bluuebunny/crossref_metadata_2025 huggingface dataset:
Facial and Cephalometric Features of Individuals With Mucopolysaccharidosis: A Cross-Sectional Study
Authors: Carneiro Natália Cristina Ruy , Abreu Lucas Guimarães , Milagres Roselaine Moreira Coelho , Amaral Tania Mara Pimenta , Flores-Mir Carlos , Pordeus Isabela Almeida , Borges-Oliveira Ana Cristina
Published: November 2021

Objective

The aim was to assess craniofacial features through facial anthropometric and lateral cephalometry measurements of individuals with mucopolysaccharidosis (MPS) and compare them with individuals without MPS.

Design

Cross-sectional study.

Patients

A total of 14 individuals with MPS and 28 non-MPS age- and sex-matched were enrolled in this study.

Methods

A clinical facial analysis to evaluate the soft tissues and cephalometric analysis that comprised linear and angular measurements were performed. The calculation of the method error suggested no systematic errors ( p > .05). Random errors for linear and angular measurements were low (less than 0.5° and 1.6 mm). Chi-square test and independent t-test were performed.

Results

Most individuals with MPS were dolichofacial, presented altered facial proportions with an increased anterior lower facial height (ALFH) and lip incompetence (all p < .05), when compared with non-MPS individuals. Six angular measurements (1s.Na, 1s.NB, FMA, IMPA, AFI, and Po.Or_Go.Me; all p < .05) were significantly increased among individuals with MPS, and two (1s.1i and Ba.N-Ptm.Gn, all p < .05) were significantly decreased among them. Four linear measurements were significantly increased among individuals with MPS (1s-NA, 1i-NB, S-UL, and S-LL; all p < .05) and five (PogN-Perp, Co-A, Co-Gn, Nfa-Nfp, and overbite; all p < .05) were significantly decreased among them.

Conclusion

In summary, most individuals with MPS were dolichofacial with increased ALFH. Proclined upper and lower incisors, reduced nasopharyngeal space, and reduced overbite was also noted.
Spatiotemporal Expression and Functional Analysis of miRNA-22 in the Developing Secondary Palate
Authors: Mukhopadhyay Partha , Smolenkova Irina , Seelan Ratnam S. , Pisano M. Michele , Greene Robert M.
Published: November 2021

Objective

Normal development of the embryonic orofacial region requires precise spatiotemporal coordination between numerous genes. MicroRNAs represent small, single-stranded, non-coding molecules that regulate gene expression. This study examines the role of microRNA-22 (miR-22) in murine orofacial ontogeny.

Methods

Spatiotemporal and differential expression of miR-22 (mmu-miR-22-3p) within the developing secondary palate was determined by in situ hybridization and quantitative real-time PCR, respectively. Bioinformatic approaches were used to predict potential mRNA targets of miR-22 and analyze their association with cellular functions indispensable for normal orofacial ontogeny. An in vitro palate organ culture system was used to assess the role of miR-22 in secondary palate development.

Results

There was a progressive increase in miR-22 expression from GD12.5 to GD14.5 in palatal processes. On GD12.5 and GD13.5, miR-22 was expressed in the future oral, nasal, and medial edge epithelia. On GD14.5, miR-22 expression was observed in the residual midline epithelial seam (MES), the nasal epithelium and the mesenchyme, but not in the oral epithelium. Inhibition of miR-22 activity in palate organ cultures resulted in failure of MES removal. Bioinformatic analyses revealed potential mRNA targets of miR-22 that may play significant roles in regulating apoptosis, migration, and/or convergence/extrusion, developmental processes that modulate MES removal during palatogenesis.

Conclusions

Results from the current study suggest a key role for miR-22 in the removal of the MES during palatogenesis and that miR-22 may represent a potential contributor to the etiology of cleft palate.
Parental Burnout Reduces Primary Students' Academic Outcomes: A Multi-Mediator Model of Mindful Parenting and Parental Behavioral Control
Authors: An Nguyen H. , Hong Vo T. P. , Thao Tran T. P. , Thao Le N. , Khue Nguyen M. , Phuong Tran T. T. , Thanh Nguyen M.
Published: November 2021

Academic outcomes have long been one of the important issues of childhood research, which has a strong influence on the overall development of children. The present study aimed to explore the relationship between parental burnout and academic outcomes and the mediating role of parental behavioral control, and mindful parenting. The participants included 786 Vietnamese primary school students ( Mage = 9,980, SD = 0.889) and their parents. Parents completed questionnaires about demographic information, parental burnout, behavioral control, and mindful parenting. The student's academic grades are reported by the school office where the student is enrolled. The results support three main findings: (a) parental burnout has a direct influence on student's academic outcomes, (b) the mediating role of parental behavioral control was significant, and (c) the mediating role of mindful parenting was also significant. Practical implications of these findings highlight how parent's mental health status and parenting practices influence academic outcomes.
Venous Thromboembolism in Japanese Patients With Pancreatic Cancer
Authors: Suzuki Takahito , Hori Reina , Takeuchi Kazutaka , Yamamura Ryo , Katoh Hiromasa , Noji Yoshihiro , Yamaguchi Masato , Fujino Susumu
Published: November 2021

Objective

Pancreatic ductal adenocarcinoma (PDAC) is the fourth leading cause of cancer-related deaths in Japan. Previous studies from other countries have reported venous thromboembolism prevalence rates of 12 to 36% in patients with pancreatic cancer. In this study, we aimed to determine the incidence of VTE in patients with PDAC in Japan and compare the characteristics of patients with and without VTE.

