bluuebunny/crossref_metadata_2025 huggingface dataset:
Training the social brain: Clinical and neural effects of an 8-week real-time functional magnetic resonance imaging neurofeedback Phase IIa Clinical Trial in Autism
Authors: Direito Bruno , Mouga Susana , Sayal Alexandre , Simões Marco , Quental Hugo , Bernardino Inês , Playle Rebecca , McNamara Rachel , Linden David EJ , Oliveira Guiomar , Castelo Branco Miguel
Published: March 2021

Autism spectrum disorder is characterized by abnormal function in core social brain regions. Here, we demonstrate the feasibility of real-time functional magnetic resonance imaging volitional neurofeedback. Following up the demonstration of neuromodulation in healthy participants, in this repeated-measure design clinical trial, 15 autism spectrum disorder patients were enrolled in a 5-session training program of real-time functional magnetic resonance imaging neurofeedback targeting facial emotion expressions processing, using the posterior superior temporal sulcus as region-of-interest. Participants were able to modulate brain activity in this region-of-interest, over multiple sessions. Moreover, we identified the relevant clinical and neural effects, as documented by whole-brain neuroimaging results and neuropsychological measures, including emotion recognition of fear, immediately after the intervention and persisting after 6 months. Neuromodulation profiles demonstrated subject-specificity for happy, sad, and neutral facial expressions, an unsurprising variable pattern in autism spectrum disorder. Modulation occurred in negative or positive directions, even for neutral faces, in line with their often-perceived ambiguity in autism spectrum disorder. Striatal regions (associated with success/failure of neuromodulation), saliency (insula/anterior cingulate cortex), and emotional control (medial prefrontal cortex) networks were recruited during neuromodulation. Recruitment of the operant learning network is consistent with participants’ engagement. Compliance, immediate intervention benefits, and their persistence after 6 months pave the way for a future Phase IIb/III, randomized controlled clinical trial, with a larger sample that will allow to conclude on clinical benefits from neurofeedback training in autism spectrum disorder (NCT02440451).

Lay abstract

Neurofeedback is an emerging therapeutic approach in neuropsychiatric disorders. Its potential application in autism spectrum disorder remains to be tested. Here, we demonstrate the feasibility of real-time functional magnetic resonance imaging volitional neurofeedback in targeting social brain regions in autism spectrum disorder. In this clinical trial, autism spectrum disorder patients were enrolled in a program with five training sessions of neurofeedback. Participants were able to control their own brain activity in this social brain region, with positive clinical and neural effects. Larger, controlled, and blinded clinical studies will be required to confirm the benefits.
Short report: Patterns of US federal autism research funding during 2017–2019
Authors: Harris Lauren , Gilmore Daniel , Longo Anne , Hand Brittany N
Published: March 2021

In 2017, the Interagency Autism Coordinating Committee, a federal advisory panel consisting of autism researchers and community members, recommended that funders of autism research prioritize research projects on: (1) treatments/interventions, (2) evidence-based services, and (3) lifespan issues. We sought to describe research funding since this recommendation was made. We searched the databases of the three largest federal funders of autism research in the United States (National Institutes of Health, Department of Education, and Centers for Disease Control and Prevention) for grants awarded during 2017–2019. We categorized grants as follows: autism screening and diagnosis, biology, risk factors, treatments and interventions, services, lifespan issues, or infrastructure and surveillance. We found that funding patterns remained largely consistent during 2017–2019. Biological research received a relative majority of funding (32.59%), followed by treatments and interventions (22.87%). While given higher funding priority by the Interagency Autism Coordinating Committee’s recent budget recommendation, fewer funds were awarded to research areas like services (5.02%) and lifespan issues (2.51%), indicating a misalignment between funding patterns and the Interagency Autism Coordinating Committee budget recommendation. These findings emphasize the need for autism research funding to align with the Interagency Autism Coordinating Committee budget recommendations to best meet the needs of the autism community, particularly autistic younger, middle-aged, and older adults.

Lay abstract

In 2017, an advisory board consisting of autism researchers and community members recommended that funders of autism research prioritize research projects on: (1) treatments/interventions, (2) evidence-based services, and (3) lifespan issues. To describe funding in these areas since this recommendation was made, we searched the databases of the three largest federal funders of autism research in the United States. We found that the largest portion of federal funding during 2017–2019 was awarded to research on the biology of autism (32.59%) and treatments and interventions for autism (22.87%). Less funds were awarded to research areas that are high funding priorities by the Interagency Autism Coordinating Committee budget recommendation including services (5.02%) and lifespan issues (2.51%). Our findings emphasize that autism research funding is not consistent with the Interagency Autism Coordinating Committee budget recommendation to increase funding particularly to services and lifespan issues. We recommend that funding patterns should shift to better align with these priorities so that autism research may better serve the needs of the autism community.
Fuel economy, NOx emissions and lean NOx trap efficiency: Lessons from current driving cycles
Authors: Rodríguez-Fernández José , Hernández Juan José , Ramos Ángel , Calle-Asensio Alejandro
Published: March 2021

