bluuebunny/crossref_metadata_2025 huggingface dataset:
Recognition, multiplicity and the elusive international
Authors: Hoseason Alex
Published: May 2021

This article argues that the normative promise of recognition theory in International Relations has become increasingly inadequate to the cross-cutting and intersecting issues characteristic of a globalised and fragmented world. Engaging in critical readings of cosmopolitan forms of recognition theory, the critique of sovereignty and Markell’s influential critique of recognition theory, I suggest that the increasing ontological specificity of recognition theory in IR has come at the expense of its ability to develop links between different areas of international politics. The result is a failure to deal with recognition’s simultaneity, or the co-existence of analytically distinct and internally coherent recognition orders that is characteristic of the international. Building on this insight, I argue that a more historically-sensitive and materialist approach to recognition can be grounded in the concept of multiplicity. By opening recognition up to processes of interaction, and not merely reproduction, multiplicity frames the international more clearly as a historical presupposition, rather than a limit, of recognition. Furthermore, placing recognition struggles within the state, international institutions or transnational movements in relation to each other ensures that IR can contribute to the further development of recognition theory by situating recognition struggles at the intersection of different moral geographies.
Experience with regorafenib in the treatment of hepatocellular carcinoma
Authors: Granito Alessandro , Forgione Antonella , Marinelli Sara , Renzulli Matteo , Ielasi Luca , Sansone Vito , Benevento Francesca , Piscaglia Fabio , Tovoli Francesco
Published: May 2021

Regorafenib is a diphenylurea oral multikinase inhibitor, structurally comparable to sorafenib, which targets a variety of kinases implicated in angiogenic and tumor growth-promoting pathways. Regorafenib was the first agent to positively show significant survival advantage as a second-line therapy in patients with unresectable hepatocellular carcinoma (HCC) who had previously failed first-line treatment with sorafenib. Recent evidence has shown that its antitumor efficacy is due to a comprehensive spectrum of tumor neo-angiogenesis and proliferation inhibition and immunomodulatory effects on the tumor microenvironment, which plays a crucial role in tumor development. This review addresses the rationale and supporting evidence for regorafenib’s efficacy in HCC that led to regorafenib’s approval as a second-line therapy. In addition, we review proof from clinical practice studies that validate the RESORCE trial results. We discuss regorafenib’s potential role in the newly emerging therapeutic strategy based on combination with immune checkpoint blockade and its possible extensibility to patient categories not enrolled in the registrative study.
Critical roles of bile acids in regulating intestinal mucosal immune responses
Authors: Sun Ruicong , Xu Chunjin , Feng Baisui , Gao Xiang , Liu Zhanju
Published: May 2021

Bile acids are a class of cholesterol derivatives that have been known for a long time for their critical roles in facilitating the digestion and absorption of lipid from the daily diet. The transformation of primary bile acids produced by the liver to secondary bile acids appears under the action of microbiota in the intestine, greatly expanding the molecular diversity of the intestinal environment. With the discovery of several new receptors of bile acids and signaling pathways, bile acids are considered as a family of important metabolites that play pleiotropic roles in regulating many aspects of human overall health, especially in the maintenance of the microbiota homeostasis and the balance of the mucosal immune system in the intestine. Accordingly, disruption of the process involved in the metabolism or circulation of bile acids is implicated in many disorders that mainly affect the intestine, such as inflammatory bowel disease and colon cancer. In this review, we discuss the different metabolism profiles in diseases associated with the intestinal mucosa and the diverse roles of bile acids in regulating the intestinal immune system. Furthermore, we also summarize recent advances in the field of new drugs that target bile acid signaling and highlight the importance of bile acids as a new target for disease intervention.
An overview of lurbinectedin as a new second-line treatment option for small cell lung cancer
Authors: Patel Shetal , Petty William Jeffrey , Sands Jacob M.
Published: May 2021

Small cell lung cancer (SCLC) is a highly proliferative, aggressive form of lung cancer that carries a poor prognosis. Recent approvals with new therapeutic options represent the first in more than a decade for SCLC. Lurbinectedin, a newly approved second-line option, is a synthetic alkaloid that covalently binds DNA, generating double-strand breaks, and disrupts DNA-protein interactions and RNA transcription. Lurbinectedin may also modulate the tumor microenvironment by inducing apoptosis of peripheral blood monocytes and tumor associated macrophages, decreasing expression of the inflammatory chemokine (C-C motif) ligand 2 (CCL2) and reducing tumor angiogenesis. A single-arm, open-label, basket trial included 105 patients with SCLC that had received one prior line of therapy. Patients received lurbinectedin 3.2 mg/m2 as an intravenous infusion every 3 weeks, resulting in a response rate of 35.2% and a disease control rate of 68.6%. The response rate was 45% among those with >90 days chemotherapy free interval (CTFI) and 22% in the resistant group (CTFI < 90 days). The median overall survival was 9.3 months. Myelosuppression is the most frequent clinically significant adverse event, particularly neutropenia; however, neutropenic fever occurred in only 5% of those in the SCLC cohort of the basket trial. Nausea and fatigue were also noted. The side effect profile compares favorably to topotecan, while a direct comparison of tolerability can be made between lurbinectedin versus topotecan or pegylated-liposomal doxorubicin from CORAIL, a randomized study for platinum-resistant/refractory ovarian cancer. A press release has reported the ongoing clinical trial for SCLC including combination lurbinectedin and doxorubicin versus topotecan or cyclophosphamide, doxorubicin, and vinblastine to be negative. The details may provide more insight at publication, and future trials will be important to further define the clinical utility of lurbinectedin. Lurbinectedin represents a new option in second-line SCLC.
Ageism Kills Brands
Authors: Anesbury Zachary William , Bellman Steven , Driesener Carl , Page Bill , Sharp Byron
Published: May 2021

