bluuebunny/crossref_metadata_2025 huggingface dataset:
Spa tourism opportunities as strategic sector in aiding recovery from Covid-19: The Spanish model
Authors: Pinos Navarrete Aida , Shaw Gareth
Published: November 2020

Spa tourism has been experiencing over the last decades significant changes in its nature. Supply and demand have changed in recent years, impacting on the function of thermal centers in general, and on the use of their base resource, mineral-medicinal water, in particular. Recently, this productive sector has been forced to resituate itself due to the unexpected outbreak of the Covid pandemic whose impacts on the sector are still to be fully calibrated, although it has already halted a large part of economic activity and global flows of people and goods. The present investigation examines the function and potential that spas have as health agents. In the case of Spain, this research note reflects on the opportunities, for a repositioning of this activity in the tourist dynamics that arise during and after a period of crisis.
The work of “authenticity” in the age of mechanical reproduction: Constructions of authenticity in South African artisanal brands
Authors: Plüg Simóne , Collins Anthony
Published: November 2020

From 19th century romanticism to contemporary self-help culture, a popular philosophical thread has asserted, in apparent opposition to the rise of consumer culture, that it is better to focus on who you “really” are, rather than what you have. This paper uses a qualitative research design, social constructionist theoretical framework, and discourse analytic method, to critically discuss the discursive constructions of authenticity deployed by 15 South African artisanal/craft brands. This exploration highlights the tension between a purportedly critical version of authenticity- ostensibly offering an alternative to materialist hierarchies of social status and the manipulations of marketing (James, 2007) – and the increasing appearance of these discourses in lifestyle and marketing media. Here authenticity is offered precisely through personalised consumer options and participation in the dominant regime of consumption. The paper highlights the role that these contradictory discursive articulations play in the production of particular subject positions and social relationships. It hopes to extend the current literature by exploring these issues in a developing country, characterised by inequality.
Integrated and shared education: Sinn Féin, the Democratic Unionist Party and educational change in Northern Ireland
Authors: Hansson Ulf , Roulston Stephen
Published: November 2020

There is a considerable literature concerning divided societies and the role of education in such societies. In the case of Northern Ireland, education is characterised by a largely separate system of education for its two main communities. There is also a considerably smaller integrated schools sector, where the two communities learn together. A more recent intervention is that of shared education where separate schools are retained but shared classes and other opportunities for sharing are offered. Politically, there has never been extensive support for integrated education, particularly from the two largest parties in the Assembly and power-sharing Executive: The Democratic Unionist Party and Sinn Féin. While not active proponents of integrated education the two parties have embraced shared education and with their own interpretation of its implementation. The introduction of shared education can be seen as a triumph as the two main parties in the coalition have agreed on a policy designed to bridge the gap in education. An alternative view is that shared education is the least-worst option for these two parties but may do little to advance reconciliation.
Dysfunction, Deviancy, and Sexual Autonomy: The Single Female Detective in Primetime TV
Authors: Gilchrist Kate R.
Published: November 2020

As the number of single women has grown within Anglo-American society, there has been a proliferation of discourses around single women within popular culture. At the same time, there has been a resurgence in female-centered media representations of detectives. This article asks what cultural work the convergence of the single woman with the unconventional figure of the detective performs, and what this means for contemporary feminine subjectivities, exploring how she is constructed in three primetime TV crime dramas: The Bridge, The Good Wife and Fargo. I argue that while the single female detective foregrounds discourses of professionalism, rationality, and sexual autonomy, she simultaneously reinscribes patriarchal discourses of heteronormative coupledom and normative femininity through her social dysfunction, vulnerability and deviance, rendering the single woman a threat to femininity. Yet, at times, her liminal positioning allows her to occupy a more transgressive feminine subjectivity and subversively trouble the gender binary.
Long Non-Coding RNA NKILA Reduces Oral Squamous Cell Carcinoma Development Through the NF-KappaB Signaling Pathway
Authors: Hu Daoyong , Zhong Tian , Dai Qun
Published: November 2020

Objective:

Emerging studies have identified that long non-coding RNAs (lncRNAs) play critical roles in cancer development. This study aims to explore the mechanism of NF-KappaB (NF-κB) interacting lncRNA (NKILA) in the pathological process of oral squamous cell carcinoma (OSCC).

Methods:

NKILA expression in OSCC tissues, paracancerous tissues, and normal human oral keratinocytes and OSCC cell lines was detected using RT-qPCR. KB cells were selected for the follow-up experiments. The role of NKILA in cell proliferation, migration, invasion, and NF-κB signaling pathway was identified using the gain- and loss-of function of NKILA in OSCC cells. Additionally, the role of NKILA in vitro was determined by inducing xenograft tumors in nude mice.

Results:

NKILA was poorly expressed in OSCC tissues and cells. Cell proliferation, invasion and migration, tumor volume and weight were significantly suppressed in cells with overexpressed NKILA, while silencing NKILA led to opposite trends. Moreover, the protein levels of p-IκBα and nuclear-p65 were markedly decreased, while the levels of IκBα and cytoplasm-p65 were enhanced in cells with overexpressed NKILA.