Methods

In this retrospective cohort study, clinicopathological characteristics of patients with and without concomitant VTE were compared.

Patients

Patients with PDAC treated at Fukui Prefectural Hospital, Japan from 2010 to 2019.

Results

The 1-year survival rate of all patients with pancreatic cancer was 40.7%. Among 432 patients with PDAC, 31 developed VTE. Seventeen (55%) patients received anticoagulant therapy. Compared with the non-VTE group, the VTE group had significantly more patients whose body mass index was >25 kg/m² ( p = .035) and had a significantly higher rate of chemotherapy ( p = .024). There was no significant difference in median survival time from PDAC diagnosis between the VTE and non-VTE groups. The 6-month mortality rate after VTE diagnosis was 54.8%. PDAC-related death was the most frequent cause of death, and thrombus-related death was not observed.

Conclusion

Several baseline characteristics differed between patients with and without VTE. The incidence of VTE in patients with PDAC is high. However, because the prognosis of PDAC itself remains quite poor, VTE may not have a significant effect on prognosis.
Gender Differences do not Influence the Blood Coagulopathy in Patients Undergoing Total Knee Arthroplasty: A Retrospective Thromboelastography Analysis
Authors: Jin Wang-yi , Pang Yong , Zhang Xing-chen , Peng Da-lin , Yan Zi-wen , Pan Sheng , Huang Chao-ran , Guo Kai-jin , Zheng Xin
Published: November 2021

Objective

Deep vein thrombosis (DVT) is one of the severe complications after total knee arthroplasty (TKA). Gender has been considered to influence the incidence of the thrombosis formation in TKA patients. However, it remains controversial which gender would be more prone to form thrombosis. The aim of this study was to assess the effects of gender differences on coagulation status after TKA via the thromboelastography (TEG).

Methods

A total of 57 male patients who underwent primary TKA from September 2015 to January 2021 were included in this study. According to the matching principle of age, body mass index (BMI), and anticoagulation treatment, 60 female patients were selected. The conventional coagulation tests, routine blood tests, and thromboelastography were conducted before the operation, 1 day and 7 days after the operation. In addition, Doppler ultrasound was also performed 1 day before the operation and at the 7 days after the operation. The parameters of conventional coagulation tests, routine blood tests, and thromboelastography were compared between the two groups.

Results

There were no significant differences in the blood transfusion rate, the incidence of DVT during the perioperative period, D-dimer (D-D), fibrin degradation products (FDP), hemoglobin (HB), hematocrit (HCT), prothrombin time (PT), activated partial thromboplastin time (APTT), and C-reactive protein (CRP) at any corresponding time point between the male group and the female group ( P > .05). There were no significant differences in neutrophil-to-lymphocyte ratio (NLR) preoperatively; however, there were significant differences in NLR 1 day after the surgery and 7 days after the surgery between the two groups ( P < .05). There were significant differences in reaction time (R) and α angle 1 day after the surgery between the two groups ( P < .05), but there were no significant differences in other TEG indexes at any corresponding time point between the two groups ( P > .05). Binary logistic regression analysis demonstrated that gender, age, BMI, tourniquet application time were not independent predictors ( P > .05).

Conclusion

Gender differences have no significant influence in TKA patients with regard to conventional coagulation tests and thromboelastography.
Examining an In-Home Behavioral Parent Training Protocol Among Parents Who Use Substances Involved Child Welfare: Effectiveness of SafeCare
Authors: Moreland Angela , Crum Kathleen , Rostad Whitney L. , Stefanescu Andrei , Whitaker Daniel
Published: November 2021

Given the detrimental impact of substance use (SU) on both parent and child outcomes including child maltreatment, research and service efforts have focused on incorporating parenting resources into integrated SU treatment programs. While promising, it is imperative to examine and test parenting programs in a variety of settings. This study examined whether SU moderated the relationship between treatment condition and parenting outcomes among parents who participated in SafeCare, and parent ratings of engagement, service satisfaction, and perceived cultural competency of services. Results indicated that SU did not moderate the relationship between treatment condition and abuse potential, but did moderate this relationship for depression and parental distress such that parents with higher levels of SU reported less improvement in depression and parental distress. Results underscore that SU problems may impact the effectiveness of SC on specific risk factors, such as depression and parental distress, potentially indicating unique treatment needs and the need to adapt interventions to ensure treatment success. In addition, this study found that SafeCare was not found to be beneficial for parents with SU problems above and beyond the treatment as usual condition. Finally, results indicated that parents with SU concerns and without SU concerns engaged very similarly in SafeCare.
Anesthetic Considerations in Pediatric Patients With Acute Decompensated Heart Failure
Authors: Sebastian Roby , Ullah Sana , Motta Pablo , Das Bibhuti , Zabala Luis
Published: November 2021