Market share growth requires building mental and physical availability among all category buyers. However, if younger category buyers are more likely to purchase new-to-market products, then perhaps younger buyers are, relatively speaking, more important for growth. This research investigates the relationship between category buyer age, brand buyer age, and brand failure. When sub-brand buyer age is younger than category buyer age, the sub-brand is likely to be (a) new-to-market or (b) growing in market share. Older-than-category sub-brand-buyer age is likely for sub-brands that are (a) declining or (b) dead. Results from 17 years (1998–2014) of U.K. household panel data, including 5,913 sub-brands from 101 categories, show that age skews were uncommon (only 18% of sub-brands), and second, that growing, stable and declining sub-brands appealed equally to all ages. Finally, we identified that new launches and dead brands tend to skew to younger consumers, suggesting that new launches need to appeal to all ages to avoid failure.
Investigating the relationships between service capabilities and financial statements indicators
Authors: Calabrese Armando , Ghiron Nathan Levialdi , Tiburzi Luigi
Published: May 2021

This study analyses the relationships between service capabilities and financial statements indicators of 76 U.K. service providers belonging to the Standard Industry Classification (SIC) 49410 (‘Freight transport by road’). These firms were clustered in four different groups according to their service capabilities by employing content analysis on open secondary data. Then, statistical tests were employed to analyse whether groups with different service capabilities differ in key financial statements indicators. As the results show, economic-financial indicators (e.g., turnover) do not vary significantly between the groups, whereas differences arise in the number of employees and other asset-related indicators. It follows from these results that within the same SIC code, the various assortments of service capabilities do not have repercussions on the firms’ profitability; on the other hand, these assortments are correlated with firms’ size and infrastructure (e.g., magnitude of the Stock & W.I.P.). This research develops a heuristic approach using open secondary data to identify and classify service capabilities, and to investigate their relationship with financial statements indicators. This approach can be replicated in other business sectors thus supporting managers in identifying their firm’s capabilities and those of their competitors.
Official Truths in a War on Fake News: Governmental Fact-Checking in Malaysia, Singapore, and Thailand
Authors: Schuldt Lasse
Published: May 2021

This article analyses the practice of state-operated fact-checking websites in Malaysia, Singapore, and Thailand. It is the first empirical study of governmental news corrections in Southeast Asia and covers more than 2,700 official posts published by Malaysia’s Sebenarnya.my, Singapore’s Factually, and Thailand’s Anti-Fake News Center. It finds that correction practices across the sites mainly function to sustain the salience of a supposedly constant and omnipresent fake news threat. Assuming an important role in strategic political communication, official fact checks accompany domestic fake news discourses that prepare the ground for restrictive legislation. At the same time, the analysis did not reveal any propagandistic abuse as the sites refrained from excessively defending governments and accusing political opponents. This finding is qualified regarding Singapore’s Factually that recently changed its approach towards targeting government critics personally.
A Video Game for Brazilian T1D Children about Knowledge of Disease and Self-care: A Methodological Study
Authors: Sparapani Valéria de Cássia , Fels Sidney , Kamal Noreen , Ortiz La Banca Rebecca , Nascimento Lucila Castanheira
Published: May 2021

Background:

Video games are interactive technologies able to support children in health promotion, behavior changes, and chronic disease self-management. The use of health behavior change determinants in video game design can increase its effectiveness. This study describes the process of designing a video game for Brazilian children with T1D clarifying the use of health behavior change determinants that may influence self-management behaviors.

Methods:

This was a methodological study based on health behavior change theories and the user-centered design approach. The results of a qualitative study conducted with children aged 7 to 12 years identified learning needs about knowledge on diabetes and self-care tasks which contribute to inappropriate behaviors. A Behavioral Diagnosis presented health behavior change determinants, capable of influencing children’s learning needs and behaviors, that were considered to design The Heroes of Diabetes—the power of knowledge.

Results:

The results presented the process of designing 4 mini games with its description and theory foundation to reach children’s lack of understanding about T1D, insulin’s role, SMBG requirements, food groups and physical activity’s role in glycemic control. Knowledge, goal settings, extrinsic and intrinsic motivation determinants were related with video games design features.

