bluuebunny/crossref_metadata_2025 huggingface dataset:
Economic and Performance Impact of Anterior Cruciate Ligament Injury in National Basketball Association Players
Authors: Vaudreuil Nicholas J. , van Eck Carola F. , Lombardo Stephen J. , Kharrazi F. Daniel
Published: September 2021

Background:

Anterior cruciate ligament (ACL) tears are one of the most devastating injuries seen in the National Basketball Association (NBA). No previous studies have examined the economic impact of ACL tears in the NBA.

Purpose/Hypothesis:

The purpose of this study was to examine the economic impact of ACL tears on NBA players and teams by calculating the costs of recovery (COR) and classifying players based on preinjury success level (All-Star or equivalent, starter, or reserve) and salary (in US$ million: <1.5, 1.5-4, or >4 per season). It was hypothesized that players with a lower preinjury salary or primarily a reserve role would have decreased costs, lower rates of return to play (RTP), and shorter careers.

Study Design:

Descriptive epidemiology study.

Methods:

We reviewed the publicly available records of NBA players treated with ACL reconstruction from 2000 to 2015. Data collected included player demographics, player salaries, statistical performance using player efficiency rating (PER), and specifics regarding time missed and RTP rate.

Results:

A total of 35 players met the study inclusion criteria. The cumulative economic loss from ACL injuries in the NBA from 2000 to 2015 was $99 million. The average COR was $2.9 million per player. RTP rate was 91% overall, with 70% retention at 3 years. Players that made a salary of less than $1.5 million per season before the injury had a significant drop in PER (difference of –7), RTP rate of 63%, and only 37% retention at 3 years. Conversely, recovering All-Star players also had a significant drop in PER (–6.2), and no players repeated as All-Stars in the season after ACL reconstruction (0%), although they did have a 100% RTP rate and an average career length of 5.6 seasons postinjury.

Conclusion:

While the RTP rate in NBA athletes remained high, ACL reconstruction can result in decreased statistical performance and/or inability to return to prior levels of play. Players who made less than $1.5 million preinjury or played primarily in a reserve role were associated with lower RTP and retention in the NBA at 3 years.
Sex Differences in Peritraumatic Inflammatory Cytokines and Steroid Hormones Contribute to Prospective Risk for Nonremitting Posttraumatic Stress Disorder
Authors: Lalonde Chloe S. , Mekawi Yara , Ethun Kelly F. , Beurel Eleonore , Gould Felicia , Dhabhar Firdaus S. , Schultebraucks Katharina , Galatzer-Levy Isaac , Maples-Keller Jessica L. , Rothbaum Barbara O. , Ressler Kerry J. , Nemeroff Charles B. , Stevens Jennifer S. , Michopoulos Vasiliki
Published: September 2021

Women are at higher risk for developing posttraumatic stress disorder (PTSD) compared to men, yet little is known about the biological contributors to this sex difference. One possible mechanism is differential immunological and neuroendocrine responses to traumatic stress exposure. In the current prospective study, we aimed to identify whether sex is indirectly associated with the probability of developing nonremitting PTSD through pro-inflammatory markers and whether steroid hormone concentrations influence this effect. Female ( n = 179) and male ( n = 197) trauma survivors were recruited from an emergency department and completed clinical assessment within 24 h and blood samples within ∼three hours of trauma exposure. Pro-inflammatory cytokines (IL-6, IL-1[Formula: see text], TNF, IFNγ), and steroid hormone (estradiol, testosterone, progesterone, cortisol) concentrations were quantified in plasma. Compared to men, women had a higher probability of developing nonremitting PTSD after trauma ( p = 0.04), had lower pro-inflammatory cytokines and testosterone ( p’ s<0.001), and had higher cortisol and progesterone ( p’ s<0.001) concentrations. Estradiol concentrations were not different between the sexes ( p = 0.24). Pro-inflammatory cytokines were a significant mediator in the relationship between sex and probability of developing nonremitting PTSD ( p < 0.05), such that men had higher concentrations of pro-inflammatory cytokines which were associated with lower risk of nonremitting PTSD development. This effect was significantly moderated by estradiol ( p < 0.05), as higher estradiol levels in men were associated with higher pro-inflammatory cytokine concentrations and lower risk for developing nonremitting PTSD. The current results suggest that sex differences in the pro-inflammatory cytokine response to trauma exposure partially mediate the probability of developing nonremitting PTSD, and that the protective ability to mount an pro-inflammatory cytokine response in men may depend on higher estradiol levels in the aftermath of trauma exposure.
Asylum-seeking children in shutdown: Neurobiological models
Authors: Kozlowska Kasia , Scher Stephen , Helgeland Helene , Carrive Pascal
Published: September 2021

Asylum-seeking children presenting in the shutdown state have been the subject of much discussion and controversy—on both government and medical system levels—in Australia and in Sweden. In this article, we conceptualize the shutdown state as an evolutionary response to extreme threat. We adopt a neuroscience approach to present five plausible models for explaining this shutdown state, their strengths and shortcomings, and the overlaps between them. Model 1—the sustained autonomic arousal model—draws on polyvagal theory. Model 2—the innate-defence model—draws on research pertaining to animal and human innate defence responses. Model 3—the catatonia model—draws on clinical and research data with patients presenting with catatonia. Model 4—the hypometabolic model—draws on an emerging body of work pertaining to hypometabolic states in animals and humans. Model 5—the defence cascade model of dissociation—draws on clinical research pertaining to human trauma states that present as dissociation. At present, each of the models provides a plausible pathophysiological explanation—or a component of a potential pathophysiological explanation—and none of them, for the moment, has enough evidence to be either accepted or disregarded. We hope that our discussion of the models advances scientific discussion and opens up possibilities for effective treatment.
An Interesting Case of Acute Stroke: When Many Things Went Wrong, but the Patient Laughed at Last!
Authors: Chakraborty Debabrata , Ray Nirmalya , Dey Sadanand , Bhaumik Sanjay
Published: September 2021