Conclusion:

This study provided evidence that NKILA could reduce proliferation, invasion and migration of OSCC cells through inhibiting the NF-κB signaling pathway. The findings may offer new insights for OSCC prevention and treatment.
A multiresolution simulation system and simulation development processes
Authors: Jee Young-Jun , Lee Tae-Gyung , Park Sang-Ho , Cho Jun-Ho , Kim Hee-Soo , Lee Tae-Eog
Published: November 2020

Defense modeling and simulation often should run multiple simulation models together to share information on their combat entity states and battlefields and to interact with each other. However, most simulation models were developed by various parties with different purposes, modeling views, and model resolutions. Therefore, it has been challenging to identify differences between the models, transform one’s information for the other models, and manage interoperation between the models. There have been numerous works on multiresolution modeling (MRM) and simulation. However, we yet should have more systematic and integrated methods for designing, managing, and executing the interoperation processes of different simulation models.

In this paper, we propose an integrated multiresolution simulation system for designing, developing, simulating, and managing multiple simulation models with different modeling views and resolutions. We propose an architecture, component functions, and processes, including model resolution conversion and management processes, and their Unified Modeling Language models. We also extend the Distributed Simulation Engineering and Execution Processes standard to incorporate MRM design and development processes. Finally, we present a case of MRM design and development of war game models by using the proposed system.
Qualitative Research via Focus Groups: Will Going Online Affect the Diversity of Your Findings?
Authors: Richard Brendan , Sivo Stephen A. , Orlowski Marissa , Ford Robert C. , Murphy Jamie , Boote David N. , Witta Eleanor L.
Published: November 2020

Practitioners and researchers are conducting more focus groups online as a qualitative data collection method, yet rigorous methodological studies investigating the diversity of findings versus traditional in-person focus groups are limited. Previous studies primarily focused on health topics, varied on topic scope (broad to sensitive), format (synchronous vs. asynchronous), and online platform (several no longer exist). This experimental study sought to address that gap by randomly assigning participants into treatment groups to brainstorm sustainable practices for the hospitality industry (i.e., a broad topic) on a popular publicly available platform (i.e., Reddit). Although the in-person focus groups generated a greater word count and number of ideas, they generated an equivalent number of unique ideas. In terms of idea diversity, thematic analysis revealed a relatively high degree of overlap in themes from both groups. Of 13 themes, 10 (77%) occurred in both treatment groups. The overlapping themes represented 91% of all key words generated across both groups. These results highlight the potential for online focus groups to generate idea diversity at a level that is comparable to in-person focus groups. For practitioners seeking to benefit from guest insights, the findings help to substantiate the value of a lower cost, faster-to-market data collection method.
Triangulated Research Methods to Operationalize Career and Technical Education Administrator Knowledge and Skill Core Competencies in Pennsylvania
Authors: Harvey Michael W. , Fleck Joey A. , Threeton Mark D.
Published: November 2020

The position of the career and technical education (CTE) administrator is generally well-known but the multitude of tasks (e.g., management/leadership) are not widely understood by those outside CTE. The purpose of this study was to operationalize and establish a set of knowledge and skill core competencies (KSCC) nested in specific focus areas for CTE leadership training in Pennsylvania. The study used triangulated multi-method research procedures to establish consensus. The resulting KSCC frame standards for CTE leadership training for administrator candidates in Pennsylvania and can be used to establish a national skill set. The KSCC compliments the NELP (2018) Standards.
Linezolid to treat urinary tract infections caused by vancomycin-resistant Enterococcus
Authors: Pontefract Benjamin Alan , Rovelsky Suzette Amy , Madaras-Kelly Karl Joseph
Published: November 2020

Background:

Vancomycin-resistant Enterococcus can cause urinary tract infection. Linezolid possesses antimicrobial activity against vancomycin-resistant Enterococcus but has limited urinary excretion. Minimal data demonstrate efficacy of linezolid for treatment of urinary tract infections.

Objective:

The main aim of this study is to compare post-treatment outcomes of linezolid to other antibiotics with vancomycin-resistant Enterococcus activity in the treatment of urinary tract infection caused by vancomycin-resistant Enterococcus.

Methods:

A retrospective cohort of inpatients within Veterans Health Administration facilities with urinary tract infection caused by vancomycin-resistant Enterococcus was created. Patients with vancomycin-resistant Enterococcus isolated from urine cultures and chart documentation meeting criteria for urinary tract infection were identified. Demographics, comorbidity, treatments, and post-treatment outcomes were extracted from the electronic health record. Outcomes were compared between patients treated with linezolid and alternative antibiotics possessing vancomycin-resistant Enterococcus activity 14 days after treatment completion. Logistic regression adjusted for covariates associated with each outcome.