Conclusions:

The findings support the use of health behavior change determinants into video game design as a guide to achieve children learning needs and that might influence self-management behaviors.
Looks Clear and Sounds Familiar: How Consumers Form Inferential Beliefs About Luxury Hotel Service Quality
Authors: Ryu Sann , Park Yun-na , Park Jungkun
Published: May 2021

The purpose of this study is to examine how varying levels of brand familiarity and photographic image quality of hotel pictures influence consumers’ perceptions about luxury hotel services and attitudinal responses and whether their visual aesthetic experience and inferential beliefs about service quality can mediate such effects. This is a 2 (brand familiarity: familiar vs. unfamiliar brand) × 2 (image quality: high vs. low image resolution) factorial design randomized experiment and the proposed model was tested using a structural equation model ( N = 430). The proposed model was confirmed that consumers viewed the visual appearance of a hotel suite room (varying in image quality) and brand name (varying in brand familiarity), experienced processing fluency, drew inferential beliefs (about tangible and intangible service quality), formed attitudes toward the brand, and purchase intentions. The study presents an explanatory framework that delineates how varying hotel-related cues in an online setting can shape consumers’ perceptions and judgments of a luxury hotel brand. To one’s best knowledge, no research has examined the impact of both brand familiarity and photographic image quality of a hotel room. More importantly, this study reveals to what extent consumers’ inferential beliefs about service quality can be influenced by the heuristic cues and provides direct evidence for the mediating role of processing fluency and aesthetic appreciation.
The Relationships Between Sport Specialization, Sleep, and Quality of Life in Female Youth Volleyball Athletes
Authors: Watson Andrew , McGuine Timothy , Lang Pamela , Post Eric , Biese Kevin , Kliethermes Stephanie , Brooks M. Alison , Bell David
Published: May 2021

Background:

Although sport specialization may be associated with stress and burnout among youth athletes, the relationship with quality of life (QOL) remains unknown. The purpose of this study was to evaluate the relationship between sport specialization, sleep, and QOL in female youth athletes.

Hypothesis:

Higher levels of specialization are associated with increased daytime sleepiness and worse QOL.

Study Design:

Cross-sectional study.

Level of Evidence:

Level 4.

Methods:

Female high school volleyball players completed preseason surveys to determine sport specialization (low, moderate, high), injury history, QOL, sleep duration, and daytime sleepiness. QOL and sleep variables were compared across specialization groups. Multivariable linear regression models were developed to evaluate the associations between sleepiness, QOL, specialization, grade in school, and injury history.

Results:

Of 1482 participants, 591 (40%), 436 (29%), and 455 (31%) were categorized as low, moderate, and high specialization, respectively. Highly specialized athletes demonstrated worse QOL (median 91.3 [interquartile range 86-96]) than low (92.4 [88-97], P = 0.05) and moderate (93.5 [88-99], P = 0.05) specialization groups and greater daytime sleepiness (11 [7-15]) than low (10 [6-14], P < 0.001) and moderate (10 [6-14], P < 0.001) specialization groups. In the multivariable model, QOL was negatively associated with prior injury occurrence (β = −1.1 ± 0.5, P = 0.02), but not grade in school (β = −0.08 ± 0.2, P = 0.71) or specialization (moderate: β = 0.08 ± 0.5, P = 0.88; high: β = −0.70 ± 0.5, P = 0.18). Daytime sleepiness increased with high specialization (β = 1.12 ± 0.3, P < 0.001) and grade (β = 0.76 ± 0.1, P < 0.001), but not prior injury (β = 0.51 ±0.3, P = 0.10).

Conclusion:

Highly specialized female volleyball athletes demonstrate decreased QOL, perhaps because of higher rates of prior injury. Specialization is also associated with increased daytime sleepiness.

Clinical Relevance:

Sport participation patterns and injury may have implications for QOL in youth athletes.
The role of axicabtagene ciloleucel as a treatment option for patients with follicular/marginal zone lymphoma
Authors: Sandoval-Sus Jose , Chavez Julio C.
Published: May 2021

Chimeric antigen receptor (CAR) T-cell therapy with axicabtagene ciloleucel (axi-cel) continues to make its way in the treatment of B-cell lymphomas. Follicular lymphoma (FL) is the second most common non-Hodgkin’s lymphoma. While its prognosis is usually good, the disease is considered incurable and patients still relapse. High-risk subgroups such as high FLIPI score or early relapses (POD24) face poor outcomes. Current treatment options with phosphatidylinositol 3-kinase (Pi3K) inhibitors or other novel agents have clinical activity but short remission with cures remaining elusive. The ZUMA-5 study of axi-cel has shown high response rates with durable remissions with manageable toxicities, particularly in poor risk FL, replicating the outcomes in smaller and earlier studies. Long-term follow up will demonstrate the real impact of axi-cel in relapsed FL.
The Modulation of Exogenous Attention on Emotional Audiovisual Integration
Authors: Li Yueying , Li Zimo , Deng Aihui , Zheng Hewu , Chen Jianxin , Ren Yanna , Yang Weiping
Published: May 2021

Although emotional audiovisual integration has been investigated previously, whether emotional audiovisual integration is affected by the spatial allocation of visual attention is currently unknown. To examine this question, a variant of the exogenous spatial cueing paradigm was adopted, in which stimuli varying by facial expressions and nonverbal affective prosody were used to express six basic emotions (happiness, anger, disgust, sadness, fear, surprise) via a visual, an auditory, or an audiovisual modality. The emotional stimuli were preceded by an unpredictive cue that was used to attract participants’ visual attention. The results showed significantly higher accuracy and quicker response times in response to bimodal audiovisual stimuli than to unimodal visual or auditory stimuli for emotional perception under both valid and invalid cue conditions. The auditory facilitation effect was stronger than the visual facilitation effect under exogenous attention for the six emotions tested. Larger auditory enhancement was induced when the target was presented at the expected location than at the unexpected location. For emotional perception, happiness shared the biggest auditory enhancement among all six emotions. However, the influence of exogenous cueing effect on emotional perception seemed to be absent.
Three dimensional porous scaffolds derived from collagen, elastin and fibrin proteins orchestrate adipose tissue regeneration
Authors: Sawadkar Prasad , Mandakhbayar Nandin , Patel Kapil D , Buitrago Jennifer Olmas , Kim Tae Hyun , Rajasekar Poojitha , Lali Ferdinand , Kyriakidis Christos , Rahmani Benyamin , Mohanakrishnan Jeviya , Dua Rishbha , Greco Karin , Lee Jung-Hwan , Kim Hae-Won , Knowles Jonathan , García – Gareta Elena
Published: May 2021