Transport sector is within a profound changing period, but diesel engines are still called to play a significant role in future supported on their solid share in many regions and superior thermal efficiency compared to spark-ignited engines. This work identifies the parameters that most affect fuel consumption and NOx emissions on a diesel passenger car equipped with a lean NOx trap under different driving cycles and ambient temperatures. High average vehicle velocity was beneficial to reduce the fuel consumed per kilometer. The driving dynamics was of little importance, easily counteracted by a higher thermal efficiency, higher engine temperature (because of a longer trip) or/and an efficient gear shifting strategy. Moreover, at low ambient temperature the latter two factors doubled their weight on fuel economy. Regarding tailpipe NOx, keeping high aftertreatment performance was crucial. For this, low engine-out NOx emissions were four times more important than exhaust temperature or flow rate.
Tracing roots of group representation among MPs with immigrant backgrounds: A content analysis on parliamentary questions in the Netherlands
Authors: Aydemir Nermin , Vliegenthart Rens
Published: March 2021

This study investigates the representative patterns of MPs with immigrant backgrounds in the case of the Netherlands. Departing from existing literature on minority representatives, we claim that minority representatives can adopt suppressive, as well as supportive, framings when addressing constituencies with whom they share similar backgrounds. A content analysis was conducted on the parliamentary work of minority representatives to detect which frames those representatives adopt when they address cultural and/or religious rights and liberties. As for explanatory variables, we examined the role of the retreat from multicultural policies in the Netherlands on the one hand and individual and group related variables on the other. Our content analysis reveals no fundamental linear shift towards more suppressive framing during the 2002–2017 period. Minority MPs from progressive parties are more likely to use supportive frames than those MPs from conservative parties. Coming from a Turkish background – the most organized ethnic group with the highest social capital in the country – significantly adds to the likelihood of a supportive form of representation. Gender is another significant variable explaining where minority representatives stand, with male MPs being more inclined to use supportive frames on ethnic and/or religious rights and liberties than female MPs.
Thriving and retention of expatriates: Cultural intelligence and organizational embeddedness inputs
Authors: Ren Hong , Yunlu Dilek G , Shaffer Margaret A , Fodchuk Katherine M
Published: March 2021

Drawing on Conservation of Resources theory and the socially embedded model of thriving, we examine the resource antecedents and retention outcome of expatriate thriving. Using two-wave panel data from 103 international teachers in the United States, we found that the personal resource of cultural intelligence directly influenced thriving, and thriving led to expatriate actual retention. In addition, the contextual resource of organizational embeddedness served as a boundary condition that augmented cultural intelligence’s positive effect on thriving. Applying the concept of thriving to explicate expatriate experiences, we go beyond the dominant emphasis in the expatriate literature on expatriate adjustment. In doing so, we highlight the joint contribution of both personal and contextual resources associated with global work experiences and pinpoint potential boundary conditions that enable thriving.
Research of vehicular cloud storage resource management based on trust mechanism
Authors: Wang Jin , Zhang Miao , Gu Xiang , Wang Tiequan , Wang Jie , Chen Liang
Published: March 2021

This article focuses on how to effectively make full use of the storage resources in vehicular cloud. A trust mechanism called DI-Trust (Trust Model Based on Dynamic Incentive Mechanism) is proposed to schedule vehicular cloud storage resource. The discussion is under the scenario of the parking lot where vehicle nodes are in static state. The model can reasonably arrange the suitable scheduling algorithm according to the attribute characteristics of different kind of service requirements. The trust value of a vehicle is updated according to the model to fully utilize the vehicle idle storage resources. The simulation experiment results show that the model can work effectively. It can objectively evaluate trust values of vehicle nodes, and construct the effective resource schedule of the vehicular cloud storage resource to meet needs from users.
Effect of wet processing operations on the functional properties imparted to polyester fabrics loaded with different metal oxides NPs part II: Effect of the different sequences of dyeing
Authors: Shalaby Samy E , Al-Balakocy Naser Gad , Beliakova Margrita K , Othman Abdelmageed M
Published: March 2021

The present work aims at investigating the effect of applying different dyeing sequences on the imparted functional properties to partially hydrolysed and bleached PET and PET/CO fabrics loaded with TiO2, ZnO and SnO2 nanoparticles (NPs). The so obtained dyed fabrics have been characterized using SEM, EDX and FT-IR analytical techniques. The obtained results revealed that, an interaction has taken place between COOH groups created on dyed polyester fabrics and each of the applied NPs. Moreover, the effect of loading and sequence of dyeing wet operation on the functional performances of polyester fabrics was evaluated by estimating its antimicrobial efficacy and ultraviolet protection properties. The antimicrobial activity was tested against B. mycoides, E. coli and C. albicans. It has been found that, loading polyester fabrics with TiO2 and ZnO during dyeing process using exhaustion or after dyeing using pad-dry-cure methods paves the way for imparting outstanding antimicrobial activity even after five washing cycles. Moreover, the obtained results have also reviled that, the UPF values are dependent on the sequences of the loading of abovementioed NPs during or after dyeing wet operation.
Blur-readable two-dimensional barcode based on blur-invariant shape and geometric features
Authors: Xie Shundao , Tan Hong-Zhou
Published: March 2021