Acute decompensated heart failure (ADHF) in pediatrics is a significant cause for morbidity and mortality in children. Congenital heart disease and cardiomyopathy are the leading etiologies of ADHF. It is common for these children to undergo diagnostic, therapeutic, or surgical procedure under anesthesia, which may be associated with significant morbidity and mortality. The importance of preanesthetic multidisciplinary planning with all involved teams, including anesthesia, cardiology, intensive care, perfusion, and cardiac surgery, cannot be emphasized enough. In order to safely manage these patients, it is imperative for the anesthesiologist to understand the complex pathophysiological interactions between cardiopulmonary systems and anesthesia during these procedures. This review discusses the etiology, pathophysiology, clinical manifestations, and perioperative management of these patients.
Smoking is associated with a higher complication and failure rate in arteriovenous grafts for haemodialysis: A multi-centre experience
Authors: Kler Aaron , Khambalia Hussein , Pondor Zulfikar , Donne Rosie , Giuffrida Giuseppe , Augustine Titus , Campbell Babatunde , van Dellen David
Published: November 2021

Introduction:

Arteriovenous grafts (AVG) for haemodialysis (HD) access are recommended as a second line modality due to higher morbidity and mortality rates than arteriovenous fistulae (AVF). Smoking is already established as a risk factor in lower extremity bypass graft failure used for peripheral vascular disease, but its effect on AVGs remains unclear. We aimed to investigate the relationship of smoking on AVG outcomes.

Methods:

A 3 year (01/08/2015–01/08/2018) multi-centre retrospective study was carried out on patients receiving an AVG for HD. Data included patient demographics, medical history, operation, type of graft, postoperative course and primary and secondary patency rates. Statistical analyses performed were Kaplan-Meier curves and Cox’s proportional hazard regression.

Results:

Fifty-five AVGs were performed (1052 AVF performed) in this period. The most common complication was thrombosis (38.9%). Primary patency at 6, 12 and 24 months were 55%, 45% and 44% respectively. Secondary patency at 6, 12 and 24 months were 63%, 56% and 54% respectively. Smoking was found to be a poor prognostic factor for primary (HR 3.734 (1.818–7.668 95% CI) p < 0.001) and secondary patency (HR 6.238 (2.729–14.257) p < 0.001). Smoking was also significantly associated with graft thrombosis (HR 5.741 (2.380–13.848 95% CI) p < 0.001).

Discussion:

Primary patency rates are lower than previous reports whilst secondary patency is equivalent. Smoking results in a greater risk of thrombosis and poorer primary and secondary patency. This is recognised in vascular surgical grafts, but has not been previously described in AVGs for HD access. Smoking is a modifiable risk factor and as AVGs are typically used for end-stage vascular access patients. Pre-operative strategies to promote smoking cessation, including patient education and prehabilitation should be employed to improve outcomes.
Real-World Treatment Patterns of Lung Cancer in a Resource-Restricted Country: the Experience of Georgia
Authors: Kiladze Ivane , Mariamidze Elene , Jeremic Branislav
Published: November 2021

Lung cancer (LC) is the most common malignancy responsible for 1.8 million of deaths worldwide. Lung and bronchus cancer represents 13% (n = 1217) of all new cancer cases in Georgia. In 2018, in Georgian males lung cancer age-standardized incidence rate was 35.7/per 100 000, less compared to regional countries as Turkey (70.6), Russia (48.2), Ukraine (41.7), and Armenia (58.5), but higher than in neighbor Azerbaijan (25.5). Incidence is higher compared to central and eastern Europe (27.3) and near similar to North America (34.5). Georgia is an Eastern European, middleincome country with 3.7 million residents and one of the highest numbers of active smokers in the European Region. The Georgian health care system is divided into a public and a private sector, with coverage of nearly 100% of the population. There is a national healthcare system as well as private insurance and all patients, irrespective of insurance (private or governmental) can choose the hospital for treatment by themselves all over the country. The Basic Package of the Universal Health Care Program includes the treatment of oncologic patients, specifically surgery, chemotherapy, hormone therapy and radiotherapy and investigations and medications related to these procedures. The program covers all types of laboratory and instrumental investigations related to planned treatment. Georgia lacks an LC screening program for smokers and partially because of this, the majority of patients with lung cancer present at an advanced stage. The National Centre for the Disease Control (NCDC) showed that almost 90% of LC patients in the country present with advanced stages (III-IV) with 60% of patients having stage IV disease at diagnosis . Lung cancer is generally diagnosed at an advanced stage. For non-small cell lung cancer (NSCLC), the proportion with metastatic disease (TNM stage IV) ranged from 46.8% to 61.2% in developed countries. In recent years, there have been several publications addressing specifics of LC worldwide, but none concerning Georgia. In light of the rapidly changing landscape in the diagnosis, staging, and treatment of LC, we thought to define the state of practice in Georgia by convening specialists who treat LC across 13 institutions in our country with the goal to describe differences in access and approaches to LC.
Some aspects on quantification of the wear at steel wire ropes
Authors: Olszyna Grzegorz , Gašić Vlada , Tytko Andrzej
Published: November 2021