Results:

Of 4,683 patients with a positive vancomycin-resistant Enterococcus culture, 624 (13%) met criteria for chart review, and 92 (15%) had documentation of urinary tract infection symptoms and treatment. The primary reason for exclusion was asymptomatic bacteriuria (64%). Patients had high Charlson Comorbidity Scores (mean = 8.7; standard deviation (SD) = 3.3), and 70% were located on general medical/surgical wards on the day of culture collection. Linezolid was prescribed in 54 (59%) cases. No difference between linezolid and comparator antibiotics were observed in re-initiation of antibiotics for vancomycin-resistant Enterococcus urinary tract infection (9% and 5% respectively (p = 0.56), (adjusted odds ratio (OR) = 1.90; 95% confidence interval (CI) = 0.34–10.63)), recurrent positive vancomycin-resistant Enterococcus culture (4% and 11%, respectively (p = 0.23), (adjusted OR = 0.36; 95% CI = 0.05–2.31)), or mortality (7% and 3%, respectively (p = 0.39) (adjusted OR = 2.96; 95% CI = 0.37–41.39)).

Conclusion:

Most patients with vancomycin-resistant Enterococcus identified on urine culture were asymptomatic. Linezolid appears effective as comparator antibiotics for the treatment of mild vancomycin-resistant Enterococcus urinary tract infection.
Suicidal thoughts, suicidal behaviours and self-harm in daily life: A systematic review of ecological momentary assessment studies
Authors: Gee Brendan Loo , Han Jin , Benassi Helen , Batterham Philip J
Published: November 2020

Background

Ecological Momentary Assessments (EMA) offer an approach to understand the daily risk factors of suicide and self-harm of individuals through the use of self-monitoring techniques using mobile technologies.

Objectives

This systematic review aimed to examine the results of studies on suicidality risk factors and self-harm that used Ecological Momentary Assessments.

Methods

Pubmed and PsycINFO databases were searched up to April 2020. Bibliographies of eligible studies were hand-searched, and 744 abstracts were screened and double-coded for inclusion.

Results

The 49 studies using EMA included in the review found associations between daily affect, rumination and interpersonal interactions and daily non-suicidal self-injury (NSSI). Studies also found associations between daily negative affect and positive affect, social support, sleep, and emotions and a person’s history of suicide and self-harm. Associations between daily suicide thoughts and self-harm, and psychopathology factors measured at baseline were also observed.

Conclusions

Research using EMA has the potential to offer clinicians the ability to understand the daily predictors, or risk factors, of suicide and self-harm. However, there are no clear reporting standards for EMA studies on risk factors for suicide. Further research should utilise longitudinal study designs, harmonise datasets and use machine learning techniques to identify patterns of proximal risk factors for suicide behaviours.
Effect of early body cavity continuous circulation hyperthermia perfusion chemotherapy combined with systemic chemotherapy (and nursing) on survival rate and serum tumor markers in patients with advanced gastric cancer
Authors: Liu Xia , Tang Miao
Published: November 2020

This study was designed to investigate the effects of early coelom continued circulatory hyperthermic perfusion chemotherapy combined with systemic chemotherapy on the survival and serum tumor markers. A total of 128 patients with advanced gastric carcinoma who have received surgical treatments were selected and were randomly divided into study group (receiving early circulatory intraperitoneal hyperthermic perfusion chemotherapy combined with systemic chemotherapy postoperatively) and control group (receiving chemotherapy alone postoperatively), with 64 cases in each. Comparison of serum tumor markers (CA724, CA242), vascular endothelial growth factor (VEGF), matrix metalloproteinase-2 (MMP-2), matrix metalloproteinase-9 (MMP-9), immune function indexes (CD3+, CD4+, CD8+), and 5-year survival rate was assessed. Before treatment, there was no significant difference in the serum tumor markers (CA724 and CA242) as well as the serum VEGF, MMP-2, and MMP-9 levels among the two groups ( P > 0.05). However, the above parameters in the study group were significantly lower than control group 8 weeks after the treatment ( P < 0.05). Before treatment, there was no significant difference in CD3+, CD4+, CD8+ and CD4+/CD8+ between the two groups ( P > 0.05). Eight weeks after the treatment, the CD3+, CD4+ and CD4+/CD8+ in the study group were significantly higher than those in the control group ( P < 0.05), while the CD8+ levels was significantly lower than the latter group ( P < 0.05). The 2-year recurrence rate in the study group was lower than the control group ( P < 0.05). Furthermore, survival rates (1-year, 3-year and 5-year) of the study group were all higher than control group ( P < 0.05). Early circulatory hyperthermia perfusion chemotherapy combined with systemic chemotherapy contributed to the decrease in the serum tumor markers (CA724, CA242) as well as the serum VEGF, MMP-2, and MMP-9 levels, improved the immune functions. This therapeutic regimen prolonged the long-term survival conditions of the patients as well as proved the safety and effectiveness.
Exploring the Phenomenon of Rural School Counselors’ Professional Identity Construction
Authors: Grimes Tameka Oliphant
Published: November 2020

This phenomenological study explored the impact of the rural context on the experiences of rural school counselors related to their professional identity construction. The author interviewed six participants in their respective communities and identified three themes—(a) the tight-knit community, (b) permeable professional/personal boundaries, and (c) fewer resources—as characteristics of the rural context that influence school counselors’ professional identity construction. This article presents implications and provides recommendations for practicing school counselors and counselor education programs.
Stakeholders’ Intention to Adopt Gene Therapy in Malaysia: Effects of Age, Education, and Religion
Authors: Mustapa Muhammad Adzran Che , Amin Latifah , Arham Ahmad Firdhaus
Published: November 2020