In recent years, the application of two-dimensional (2D) barcode is more and more extensive and has been used as landmarks for robots to detect and peruse the information. However, it is hard to obtain a sharp 2D barcode image because of the moving robot, and the common solution is to deblur the blurry image before decoding the barcode. Image deblurring is an ill-posed problem, where ringing artifacts are commonly presented in the deblurred image, which causes the increase of decoding time and the limited improvement of decoding accuracy. In this article, a novel approach is proposed using blur-invariant shape and geometric features to make a blur-readable (BR) 2D barcode, which can be directly decoded even when seriously blurred. The finder patterns of BR code consist of two concentric rings and five disjoint disks, whose centroids form two triangles. The outer edges of the concentric rings can be regarded as blur-invariant shapes, which enable BR code to be quickly located even in a blurred image. The inner angles of the triangle are of blur-invariant geometric features, which can be used to store the format information of BR code. When suffering from severe defocus blur, the BR code can not only reduce the decoding time by skipping the deblurring process but also improve the decoding accuracy. With the defocus blur described by circular disk point-spread function, simulation results verify the performance of blur-invariant shape and the performance of BR code under blurred image situation.
Clinical effectiveness of drugs in hospitalized patients with COVID-19: a systematic review and meta-analysis
Authors: Abeldaño Zuñiga Roberto Ariel , Coca Silvia Mercedes , Abeldaño Giuliana Florencia , González-Villoria Ruth Ana María
Published: March 2021

The aim was to assess the clinical effectiveness of drugs used in hospitalized patients with COVID-19 infection. We conducted a systematic review of randomized clinical trials assessing treatment with remdesivir, chloroquine, hydroxychloroquine, lopinavir, ritonavir, dexamethasone, and convalescent plasma, for hospitalized patients with a diagnosis of SARS-CoV-2 infection. The outcomes were mortality, clinical improvement, duration of ventilation, duration of oxygen support, duration of hospitalization, virological clearance, and severe adverse events. A total of 48 studies were retrieved from the databases. Eleven articles were finally included in the data extraction and qualitative synthesis of results. The meta-analysis suggests a benefit of dexamethasone versus standard care in the reduction of risk of mortality at day 28; and the clinical improvement at days 14 and 28 in patients treated with remdesivir. We can conclude that dexamethasone would have a better result in hospitalized patients, especially in low-resources settings. The analysis of the main treatments proposed for hospitalized patients is of vital importance to reduce mortality in low-income countries, since the COVID-19 pandemic had an economic impact worldwide with the loss of jobs and economic decline in countries with scarce resources.

The reviews of this paper are available via the supplemental material section.
“Crazy Jack” and the “Gay CEO”: Visions, Entrepreneurship, and the Chinese State in the New Digital Economy
Authors: Svensson Marina
Published: March 2021

This article analyses the visions, careers, and companies of Jack Ma of Alibaba and Geng Le of Blue City. Jack Ma is a well-known business leader and visionary, whereas the less well-known Geng Le only began to receive more attention since launching a successful gay dating app in 2012. The article focuses on the personal narratives and visions of these two IT entrepreneurs. It provides new perspectives on the role of individual entrepreneurs in relation to the Chinese state’s global ambitions and vision of creating a “strong internet country.” It argues that the commercialisation and platformisation of the Chinese internet, and the growing transnational nature of Chinese IT companies, serve to make them more, not less, co-dependent of the state and its visions. The internet’s emancipatory potential is today increasingly conflated with consumption, and online spaces and social relations are subject to both commodification and datafication.
The benefit of exercise‐based rehabilitation programs in patients with pulmonary hypertension: a systematic review and meta‐analysis of randomized controlled trials
Authors: Yan Lu , Shi Wence , Liu Zhihong , Zhao Zhihui , Luo Qin , Zhao Qing , Jin Qi , Zhang Yi , Li Xin , Duan Anqi
Published: March 2021

Several studies have suggested that exercise capacity and quality of life are reduced in patients with pulmonary hypertension, and exercise‐based rehabilitation can improve exercise capacity and quality of life in patients with pulmonary hypertension. The aim of this study is to assess the efficacy and safety of exercise‐based rehabilitation in patients with pulmonary hypertension through a meta‐analysis of randomized controlled trials. We searched PubMed, Embase, Medline, and the Cochrane Central Register of Controlled Trials up to November 2018. All randomized controlled trials comparing exercise capacity and quality of life between patients undergoing exercise‐based rehabilitation and those undergoing non‐exercise training were included. Data were extracted separately and independently by two investigators, and discrepancies were arbitrated by the third investigator. We used the random‐effects model to analyze the results, the GRADE to assess the risk of bias in the included studies, and I2 statistic to estimate the degree of heterogeneity. Nine randomized controlled trials are included; however, only seven randomized controlled trials were able to extract data. Including inpatients and outpatients, the total number of participants was 234, most of whom were diagnosed as pulmonary artery hypertension. The study duration ranged from 3 to 15 weeks. The mean six‐minute walking distance after exercise training was 51.94 m higher than control (27.65–76.23 m, n = 234, 7 randomized controlled trials, low quality evidence), the mean peak oxygen uptake was 2.96 ml/kg/min higher (2.49–3.43 ml/kg/min, n = 179, 4 randomized controlled trials, low‐quality evidence) than in the control group. In conclusion, our finding suggests that an exercise‐based training program positively influences exercise capacity in patients with pulmonary hypertension.
Editorial: ‘One City, Many Tales’: COVID-19, perception, and the importance of contextualization
Authors: Zhang Xiaoling
Published: March 2021