Steel ropes are widely used in material handling machines. The excessive wear of wires is often presented as a type of rope degradation. One of many indicators of the wear is abrasion, corrosion and fatigue cracks. Within this class of rope degradation, the main representation of wear is wire abrasion in the layers of the external wires. This is especially noticeable at the steel ropes which are operating in the drum devices with multilayer winding and in hoists of mining shafts. Over performed work cycles, the estimation of losses in rope cross-section is important for the calculation of the rope capacity. Abrasive wear of external wires is a relatively easy phenomenon to detect with a qualitative interpretation. However, it is a very difficult phenomenon to quantify. The aim of this article is to address this issue. A brief survey of usual methods for rope inspections is given, which can serve as practical guidance for the engineers in this field. With accompanying case study, it presented the advantages of magnetic method in rope inspections oriented towards measuring the changes of wires within the wear assessment.
Siblings of children with chronic disorders: Family and relational factors as predictors of mental health
Authors: Fredriksen Trude , Marie Vatne Torun , Bjartveit Haukeland Yngvild , Tudor Megan , Fjermestad Krister Westlye
Published: November 2021

Siblings of children with chronic disorders are at increased risk of mental health problems. Predictors of siblings’ mental health require further study to identify children in need of interventions and to design effective intervention programs. Siblings of children with chronic disorders ( n = 107; M age = 11.5 years; SD = 2.1, 54.6% girls) and their parents ( n = 199; 50.3% mothers) were included in a survey study. Siblings and parents completed questionnaires on mental health. Siblings completed questionnaires on parent–child communication, relationships with parents, and an adjustment measure on the sibling situation. Multiple linear regression analyses were applied to identify predictors of siblings’ mental health. Sibling-reported relationship with parents was a significant predictor of sibling mental health reported by siblings, fathers, and mothers ( R 2 = 0.26 - R 2 = 0.46). Siblings’ adjustment was significantly associated with fathers’ report of siblings’ mental health ( r = .36), but not mothers’ report ( r = .17). Siblings’ relationships ( d = 0.26) and communication ( d = 0.33) with mothers were significantly better than with fathers. We conclude that the sibling–parent relationship is a significant factor in identifying siblings at risk and that family-based intervention programs should be developed.
Activism to make and do: The (quiet) politics of textile community groups
Authors: Warner Helen , Inthorn Sanna
Published: November 2021

Based on qualitative interviews conducted with local guilds, charities and community groups in England, this article highlights the public service older women provide for their communities by volunteering their labour to local textile craft groups. Driven by an ethics of care, they make up for a lack of services formerly provided by the welfare state, such as public transport and mental health support. We mobilise existing literature on ‘quiet activism’ to argue that their community work constitutes a form of political activism, albeit one that stops short of overtly challenging the political system. While highlighting the ways in which older women quietly go about helping their communities, we argue that by being ‘louder’ about the public service they provide, they could help disrupt the narrative of a system that has failed their communities and exploits their free labour.
Distribution of wounding patterns in casualties from mass shooting events
Authors: Atia Andrew , Halligan Lauren , Brezina Libor , Levites Heather , Hollins Andrew , Blau Jared , Hernandez J Andres , Lohmeier Steven , Suresh Visakha , Powers David B
Published: November 2021

Introduction

The incidence and severity of public mass shootings, and mass casualty incidents (MCI), continues to rise. Understanding the wounding pattern and incidence of potentially preventable death after these incidents is key not only to Health System and Trauma Center emergency response planning but also to community outreach and initial emergency interventions.

Methods

A retrospective study of autopsy reports after events with at least 10 fatalities exclusive of the assailants identified via the Federal Bureau of Investigation database from 1 January 1999 to 31 December 2020 was performed. Sites of injury, identification of weaponry, and identification of potentially survivable wounds were compiled.

Results

Nine events including 203 victims were reviewed. Overall, 56% of gunshots were to the head/neck/face; 37% were to the chest; 43% were to the abdomen/torso/back; 31% were to the lower extremity; and 36% were to the upper extremity. On average, there were 29 fatalities per event.

Conclusion

Emergency response disaster care strategy should focus on immediate point of care at the site of wounding by both the civilian population and medical personnel, as well as rapid extrication of victims for definitive medical care. Review of these autopsy results indicates exsanguination, often treatable, is the primary cause of death—supporting community education efforts in hemorrhage control. The location of the wounding patterns seen in this study warrants primary integration of craniomaxillofacial, orthopedic trauma, neurotrauma, and surgical critical care/trauma surgical specialists into the initial response team for MCI.
A systematic approach to calibrate spray and break-up models for the simulation of high-pressure fuel injections
Authors: Sciortino Davide Domenico , Bonatesta Fabrizio , Hopkins Edward , Bell Daniel , Cary Mark
Published: November 2021