A 52-year-old lady with hypertrophic obstructive cardiomyopathy, atrial flutter, and old right hemispheric stroke in the background underwent implantable cardioverter-defibrillator implantation for complete heart block. She was yet to start her regular anticoagulant and presented to hospital emergency with acute right middle cerebral artery (MCA) territory stroke (NIH Stroke Scale/Score of 14). After ruling out absolute contraindications, she was given intravenous thrombolysis (did not have a blood vessel target for endovascular therapy). Post thrombolysis, she had clot mobilization from the internal carotid artery to the MCA and systemic embolization to kidneys and lower limbs. The patient underwent an urgent embolectomy and lower limbs were saved from amputation. Our case highlights the importance of checking peripheral pulses in acute stroke patients post thrombolysis. Though the patient had initial deterioration after thrombolysis, she gradually improved and later achieved satisfactory modified Rankin scale underscoring the ultimate potential benefits of thrombolysis in acute stroke. There is a high chance of thrombus formation in patients with atrial flutter who undergo recent cardiac procedure especially if they are off anticoagulation for even a short period. Hence, unnecessary apprehension of anticoagulant use in proper situations may create life-threatening complications.
Trade Facilitation, Diversity and Intra-Regional Exportability: A Study of Small Island Economies in the Caribbean and the South Pacific
Authors: Rai Khushbu , Maiti Dibyendu
Published: September 2021

Despite the contentious success of the trade agreements, the island countries have still been vehemently negotiating further trade deals. This study explores the element which enhances trade flows for selected Commonwealth countries in the Caribbean and Pacific regions. The results suggest that income (gross domestic product) growth as significant support for trade flows, regional trade integrations of the Pacific and Caribbean are explained in its quiet dynamism, worth strengthening and further reforming. This study, by means of a comparative investigation of selected countries from within the Pacific and the Caribbean regions, proposes that the strategy for enhancing trade integration is creating demand for diversification in the region through greater regional integration. The estimates demonstrate that the level of diversification positively impacted the regions’ bilateral export, having the Pacific region influenced almost twice as much like the Caribbean. Moreover, whilst understanding that the geographical location of the Caribbean already lets its states thrive through lower trading costs as compared to the Pacific, analysis in the study shows that the distance, remoteness and logistics difficulties inflate the price (or trade costs) limiting the success of regional trade agreements.

JEL Classification: F13, F15
Sonographic Imaging of Surgically Transpositioned Ovaries in the Treatment of Rectal Carcinoma
Authors: Ortiz Sovereign K.
Published: September 2021

Pelvic radiation therapy in patients with advanced rectal carcinoma improves oncological outcomes, but often raises infertility concerns in reproductive-age patients. Laparoscopic ovarian transposition is a surgical method which may offer preservation of ovarian function during and after cancer treatment. Sonographic evaluation of the ovaries post transposition gives insight into their condition and the efficacy of ovarian transposition in the continuation of ovarian function after radiation. This case describes how sonography was used to identify and evaluate surgically transpositioned ovaries in a patient with rectal adenocarcinoma.
Combined ibrutinib and venetoclax treatment vs single agents in the TCL1 mouse model of chronic lymphocytic leukemia
Authors: Kater Arnon P. , Slinger Erik , Cretenet Gaspard , Martens Anne W. , Balasubramanian Sriram , Leverson Joel D. , Eldering Eric
Published: September 2021

The covalent inhibitor of Bruton’s tyrosine kinase ibrutinib and the specific Bcl-2 inhibitor venetoclax are both highly efficacious single-agent drugs in the treatment of chronic lymphocytic leukemia (CLL). Based on their complementary modes of action, ibrutinib and venetoclax are hypothesized to act in a synergistic fashion. Currently, it is unclear whether combined treatment is indeed superior to continuous single-agent treatment and what mechanisms underlie the resistance to combination treatment. In addition, the effects of such treatment on the skewed T-cell compartment characteristic of CLL are as yet unknown. In the murine Eµ-TCL1 adoptive transfer model resembling aggressive CLL, we found that combined treatment resulted in the deepest responses, with the longest duration related to a combination of decreased proliferation and increased induction of apoptosis. In addition, alterations in T-cell subsets were most prominent after combination treatment, with increased naive cells and reduced effector memory cells. Remarkably, effects of single agents but also combination treatment were eventually interrupted by relapse, and we found downregulation of BIM expression as a plausible cause of acquired drug resistance. Nevertheless, in this murine model, the combination of venetoclax and ibrutinib has increased efficacy over single agents, accompanied by a restoration of the T-cell compartment.
Machine learning–based scoring models to predict hematopoietic stem cell mobilization in allogeneic donors
Authors: Xiang Jingyu , Shi Min , Fiala Mark A. , Gao Feng , Rettig Michael P. , Uy Geoffrey L. , Schroeder Mark A. , Weilbaecher Katherine N. , Stockerl-Goldstein Keith E. , Mollah Shamim , DiPersio John F.
Published: September 2021