This introduction to the special issue summarizes the contributions from the five leading scholars in the field—their contribution to the conceptualization of such concepts as soft power, sharp power, image shaping, image reception, as well as methodological approaches. It highlights the importance of contextualizing their findings for a full understanding of the image of China in the media narratives examined. In doing so, the Introduction lays foundation for further investigations on the relationship between media coverage of health crisis and image construction as the world continues to fight against the virus.
Who Am I? Let Me Think: Assessing the Considered Self-Concept
Authors: Griffo Robert , Lemay Edward , Moreno Amanda H.
Published: March 2021

My Multiple Selves (MMS) is an open-ended self-concept measure that leads respondents to systematically explore who they are before selecting and rank-ordering their most important selves. A sample of college students ( n = 204) completed either the MMS or the frequently used Twenty Statements Test (TST). As predicted, results demonstrated that MMS responses included elements underdetected by the TST: other people, school crowd labels, aspirations for the future, and undesirable selves. Furthermore, the MMS revealed that when other people are included in self, they are rank ordered by participants as the most important element. Shortcomings of the MMS are discussed, and directions for future research outlined.
Impact of Eustress on Work-life Balance: An Analysis on Public Sector Bank Employees in South India
Authors: Pavithra A. C. , Sivakumar V. J.
Published: March 2021

The positive psychological response to a stressor, by the occurrence of certain psychological conditions, is known as eustress. Many psychological studies suggest that the eustress can aid the person to stay motivated and achieve the goal without any psychological draining. In the present study, mediating effect of eustress on personal and organisational factors of public sector banks’ employees is investigated. Nearly 600 respondents from different banks in South India were selected randomly and the data are collected through the questionnaires. The collected data were used to analyse the formulated hypothesis. The research establishes that the relationship between individual and organisational factors and work-life balance is positive and gets enhanced and strengthened by eustress in the public banking sector.
Explanation Plus Prediction—The Logical Focus of Project Management Research
Authors: Hair Joseph F. , Sarstedt Marko
Published: March 2021

Most project management research focuses almost exclusively on explanatory analyses. Evaluation of the explanatory power of statistical models is generally based on F-type statistics and the R 2 metric, followed by an assessment of the model parameters (e.g., beta coefficients) in terms of their significance, size, and direction. However, these measures are not indicative of a model’s predictive power, which is central for deriving managerial recommendations. We recommend that project management researchers routinely use additional metrics, such as the mean absolute error or the root mean square error, to accurately quantify their statistical models’ predictive power.
Difficult airway predictors were associated with decreased use of neuromuscular blocking agents in emergency airway management: a retrospective cohort study in Thailand
Authors: Saoraya Jutamas , Vongkulbhisal Komsanti , Kijpaisalratana Norawit , Lumlertgul Suthaporn , Musikatavorn Khrongwong , Komindr Atthasit
Published: March 2021

Background

It is recommended that difficult airway predictors be evaluated before emergency airway management. However, little is known about how patients with difficult airway predictors are managed in emergency departments. We aimed to explore the incidence, management and outcomes of patients with difficult airway predictors in an emergency department.

Methods

We conducted a retrospective study using intubation data collected by a prospective registry in an academic emergency department from November 2017 to October 2018. Records with complete assessment of difficult airway predictors were included. Two categories of predictors were analyzed: predicted difficult intubation by direct laryngoscopy and predicted difficult bag-mask ventilation. The former was evaluated based on difficult external appearance, mouth opening and thyromental distance, Mallampati score, obstruction, and limited neck mobility as in the mnemonic “LEMON”. The latter was evaluated based on difficult mask sealing, obstruction or obesity, absence of teeth, advanced age and reduced pulmonary compliance as in the mnemonic “MOANS”. The incidence, management and outcomes of patients with these difficult airway predictors were explored.

Results

During the study period, 220 records met the inclusion criteria. At least 1 difficult airway predictor was present in 183 (83.2%) patients; 57 (25.9%) patients had at least one LEMON feature, and 178 (80.9%) had at least one MOANS feature. Among patients with at least one difficult airway predictor, both sedation and neuromuscular blocking agents were used in 105 (57.4%) encounters, only sedation was used in 65 (35.5%) encounters, and no medication was administered in 13 (7.1%) encounters. First-pass success was accomplished in 136 (74.3%) of the patients. Compared with patients without predictors, patients with positive LEMON criteria were less likely to receive neuromuscular blocking agents (OR 0.46 (95% CI 0.24–0.87), p = 0.02) after adjusting for operator experience and device used. There were no significant differences between the two groups regarding glottic view, first-pass success, or complications. The LEMON criteria poorly predicted unsuccessful first pass and glottic view.

Conclusions

In emergency airway management, difficult airway predictors were associated with decreased use of neuromuscular blocking agents but were not associated with glottic view, first-pass success, or complications.
Higher frailty burden in older adults with chronic constipation
Authors: Lim Jihye , Park Hyungchul , Lee Heayon , Lee Eunju , Lee Danbi , Jung Hee-Won , Jang Il-Young
Published: March 2021

Background

Despite constipation being a common clinical condition in older adults, the clinical relevance of constipation related to frailty is less studied. Hence, we aimed to investigate the association between chronic constipation (CC) and frailty in older adults.

Methods

This is a cross-sectional analysis of a population-based, prospective cohort study of 1278 community-dwelling older adults in South Korea. We used the Rome criteria to identify patients with irritable bowel syndrome with predominant constipation (IBS-C) and functional constipation (FC). We investigated whether participants consistent with the criteria for IBS-C and FC had CC. Frailty was assessed using the Cardiovascular Health Study (CHS) frailty phenotype.