Current gold standard to treat soft tissue injuries caused by trauma and pathological condition are autografts and off the shelf fillers, but they have inherent weaknesses like donor site morbidity, immuno-compatibility and graft failure. To overcome these limitations, tissue-engineered polymers are seeded with stem cells to improve the potential to restore tissue function. However, their interaction with native tissue is poorly understood so far. To study these interactions and improve outcomes, we have fabricated scaffolds from natural polymers (collagen, fibrin and elastin) by custom-designed processes and their material properties such as surface morphology, swelling, wettability and chemical cross-linking ability were characterised. By using 3D scaffolds, we comprehensive assessed survival, proliferation and phenotype of adipose-derived stem cells in vitro. In vivo, scaffolds were seeded with adipose-derived stem cells and implanted in a rodent model, with X-ray microtomography, histology and immunohistochemistry as read-outs. Collagen-based materials showed higher cell adhesion and proliferation in vitro as well as higher adipogenic properties in vivo. In contrast, fibrin demonstrated poor cellular and adipogenesis properties but higher angiogenesis. Elastin formed the most porous scaffold, with cells displaying a non-aggregated morphology in vitro while in vivo elastin was the most degraded scaffold. These findings of how polymers present in the natural polymers mimicking ECM and seeded with stem cells affect adipogenesis in vitro and in vivo can open avenues to design 3D grafts for soft tissue repair.
Leishmania: manipulation of signaling pathways to inhibit host cell apoptosis
Authors: Solano-Gálvez Sandra-Georgina , Álvarez-Hernández Diego-Abelardo , Gutiérrez-Kobeh Laila , Vázquez-López Rosalino
Published: May 2021

The maintenance of homeostasis in living systems requires the elimination of unwanted cells which is performed, among other mechanisms, by type I cell death or apoptosis. This type of programmed cell death involves several morphological changes such as cytoplasm shrinkage, chromatin condensation (pyknosis), nuclear fragmentation (karyorrhexis), and plasma membrane blebbing that culminate with the formation of apoptotic bodies. In addition to the maintenance of homeostasis, apoptosis also represents an important defense mechanism for cells against intracellular microorganisms. In counterpart, diverse intracellular pathogens have developed a wide array of strategies to evade apoptosis and persist inside cells. These strategies include the manipulation of signaling pathways involved in the inhibition of apoptosis where mitogen-activated protein kinase (MAPK) and phosphoinositide 3-kinase (PI3K) play a key role. Leishmania is an intracellular protozoan parasite that causes a wide spectrum of diseases known as leishmaniasis. This parasite displays different strategies, including apoptosis inhibition, to down-regulate host cell defense mechanisms in order to perpetuate infection.
Hematological parameters abnormalities and associated factors in HIV-positive adults before and after highly active antiretroviral treatment in Goba Referral Hospital, southeast Ethiopia: A cross-sectional study
Authors: Duguma Negesso , Tesfaye Kiya Girum , Adissu Maleko Wondimagegn , Bimerew Lealem Gedefaw
Published: May 2021

Objectives:

Hematological abnormalities of the major blood cell lines are frequently reported in patients with HIV-1 infection, in patients without antiretroviral therapy, and during the advanced stages of the disease. Chronic immune activation and inflammation results in the progressive depletion of CD4+ T-cells play a significant role in the clinical progression and pathogenesis of this infection. This study was aimed at assessing the prevalence of hematological abnormalities and their associated factors before and after the initiation of antiretroviral therapy in adults with HIV-1 infection in a referral hospital.

Methods:

The study was conducted from 1 April to 30 June 2018, at Goba Referral Hospital. A total of 308 HIV-positive adults on treatment were enrolled during the study period. Socio-demographic and clinical data were collected using a structured questionnaire, with pre-highly active antiretroviral therapy data were extracted from medical records while post-treatment immuno-hematological measurements were done on blood samples collected at the time of enrollment.

Results:

The prevalence of anemia, leukopenia, and thrombocytopenia before initiation of antiretroviral treatment was higher, although anemia and thrombocytopenia decreased correspondingly after initiation of treatment leukopenia increased by 4%. Mean values of immuno-hematological parameters before and after treatment initiation were significant ( p < 0.05). CD4+ T-cell count <200 cells/µL was the only independent risk factor for anemia and leukopenia before highly active antiretroviral therapy, while stage IV disease, female sex, zidovudine, lamivudine, and nevirapine treatment, and intestinal parasite infection were predictors of anemia after treatment initiation.