Mobilized peripheral blood has become the primary source of hematopoietic stem cells for both autologous and allogeneic stem cell transplantation. Granulocyte colony-stimulating factor (G-CSF) is currently the standard agent used in the allogeneic setting. Despite the high mobilization efficacy in most donors, G-CSF requires 4–5 days of daily administration, and a small percentage of the donors fail to mobilize an optimal number of stem cells necessary for a safe allogeneic stem cell transplant. In this study, we retrospectively reviewed 1361 related allogeneic donors who underwent stem cell mobilization at Washington University. We compared the standard mobilization agent G-CSF with five alternative mobilization regimens, including GM-CSF, G-CSF+GM-CSF, GM-CSF + Plerixafor, Plerixafor and BL-8040. Cytokine-based mobilization strategies (G-CSF or in combination with GM-CSF) induce higher CD34 cell yield after 4–5 consecutive days of treatment, while CXCR4 antagonists (plerixafor and BL-8040) induce significantly less but rapid mobilization on the same day. Next, using a large dataset containing the demographic and baseline laboratory data from G-CSF–mobilized donors, we established machine learning (ML)–based scoring models that can be used to predict patients who may have less than optimal stem cell yields after a single leukapheresis session. To our knowledge, this is the first prediction model at the early donor screening stage, which may help identify allogeneic stem cell donors who may benefit from alternative approaches to enhance stem cell yields, thus ensuring safe and effective stem cell transplantation.
Intracolic ultrasound molecular imaging: a novel method for assessing colonic tumor necrosis factor-α expression in inflammatory bowel disease
Authors: Miao Xiaoyan , Mao Ren , You Yujia , Zhou Huichao , Qiu Chen , Li Xuehua , Chen Zhihui , Ren Jie , Chen Minhu , Wang Ping , Zheng Rongqin , Yin Tinghui
Published: September 2021

Background

While anti-tumor necrosis factor alpha (TNF-α) therapy has been proven effective in inflammatory bowel disease (IBD), approximately 40% of patients lose the response. Transmembrane TNF-α (mTNF-α) expression in the intestinal mucosa is correlated with therapeutic efficacy, and quantification of mTNF-α expression is significant for predicting response. However, conventional intravenous application of microbubbles is unable to assess mTNF-α expression in intestinal mucosa. Herein, we proposed intracolic ultrasound molecular imaging with TNF-α-targeted microbubbles (MBTNF-α) to quantitatively detect mTNF-α expression in the intestinal mucosa.

Methods

MBTNF-α was synthesized via a biotin–streptavidin bridging method. TNF-α-targeted ultrasound imaging was performed by intracolic application of MBTNF-α to detect mTNF-α expression in surgical specimens from a murine model and patients with IBD. Linear regression analyses were performed to confirm the accuracy of quantitative targeted ultrasound imaging.

Results

On quantitative TNF-α-targeted ultrasound images, a greater signal intensity was observed in the mouse colons with colitis ([1.96 ± 0.45] × 106 a.u.) compared to that of the controls ([0.56 ± 0.21] × 106 a.u., P < 0.001). Targeted US signal intensities and inflammatory lesions were topographically coupled in mouse colons. Linear regression analyses in specimens of mice and patients demonstrated significant correlations between the targeted ultrasound signal intensity and mTNF-α expression (both P < 0.001). Furthermore, TNF-α-targeted ultrasound imaging qualitatively distinguished the varying inflammatory severity in intestinal specimens from IBD patients.

Conclusion

Intracolic ultrasound molecular imaging with MBTNF-α enables quantitative assessment of mTNF-α expression. It may be a potential tool for facilitating the implementation of personalized medicine in IBD.
Mechanical performance of aluminum reinforced wood plastic composites under axial tension: an experimental and numerical investigation
Authors: Zhao Longlong , Xi Fei , Wang Xiaorui
Published: September 2021

Wood plastic composites (WPCs) are low-cost biomass composite materials with good mechanical stability and good weather resistance that are mainly used in the areas with low stress levels. Aimed at improving the mechanical properties of WPCs, this paper proposes a new WPC reinforced with aluminum. The WPC and aluminum were hot pressed to form an aluminum reinforced wood plastic composites (A-WPC). The axial tensile properties, stress–strain relationship, and failure mechanism of the composite were studied experimentally. The results show that the ultimate stress and strain, elastic modulus, and other mechanical parameters of A-WPCs are much higher than those of WPCs. The elongation at break is 10.13 times that of WPCs, which greatly improves the ductility. Based on the equivalent stiffness theory, two calculation models were proposed to predict the tensile stress–strain relationship of A-WPCs. The tensile rebound process of A-WPCs was analyzed in depth, and then the calculation formula of the residual curvature was deduced to compare with the test results. The experimental results are in good agreement with the calculation results.
Genetic and antimicrobial resistance profiles of non-O157 Shiga toxin-producing Escherichia coli from different sources in Egypt
Authors: Elsayed Mohamed Sabry Abd Elraheam , Eldsouky Samah Mahmoud , Roshdy Tamer , Bayoume Abeer Mohamed Ahmed , Nasr Ghada M. , Salama Ali S. A. , Akl Behiry A. , Hasan Al Shaimaa , Shahat Amany Kasem , Khashaba Rana Atef , Abdelhalim Walid Abdellatif , Nasr Hend E. , Mohammed Lina Abdelhady , Salah Ahmed
Published: September 2021

Background

The Shiga toxin-producingEscherichia coli(STEC) represented a great risk to public health. In this study, 60 STEC strains recovered from broiler and duck fecal samples, cow’s milk, cattle beef, human urine, and ear discharge were screened for 12 virulence genes, phenotypic and genotypic antimicrobial resistance, and multiple-locus variable-number tandem-repeat analysis (MLVA).