A novel calibration methodology is presented to accurately predict the fundamental characteristics of high-pressure fuel sprays for Gasoline Direct Injection (GDI) applications. The model was developed within the Siemens Simcenter STAR-CD 3D CFD software environment and used the Lagrangian–Eulerian solution scheme. The simulations were carried out based on a quiescent, constant volume, computational vessel to reproduce the real spray testing environment. A combination of statistic and optimisation methods was used for spray model selection and calibration and the process was supported by a wide range of experimental data. A comparative study was conducted between the two most commonly used models for fuel atomisation: Kelvin–Helmholtz/Rayleigh–Taylor (KH–RT) and Reitz–Diwakar (RD) break-up models. The Rosin–Rammler (RR) mono-modal droplet size distribution was tuned to assign initial spray characteristics at the critical nozzle exit location. A half factorial design was used to reveal how the various model calibration factors influence the spray properties, leading to the selection of the dominant ones. Numerical simulations of the injection process were carried out based on space-filling Design of Experiment (DoE) schedules, which used the dominant factors as input variables. Statistical regression and nested optimisation procedures were then applied to define the optimal levels of the model calibration factors. The method aims to give an alternative to the widely used trial-and-error approach and unveils the correlation between calibration factors and spray characteristics. The results show the importance of the initial droplet size distribution and secondary break-up coefficients to accurately calibrate the entire spray process. RD outperformed KH–RT in terms of prediction when comparing numerical spray tip penetration and droplet size characteristics to the experimental counterparts. The calibrated spray model was able to correctly predict the spray properties over a wide range of injection pressure. The work presented in this paper is part of the APC6 DYNAMO project led by Ford Motor Company.
Effects of differential pressure measurement characteristics on high pressure-EGR estimation error in SI-engines
Authors: Dadam Sumanth Reddy , Ali Imtiaz , Zhu Di , Kumar Vivek
Published: November 2021

With proper control, exhaust gas recirculation (EGR) can be used for knock mitigation in SI engines, enabling fuel economy improvements through more optimal combustion phasing and lower fuel-enrichment at high loads. Due to significant pressure pulsations across the EGR valve, estimating the mass flow rates at transient and reversing flows across the valve can be challenging. Many systems utilize the pressure drop across a restriction in a flow path as an indication of mass flow. In automotive applications, the measurement of the pressure drop is accomplished by the use of a delta pressure sensor and the pressure drop mechanism could be a sharp edge orifice or other restrictions such as a valve opening. This technique works well for steady-state flow; however, if pressure fluctuations exist, especially at higher frequencies, this method of measuring mass flow can have large errors. The accuracy of EGR mass flow estimation based on a pressure differential (Δ P) measurement and the steady compressible flow orifice equation is investigated for various Δ P sensor frequencies and sampling rates on Ford 3.5L V6 GTDI and 2.3L I4 GTDI engines. This paper identifies the two major contributors of the error are the long length of the gauge lines and the close location of the downstream tap. The long length of the gauge line results in resonances at low frequency which affects the sensor performance. When the downstream tap is placed too close to the orifice, the accuracy of sensor reading is reduced. The proposed solution suggests keeping the gauge line as short as possible and the downstream tap at least two diameters away from the orifice and using a high-speed sensor. The result from engine testing shows a great improvement in the measurement accuracy by 43%. It is demonstrated that using a slow responding sensor with a low sample rate leads to erroneous mass flow calculation when significant pressure pulsations exist. A minimum of 1 kHz sample rate is needed to increase the accuracy of the EGR estimate within ±1%.
European Political Science versus the Pandemic: Patterns of Professional Adaptation
Authors: Capano Giliberto , Verzichelli Luca , Vicentini Giulia
Published: November 2021

The emergence of the COVID-19 outbreak can be considered a potential driver of changes not only in academic disciplines but also, as most observers underline, in the teaching mission of higher education. This raises the main question of this article, that is, exactly whether and how an external shock such as COVID-19 can impact the comprehensive profile of academic disciplines. By focusing on European political science, the article assesses the differences among scholars in this community in terms of potential long-term reactions. The study, based on the outcomes of an original survey conducted among 1400 European professional political scientists (EPSs) at the end of 2020, aims at detecting the “predisposition to adaptation” of the community, by examining the attitudes revealed by EPSs during the early phase of pandemic. In this regard, we focus on the explanations of different aspects of ‘professional adaptation’, discussing three dimensions that seem to be present in our sample, although with very different weights: passive, proactive and innovative adaptation.
Validation of a Spanish version of the Leicester Cough Questionnaire in cystic fibrosis
Authors: Muñoz Gerard , de Gracia Javier , Giron Rosa , Olveira Casilda , Alvarez Antonio , Buxó Maria , Birring Surinder S , Vendrell Montserrat
Published: November 2021

Cough is a main symptom in cystic fibrosis (CF). We aim to validate a Spanish version of the Leicester Cough Questionnaire (LCQ-Sp) to measure the impact of cough in CF bronchiectasis. A prospective longitudinal multicentre study was performed. Internal consistency and score changes over a 15-day period in stable state were assessed to analyse reliability. Concurrent validity was analysed by correlation with Saint George’s Respiratory Questionnaire (SGRQ) and convergent validity by assessing the association with clinical variables. Changes in scores between stable state and the first exacerbation were assessed to analyse responsiveness. 132 patients (29.73 ± 10.52 years) were enrolled in four hospitals. Internal consistency was high for the total score and good for the three domains (Cronbach’s α 0.81–0.93). The test–retest reliability showed an intraclass correlation coefficient of 0.86 for the total score. The correlation between LCQ-Sp and SGRQ scores was −0.74. The LCQ-Sp score negatively correlated with sputum volume, and the mean score decreased at the beginning of exacerbations (16.04±3.81 vs 13.91±4.29) with a large effect size. The LCQ-Sp is a reliable, repeatable and responsive instrument to assess the impact of cough in CF bronchiectasis and is responsive to change in the event of exacerbations.
Incidence and Risk Factors of Diabetic Foot Syndrome in Patients Early After Pancreas or Kidney/Pancreas Transplantation and its Association with Preventive Measures
Authors: Vrátná E. , Husáková J. , Králová K. , Kratochvílová S. , Girman P. , Saudek F. , Dubský M. , Bém R. , Wosková V. , Jirkovská A. , Dad'ová K. , Vařeková J , Lánská V. , Fejfarová V.
Published: November 2021