Conclusion:

The study revealed that hematological abnormalities are common in HIV infection, while the occurrence of abnormalities after highly active antiretroviral therapy initiation. Different risk factors are associated with hematological abnormalities at pre- and post-highly active antiretroviral therapy with regular monitoring of risk factors, adherence to the early initiation of highly active antiretroviral therapy, and conduct of further longitudinal studies are recommended.
The relationship between the stone-free status after extracorporeal shockwave lithotripsy (ESWL) treatment in different patient and kidney stone characteristics: A single center experience in Saudi Arabia
Authors: Katib Atif , Al-Wafi Osama , Dakkak Basem , Bawa Abdallah , Basheer Mansur , Al-Bilal Izzeldin
Published: May 2021

Purpose:

The objective was to unveil the relationship between different relevant patient and kidney stone characteristics and the stone-free status post extracorporeal shockwave lithotripsy (ESWL) treatment.

Materials and methods:

Kidney stones cases referred for ESWL from October 2019 to January 2020 were collected. A total of 225 adult patients who met the criteria of being new cases of single radio-opaque kidney stones measuring 5 to 20 mm were included. We were looking for disintegrated stones down to 4 mm or less as a marker for stone-free (SF) status. The studied parameters were gender, laterality (right or left kidney), location of the stone within the kidney, stone’s density measured in Hounsfield units (HU), stone’s size, and stone-to-skin distance (SSD).

Results:

Out of the 225 cases treated, only 175 (77.8%) became SF after or during the study timeframe. SF status was achieved after the first session in 131 cases (58.2%). The bivariate analysis of the factors associated with higher SF rates found to be statistically significant were left kidney ( p-value of < 0.01), low stone density ( p-value of < 0.01), short stone–skin distance ( p-value of < 0.01), and small stone size ( p-value of < 0.01). On the other hand, gender and stone location within the kidney showed no association with ESWL outcomes.

Conclusion:

Kidney laterality, SSD, stone density, and size are influencing parameters on ESWL outcomes and achievement of stone-free status.
A Case Report of Recurrent Hypokalemia During Pregnancies Associated With Nonaldosterone-Mediated Renal Potassium Loss
Authors: Pintavorn Pairach , Munie Stephanie
Published: May 2021

Rationale:

Geller et al reported a rare mutation in the mineralocorticoid receptor (MR) resulting in constitutive MR activity. Progesterone, normally an MR antagonist, acts as a potent agonist with this mutation. Progesterone levels can increase 100-fold during pregnancy and thus lead to increased MR activity in this setting, resulting in hypertension (HTN) and hypokalemia during pregnancy and resolution of hypokalemia after delivery.

Presenting concerns:

Our patient was a 33-year-old African American female with a history of pregnancy-induced HTN associated with hypokalemia during her last pregnancy. She presented with muscle weakness from profound hypokalemia complicated by nephrogenic diabetes insipidus (DI) and rhabdomyolysis.

Diagnosis:

Her admission potassium was 1.9 mmol/L (3.5-5.1 mmol/L) with a 24-hour urine potassium of 35 mmol per day and an unmeasurable serum aldosterone level. Her potassium normalized 1 day after delivery off potassium supplementation and amiloride, which were last given 1 day prior to her delivery. Recurrent hypokalemia from nonaldosterone-mediated renal potassium wasting during pregnancy (with normal potassium in a nongestational state) is consistent with the cases of gain-of-function mutation in MR that Geller et al report. A definite diagnosis requires genetic analysis.

Interventions:

Her hypokalemia was refractory to potassium replacement but quickly responded to an inhibitor of the epithelial sodium channel (ENaC), amiloride.

Outcomes:

Her potassium normalized on amiloride 10 mg per day and KCL 40 mEq daily during the remainder of her pregnancy, and her nephrogenic DI resolved after this correction of hypokalemia. After her delivery, her potassium remained normal off the potassium supplements and amiloride.

Novel findings:

Pregnancy-induced hypokalemia from an activating MR mutation has rarely been reported. Pregnancy-induced HTN is often the first differential diagnosis in a patient who develops worsening in her HTN during pregnancy. We should also consider the possibility of a gain-of-function mutation in MR in these patients who also have associated hypokalemia.
Recruiting patients to a digital self-management study whilst in hospital for a chronic obstructive pulmonary disease exacerbation: A feasibility analysis
Authors: Whelan Maxine , Biggs Christopher , Areia Carlos , King Elizabeth , Lawson Beth , Newhouse Nikki , Ding Xiaorong , Velardo Carmelo , Bafadhel Mona , Tarassenko Lionel , Watkinson Peter , Clifton David , Farmer Andrew
Published: May 2021

Background

Patients with chronic obstructive pulmonary disease (COPD) are often hospitalised with acute exacerbations (AECOPD) and many patients get readmitted. Intervening with hospitalised patients may be optimal timing to provide support. Our previous work demonstrated use of a digital monitoring and self-management support tool in the community. However, we wanted to explore the feasibility of recruiting patients whilst hospitalised for an AECOPD, and to identify the rate of dropout attrition around admission for AECOPD.

Methods

Patients were recruited to the EDGE2 study between May 2019 and March 2020. Patients were identified by the clinical teams and patients were recruited by members of the clinical research team. Participants were aged 40 years or older, had a diagnosis of COPD and were attending or admitted to hospital for an AECOPD. Participants were given a tablet computer, Bluetooth-linked pulse oximeter and wrist-worn physical activity monitor to use until 6 months post-discharge. Use of the system aimed to support COPD self-management by enabling self-monitoring of vital signs, COPD symptoms, mood and physical activity, and access to multi-media educational resources.