Results

The majority of strains harbored Shiga toxin 1 (stx1) andstx1d,stx2andstx2e, andehxA genes, while a minority harboredstx2csubtype andeaeA. We identified 10stxgene combinations; most of strains 31/60 (51.7%) exhibited four copies ofstxgenes, namely thestx1,stx1d,stx2, andstx2e, and the strains exhibited a high range of multiple antimicrobial resistance indices. The resistance genesblaCTX-M-1 andblaTEM were detected. For the oxytetracycline resistance genes, most of strains containedtetA,tetB,tetE, andtetG while thetetC was present at low frequency. MLVA genotyping resolved 26 unique genotypes; genotype 21 was highly prevalent. The six highly discriminatory loci DI = 0.9138 are suitable for the preliminary genotyping of STEC from animals and humans.

Conclusions

The STEC isolated from animals are virulent, resistant to antimicrobials, and genetically diverse, thus demands greater attention for the potential risk to human.
Association between anion gap and mortality of aortic aneurysm in intensive care unit after open surgery
Authors: Gao Yijing , Hong Zilin , Shen Runnan , Zhang Shiran , You Guochang , Chen Jie , Guo Xushun , Peng Senyi , Huang Kai
Published: September 2021

Background

There has not been a well-accepted prognostic model to predict the mortality of aortic aneurysm patients in intensive care unit after open surgery repair. Otherwise, our previous study found that anion gap was a prognosis factor for aortic aneurysm patients. Therefore, we wanted to investigate the relationship between anion gap and mortality of aortic aneurysm patients in intensive care unit after open surgery repair.

Methods

From Medical Information Mart for Intensive Care III, data of aortic aneurysm patients in intensive care unit after open surgery were enrolled. The primary clinical outcome was defined as death in intensive care unit. Univariate analysis was conducted to compare the baseline data in different groups stratified by clinical outcome or by anion gap level. Restricted cubic spline was drawn to find out the association between anion gap level and mortality. Subgroup analysis was then conducted to show the association in different level and was presented as frost plot. Multivariate regression models were built based on anion gap and were adjusted by admission information, severity score, complication, operation and laboratory indicators. Receiver operating characteristic curves were drawn to compare the prognosis ability of anion gap and simplified acute physiology score II. Decision curve analysis was finally conducted to indicate the net benefit of the models.

Results

A total of 405 aortic aneurysm patients were enrolled in this study and the in-intensive-care-unit (in-ICU) mortality was 6.9%. Univariate analysis showed that elevated anion gap was associated with high mortality (P value < 0.001), and restricted cubic spline analysis showed the positive correlation between anion gap and mortality. Receiver operating characteristic curve showed that the mortality predictive ability of anion gap approached that of simplified acute physiology score II and even performed better in predicting in-hospital mortality (P value < 0.05). Moreover, models based on anion gap showed that 1 mEq/L increase of anion gap improved up to 42.3% (95% confidence interval 28.5–59.8%) risk of death.

Conclusions

The level of serum anion gap was an important prognosis factor for aortic aneurysm mortality in intensive care unit after open surgery.
Patient decision aid for trial of labor after cesarean (TOLAC) versus planned repeat cesarean delivery: a quasi-experimental pre-post study
Authors: Venkatesh Kartik K. , Brodney Suzanne , Barry Michael J. , Jackson Jamie , Lyons Kiira M. , Talati Asha N. , Ivester Thomas S. , Munoz Maria C. , Thorp John M. , Nicholson Wanda K.
Published: September 2021

Objective

To assess the impact of a web-based decision aid on patient-centered decision making outcomes among women considering a trial of labor after cesarean (TOLAC) versus planned repeat cesarean delivery.

Methods

The Birth Decision Aid Study (B-READY) was a quasi-experimental pre-post study of two sequential cohorts. From June 18, 2018 to July 31, 2019, 50 women were enrolled in routine care, followed by 50 women who were enrolled in the decision aid group. Inclusion criteria were singleton pregnancies between 19/0 to 36/6 weeks, ≤2 prior cesareans, and no contraindications to TOLAC. The decision aid group viewed the online Healthwise® “Pregnancy: Birth Options After Cesarean” program. Both groups received the same birth options counseling and completed the same online assessment. Primary patient-centered outcomes were knowledge about birth options and shared decision making at online assessment, and informed, patient-centered decision making about her preferred mode of delivery at delivery admission.

Results

Among 100 women participated in this study (50 per group), the mean gestational age at enrollment was 31 weeks, and 71% or 63/89 women who consented to delivery data abstraction had a cesarean delivery. Women in the patient decision aid group gained more knowledge (defined as score ≥ 75%) about birth options compared to those in the routine care group (72% vs. 32%; adjusted odds ratio, AOR: 6.15 [95% CI: 2.34 to 16.14]), and were more likely to make an informed, patient-centered decision (60% vs. 26%; AOR: 3.30 [95% CI: 1.20 to 9.04]. Women in both groups reported similar involvement in shared decision making, as well as satisfaction and values. More than 90% of decision aid users reported it was a useful tool and would recommend it to other TOLAC-eligible women.