Diabetic foot (DF) can develop in diabetic patients after organ transplantation (Tx) due to several factors including peripheral arterial disease (PAD), diabetic neuropathy and inappropriate DF prevention. Aim: To assess the occurrence of DF and associated risk factors in transplant patients. Methods: Fifty-seven diabetic patients were enrolled as part of this prospective study. All patients underwent organ Tx (01/2013-12/2015) and were followed up for minimum of 12 months up to a maximum of 50 months. Over the study period we evaluated DF incidence and identified a number of factors likely to influence DF development, including organ function, presence of late complications, PAD, history of DF, levels of physical activity before and after Tx, patient education and standards of DF prevention. Results: Active DF developed in 31.6% (18/57) of patients after organ Tx within 11 months on average (10.7 ± 8 months). The following factors significantly correlated with DF development: diabetes control (p = .0065), PAD (p<0.0001), transcutaneous oxygen pressure (TcPO2;p = .01), history of DF (p = .0031), deformities (p = .0021) and increased leisure-time physical activity (LTPA) before Tx (p = .037). However, based on logistic stepwise regression analysis, the only factors significantly associated with DF during the post-transplant period were: PAD, deformities and increased LTPA. Education was provided to patients periodically (2.6 ± 2.5 times) during the observation period. Although 94.7% of patients regularly inspected their feet (4.5 ± 2.9 times/week), only 26.3% of transplant patients used appropriate footwear. Conclusions: Incidence of DF was relatively high, affecting almost 1/3 of pancreas and kidney/pancreas recipients. The predominant risk factors were: presence of PAD, foot deformities and higher LTPA before Tx. Therefore, we recommend a programme involving more detailed vascular and physical examinations and more intensive education focusing on physical activity and DF prevention in at-risk patients before transplantation.
Artful Representations as Productive Resistance: Researcher Learnings in Expanding Boundaries of Critical Methodology in Speech-Language Pathology
Authors: Abrahams Kristen , Mallick Rizwana , Pillay Daisy , Kathard Harsha
Published: November 2021

In this paper, we engage in productive resistance through exploring the application of an arts-based method in expanding the critical research methodology repertoire in the profession of speech-language pathology. There is a specific focus on the value of painting in the data representation process. We explore how a playful, creative analysis deepened the critical interpretative meaning-making process. In particular, we explain how artful representations in the data analysis process can broaden communication in research beyond the written modality to generate alternative knowledges. We use the concepts of productive ambiguity and unknowing as key conceptual tools to reimagine the data analysis process with particular focus on the process of data representation. We conclude that embracing the uncertainty of creative ways of knowing create possibilities for new meanings and knowledges to emerge.
The reliability of clinical assessment of distal radioulnar joint instability
Authors: Pickering Greg Thomas , Fine Nicola Francesca , Knapper Thomas David , Giddins Grey Edward Bence
Published: November 2021

Accurate assessment of distal radioulnar joint (DRUJ) stability is increasingly recognized as an important part of clinical examination of the wrist. The ability of 30 specialist UK hand surgeons to clinically determine the stability of four volunteers’ wrists was assessed. Volunteers’ wrist stability had previously been confirmed with a validated measurement rig. Use of the wrist ballottement test as the primary examination technique yielded a positive predictive value of 81%, a negative predictive value of 55%, a specificity of 94% and a sensitivity of only 24%, for the detection of DRUJ instability. No correlation between background speciality (orthopaedic versus plastic surgery), nor years of clinical experience was found. Clinical assessment of DRUJ instability among experienced clinicians appears unreliable and instability is typically under recognized. Previous research to date using this clinical assessment method as a parameter of success is therefore brought into question.

Level of evidence: IV
Pre-eclampsia and hypertensive disorders of pregnancy
Authors: Vinayagam Dimuthu
Published: November 2021

Hypertensive disorders of pregnancy, including pre-eclampsia, are a significant and commonly encountered group of medical disorders of pregnancy. A primary care clinician is ideally placed to screen for, diagnose and, if confident, initiate management in antenatal and postnatal women. Early involvement of maternity services is advised if a hypertensive disorder in pregnancy is suspected or diagnosed. Checking of maternal blood pressure and urinalysis should be encouraged during all routine appointments with pregnant women. The aim of this article is to provide an overview of the hypertensive disorders of pregnancy, their diagnosis and management in primary care, with a review of commonly used antihypertensive agents in current UK clinical practice.
Seasonal Variation in the Home Ranges of Black Curassow, Crax alector, in French Guiana
Authors: Lormée Hervé , Berzins Rachel , Rocheteau Vincent , Coster Fran De , Denis Thomas , Richard-Hansen Cécile
Published: November 2021