Results

In the study population with a mean age of 75.3 ± 6.3 years, 136 (10.7%) had CC. The participants with CC were older, had higher medication burdens, and had worse physical performances compared to those without CC (All P < .05). By association analysis, the prevalence of CC was associated with frailty by the CHS criteria (P < .001). The CHS frailty score was associated with the presence of CC by the univariate logistic regression analysis and the multivariate analysis adjusted for age, sex, and multimorbidity.

Conclusions

Frailty was associated with CC in community-dwelling older people, suggesting that constipation should be considered as an important geriatric syndrome in clinical practice concerning frail older adults.
Correlates of premature pap test screening, under 25 years old: analysis of data from the CONSTANCES cohort study
Authors: Mignot Stéphanie , Ringa Virginie , Vigoureux Solène , Zins Marie , Panjo Henri , Saulnier Pierre-Jean , Fritel Xavier
Published: March 2021

Background

Many countries currently recommend that screening for cervical cancer begin at the age of 25 years. Premature screening (before that age) could lead to unnecessary follow-up examinations and procedures that turn out to be useless. Our objective is to ascertain if the use of particular contraceptive methods are associated with premature screening.

Methods

This cross-sectional study based on the CONSTANCES cohort enabled us to include 4297 women younger than 25 years. The factors associated with premature screening were modeled by logistic regression. Missing data were handled by multiple imputations. The multivariate analyses were adjusted for sex life, social and demographic characteristics, and health status.

Results

Nearly half (48.5%) the women younger than 25 years had already undergone premature screening. Women not using contraceptives (aOR 0.3, 95% CI 0.3–0.5) and those using nonmedicalized contraceptives (condom, spermicide, etc.) (aOR 0.5, 95% CI 0.4–0.6) had premature screening less often than women using birth control pills. Higher risks of premature screening were observed in 20-year-old women (aOR 2.7, 95% CI 2.2–3.3) and in those with more than 5 lifetime partners (aOR 2.5, 95% CI 2.0–3.1), compared respectively with women who were younger and those with 5 or fewer lifetime partners.

Conclusion

Young women using contraceptives that require a doctor’s prescription are exposed to premature screening more often than those not using contraception and those with nonmedicalized contraceptives.
Epidemiology of distal radius fractures in children and adults during the COVID-19 pandemic – a two-center study
Authors: Olech Jarosław , Ciszewski Mariusz , Morasiewicz Piotr
Published: March 2021

Background

Distal radius fractures (DRFs) constitute 15–21% of all fractures. There are no detailed data on the possible changes in the epidemiology and treatment of DRFs in children and adults during the Covid pandemic. The purpose of our study was a comprehensive assessment of the impact of the COVID-19 pandemic on distal radius fractures (DRF) epidemiology, including both children and adults and various fracture fixation methods in two large trauma centers in Poland.

Methods

This study compared the medical data on the treatment of distal radius fractures in Poland in two periods: the period of the COVID-19 pandemic (from March 15 to October 15, 2020) and the corresponding period prior to the pandemic (from March 15 to October 15, 2019). We assessed detailed data from two trauma centers for pediatric and adult patients. Outpatients seeking medical attention at emergency departments and inpatients undergoing surgery at trauma-orthopedic wards were evaluated. We compared epidemiological data, demographic data, treatment type, and hospital stay duration.

Results

The total number of patients hospitalized due to DRF during the pandemic was 180, it was 15.1% lower than that from the pre-COVID-19 pandemic period (212). In the case of adult patients, the total number of those hospitalized during the pandemic decreased significantly (by 22%) from 132 to 103 patients. Analysis of the individual treatment methods revealed that the number of adults who underwent conservative treatment was considerably (by 30.3%) significantly lower in the period of the COVID-19 pandemic, from 119 to 83 patients. Compared to 13 patients from the pre-pandemic period, the number of surgically treated adults statistically increased to 20 patients (by 53.8%). Our analyses showed hospitalizations of surgically treated adults to be shorter by 12.7% during the pandemic, with the corresponding hospitalizations of surgically treated pediatric patients to be shorter by11.5%.

Conclusions

Our study showed a significant impact of the COVID-19 pandemic on the epidemiology and treatment of DRFs in children and adults. We found decreased numbers of pediatric and adult patients with DRFs during the COVID-19 pandemic. The pandemic caused an increase in the number of children and significantly increase adults undergoing surgical treatment for DRFs, a decrease in mean patient age, shorter significantly length of hospital stay, and an increased number of men with DRFs.
Evaluation of an international medical E-learning course with natural language processing and machine learning
Authors: Borakati Aditya
Published: March 2021

Background

In the context of the ongoing pandemic, e-learning has become essential to maintain existing medical educational programmes. Evaluation of such courses has thus far been on a small scale at single institutions. Further, systematic appraisal of the large volume of qualitative feedback generated by massive online e-learning courses manually is time consuming. This study aimed to evaluate the impact of an e-learning course targeting medical students collaborating in an international cohort study, with semi-automated analysis of feedback using text mining and machine learning methods.