Conclusions

A web-based birth options patient-centered decision aid for TOLAC eligible women can be integrated into prenatal Telehealth and may improve the quality of decision making about mode of delivery.

Trial registration

The study was registered with ClinincalTrials.gov and the ID# was NCT04053413. Registered 12 August 2019 – Retrospectively registered.
Comparison of nostril sizes of newborn infants with outer diameter of endotracheal tubes
Authors: Haase Bianca , Badinska Ana-Maria , Maiwald Christian A. , Poets Christian F. , Springer Laila
Published: September 2021

Background

Recommendations for endotracheal tube (ETT) size usually refer to the inner diameter (ID). Outer diameters (OD), however, vary greatly between manufacturers, which in some brands might cause difficulties in passing the ETT through the nostrils if choosing the nasal route for intubation. Even though the nostrils are dilatable by an ETT, it might be difficult to pass an ETT through the posterior naris (narrowest point of the nasal passage), if the OD is bigger than the nostrils. Therefore, nostril size may provide some guidance for the appropriate ETT size preventing unsuccessful intubation attempts. This study therefore compares nostril sizes of newborn infants with ODs of ETTs from several manufacturers.

Methods

This is a subgroup analysis of a prospective observational study, performed in a single tertiary perinatal centre in Germany. The diameter of the nostril of infants born between 34 and 41 weeks´ gestation was measured in 3D images using 3dMDvultus software and compared to the OD of ETT from five different manufacturers.

Results

Comparisons of nostril sizes with ODs of different ETTs were made for 99 infants with a mean (SD) birthweight of 3058g (559) [range: 1850-4100g]. Mean (SD) nostril size was 5.3mm (0.6). The OD of the 3.5mm ETT of different manufacturers ranged from 4.8-5.3mm and was thus larger than the nostril size of 20-46% of late preterm or term infants.

Some OD of a 3.0mm ETT were even bigger than the OD of a 3.5mm ETT (e.g. the 3.0mm ETT from Rüsch® has an OD of 5.0mm while the 3.5mm ETT from Portex® has an OD of 4.8mm).

Conclusions

Clinicians should be aware of the OD of ETTs to reduce unsuccessful intubation attempts caused by ETT sizes not fitting the nasal cavity. Generated data may help to adapt recommendations in future.

Trial registration

Subgroup analysis of the “Fitting of Commonly Available Face Masks for Late Preterm and Term Infants (CAFF)”-study: NCT03369028, www.ClinicalTrials.gov, December 11, 2017.
Financial, institutional, environmental, technical, and social (FIETS) aspects of water, sanitation, and hygiene conditions in indigenous - rural Indonesia
Authors: Daniel D. , Djohan Dennis , Machairas Ilias , Pande Saket , Arifin Arifin , Al Djono Trimo Pamudji , Rietveld Luuk
Published: September 2021

Background

There is increasing recognition of the complexity underlying WASH conditions in developing countries. This article explores the complexity by assessing the vulnerability of a specific area to poor WASH conditions using a qualitative approach.

Methods

We present our findings for the district of East Sumba in Indonesia. This area is known as one of the poorest regions in Indonesia with inadequate WASH services, indigenous belief that hinder the practice of WASH-related behaviours, and has a high rate of children malnutrition. All the factors that contribute to poor WASH conditions were discussed through the lens of the Financial, Institutional, Environmental, Technological, and Social (FIETS) framework. We then summarised the factors and visualized the “system” using a mind map which shows how factors are interconnected and helps to find the root causes of poor WASH conditions.

Results

There are three main challenges that inhibit the improvement of WASH conditions in this area: inadequate institutional capacity, water scarcity, and poor socio-economic conditions. We found that a village leader is the most important actor who influences the sustainability of WASH services in this area and healthcare workers are influential WASH promoters. This study also shows how culture shapes people’s daily lives and institution performance, and influences the current WASH conditions in East Sumba. The mind map shows there is an overlap and interconnection between FIEST aspects and WASH conditions in the study area.

Conclusion

WASH conditions are influenced by many factors and are often interconnected with each other. Understanding this complexity is necessary to improve WASH conditions and sustain adequate WASH services in developing countries. Finally, WASH interventions have to be considerate of the prevailing cultural practices and should involve multidisciplinary stakeholders.
Caught in the middle: a thematic analysis of the experiences of Korean-Canadian caregiver-employees in the greater Toronto and Hamilton area
Authors: Lyeo Joonsoo S. , Williams Allison
Published: September 2021

Background

The objective of this study was to investigate the experiences of caregiver-employees (CEs) from the Korean-Canadian community in the Greater Toronto and Hamilton Area.

Methods

Nine participants were recruited and invited to partake in data collection, which consisted of the completion of a sociodemographic questionnaire as well as a qualitative, semi-structured interview. The interview transcripts were thematically analyzed.

Result

The thematic analysis revealed four primary themes, each of which had three sub-themes. The four primary themes are:: (i) tensions, (ii) adaptations to the dual role of being a CE, (iii) coping mechanisms, and (iv) desired changes to the status quo.