Cracidae is the most threatened avian family in the Neotropics, mainly because of habitat destruction, heavy hunting pressure and poaching. In French Guiana, Black Curassows are heavily hunted, although basic knowledge of the ecological and demographical traits of the species remains limited. Such a gap prevents any attempt to assess the impact of hunting and to help stakeholders to develop proposals ensuring hunting sustainability. The spatial relationship between animals and their habitat is important for conservation management, being related to population densities through complex patterns. Here, we report on a radio-tracking study of Black Curassows in tropical primary rainforest, in Nouragues National Reserve, French Guiana. The aims of the study were to estimate home range size and its variation across seasons, and to quantify movement patterns of the birds. We captured and fitted VHF tags to four adults, and tracked them for 10 to 21.5 months. Daily movements were recorded, and home ranges estimated using the Kernel Density method, for two consecutive wet seasons and one dry season. Using 95% and 50% Kernel densities, the average annual home range and core area were 96.3± 32.6 ha (SE) and 22.8 ± 2.8 ha respectively. Home ranges appeared spatially stable over the two years, and overlapped between neighbouring groups. During the dry season, Black Curassows did not migrate but tended to enlarge their home range, with greater daily movements and higher home range overlap. Although additional data are still needed, our results can help to improve the knowledge and management of this poorly studied species.
Utility of diffusion-weighted magnetic resonance imaging in predicting the treatment response of nasopharyngeal carcinoma
Authors: Tangyoosuk Thidaporn , Lertbutsayanukul Chawalit , Jittapiromsak Nutchawan
Published: November 2021

Objective

Predicting the treatment response in patients with nasopharyngeal carcinoma (NPC) is challenging. This study evaluated the utility of diffusion-weighted imaging (DWI) in predicting the treatment response in patients with NPC.

Methods

We prospectively enrolled 33 patients with newly diagnosed NPC who underwent magnetic resonance imaging with the propeller DWI and apparent diffusion coefficient (ADC) map before and at 5 weeks after chemoradiation. The following ADC values of the primary tumor were calculated: pre-treatment ADC (pre-ADC), pre-treatment ADC ratio (pre-ADC ratio), ADC change (▵ADC), ADC change ratio (▵ADC ratio), and percentage of ADC change (▵%ADC). The correlations between these parameters and treatment outcomes were explored, and the patients were classified as good responders (complete response) and poor responders (stable disease, partial response, or progressive disease) based on the Response Evaluation Criteria in Solid Tumors, version 1.1.

Results

The ▵ADC, ▵ADC ratio, and ▵%ADC were significantly lower in the poor-responder group ( n = 12) than in the good-responder group ( n = 21; p = 0.001, p = 0.002, and p = 0.004, respectively). There was no significant difference between groups in the pre-ADC and pre-ADC ratios ( p = 0.602 and p = 0.685, respectively). The optimal ▵ADC, ▵ADC ratio, and ▵%ADC cutoff values for predicting poor response were >0.65 mm2/sec, 0.28, and 60%, respectively (sensitivity: 83.3%, 75%, and 83.3%; specificity: 71.4%, 85.7%, and 71.4%, respectively).

Conclusion

The ▵ADC, ▵ADC ratio, and ▵%ADC obtained during the pre-treatment and mid-treatment periods could be potential biomarkers for predicting treatment response in patients with NPC.
Dental Emergencies: Perceived impact of the COVID-19 pandemic on the mental health and wellbeing of dental teams in the UK
Authors: Ellwood Fiona
Published: November 2021

The burden of the COVID-19 pandemic has and continues to stretch the healthcare systems and the workforce alike, both nationally and internationally. This is equally true of the dental care systems and the dental workforce which had to respond and act promptly.

This paper examines the perceived impact of the COVID-19 pandemic on the mental health and wellbeing of dental teams in the UK and provides insight into not only this impact, but the early signs of mental ill health commonly triggered by life events, anxiety and fear, and often exacerbated by stresses. A sample of an established body of literature and recognised sources are considered. Finally, extracts of common threads from meaningful conversations will be alluded to, shining a light on the current state of the mental health and wellbeing of many in dentistry and the need for intervention and longer-term plans. We are often reminded that this period in time is a marathon not a sprint, the same could perhaps be said about a national response to mental health and wellbeing, as it will take time, but the time to begin is now.
Dentists deployed: an insider’s perspective of life on the NHS front line
Authors: Powell Harriet E.
Published: November 2021

The COVID-19 pandemic has stretched and overburdened healthcare services within the UK. This national crisis has led to the widespread redeployment of healthcare workers and reorganization of services throughout the NHS in the UK. The flexible and altruistic nature of healthcare workers has been inspiring, and central in the UK’s response to the COVID-19 pandemic. This article describes the ‘first-hand’ experience of a secondary care dentist, highlighting the redeployment journey to the emergency department (ED) of a major trauma hospital in the North-West of England during the first wave of the COVID-19 pandemic.
Siponimod (BAF312) penetrates, distributes, and acts in the central nervous system: Preclinical insights
Authors: Bigaud Marc , Rudolph Bettina , Briard Emmanuelle , Beerli Christian , Hofmann Andreas , Hermes Erwin , Muellershausen Florian , Schubart Anna , Gardin Anne
Published: November 2021

Background

Siponimod (BAF312), a selective S1P1/S1P5 agonist, reduces disability progression in secondary progressive MS. Recent observations suggest it could act via S1P1/S1P5-dependent anti-inflammatory and pro-myelination effects on CNS-resident cells.