Method

This study was based on a multi-centre cohort study exploring gastrointestinal recovery following elective colorectal surgery. Collaborators were invited to complete a series of e-learning modules on key aspects of the study and complete a feedback questionnaire on the modules. Quantitative data were analysed using simple descriptive statistics. Qualitative data were analysed using text mining with most frequent words, sentiment analysis with the AFINN-111 and syuzhet lexicons and topic modelling using the Latent Dirichlet Allocation (LDA).

Results

One thousand six hundred and eleventh collaborators from 24 countries completed the e-learning course; 1396 (86.7%) were medical students; 1067 (66.2%) entered feedback. 1031 (96.6%) rated the quality of the course a 4/5 or higher (mean 4.56; SD 0.58). The mean sentiment score using the AFINN was + 1.54/5 (5: most positive; SD 1.19) and + 0.287/1 (1: most positive; SD 0.390) using syuzhet. LDA generated topics consolidated into the themes: (1) ease of use, (2) conciseness and (3) interactivity.

Conclusions

E-learning can have high user satisfaction for training investigators of clinical studies and medical students. Natural language processing may be beneficial in analysis of large scale educational courses.
Molecular characterization and antimicrobial resistance of potentially human‐pathogenic Escherichia coli strains isolated from riding horses
Authors: Reshadi Pouya , Heydari Fatemeh , Ghanbarpour Reza , Bagheri Mahboube , Jajarmi Maziar , Amiri Mohadese , Alizade Hesam , Badouei Mahdi Askari , Sahraei Shademan , Adib Nasrin
Published: March 2021

Background

Transmission of antimicrobial resistant and virulent Escherichia coli (E. coli) from animal to human has been considered as a public health concern. This study aimed to determine the phylogenetic background and prevalence of diarrheagenic E. coli and antimicrobial resistance in healthy riding-horses in Iran. In this research, the genes related to six main pathotypes of E. coli were screened. Also, genotypic and phenotypic antimicrobial resistance against commonly used antibiotics were studied, then phylo-grouping was performed on all the isolates.

Results

Out of 65 analyzed isolates, 29.23 % (n = 19) were determined as STEC and 6.15 % (n = 4) as potential EPEC. The most prevalent antimicrobial resistance phenotypes were against amoxicillin/clavulanic acid (46.2 %) and ceftriaxone (38.5 %). blaTEM was the most detected resistance gene (98.4 %) among the isolates and 26.15 % of the E. coli isolates were determined as multi-drug resistant (MDR). Three phylo-types including B1 (76.92 %), A (13.85 %) and D (3.08 %) were detected among the isolates.

Conclusions

Due to the close interaction of horses and humans, these findings would place emphasis on the pathogenic and zoonotic potential of the equine strains and may help to design antimicrobial resistance stewardship programs to control the dissemination of virulent and multi-drug resistant E. coli strains in the community.
Impact of subthreshold depression on health-related quality of life in patients with Parkinson’s disease based on cognitive status
Authors: Schönenberg Aline , Zipprich Hannah M. , Teschner Ulrike , Grosskreutz Julian , Witte Otto W. , Prell Tino
Published: March 2021

Background

In patients with Parkinson’s disease (PD), depression has a strong impact on quality of life (QoL). However, little is known about the influence of subthreshold depression (STD) on QoL in PD patients.

Methods

A total of 230 hospitalized PD patients with normal and impaired cognitive status were included in this observational study. We collected the following data for analysis: Beck Depression Inventory level, Montreal Cognitive Assessment (MOCA) score, non-motor symptoms questionnaire score, PD questionnaire-39 (PDQ-39) score, Hoehn–Yahr stage, and Movement Disorder Society-sponsored revision of the unified PD rating scale III (MDS-UPDRS III) score. To study the impact of STD on the PDQ-39 summary index (SI) and its domains, we used multivariate analysis of variance and multivariate analysis of covariance.

Results

In this cohort, 80 (34.8%) patients had STD [44 (32.3%) with high MOCA score (> 21) and 36 (38.3%) with low MOCA score (< 21)]. In PDQ-39 SI, there was a significant effect on depression level. In patients with higher MOCA score, STD was associated with worse PDQ-39 domains emotional well-being and cognition, whereas in patients with lower MOCA score, STD had no significant effect on PDQ-39 SI or its subdomains.

Conclusion

In PD patients, QoL is significantly affected by STD, and thus, more attention in medical care should be focused on treating STD. However, the impact is only observable in PD patients with normal cognitive function. STD patients show more reduced QoL than non-depressed patients, indicating that STD should be treated as a transition zone between normal mood and depression.
Less blood loss in supercapsular percutaneously assisted versus posterolateral total hip arthroplasty
Authors: Hu Yong , Wang Min-Cong , Wang Tao , Meng Yue , Chao Xiao-Min , Zhu Hui-Feng , Li Cheng-Guo , Pan Cheng-Long , He He-Bei
Published: March 2021

Background

Although excellent clinical outcomes of supercapsular percutaneously assisted total hip arthroplasty (SuperPath) have been reported, the peri-operative blood loss has rarely been reported. The current study determined the blood loss during SuperPath and compared the blood loss with conventional posterolateral total hip arthroplasty (PLTH).