Conclusion

The result of this study suggest that Korean-Canadian CEs, as a consequence of their position at the convergence of Korean and Western cultural values, would be best supported through the provision of culturally sensitive supports and greater workplace accommodation.
Renaming COPD exacerbations: the UK respiratory nursing perspective
Authors: Mwasuku Christine , King Joanne , Russell Richard E. K. , Bafadhel Mona
Published: September 2021

Background

Patients with COPD experience acute worsenings, termed ‘exacerbations’. While other terms to describe these events have been proposed there is no consensus on terminology which has led to multiple terms being used across the UK. Respiratory nurses are part of a multi-disciplinary team managing COPD patients, however, the nursing perspective on the term ‘exacerbation’ is unknown.

Methods

An anonymised survey of 17 questions was sent to respiratory nurses through an email invitation link. The survey link was open for one month. The aim was to understand the nurse perspective on ‘exacerbation’. Alternative terms used in the UK were compared versus the term 'exacerbation’.

Results

Responses were received from 113 nurses. The majority (88%) were female. There was no consensus on preference or meaning for the term ‘exacerbation’ between nurses. Less than 5% of nurses thought that patients with COPD would understand the term ‘exacerbation’. In ranked order, the nurses preferred the following terms: ‘flare-up’, ‘lung attack’, ‘crisis’, ‘exacerbation’ and ‘chest infection’. The term ‘crisis’, although new, was considered to be the term that most resonated with clinical practice.

Conclusion

Respiratory nurses in the UK report that the term ‘exacerbation’ is not fit for purpose for patients, and alternatives should be sought.
Are postoperative NLR and PLR associated with the magnitude of surgery-related trauma in young and middle-aged patients with bicondylar tibial plateau fractures? A retrospective study
Authors: Wang Zhongzheng , Wang Yanwei , Wang Yuchuan , Chen Wei , Zhang Yingze
Published: September 2021

Background

The invasiveness of different surgical procedures is variable. The purpose of this study was to investigate the value of the postoperative neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as biomarkers in assessing the magnitude of surgery-related trauma in young and middle-aged patients with bicondylar tibial plateau fractures (TPFs).

Methods

A total of 136 young and middle-aged patients with bicondylar TPFs who underwent surgical treatment between May 2016 and April 2020 were included. Details about demographic information, pre- and postoperative laboratory data, and surgical variables were obtained from the electronic database of our level I trauma center. According to the different surgery programs, all patients were divided into two groups: group 1, which represented minimally invasive reduction and internal fixation (MIRIF), and group 2, which represented open reduction and internal fixation (ORIF). Univariate and multivariate logistic regression and ROC curve analyses were used.

Results

The operative time, intraoperative tourniquet use, intraoperative blood loss, length of incision, postoperative NLR, PLR, RBC and HCRP were significantly different between the two groups (P < 0.05). In the multivariate analysis, postoperative PLR ≥ 223.9, surgical incision > 19.0 cm and operative time > 130 min were closely related to severe surgery-related trauma. The ROC curve analysis indicated that postoperative PLR could predict severe surgery-related trauma with a specificity of 76.0 % and a sensitivity of 55.7 %.

Conclusions

Postoperative PLR appears to be a useful biomarker that is closely associated with magnitude of surgery-related trauma in young and middle-aged patients with bicondylar TPFs.
Peripheral quantitative computed tomography in the assessment of bone mineral density in anti-TNF-treated rheumatoid arthritis and ankylosing spondylitis patients
Authors: Juhász Balázs , Gulyás Katalin , Horváth Ágnes , Végh Edit , Pusztai Anita , Szentpétery Ágnes , Pethő Zsófia , Bodnár Nóra , Hamar Attila , Bodoki Levente , Bhattoa Harjit Pal , Szekanecz Éva , Hodosi Katalin , Domján Andrea , Szamosi Szilvia , Horváth Csaba , Szántó Sándor , Szűcs Gabriella , Raterman Hennie G. , Lems Willem F. , FitzGerald Oliver , Szekanecz Zoltán
Published: September 2021

Introduction

Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are associated with osteoporosis. There have not been many peripheral quantitative computed tomography (QCT) studies in patients receiving biologics. We assessed volumetric and areal bone mineral density (BMD) by forearm QCT and dual-energy X-ray absorptiometry (DXA), respectively in addition to laboratory biomarkers in these arthritides.

Methods

Forty RA and AS patients treated with either etanercept (ETN) or certolizumab pegol (CZP) were undergoing follow-ups for one year. Volumetric and areal BMD, as well as parathyroid hormone (PTH), osteocalcin, RANKL, 25-hydroxyvitamin D (VITD), P1NP, CTX, sclerostin (SOST), Dickkopf 1 (DKK-1) and cathepsin K (CATHK) were determined.

Results

We did not observe any further bone loss during the 12-month treatment period. Volumetric and areal BMD showed significant correlations with each other (p<0.017 after Bonferroni’s correction). Trabecular QCT BMD at baseline (p=0.015) and cortical QCT BMD after 12 months (p=0.005) were inversely determined by disease activity at baseline in the full cohort. Trabecular QCT BMD at baseline also correlated with CTX (p=0.011). In RA, CRP negatively (p=0.014), while SOST positively (p=0.013) correlated with different QCT parameters. In AS, RANKL at baseline (p=0.014) and after 12 months (p=0.007) correlated with cortical QCT BMD. In the full cohort, 12-month change in QTRABBMD was related to TNF inhibition together with elevated VITD-0 levels (p=0.031). Treatment and lower CATHK correlated with QCORTBMD changes (p=0.006). In RA, TNF inhibition together with VITD-0 (p<0.01) or CATHK-0 (p=0.002), while in AS, treatment and RANKL-0 (p<0.05) determined one-year changes in QCT BMD.