Gene therapy is a medical procedure in which new genetic material (genes) are introduced into the human body to treat disorders or diseases. Although the technology holds huge promises for improving human health, it is also one of the most controversial topics in modern medicine. Therefore, research into stakeholders’ intention to adopt gene therapy and its predicting factors is important to influence the successful implementation of this new therapeutic tool. The objective of this article is to assess the effect of background variables such as age, gender, and religion on behavioral intention to adopt gene therapy and its predicting factors. A validated questionnaire was distributed to 421 adult respondents (aged 18 years and older) comprised of two groups: health care providers ( n = 221) and patients ( n = 200). The results of the study suggest that the Malaysian stakeholders involved in the study were cautious although they perceived gene therapy as having high benefits, and were highly accepting from a religious perspective. This was reflected in their high intention to adopt gene therapy. At the same time however, they acknowledged the existence of moderate risks. One-way MANOVA analysis detected significant differences in terms of perceived benefits across ages, and behavioral intention across educational level. However, no significant differences were detected in the comparison of all factors across religions. This study serves as a useful baseline for scientists, government regulators, policy makers, and political leaders for understanding Malaysian acceptance of gene therapy and should encourage more research in the future.
The Monetary Value of Disability-Adjusted Life Years in Kenya in 2017
Authors: Muthuri Rose Nabi Deborah Karimi , Kirigia Joses Muthuri
Published: November 2020

All diseases and injuries exert a heavy epidemiological and socioeconomic burden on Kenya. The specific objectives of this study were (a) to estimate the monetary value of disability-adjusted life years (DALYs) from all causes in 2017 with the ongoing implementation of United Nations sustainable development goal (SDG) 3 and (b) to estimate the reductions in the monetary value of DALYs in Kenya, assuming diseases and injuries related to SDG3 targets are achieved by 2030. A variant of human capital (or net output) analytical framework was applied to value DALYs from 162 diseases and injuries into their monetary equivalents. The 17.9 million DALYs from 162 causes in Kenya in 2017 had a total monetary value of Int$ 67,012,790,388. Approximately 57% of the monetary value of DALYs emanated from communicable, maternal, neonatal, and nutritional diseases; 36% from noncommunicable diseases; and 7% from injuries. We estimate that attainment of the five SDG3 targets would lead to an Int$ 21.5 billion (45%) decrease in the SDG3-related monetary value of DALYs by 2030. There is an urgent need for health policy-makers to use this kind of evidence when advocating among public and private sectors for increased spending on health development.
Investigating the Chronology of Meniscus Root Tears: Do Medial Meniscus Posterior Root Tears Cause Extrusion or the Other Way Around?
Authors: Krych Aaron J. , LaPrade Matthew D. , Hevesi Mario , Rhodes Nicholas G. , Johnson Adam C. , Camp Christopher L. , Stuart Michael J.
Published: November 2020

Background:

Meniscus root tears are increasingly being recognized. Meniscal extrusion has previously been associated with medial root tears; however, the relationship between secondary meniscal restraints, such as the meniscotibial (MT) ligament, extrusion, and root tears has yet to be formally evaluated.

Purpose:

To better understand the association between MT ligament competence, medial meniscal extrusion, and medial meniscus posterior root tears (MMPRTs) as well as to determine the progression of meniscal extrusion over time.

Study Design:

Case series; Level of evidence, 4.

Methods:

Serial magnetic resonance imaging (MRI) scans were reviewed for patients who showed evidence of medial meniscal extrusion and MMPRTs on at least 1 of ≥2 available MRI scans. All patients were symptomatic at the time of diagnosis. All MRI scans were analyzed independently by 2 board-certified musculoskeletal radiologists. MT ligament disruption, medial meniscal extrusion, and MMPRTs were recorded for each MRI scan. The time between MRI scans, presence of insufficiency fractures, and Outerbridge classification for the medial femur and tibia were also evaluated.

Results:

Overall, 27 knees in 26 patients were included in this study, with a total of 63 MRI scans analyzed (21 knees with 2 MRI scans, 3 with 3 MRI scans, and 3 with 4 MRI scans). All patients demonstrated clear medial meniscal extrusion and MT ligament disruption before the subsequent development of MMPRTs ( P < .001). Mean extrusion at the time of initial MRI was 3.3 ± 1.1 mm and increased significantly to 5.5 ± 1.8 mm at the time of first imaging with an identified MMPRT ( P < .001). The mean time between initial MRI and the first identification of an MMPRT on later MRI was 1.7 ± 1.6 years.