Methods

This retrospective study enrolled patients who underwent unilateral primary THA between January 2017 and December 2019. The demographic data, diagnoses, affected side, radiographic findings, hemoglobin concentration, hematocrit, operative time, transfusion requirements, and intra-operative blood loss were recorded. The peri-operative blood loss was calculated using the OSTHEO formula. Blood loss on the 1st, 3rd, and 5th post-operative days was calculated. Hidden blood loss (HBL) was determined by subtracting the intra-operative blood loss from the total blood loss.

Results

Two hundred sixty-three patients were included in the study, 85 of whom were in the SuperPath group and 178 in the posterolateral total hip arthroplasty (PLTH) group. Patient demographics, diagnoses, affected side, operative times, and pre-operative hemoglobin concentrations did not differ significantly between the two groups (all P > 0.05). Compared to the PLTH group, the SuperPath group had less blood loss, including intra-operative blood loss, 1st, 3rd, and 5th post-operative days blood loss, and HBL (all P < 0.05). Total blood loss and HBL was 790.07 ± 233.37 and 560.67 ± 195.54 mL for the SuperPath group, respectively, and 1141.26 ± 482.52 and 783.45 ± 379.24 mL for the PLTH group. PLTH led to a greater reduction in the post-operative hematocrit than SuperPath (P < 0.001). A much lower transfusion rate (P = 0.028) and transfusion volume (P = 0.019) was also noted in the SuperPath group.

Conclusion

SuperPath resulted in less perioperative blood loss and a lower transfusion rate than conventional PLTH.
The CD33 short isoform is a gain-of-function variant that enhances Aβ1–42 phagocytosis in microglia
Authors: Bhattacherjee Abhishek , Jung Jaesoo , Zia Sameera , Ho Madelene , Eskandari-Sedighi Ghazaleh , St. Laurent Chris D. , McCord Kelli A. , Bains Arjun , Sidhu Gaurav , Sarkar Susmita , Plemel Jason R. , Macauley Matthew S.
Published: March 2021

Background

CD33 is genetically linked to Alzheimer’s disease (AD) susceptibility through differential expression of isoforms in microglia. The role of the human CD33 short isoform (hCD33m), preferentially encoded by an AD-protective CD33 allele (rs12459419T), is unknown. Here, we test whether hCD33m represents a loss-of-function or gain-of-function variant.

Methods

We have developed two models to test the role of hCD33m. The first is a new strain of transgenic mice expressing hCD33m in the microglial cell lineage. The second is U937 cells where the CD33 gene was disrupted by CRISPR/Cas9 and complemented with different variants of hCD33. Primary microglia and U937 cells were tested in phagocytosis assays and single cell RNA sequencing (scRNAseq) was carried out on the primary microglia. Furthermore, a new monoclonal antibody was developed to detect hCD33m more efficiently.

Results

In both primary microglia and U937 cells, we find that hCD33m enhances phagocytosis. This contrasts with the human CD33 long isoform (hCD33M) that represses phagocytosis, as previously demonstrated. As revealed by scRNAseq, hCD33m+ microglia are enriched in a cluster of cells defined by an upregulated expression and gene regulatory network of immediate early genes, which was further validated within microglia in situ. Using a new hCD33m-specific antibody enabled hCD33m expression to be examined, demonstrating a preference for an intracellular location. Moreover, this newly discovered gain-of-function role for hCD33m is dependent on its cytoplasmic signaling motifs, dominant over hCD33M, and not due to loss of glycan ligand binding.

Conclusions

These results provide strong support that hCD33m represents a gain-of-function isoform and offers insight into what it may take to therapeutically capture the AD-protective CD33 allele.
Early-onset sepsis risk calculator: a review of its effectiveness and comparative study with our evidence-based local guidelines
Authors: Laccetta Gianluigi , Ciantelli Massimiliano , Tuoni Cristina , Sigali Emilio , Miccoli Mario , Cuttano Armando
Published: March 2021

Background

According to most early-onset sepsis (EOS) management guidelines, approximately 10% of the total neonatal population are exposed to antibiotics in the first postnatal days with subsequent increase of neonatal and pediatric comorbidities. A review of literature demonstrates the effectiveness of EOS calculator in reducing antibiotic overtreatment and NICU admission among neonates ≥34 weeks’ gestational age (GA); however, some missed cases of culture-positive EOS have also been described.

Methods

Single-center retrospective study from 1st January 2018 to 31st December 2018 conducted in the Division of Neonatology at Santa Chiara Hospital (Pisa, Italy). Neonates ≥34 weeks’ GA with birth weight ≤ 1500 g, 34–36 weeks’ GA neonates with suspected intraamniotic infection and neonates ≥34 weeks’ GA with three clinical signs of EOS or two signs and one risk factor for EOS receive empirical antibiotics. Neonates ≥34 weeks’ GA with risk factors for EOS or with one clinical indicator of EOS undergo serial measurements of C-reactive protein and procalcitonin in the first 48–72 h of life; they receive empirical antibiotics in case of abnormalities at blood exams with one or more clinical signs of EOS. Two hundred sixty-five patients at risk for EOS met inclusion criteria; they were divided into 3 study groups: 34–36 weeks’ GA newborns (n = 95, group A), ≥ 37 weeks’ GA newborns (n = 170, group B), and ≥ 34 weeks’ GA newborns (n = 265, group A + B). For each group, we compared the number of patients for which antibiotics would have been needed, based on EOS calculator, and the number of the same patients we treated with antibiotics during the study period. Comparisons between the groups were performed using McNemar’s test and statistical significance was set at p < 0.05; post-hoc power analysis was carried out to evaluate the sample sizes.