Results

281 patients were identified and 126 approached. The main referral source was the specialist respiratory nursing and physiotherapist team (49.8% of patients identified). Twenty-six (37.1%) patients were recruited. As of 21 April 2020, 14 (53.8%) participants withdrew and 11 (of 14; 78.6%) participants withdrew within four weeks of discharge. The remaining participants withdrew between one and three months follow-up (1 of 14; 7.1%) and between three and six months follow-up (2 of 14; 14.3%).

Conclusion

A large number of patients were screened to recruit a relatively small sample and a high rate of dropout was observed. It does not appear feasible to recruit patients with COPD to digital interventional studies from the hospital setting when they have the burden of coping with acute illness.
Relapse recovery in multiple sclerosis: Effect of treatment and contribution to long-term disability
Authors: Sotiropoulos Marinos G , Lokhande Hrishikesh , Healy Brian C , Polgar-Turcsanyi Mariann , Glanz Bonnie I , Bakshi Rohit , Weiner Howard L , Chitnis Tanuja
Published: May 2021

Background

Although recovery from relapses in MS appears to contribute to disability, it has largely been ignored as a treatment endpoint and disability predictor.

Objective

To identify demographic and clinical predictors of relapse recovery in the first 3 years and examine its contribution to 10-year disability and MRI outcomes.

Methods

Relapse recovery was retrospectively assessed in 360 patients with MS using the return of the Expanded Disability Status Scale (EDSS), Functional System Scale and neurologic signs to baseline at least 6 months after onset. Univariate and multivariable models were used to associate recovery with demographic and clinical factors and predict 10-year outcomes.

Results

Recovery from relapses in the first 3 years was better in patients who were younger, on disease-modifying treatment, with a longer disease duration and without bowel or bladder symptoms. For every incomplete recovery, 10-year EDSS increased by 0.6 and 10-year timed 25-foot walk increased by 0.5 s. These outcomes were also higher with older age and higher baseline BMI. Ten-year MRI brain atrophy was associated only with older age, and MRI lesion volume was only associated with smoking.

Conclusions

Early initiation of disease-modifying treatment in MS was associated with improved relapse recovery, which in turn prevented long-term disability.
The Impact of “Manipulated News” on Student Attitudes and Perceptions and Their Participation in the Umbrella Movement in Hong Kong
Authors: Wong Chesca Ka Po , Zhu Runping , Krever Richard , Choi Alfred Siu
Published: May 2021

While the impact of fake news on viewers, particularly marginalized media users, has been a cause of growing concern, there has been little attention paid to the phenomenon of deliberately “manipulated” news published on social media by mainstream news publishers. Using qualitative content analysis and quantitative survey research, this study showed that consciously biased animated news videos released in the midst of the Umbrella Movement protests in Hong Kong impacted on both the attitudes of students and their participation in the protests. The findings raise concerns over potential use of the format by media owners to promote their preferred ideologies.
Patients with chronic mild or moderate traumatic brain injury have abnormal longitudinal brain volume enlargement more than atrophy
Authors: Ross David E , Seabaugh John D , Seabaugh Jan M , Plumley Jennifer , Ha Junghoon , Burton Jason A , Vandervaart Andrew , Mischel Ryan , Blount Alyson , Seabaugh Daniel , Shepherd Katherine , Barcelona Justis , Ochs Alfred L ,   for the Alzheimer’s Disease Neuroimaging Initiative
Published: May 2021

Introduction

Many studies have found brain atrophy in patients with traumatic brain injury (TBI), but most of those studies examined patients with moderate or severe TBI. A few recent studies in patients with chronic mild or moderate TBI found abnormally large brain volume. Some of these studies used NeuroQuant®, FDA-cleared software for measuring MRI brain volume. It is not known if the abnormal enlargement occurs before or after injury. The purpose of the current study was to test the hypothesis that it occurs after injury.

Methods

55 patients with chronic mild or moderate TBI were compared to NeuroQuant® normal controls ( n > 4000) with respect to MRI brain volume change from before injury (time 0 [t0], estimated volume) to after injury (t1, measured volume). A subset of 36 patients were compared to the normal controls with respect to longitudinal change of brain volume after injury from t1 to t2.

Results

The patients had abnormally fast increase of brain volume for multiple brain regions, including whole brain, cerebral cortical gray matter, and subcortical regions.

Discussion

This is the first report of extensive abnormal longitudinal brain volume enlargement in patients with TBI. In particular, the findings suggested that the previously reported findings of cross-sectional brain volume abnormal enlargement were due to longitudinal enlargement after, not before, injury. Abnormal longitudinal enlargement of the posterior cingulate cortex correlated with neuropathic headaches, partially replicating a previously reported finding that was associated with neuroinflammation.
China’s Preschool Education Toward 2035: Views of Key Policy Experts
Authors: Jiang (姜勇) Yong , Zhang (张蓓蓓) Beibei , Zhao (赵颖) Ying , Zheng (郑楚楚) Chuchu
Published: May 2021

Purpose:

2020 is the concluding year of the basic preschool education popularization policy in China and marks the beginning of China’s Education Modernization 2035. This study focuses on the top-level design and the prospect of the development plan of China’s preschool education toward 2035.