Conclusion:

In a sample of 27 symptomatic knees with serial MRI scans both before and after an MMPRT diagnosis, all patients demonstrated MT ligament disruption and associated meniscal extrusion before the development of subsequent medial meniscus root tears. These findings suggest that MT ligament disruption and medial meniscal extrusion represent early and predisposing events contributing to MMPRTs. Therefore, this provides a possible explanation of why meniscal extrusion is not corrected with medial meniscus root repair.
Which Factors Predict Hospital Length-of-Stay for Children Admitted to the Neonatal Intensive Care Unit and Pediatric Ward? A Hospital-Based Prospective Study
Authors: Sahiledengle Biniyam , Tekalegn Yohannes , Zenbaba Demisu , Woldeyohannes Demelash , Teferu Zinash
Published: November 2020

Background. The ability to accurately predict hospital length of stay (LOS) or time to discharge could aid in resource planning, stimulate quality improvement activities, and provide evidence for future research and medical practice. This study aimed to determine the predictive factors of time to discharge among patients admitted to the neonatal intensive care unit (NICU) and pediatric ward in Goba referral hospital, Ethiopia. Methods. A facility-based prospective follow up study was conducted for 8 months among 438 patients. Survival analyses were carried out using the Kaplan Meier statistics and Cox regression model. Results. The median length of hospital stay was 7 days (95% confidence interval (CI): 6.45-7.54) and 6 days (95% CI: 5.21-6.78) for patients admitted to NICU and pediatric ward, respectively. In the multivariable Cox regression, the hazard of neonatal patients with less than 37 weeks of gestational age, low birth weight, and those who develop hospital-acquired infection (HAI) after admission had prolonged time to discharge by 54% [adjusted hazard ratio (AHR): 0.46, (95% CI: 0.31-0.66)], 40% [AHR: 0.60, (95% CI: 0.40-0.90)], and 56% [AHR: 0.44, (95% CI: 0.26-0.74)], respectively. The rate of time to discharge among patients who were admitted to the pediatric ward and had HAI delayed discharge time by 49% [AHR: 0.51, (95% CI: 0.30-0.85)] compared to their counterparts. Conclusion. Hospital-acquired infections prolonged hospital stay among neonates and children admitted to the pediatric ward. On a similar note, low gestational age and low birth weight were found to be the independent predictor of longer hospital stay among neonates.
Minority Representation and Reserved Legislative Seats in Iraqi Kurdistan
Authors: Abdullah Farhad Hassan , Hama Hawre Hasan
Published: November 2020

Ethnic and religious minorities have played a significant role in the long history of Kurdistan. At an official level, their political position was significantly strengthened with the advent of autonomy for the Kurdistan Region in northern Iraq in 1992. Most importantly, a quota system was established that reserved seats for several minority groups in the Kurdistan Parliament, often cited as an example of tolerance for diversity and respect for minority rights. Nevertheless, there is a lack of empirical research examining how ethnic and religious quotas affect democratic stability, quality of representation, and opportunities to represent authentic interests within the Kurdistan Regional Government (KRG). The politicians who occupy the reserved seats have come under criticism for merely supporting the policy programs of the dominant Kurdish parties, which deprives ethnic and religious minority groups of authentic representation and exposes the minority parties to allegations that they are politically exploited. This article analyzes the dynamics of minority political participation in Iraqi Kurdistan, how representation has been affected by the dominance of the ruling parties, and factors that guide the behavior of minority politicians while serving in quota-allocated positions. It also examines the effects of reserving seats through the quota system on the political behavior of minority groups. To these ends, this article focuses on parliamentary quotas and their impact on democratic stability, decision-making, and the empowerment of minority groups in the Kurdistan Region.
Searching Racism after George Floyd
Authors: Barrie Christopher
Published: November 2020

On May 25, 2020, George Floyd, a 46-year-old African American man, was killed by a white police officer in Minneapolis, Minnesota. His death led to U.S.-wide protest that would eventually cross borders, spanning multiple continents. The transnational diffusion of protest and movement frames is a recognized phenomenon in the study of contention. Less well documented are the consequences of such protest for political interest; absent survey data, this is difficult to measure. One alternative is to use Internet search data. This visualization uses Google Trends to document variation in search interest for “racism” across 101 countries and 32 languages during the period before and after George Floyd’s killing. In the majority of countries, there was significantly increased search interest that was sustained for at least two weeks. The findings suggest that transnational protest diffusion may lead to global increases in political interest.
Culture-Negative C acnes Endophthalmitis Following Implantation of a Phakic Implantable Collamer Lens
Authors: Robbins Calvin C. , Sobrin Lucia , Ma Kevin K. , Brouillette Kathryn M. , Moore Jeffrey K.
Published: November 2020

Purpose:

This work describes a case of Cutibacterium acnes (formerly Propionibacterium acnes) endophthalmitis following a posterior-chamber, phakic, Implantable Collamer Lens (ICL) surgery.

Methods:

A 34-year-old previously healthy woman presented with chronic unilateral iritis 8 months after bilateral ICL surgery. Original testing revealed no cause for the iritis with normal culture, serology, and autoimmune testing results.

Results:

Follow-up revealed C acnes by polymerase chain reaction on vitrectomy samples. Complete resolution of symptoms was achieved following removal of the implant, lensectomy, and intravitreal antibiotics.

