (MCP sign). We suspected NIID from the clinical picture and the radiological findings, and performed a skin biopsy. The skin biopsy specimen showed ubiquitin- and p62-positive intranuclear inclusions, suggesting NIID. However, a genetic analysis for NIID using repeat-primed polymerase chain reaction (RP-PCR) revealed no expansion detected in the Notch 2 N-terminal like C (NOTCH2NLC) gene. We then performed genetic analysis for FXTAS using RP-PCR, which revealed a repeat CGG/GGC expansion in the FMRP translational regulator 1 (FMR1) gene. The number of repeats was 83. We finally diagnosed the patient with FXTAS rather than NIID.

Conclusions

For the differential diagnosis of FXTAS and NIID, a skin biopsy alone is insufficient; instead, genetic analysis, is essential. Further investigations in additional cases based on genetic analysis are needed to elucidate the clinical and pathological differences between FXTAS and NIID.
Strategies for supplying face masks to the population of Taiwan during the COVID-19 pandemic
Authors: Liu Chin-Mei , Lee Charles Tzu-Chi , Chou Shu-Mei , Ko Hai-Yun , Wang Jen-Hsin , Chih Yi-Chien , Chang Chia-Chi
Published: October 2021

Background

The use of face masks has become ubiquitous in Taiwan during the early COVID-19 pandemic. A name-based rationing system was established to enable the population of Taiwan to purchase face masks. This study is to assess the extent and fairness of face mask supply to the public in Taiwan.

Methods

The weekly face marks supplies were collected from name-based rationing system administrative statistics included national health insurance card and e-Mask selling record. National registered population statistics by age, gender, and district were collected from department of statistics ministry of the interior. The number of COVID-19 non-imported cases of Taiwan was collected from Taiwan centers of disease control.

Results

A total of 146,831,844 person times purchase records from February 6, 2020, to July 19, 2020, the weekly average face mask supply is 0.5 mask (per person) at the start of name-based rationing system, and gradually expanded to the maximum 5.1 masks (per person). Comparing the highest weekly total face mask supply (from Apr 9, 2020, to Apr 15, 2020) in aged 0–9 -, 10–19 -, 20–29 -, 30–39 -, 40–49 -, 50–59 -, 60–69 -,70–79 -, 80–89 -, 90–99, and > 100 years to the register population showed similar distribution between mask supplied people and total population (all standardized difference < 0.1).

Conclusion

The masks supply strategies has gradually escalated the number of face masks for the public, it not only has dominant decreased the barrier of acquiring face mask, but a fair supply for total population use of Taiwan.
Histological and molecular features of the subacromial bursa of rotator cuff tears compared to non-tendon defects: a pilot study
Authors: Minkwitz Susann , Thiele Kathi , Schmock Aysha , Bormann Nicole , Nguyen Thanh Huyen , Moroder Philipp , Scheibel Markus , Wildemann Britt , Plachel Fabian , Klatte-Schulz Franka
Published: October 2021

Background

The role of the subacromial bursa in the development or healing of shoulder pathologies is unclear. Due to this limited knowledge, we aimed to understand specific reactions of the subacromial bursa according to rotator cuff (RC) pathologies compared to non-tendon defects of the shoulder. We hypothesized that the tissue composition and inflammatory status of the bursa are likely to vary between shoulder pathologies depending on the presence and the extent of RC lesion.

Method

Bursa samples from patients with either 1) shoulder instability with intact RC (healthy bursa, control), 2) osteochondral pathology with intact RC, 3) partial supraspinatus (SSP) tendon tear, or 4) full-thickness SSP tear were investigated histologically and on gene expression level.

Result

Bursae from SSP tears differed from non-tendon pathologies by exhibiting increased chondral metaplasia and TGFβ1 expression. MMP1 was not expressed in healthy bursa controls, but strongly increased with full-thickness SSP tears. Additionally, the expression of the inflammatory mediators IL1β, IL6, and COX2 increased with the extent of SSP tear as shown by correlation analysis. In contrast, increased angiogenesis and nerve fibers as well as significantly upregulated IL6 and COX2 expression were features of bursae from patients with osteochondral pathology. Using immunohistochemistry, CD45+ leukocytes were observed in all examined groups, which were identified in particular as CD68+ monocytes/macrophages.

Conclusion

In summary, besides the strong increase in MMP1 expression with SSP tear, molecular changes were minor between the investigated groups. However, expression of pro-inflammatory cytokines correlated with the severity of the SSP tear. Most pronounced tissue alterations occurred for the osteochondral pathology and full-thickness SSP tear group, which demonstrates that the bursal reaction is not exclusively dependent on the occurrence of an SSP tear rather than longstanding degenerative changes. The present bursa characterization contributes to the understanding of specific tissue alterations related to RC tears or non-tendon shoulder pathologies. This pilot study provides the basis for future studies elucidating the role of the subacromial bursa in the development or healing of shoulder pathologies.
Cavernous lymphangioma of the urinary bladder in an adult woman: an additional case report of a rare lesion and literature review
Authors: He Wei , Jin Li , Lin Fang-fang , Qi Xiao-long , He Xiang-lei , Zhang Da-hong , Zhao Ming
Published: October 2021

Background

Urinary bladder lymphangioma is a rare and benign lesion that is often causes symptoms related to irritation and urinary tract obstruction. Because a lymphangioma may resemble a true neoplasm of the urinary bladder clinically, the lesion must be removed for accurate histologic diagnosis and to rule out malignancy.

Case presentation

We present a case of a 40-year-old female who was evaluated for painless gross hematuria. Clinical and diagnostic work up revealed a sharply defined mass involving the wall and bulging into the cavity on the dome of the bladder. Partial cystectomy was performed and histologic findings were compatible with cavernous lymphangioma. The symptom of hematuria relieved after the procedure and the patient was in good status without evidence of recurrence by cystoscopy at follow-up 6 months later.

Conclusions

Lymphangioma of the urinary bladder is treated with surgical excision and seems to have no recurrence once completely resected, but long-time follow-up may be needed.