Objective

Generate preclinical evidence confirming siponimod's CNS penetration and activity.

Methods

Siponimod's CNS penetration and distribution was explored in rodents and non-human primates (NHPs) using: Liquid Chromatography coupled to tandem Mass Spectrometry (LC-MS/MS), quantitative whole-body autoradiography (QWBA) using 14C-radiolabeled siponimod or non-invasive single-photon emission CT (SPECT) with a validated 123I-radiolabeled siponimod analog. Functional CNS activity was investigated by S1P1 receptor quantification in brain homogenates.

Results

In mice/rats, siponimod treatments achieved dose-dependent efficacy and dose-proportional increase in drug blood levels, with mean brain/blood drug-exposure ratio (Brain/BloodDER) of 6–7. Efficacy in rat brain tissues was revealed by a dose-dependent reduction in brain S1P1 levels. QWBA distribution analysis in rats indicated that [14C]siponimod related radioactivity could readily penetrate CNS, with particularly high uptakes in white matter of cerebellum, corpus callosum, and medulla oblongata versus lower exposures in other areas such as olfactory bulb. SPECT monitoring in NHPs revealed CNS distribution with a brain/bloodDER of ∼6, as in rodents.

Conclusion

Findings demonstrate siponimod's CNS penetration and distribution across species, with high translational potential to human.
Why Do People Continue Using Fitness Wearables? The Effect of Interactivity and Gamification
Authors: Windasari Nila Armelia , Lin Fu-ren
Published: November 2021

Technology use for personal health management should not only be assessed in terms of the rate of adoption but also examined in the form of sustained use to ensure the long-term benefit. This study addressed the issue of the continued use of wearable devices by ensuring value co-creation among a user, the wearable device, and other users within a service system. This study was a scenario-based experiment to examine interaction design, including interactivity level and game dynamics, which act as a combination of value co-creation mechanisms to elicit a user’s intentions to continuously use wearables. The study also examined user perception factors, such as self and social perceptions, as moderators. This study contributes to existing literature by using the value co-creation and service system perspective to examine continued use behavior. The findings of the research also offer practical insights into designing the features of wearable fitness trackers to promote long-term value for their users.
Expanding Phenotype of ATP1A3 - Related Disorders: A Case Series
Authors: De Vrieze Jelena , van de Laar Ingrid M.B.H. , de Rijk-van Andel Johanneke F. , Kamsteeg Erik-Jan , Kotsopoulos Irene A.W. , de Man Stella A.
Published: November 2021

Neurologic disorders caused by mutations in the ATP1A3 gene were originally reported as three distinct rare clinical syndromes: Alternating Hemiplegia of Childhood (AHC), Rapid-onset Dystonia Parkinsonism (RDP) and Cerebellar ataxia, Areflexia, Pes cavus, Opticus atrophy and Sensorineural hearing loss (CAPOS). In this case series, we describe 3 patients. A mother and her daughter showed an intermediate phenotype different from each other with the same heterozygous missense mutation (p.[R756C]), recently described in literature as Relapsing Encephalopathy With Cerebellar Ataxia (RECA). In addition, a third patient showed an intermediate AHC-RDP phenotype and had a likely pathogenic novel de novo missense mutation (p.[L100 V]). These patients support the growing evidence that AHC, RDP and RECA are part of a continuous ATP1A3 mutation spectrum that is still expanding. Three common features were a sudden onset, asymmetrical neurological symptoms, as well as the presence of triggering factors. When present, the authors argue to perform exome sequencing in an early stage.
“Reclaiming Control” Patient Acceptance and Adherence to HIV Post-Exposure Prophylaxis Following Sexual Assault
Authors: Draughon Moret Jessica E. , Sheridan Daniel J. , Wenzel Jennifer A.
Published: November 2021

Sexual assault is an irrefutable trauma; an insult to the autonomy of the person forced into sexual acts. Sexual assault sequelae range from physical injury and acute traumatic stress, to pregnancy and sexually transmitted infections, including human immunodeficiency virus (HIV). HIV post-exposure prophylaxis (HIV PEP) following sexual assault may decrease the likelihood of HIV transmission. Many patients seeking healthcare post-sexual assault either do not initiate HIV PEP or do not complete the 28-day medication regimen. In this qualitative interpretive description, we interviewed sexual assault patients ( N=11) about HIV PEP discussions/reactions, attitudes and understanding related to HIV and PEP, and barriers and facilitators of HIV PEP acceptance and adherence. Participants described a process of losing and reclaiming control throughout post-assault care and follow-up; and how this affected HIV PEP-related decision-making. Most HIV PEP decisions were described as a process of reclaiming control over one outcome while simultaneously losing control of another.