Conclusions:

We believe this is the first reported case of postphakic ICL C acnes endophthalmitis. It highlights the utility of polymerase chain reaction in cases of chronic uveitis.
Successful Treatment of Guttate Psoriasis With Ixekizumab: A Case Series
Authors: Fogel Alexander L. , Strober Bruce
Published: November 2020

Guttate psoriasis is an eruptive variant of plaque psoriasis. Systemic therapy of guttate psoriasis has been inconsistently effective. Given that guttate psoriasis and plaque psoriasis share several immunopathogenic features, we hypothesized that antibodies targeting interleukin-17 (IL-17) would be effective in the treatment of guttate psoriasis. Here we present a series of 3 patients with guttate psoriasis successfully treated with ixekizumab, a monoclonal antibody against IL-17A.
Does Practicing with a Virtual Reality Driving Simulator Improve Spatial Cognition in Older Adults? A Pilot Study
Authors: Masoumzadeh Sogol , Moussavi Zahra
Published: November 2020

Memory, cognition, executive functioning, and spatial cognition loss are prevalent in the normal aging process, but these impairments are observed more extensively in individuals with dementia, specifically Alzheimer’s disease. To improve the impaired functions, serious games targeting the lost functions are commonly developed and used in training programs. In this study, we designed a virtual reality driving simulator (VRDS) as a serious game with different difficulty levels for improving the spatial cognition; we evaluated it on 11 participants with different levels of dementia for two weeks, every day except weekends (10 sessions of practice in total) and 30 min/day. We assessed the participants’ spatial cognition before and after the intervention by an independent assessment (the VR replica of Morris Water test) and also by their performance playing the VRDS during the intervention. We also assessed the participants’ mood by a standard depression scale as well as their plausible experience of simulation sickness. The results showed significant improvement in Morris water test. The participants’ normalized correct trajectory (to find the target) was improved significantly by 44.4% at post-intervention with respect to baseline. Furthermore, on average, the participants progressed to higher (more challenging) levels of the game, and their spatial learning score increased throughout the sessions. Their mood also showed improvement with respect to baseline. Overall, the results hold promise for the designed VRDS as a mood-lifting and enhancing spatial skills serious game for older adults if it is played regularly.

Trial Registry name: Investigating the Effect of Training with a Virtual Reality Driving Simulator

URL: https://clinicaltrials.gov/ct2/show/NCT04074655

Clinical Trials.gov ID: NCT04074655
Predicting Thrombosis Recurrence in Children: The Role of Thrombophilia Testing
Authors: Allahyani Bader , Ljung Rolf
Published: November 2020

Background:

The role of inherited thrombophilia testing in predicting a recurrence of deep vein thrombosis (DVT) after an incident of the first DVT in children remains unclear

Objectives:

To investigate the association between inherited thrombophilia and DVT recurrence.

Design/Method:

We conducted a retrospective regional study of all consecutive ICD10 codes of venous thromboembolism (VTE) in children over 15 years (January 1, 2000, to December 31, 2015) in a regional catchment area of southern Sweden using an electronic diagnosis registry. Eligible subjects were children aged 1-18 years presenting with DVT diagnosed with imaging and having undergone complete inherited thrombophilia workup after the first DVT event. Of the 174 patients diagnosed with DVTs, 139 were eligible for inclusion. Data regarding subject demographics and medical history, location of DVT and imaging method, coagulation studies at primary investigation including at least plasma concentrations of protein C, protein S, antithrombin, resistance to activated protein C, and the genotypes FVG1691A and FIIG20210A. Also, plasma values for coagulation factors, VIII and XI, D-dimer, INR, and cardiolipin antibodies, were analyzed.

Results:

A total of 139 patients had inherited thrombophilia workup after the incident of the first DVT. Inherited thrombophilia was found in 30 % of patients, the prevalence of minor thrombophilia among these 139 patients was 23 % (n = 32), whereas major thrombophilia accounted for 7 % (n = 10) of abnormal results. Anticoagulants as treatment were administered in 92 % of the first DVT. The majority of the cohort treated with anticoagulation therapy for 12 weeks. Patients with minor inherited thrombophilia treated for at least 24 weeks, whereas the patients with major inherited thrombophilia were continued on anticoagulation therapy for the long term. The incidence rate of recurrent thromboembolic events was 6.5 % (n = 9) of patients after their incident of the first thrombotic event. Recurrent thrombosis in patients with spontaneous DVT and proven inherited thrombophilia found in only 1 %.

Conclusion:

Inherited thrombophilia was not predictive of recurrent DVT among our cohort patients. Our findings suggest that Inherited thrombophilia testing may not predict risk for the recurrence of DVT, although it may help for adjustment of the duration of the anticoagulation therapy.

Figure

Disclosures

No relevant conflicts of interest to declare.
Prevalence of Thrombophilia in Transient Ischemic Attack and Ischemic Stroke Patients
Authors: Raslan Omar , Tran Christopher , Al-Ani Fatimah , Sposato Luciano , Lazo-Langner Alejandro
Published: November 2020

Introduction. Screening for inherited thrombophilia has been recommended in patients with cryptogenic ischemic strokes and anticoagulant therapy is frequently indicated based on these results. However, current evidence suggests that thrombophilia screening is over utilized in stroke patients and may provide more risks than benefits.

Patients and Methods.We conducted a retrospective cohort study in patients with transient ischemic attack (TIA) or ischemic stroke who had a thrombophilia screen and determined the proportions of each thrombophilia trait, and the proportion of high risk thrombophilia in this population. Pre-specified subgroup analyses were conducted for patients with ischemic stroke and transient ischemic attacks, and for patients with patent foramen ovale.