Results

32/265 (12.1%) neonates ≥34 weeks’ GA received antibiotics within the first 12 h of life. According to EOS calculator 55/265 (20.7%) patients would have received antibiotics with EOS incidence 2/1000 live births (p < 0.0001).

Conclusion

Our evidence-based protocol entails a further decrease of antibiotic overtreatment compared to EOS calculator. No negative consequences for patients were observed.
Consumption of melatonin supplement improves cardiovascular disease risk factors and anthropometric indices in type 2 diabetes mellitus patients: a double-blind, randomized, placebo-controlled trial
Authors: Bazyar Hadi , Zare Javid Ahmad , Bavi Behbahani Hossein , Moradi Fardin , Moradi Poode Bahman , Amiri Parichehr
Published: March 2021

Background

Diabetes mellitus is a common chronic disease. Dyslipidemia and hypertension are two complications that may develop in diabetic patients if hyperglycemia, insulin resistance, and weight gain are not controlled. This study investigated the effects of melatonin supplementation on some cardiovascular disease risk factors and anthropometric indices in patients with type 2 diabetes mellitus (T2DM).

Materials and methods

In this double-blind, randomized, placebo-controlled trial, 50 T2DM patients were randomly allocated to intervention and control groups which received two tablets of either melatonin or placebo (250 mg) once a day for 8 weeks. Systolic blood pressure (SBP), mean arterial pressure (MAP), pulse pressure (PP), the atherogenic index of plasma (AIP), weight, body mass index (BMI), waist and hip circumference (WC, HC), a body shape index (ABSI), abdominal volume index (AVI), body adiposity index (BAI), lipid accumulation product (LAP), conicity index, and waist-to-height ratio (WHtR) were evaluated in all the patients pre- and post-intervention.

Results

Melatonin supplementation for 8 weeks significantly decreased the mean levels of SBP, MAP, PP, weight, BMI, WC, HC, BAI, AVI, conicity index, and WHtR post-intervention (p <  0.05). Also, the median changes of SBP, MAP, PP, weight, BMI, WC, HC BAI, AVI, and conicity index were significantly lower in the intervention group compared with the control group (p <  0.05). A significant increase (p <  0.001) was observed in the mean levels of ABSI in the intervention group. The median changes of ABSI were significantly greater in the intervention group compared with the control group (p <  0.001).

Conclusions

Consumption of melatonin supplement may be effective in controlling arterial pressure including SBP, MAP, and PP and anthropometric indices (as predictors of obesity) in T2DM patients.

Trial registration

Iranian Registry of Clinical TrialsIRCT20190303042905N1. Registered on 17 May 2019.
Effect of sodium–glucose co-transporter-2 inhibitors on the levels of serum asprosin in patients with newly diagnosed type 2 diabetes mellitus
Authors: Jiang Aijun , Feng Zhanrong , Yuan Lu , Zhang Ying , Li Qian , She Yuqing
Published: March 2021

Background

Asprosin, a novel adipokine that raises glucose levels and stimulates appetite, has been proved to be pathologically increased in populations predisposed to type 2 diabetes mellitus (T2DM), obesity, and cardiovascular diseases. The mechanisms of sodium-glucose co-transporter-2 (SGLT2) inhibitors for hypoglycemic effect and cardiovascular protection have not been fully clarified. Therefore, we conducted this study to assess change in the levels of serum asprosin after treatment with SGLT2 inhibitors in patients with newly diagnosed T2DM.

Methods

This study was a randomized, double-blind, placebo-controlled trial. A total of 29 participants with newly diagnosed T2DM with body mass index (BMI) ≥ 23.0 kg/m2 and haemoglobin A1c (HbA1c) levels of 58–85 mmol/mol (7.5–10%) were randomized to SGLT2 inhibitors dapagliflozin 10 mg/d (n = 19) or placebo (n = 10) treatment for 24 weeks. We analyzed asprosin concentrations by an enzyme-linked immunosorbent assay. Besides, body weight, BMI, HbA1c, fasting plasma glucose (FPG), and lipid levels were measured at baseline and 24 weeks.

Results

At 24 weeks, participants with SGLT2 inhibitors treatment exhibited lower levels of serum asprosin (22.87 vs 45.06 ng/ml in the placebo group; P < 0.001) after adjusting for baseline values. The levels of body weight, BMI, HbA1c, FPG, and triglyceride (TG) were decreased, while high density lipoprotein-cholesterol (HDL-C) was increased after SGLT2 inhibitors dapagliflozin treatment compared with placebo (P < 0.05 for all). Low density lipoprotein-cholesterol (LDL-C) and total cholesterol (TC) levels were unchanged in the SGLT2 inhibitors group and placebo group. No statistical correlation was found between the levels of serum asprosin and body weight, BMI, HbA1c, FPG, and lipid levels during the SGLT2 inhibitor dapagliflozin treatment.

Conclusions

These findings indicated that SGLT2 inhibitors can lower serum asprosin levels and improve glucolipid and weight in patients with newly diagnosed T2DM, which may benefit the cardiovascular system.

Trial registration CTR20131268; Registered 20 March 2014 CTR20150102; Registered 03 March 2015. http://www.chinadrugtrials.org.cn/clinicaltrials.searchlistdetail.dhtml.