Conclusions

BMD as determined by QCT did not change over one year of anti-TNF treatment. Disease activity, CATHK, RANKL and VITD may be associated with the effects of anti-TNF treatment on QCT BMD changes. RA and AS may differ in this respect.
Biofilm formation following chitosan-based varnish or chlorhexidine-fluoride varnish application in patients undergoing fixed orthodontic treatment: a double blinded randomised controlled trial
Authors: Poornima Preethi , Krithikadatta Jogikalmat , Ponraj Ratna Rachel , Velmurugan Natanasabapathy , Kishen Anil
Published: September 2021

Background

Orthodontic treatment poses an increased risk of plaque accumulation and demineralisation of enamel leading to white spot lesion around the brackets. This parallel arm trial aims to assess the degree of bacterial plaque formation adjacent to orthodontic brackets, following the application of a chitosan-based varnish or chlorhexidene-fluoride varnish.

Methods

A total of 200 teeth from 20 patients undergoing fixed orthodontic therapy were assessed and biofilm formation around the brackets were recorded using the Bonded Bracket Index (Plaque index) at baseline and weekly for 6 weeks. The bacterial count and plaque pH at corresponding weekly intervals were also recorded. Following bracket bonding, the patients were cluster randomised to receive chitosan-based varnish-CHS (UNO Gel Bioschell, Germiphene corp., Brantford, Canada) or chlorhexidine-fluoride varnish-CFV (Cervitec F, Ivoclar Vivadent, Schaan, Liechtenstein) every week on the representative teeth respectively. BBI proportions were compared between groups at all time intervals using Chi square test. Mean plaque bacterial count and plaque pH were compared using Mann Whitney U test and Tukey’s HSD test respectively.

Results

Baseline characteristics were similar between the groups: Mean age was CHS = 23 and CFV = 21; male to female ratio was CHS = 5/5, CFV = 7/3. At the end of 6 weeks, chitosan-based varnish performed equal to chlorhexidine-fluoride varnish (P > 0.05) with 98% and 95% of teeth with acceptable scores respectively. The plaque bacterial count significantly reduced at 6 weeks for both varnish compared to the baseline; The value for CHS was 0.43 ± 0.4 × 104 and CFV was 0.77 ± 0.64 × 104 CFU (P < 0.05), with no difference between both the varnishes. Both varnishes had no effect on the plaque pH that remained neutral.

Conclusion

This trial showed that both chitosan-based varnish and chlorhexidine-fluoride varnish reduced bacterial count, while the plaque pH remained neutral over a period of six weeks in patients undergoing fixed orthodontic therapy. The anti-plaque effects of the natural biopolymeric chitosan-based varnish was similar to that of chlorhexidine-fluoride varnish, a known chemotherapeutic agent.

Registration: This trial protocol was registered with https://www.ctri.nic.in (CTRI/2019/05/018896). (Date of registration 02/05/2019).

Protocol: The protocol was not published before trial commencement.
Comparison of digital and silicone impressions for single-tooth implants and two- and three-unit implants for a free-end edentulous saddle
Authors: Nagata Koudai , Fuchigami Kei , Okuhama Yurie , Wakamori Kana , Tsuruoka Hayato , Nakashizu Toshifumi , Hoshi Noriyuki , Atsumi Mihoko , Kimoto Katsuhiko , Kawana Hiromasa
Published: September 2021

Background

The use of intraoral scanners (IOS) has facilitated the use of digital workflows for the fabrication of implant-supported prostheses not only for single missing teeth, but also for multiple missing teeth. However, the clinical application of IOS and computer-aided design/manufacturing (CAD/CAM) in implant-supported prosthodontics remains unclear. This study aimed to compare the accuracy of digital and silicone impressions for single-tooth implants for bounded edentulous spaces and two-unit and three-unit implant-supported fixed dental prostheses for free-end edentulous spaces.

Methods

This study enrolled 30 patients (n = 10 for each of the three groups) with an average age of 61.9 years. Conventional silicone-based and digital IOS-based impressions were made for all patients, and the implant superstructures were fabricated. We measured the scan-body misfit and compared the accuracy of the impressions for single-unit, two-unit, and three-unit implant prostheses with a bounded edentulous space by superimposing the standard triangulated language (STL) data obtained from IOS over the STL data of the plaster model used for final prosthesis fabrication. The scan bodies of the superimposed single-molar implant, two-unit implant prosthesis without teeth on the mesial side, two-unit implant prosthesis without teeth on the distal side, three-unit implant prosthesis without teeth on the mesial side, and three-unit implant prosthesis without teeth on the distal side were designated as A, B1, B2, C1, and C2, respectively. The misfit for each scan body was calculated and the accuracies were compared using the Tukey–Kramer method.

Results

The average scan-body misfit for conditions A, B1, B2, C1, and C2 was 40.5 ± 18.9, 45.4 ± 13.4, 56.5 ± 9.6, 50.7 ± 14.9, and 80.3 ± 12.4 μm, respectively. Significant differences were observed between the accuracies of A and B2, A and C2, and C1 and C2 (P < 0.001).