Results.We included 412 patients (152 male and 260 female). The prevalence of thrombophilia was 7.52% (95% CI 5.35-10.48). The proportion of major thrombophilia was 2.18 (95% CI=1.15 - 4.09). The proportion of thrombophilia traits in ischemic stroke patients was lower 4.92% (95% CI 2.61 - 9.08) than that in patients with transient ischemic attacks 9.57% (95% CI = 6.41 - 14.06); Only 2 individuals had both a positive thrombophilia screen and a patent foramen ovale.

Discussion. In this study the prevalence of thrombophilia traits in patients with ischemic stroke or transient ischemic attack was low, including high risk thrombophilic traits. Further studies are needed to determine if thrombophilia screening exposes these patients to additional risks without any benefits.

Disclosures

Sposato: Western University:Other: Kathleen and Dr. Henry Barnett Chair in Stroke Research;Boehringer Ingelheim:Honoraria, Research Funding;Pfizer:Honoraria, Research Funding;Gore:Honoraria, Research Funding;Bayer:Honoraria, Research Funding.
The New ASH ITP-Guideline Recommendations - Marching Separately, Beating Together
Authors: Matzdorff Axel , Meyer Oliver
Published: November 2020

Background:Immune thrombocytopenia (ITP) is rare. The 1996 American Society of Hematology (ASH) ITP-Guideline for many years set the standards of ITP-care. In 2019 ASH published a new ITP guideline. We wanted to assess the acceptance of these new guideline recommendations by German physicians.

Methods:This is a cross-sectional survey presenting ten recommendations on adult ITP from the new ASH ITP guideline to German hematologist, internists and other specialists at 4 medical educational activities on ITP between September 2019 and January 2020. We asked the physicians to express their preference for each recommendation on a 5-point scale. Numeric values were assigned to the degrees of agreement or disagreement. The numeric values of the responses were summed and divided by the number of respondents to create an average score. This was compared with the degree of support ASH experts expressed for each of their recommendation.

Results:One hundred thirty questionnaires were distributed and 56 were retrieved (43%). There was consensus in 7 of 10 management issues but there were obvious differences in 3. (1) German physicians were less likely to give corticosteroids in newly diagnosed but asymptomatic or only mildly symptomatic patients, but (2) in case corticosteroids were given, German physicians were more likely to prescribe longer corticosteroid treatment, and (3) German physicians clearly prefer 2nd line thrombopoietin receptor agonists (TPO-RAs) over splenectomy. The different approach may be explained by easier access to medical care for patients (higher hospital- and physician-density than in the US), universal coverage in a publicly funded health care system, and a less developed medicolegal network pushing malpractice claims in Germany.

Conclusion: The example of the recent ASH ITP guideline shows that recommendations must not be separated from the context in which they are produced. They cannot define a universal standard of care. Instead they need to be adapted and individualized, respecting the traditions of each health care system, physicians' experiences, patients' preferences, and health literacy. Guideline recommendations do not define a 'best treatment' or any universal standard of care, all they do is providing guidance to the physician in daily practice. Th. Jefferson's sentence still holds that all human beings are created equal, but this does not mean that all patients must be treated equally.

Disclosures

Matzdorff: UCB Biopharma SRL:Consultancy, Other: Honoraria paid to institution;Swedish Orphan Biovitrium GmbH:Consultancy, Other: Honoraria paid to institution;Grifols Deutschland GmbH:Consultancy, Other: Honoraria paid to institution;Amgen GmbH:Consultancy, Other: Honoraria paid to institution;Novartis Oncology:Consultancy, Other: Honoraria paid to institution;Roche Pharma AG:Other: Family stockownership.Meyer:Novartis Pharma GmbH:Honoraria;Amgen GmbH:Honoraria;Grifols Germany:Consultancy, Honoraria.
Does Upfront Autologous Stem Cell Transplant at First Relapse Improve Outcome in Transplant Eligible Follicular Lymphoma Patients Who Relapse within 24 Months
Authors: Yahya Ayel Omar Q , MacDonald David , Radhwi Osman
Published: November 2020

In Canadian adults, Follicular lymphoma (FL) is the most common subtype of NHL, Approximately 20% of patients with FL experience progression of disease (POD) within 2 years of first line chemoimmunotherapy. Those patients have an expected overall survival of less than 5 years.The optimal second-line treatment for these high-risk patients is unclear. We analyzed data from the blood and bone marrow transplantation Center at the Ottawa Hospital (TOH) to determine whether autologous hematopoietic cell transplant (ASCT) as upfront therapy for first relapse can improve outcomes in this high-risk FL subgroup. We identified 17 patients who underwent upfront ASCT between February 2012 and February 2019. All of them had relapsed within 24 months after their 1st Rituximab-based chemotherapy. The OS at 2-year and 5-year was 86.2% (95% CI: 55-96) and 71.8% (95% CI: 31-91) respectively. The PFS at 2 year and 5 year was 62.6% (95% CI: 35-81) and 53.6% (95% CI: 25-75) respectively. We demonstrate improved OS when receiving autologous hematopoietic stem cell transplant as up front at first relapse in transplant eligible follicular lymphoma who relapse within 24 months of first line therapy. However; the sample size considerably small but the results look promising. Combining other center experience the confidence intervals are wide, indicating that the sample size was too small. Considering a single center, the result looks promising, but the data need to be replicated with a larger sample size.