Design/Approach/Methods:

The research method adopted is expert interview. We interviewed 11 experts, including policymakers, educational administrators, scholars, and practitioners in the education.

Findings:

To develop China’s preschool education, we need to integrate macro-level, meso-level, and micro-level contents: focusing on public welfare as the development concept, furthering the reform of the educational system and mechanism, making quality improvement the plan’s key goal, and forming a new preschool education development mode with Chinese characteristics.

Originality/Value:

This study hopes to clarify the focus to have an impact on China’s preschool education toward 2035. It also aims to provide suggestions about preschool education development for other countries.
Organizing and Reconstructing Children’s Experiences: Compiling National Civic Textbooks in China
Authors: Gao (高德胜) Desheng , Zhang (张悦) Yue
Published: May 2021

Purpose:

The key to successful textbook compilation lies in incorporating children’s experiences and facilitating their growth. This study examines the process of textbook compilation.

Design/Approach/Methods:

This study criticizes the traditional compiling approach of excessive lecturing and reasoning. It further elaborates the theoretical and institutional background for the traditional approach. Involving retrospective narratives, researchers reflect on how new textbook compilation tends to connect with children’s experience.

Findings:

Researchers have explored several approaches to organizing and reconstructing children’s experiences in preparing textbooks, including using “an experience” to awaken children’s experiences, using the expression of experience to reconstruct children’s experience, and transforming children’s “experience” ( jing yan, 经验) into lived experiences ( ti yan, 体验). Another approach involves facilitating the connection and interaction between children’s experiences and those of others in order to bridge personal experience and sociocultural values. However, this can only be achieved by ensuring that textbooks reflect and are part of children’s lives. The successful incorporation of children’s experiences into textbook compilation lays the foundation for children to identify with textbooks and internalize textbook values.

Originality/Value:

Bridging the gap between children’s experience and textbooks constitutes the primary theoretical and practical issue in textbook compilation and education.
Experiences and Perspectives on Adopting New Practices for Social Needs-targeted Care in Safety-net Settings: A Qualitative Case Series Study
Authors: Nehme Eileen , Castedo de Martell Sierra , Matthews Hannah , Lakey David
Published: May 2021

Introduction

Clinical settings are being encouraged to identify and address patients’ social needs within the clinic or through partner organizations. The purpose of this qualitative study was to describe the current practice of social needs-targeted care in 3 Texas safety net clinics, and facilitators and barriers to adopting new social needs-targeted care tools and practices.

Methods

Interviews were conducted with staff at 3 safety net clinics serving small and mid-sized communities. Analysis focused on perspectives and decisions around adopting new tools or practices related to social needs-targeted care, including standardized screening tools and community resource referral platforms.

Results

Nine staff across 3 organizations were interviewed. Two organizations were currently using a standard social needs screening tool in their routine practice, and a third was considering doing so. One organization had adopted a community resource referral platform in partnership with a large community collaboration. Three case studies illustrate a range of facilitators, barriers, perceived benefits, and drawbacks influencing social needs-targeted practices. Benefits of systematic data collection on social needs included the generation of data for community action. Drawbacks include concerns about data privacy. Community resource referral platforms were seen as valuable for creating accountability, but required an influential community partner and adequate community resources. Concerns about disempowering clients and blurring roles were voiced, and potential to increase provider job satisfaction was identified.

Conclusions

Benefits and drawbacks of adopting new tools and practices related to social needs-targeted care are strongly influenced by the community context. For the adoption of community resource referral platforms, the outer setting is particularly relevant; adoption readiness is best assessed at the community or regional level rather than the clinic system level. While screening tools are much easier than referral platforms for clinics to adopt, the ability to address identified needs remains heavily based on the outer setting.
Associations Between Obesity With Low Muscle Mass and Physical Function in Patients With End-Stage Knee Osteoarthritis
Authors: Kim Beom Su , Lee So Young , Kim Bo Ryun , Choi Jun Hwan , Kim Sang Rim , Lee Hyun Jung , Lee Su Jong
Published: May 2021

Objective:

To investigate the prevalence of obesity with low muscle mass and its impact on physical function, quality of life (QOL) and pain in patients with end-stage knee osteoarthritis over 65 years old.

Methods:

In this cross-sectional study, we assessed a total of 562 patients. After separating the group into males and females, we divided patients into 4 further groups: normal BMI with normal muscle mass, obesity with normal muscle mass, normal BMI with low muscle mass and obesity with low muscle mass. All patients completed stair climbing test (SCT), 6-minute walk test, timed up and go test (TUG), instrumental gait analysis, Western Ontario McMaster Universities Osteoarthritis Index, VAS, and EuroQOL 5 dimensions questionnaire.

Results:

Obesity with low muscle mass was diagnosed in 6 males subjects (7.8%) and 9 female subjects (1.9%). Patients with obesity and low muscle mass performed the SCT-ascent and descent significantly slower than other body composition groups in both males and females. TUG in males and gait speed in females were also significantly slower in the obesity with low muscle mass group. Stepwise multiple linear regression analysis revealed that in males, obesity with low muscle mass was significantly predictive of SCT ascent (β = 0.409, p < 0.001), SCT-descent (β = 0.405, p < 0.001), and TUG (β = 0.283, p = 0.009), and in females, obesity with low muscle mass was significantly predictive of SCT-ascent (β = 0.231, p < 0.001), SCT-descent (β = 0.183, p < 0.001), and gait speed (β=-0.129, p = 0.004).