Conclusions

IOS and CAD/CAM can find clinical applications for implant-supported prostheses of up to three units for a bounded edentulous saddle. The use of IOS could render implant treatment easier, benefiting both the surgeons and patients. Prosthesis maladjustment may lead to peri-implantitis and prosthetic fracture. Therefore, further validation of the accuracy of IOS impressions is required in patients with multiple missing teeth in long-span implant prostheses.
Ethical considerations for involving adolescents in biomedical HIV prevention research
Authors: Nakalega Rita , Akello Carolyne , Gati Brenda , Nakabiito Clemensia , Nolan Monica , Kamira Betty , Etima Juliane , Nakyanzi Teopista , Kemigisha Doreen , Nanziri Sophie C. , Nanyonga Stella , Nambusi Maria Janine , Mulumba Emmie , Biira Florence , Nabunya Hadijah Kalule , Akasiima Simon Afrika , Nansimbe Joselyne , Maena Joel , Babirye Juliet Allen , Ngure Kenneth , Mujugira Andrew
Published: September 2021

Background

Involvement of adolescent girls in biomedical HIV research is essential to better understand efficacy and safety of new prevention interventions in this key population at high risk of HIV infection. However, there are many ethical issues to consider prior to engaging them in pivotal biomedical research. In Uganda, 16–17-year-old adolescents can access sexual and reproductive health services including for HIV or other sexually transmitted infections, contraception, and antenatal care without parental consent. In contrast, participation in HIV prevention research involving investigational new drugs requires adolescents to have parental or guardian consent. Thus, privacy and confidentiality concerns may deter adolescent participation. We describe community perspectives on ethical considerations for involving adolescent girls in the MTN 034 study in Uganda.

Methods

From August 2017 to March 2018, we held five stakeholder engagement meetings in preparation for the MTN 034 study in Kampala, Uganda (NCT03593655): two with 140 community representatives, two with 125 adolescents, and one with 50 adolescents and parents. Discussions were moderated by the study team. Proceedings were documented by notetakers. Summary notes described community perspectives of adolescent participation in HIV research including convergent, divergent or minority views, challenges, and proposed solutions.

Results

Most community members perceived parental or guardian consent as a principal barrier to study participation due to concerns about adolescent disclosure of pre-marital sex, which is a cultural taboo. Of 125 adolescent participants, 119 (95%) feared inadvertent disclosure of sexual activity to their parents. Community stakeholders identified the following critical considerations for ethical involvement of adolescents in HIV biomedical research: (1) involving key stakeholders in recruitment, (2) ensuring confidentiality of sensitive information about adolescent sexual activity, (3) informing adolescents about information to be disclosed to parents or guardians, (4) offering youth friendly services by appropriately trained staff, and (5) partnering with community youth organizations to maximize recruitment and retention.

Conclusions

Stakeholder engagement with diverse community representatives prior to conducting adolescent HIV prevention research is critical to collectively shaping the research agenda, successfully recruiting and retaining adolescents in HIV clinical trials and identifying practical strategies to ensure high ethical standards during trial implementation.
Academic service-learning nursing partnerships in the Americas: a scoping review
Authors: Markaki Adelais , Prajankett Ong-on , Shorten Allison , Shirey Maria R. , Harper Doreen C.
Published: September 2021

Background

Academic service-learning nursing partnerships (ASLNPs) integrate instruction, reflection, and scholarship with tailored service through enriched learning experiences that teach civic responsibility and strengthen communities, while meeting academic nursing outcomes.Objective: This scoping review aimed to identify, appraise, and synthesize evidence of community focused ASLNPs that promote primary health care throughout the Americas region.

Methods

A systematic search of PubMed, CINAHL, Scopus, Google Scholar, and LILACS English-language databases was performed in accordance with PRISMA guidelines. Full-text articles published since 2010 were reviewed using an inductive thematic approach stemming from the “Advancing Healthcare Transformation: a New Era for Academic Nursing Report” and the Pan American Health Organization “Strategic Directions for Nursing.”

Results

A total of 51 articles were included with the vast majority 47 (92.1 %) representing North America. Structured, established relationships between an academic nursing institution or program and one or more community serving entities resulted in high levels of effectiveness and innovation across settings. Five themes emerged: (a) sustaining educational standards and processes - improving academic outcomes (25.5 %), (b) strengthening capacity for collaborative practice and interprofessional education (13.7 %), (c) preparing nurses of the future (11.8 %), (d) enhancing community services and outcomes (21.6 %), and (e) conceptualizing or implementing innovative academic nursing partnerships (27.4 %). A synthesis of conceptual frameworks and models revealed six focus areas: communities/populations (26.2 %), nursing (26.2 %), pedagogy (19 %), targeted outreach (14.3 %), interprofessional collaboration (11.9 %), and health determinants (9.5 %). A proliferation in US articles, triggered by nursing policy publications, was confirmed.

Conclusions

ASLNPs serve as mechanisms for nurses and faculty to develop and lead change across a wide variety of community settings and healthcare systems, develop scholarship, as well as for students to apply the knowledge and skills learned. Given the lack of geographically broad evidence, successes and challenges across U.S. partnerships should be viewed cautiously. Nevertheless, ASLNPs can play a critical role towards meeting the goal of universal health access and coverage through partnering with the education sector. Further investigation of grey literature as well as Spanish and Portuguese language literature from Latin American and Caribbean countries is highly recommended.