Disclosures

MacDonald: Roche Canada: Consultancy, Honoraria; Janssen: Honoraria; AstraZeneca: Honoraria.
Establishing the Velocity of M-Protein Decline (VMD) Value in Response to Multiple Myeloma Therapy That Best Predicts M-Protein of Zero
Authors: Haddad Philip A , Ganey Nowell
Published: November 2020

Introduction:

Serum M-protein levels, measured by serum immunoelectrophoresis, have been one of the major tests that determine the type of response to therapy in Multiple Myeloma. Achieving an M-protein of zero is one of the criteria determining complete remission which in turn translates into longer progression-free survival and overall survival. Triplet therapy tends to be the standard therapeutic approach in younger, fit, and transplant candidates. However, in older non-fit patients many oncologists start with doublets and only escalate to triplet combinations upon less optimal response. The predictive value of the velocity of the M-spike decline (VMD) has not been adequately studied. We conducted this study to find the optimal VMD that predicts a serum M-protein of zero.

Methods:

A sample of mostly non-fit older Multiple Myeloma patients was identified. All patients had regular serum protein electrophoresis with M-protein levels documented every 4-8 weeks until they achieved M-protein levels of zero, plateauing without attaining the target of zero, or rebounding with progression. Best-fit line or curve was constructed and the slope of the decline was calculated. VMD was defined as the slope of the best fit-curve/line. VMD values corresponding to the binary outcomes of achieving or failing to achieve an M-protein value of zero were collected. A ROC curve was constructed to determine the cut-off VMD value that best predicts the outcome of M-protein of zero.

Results:

A total of 47 patients of mostly non-fit older Multiple Myeloma patients were included in our final sample. The median age of the sample was 71 years. Thirteen percent had triplet therapy. Thirty four percent had proteasome inhibitor based combinations while 64% had IMiD based combinations. Fifty seven percent achieved the target M-protein level of zero while 43% failed. The area under the ROC curve, AUC, was 0.98 (p<0.0001). The cut-off VMD value (the slope of the best fit M-protein curve/line) which best predicts an outcome of M-protein of zero was < -0.276 with a corresponding sensitivity of 89% and specificity of 100%.

Conclusions:

This exploratory study established the VMD value that best predicts the outcome of M-protein of zero in response to Multiple Myeloma therapy. This may be potentially used by oncologists to make early decisions regarding the need for further optimization or intensification of their therapeutic combinations as they treat their older non-fit Multiple Myeloma patients.

Disclosures

No relevant conflicts of interest to declare.
The Impact of Rituximab on the Clinical Outcomes of Primary Central Nervous System Lymphoma (PCNSL) When Added to Combination Chemotherapy: A Comprehensive Meta-Analysis
Authors: Haddad Philip A , Hammoud Dalia , Gallagher Kevin M.
Published: November 2020

Introduction:

PCNSL is a rare diffuse large B-cell lymphoma (DLBCL) confined to the central nervous system accounting for approximately 2-5% of all primary brain tumors. Although there is no standard combination of chemotherapy, high-dose methotrexate is considered the backbone of all PCNSL chemotherapy regimens. Rituximab, an anti-CD20 antibody, has been a standard component of non-CNS DLBCL combinations since it improves progression-free (PFS) and overall survival (OS). However, the role of Rituximab in the treatment of PCNSL has been controversial with contradictory results. A meta-analysis conducted in 2019 found no associated survival advantage for Rituximab when added to chemotherapy. However, this meta-analysis was small and included only 2 studies. The purpose of this meta-analysis is to evaluate in a more comprehensive way the impact of Rituximab-based chemotherapy combinations on the clinical outcomes of patients with PCNSL incorporating all available comparative studies.

Methods:

A review of the medical literature was conducted using online databases. Inclusion criteria consisted of PCNSL diagnosis, English language, and studies reporting OS and PFS with hazard ratios (HR) or Kaplan-Meier curves that compared similar regimens with and without Rituximab. A meta-analysis using an inverse variance method with a random-effects model was conducted.

Results:

Four comparative studies with a total of 467 patients were included in this meta-analysis. Two of these studies were retrospective comparative studies and two were randomized phase II trials. When added to chemotherapy, Rituximab was found to significantly improve the OS and PFS (HROS 0.75, 95%CI: 0.59-0.96, p=0.02; HRPFS 0.67, 95%CI: 0.53-0.85, p=0.001) with a heterogeneity estimate, I2=0%.

Conclusions: This is the first meta-analysis to show that adding Rituximab to chemotherapy is associated with OS and PFS in patients with PCNSL. In the absence of randomized clinical trials, this meta-analysis represents the most compelling data supporting the routine use of Rituximab combinations in PCNSL.

Disclosures

No relevant conflicts of interest to declare.