Conclusions:

This study confirms that the combination of obesity and low muscle mass is associated with impaired physical function in patients with end-stage knee osteoarthritis.
A Patient-Centered Integrative Approach Improves Visual Field Defect: A Case Report
Authors: Kao Lan , Hui Ka-Kit , Hui Edward
Published: May 2021

We present a case involving a patient with a complicated visual field defect preventing her from renewing her driver license. It highlights the underappreciated role of chronic stress in the genesis and perpetuation of ill health and the potential of Chinese medicine (CM) to complement biomedicine in the treatment of an intractable visual disorder. The patient experienced impaired vision from age 15, and ophthalmologists considered various diagnoses including optic neuritis and acute zonal occult outer retinopathy (AZOOR)-complex disorder with acute macular neuroretinopathy. She was treated with an integrative East-West medical approach incorporating acupuncture, cupping, trigger point injections, guidance on self-care and lifestyle modification. Although the eye disorder was not cured, there was visual improvement as demonstrated by various objective ophthalmologic tests, and the patient was able to renew her driver license. Visual improvement remained stable upon follow-up examination three years after the treatment intervention. Other concomitant health issues reported by the patient also improved including amelioration of neck pain, a more regular menstrual cycle, and decreased anxiety. This case demonstrates how a patient with an intractable complex eye disorder can have objective visual improvement when treated with an integrative patient-centered approach.
Book Review: Jennifer Bussell. Clients and Constituents: Political Responsiveness in Patronage Democracies
Authors: Singh Priyadarshini
Published: May 2021

Jennifer Bussell. Clients and Constituents: Political Responsiveness in Patronage Democracies. Delhi, India: Oxford University Press, 2019. 369 pages. ₹1,100.
Book Review: Ujjwal Kumar Singh and Anupama Roy. Election Commission of India: Institutionalising Democratic Uncertainties
Authors: Tripathi Vikas
Published: May 2021

Ujjwal Kumar Singh and Anupama Roy. Election Commission of India: Institutionalising Democratic Uncertainties. New Delhi, India: Oxford University Press. 2019. 366 pages. ₹1,100.
Posterior Extra-articular Ischiofemoral Impingement Can Be Caused by the Lesser and Greater Trochanter in Patients With Increased Femoral Version: Dynamic 3D CT–Based Hip Impingement Simulation of a Modified FABER Test
Authors: Lerch Till D. , Zwingelstein Sébastien , Schmaranzer Florian , Boschung Adam , Hanke Markus S. , Todorski Inga A.S. , Steppacher Simon D. , Gerber Nicolas , Zeng Guodong , Siebenrock Klaus A. , Tannast Moritz
Published: May 2021

Background:

Posterior extra-articular hip impingement has been described for valgus hips with increased femoral version (FV). These patients can present clinically with lack of external rotation (ER) and extension and with a positive posterior impingement test. But we do not know the effect of the combination of deformities, and the impingement location in early flexion is unknown.

Purpose:

To evaluate patient-specific 3-dimensional computed tomography (3D CT) scans of hips with increased FV and control hips for differences in range of motion, location and prevalence of osseous posterior intra- and extra-articular hip impingement.

Study Design:

Case series; Level of evidence, 4.

Methods:

Osseous 3D models based on segmentation of 3D CT scans were analyzed for 52 hips (38 symptomatic patients) with positive posterior impingement test and increased FV (>35°). There were 26 hips with an increased McKibbin instability index >70 (unstable hips). Patients were mainly female (96%), with an age range of 18 to 45 years. Of them, 21 hips had isolated increased FV (>35°); 22 hips had increased FV and increased acetabular version (AV; >25°); and 9 valgus hips (caput-collum-diaphyseal angle >139°) had increased FV and increased AV. The control group consisted of 20 hips with normal FV, normal AV, and no valgus (caput-collum-diaphyseal angle <139°). Validated 3D CT–based collision detection software for impingement simulation was used to calculate impingement-free range of motion and location of hip impingement. Surgical treatment was performed after the 3D CT–based impingement simulation in 27 hips (52%).

Results:

Hips with increased FV had significantly ( P < .001) decreased extension and ER at 90° of flexion as compared with the control group. Posterior impingement was extra-articular (92%) in hips with increased FV. Valgus hips with increased FV and AV had combined intra- and extra-articular impingement. Posterior hip impingement occurred between the ischium and the lesser trochanter at 20° of extension and 20° of ER. Impingement was located between the ischium and the greater trochanter or intertrochanteric area at 20° of flexion and 40° of ER, with a modification of the flexion-abduction-ER (FABER) test.

Conclusion:

Posterior extra-articular ischiofemoral hip impingement can be caused by the lesser and greater trochanter or the intertrochanteric region. We recommend performing the modified FABER test during clinical examination in addition to the posterior impingement test for female patients with high FV. In addition, 3D CT can help for surgical planning, such as femoral derotation osteotomy and/or hip arthroscopy or resection of the lesser trochanter.