bluuebunny/crossref_metadata_2025 huggingface dataset:
HE4 might be a more useful tumor biomarker to detect malignancy in patients with ovarian endometrioma when malignancy is suspected
Authors: Rius Mariona , Fusté Pere , Ros Cristina , Martínez-Zamora Ángeles , deGuirior Cristian , Gracia Meritxell , Mension Eduard , Carmona Francisco
Published: September 2021

Objective

To analyze the utility of carbohydrate antigen (CA)125 and human epididymis protein 4 (HE4) to detect malignancy in women with ovarian endometriosis, when ovarian cancer is suspected and ultrasonography results are inconclusive.

Methods

Women who underwent surgery between 2015 and 2019 for ovarian endometriosis or for adnexal masses, with a final diagnosis of ovarian carcinoma (clear cell and endometrioid) were included in this retrospective study. The women were divided into three groups: ovarian endometriosis (OE), ovarian carcinoma without endometriosis (OC), and ovarian carcinoma with endometriosis (OC + E). Adnexal masses were assessed preoperatively by transvaginal ultrasonography according to the International Ovarian Tumor Analysis (IOTA) simple rules, and CA125 and HE4 blood levels were obtained.

Results

Of 208 women, 45 had malignancy, 16 in the OC + E group and 29 in the OC group. According to transvaginal ultrasonography, 13 were classified as undetermined risk of malignancy: OC group: 3, OE group: 3, and OC + E group: 7. When we compared the tumor biomarkers, significant differences in HE4 but not in CA125 levels were found between the groups.

Conclusions

When ovarian malignancy is suspected in patients with ovarian endometriosis, HE4 is a more useful tumor biomarker to diagnose OC when ultrasonography results are inconclusive.
Diagnostic value of anti-cyclic citrullinated peptide antibody combined with rheumatoid factor in rheumatoid arthritis in Asia: a meta-analysis
Authors: Yang Xiaochun , Cai Yue , Xue Bin , Zhang Bo
Published: September 2021

Objective

This meta-analysis explored the diagnostic value of anti-cyclic citrullinated peptide antibody (anti-CCP) and rheumatoid factor (RF) for rheumatoid arthritis (RA) in the Asian population.

Methods

Embase, Medline, Cochrane Library, Chinese Science and Technology Periodicals, China National Knowledge Infrastructure, and China Wanfang Databases were searched from 1 January 2000 to 1 February 2021 to collect studies on the combined detection of anti-CCP and RF for diagnosing RA. The sensitivity, specificity, diagnostic odds ratio (DOR), positive likelihood ratio (+LR), and negative likelihood ratio (−LR) were combined and analyzed. Summary receiver operating characteristic (SROC) curves were drawn.

Results

Twenty-four published papers were analyzed, including 21 combined in series and 8 combined in parallel. In the tandem analysis, the sensitivity = 0.64 [95% confidence interval (CI): 0.58–0.70], specificity = 0.97 (95%CI: 0.95–0.98), +LR = 19.70 (95%CI: 12.74–30.46), −LR = 0.37 (95%CI: 0.31–0.43), DOR = 53.43 (95%CI: 34.46–82.40), and area under the SROC curve = 0.89. In the parallel combination, the sensitivity = 0.87 (95%CI: 0.80–0.92), specificity = 0.76 (95%CI: 0.67–0.84), +LR = 3.68 (95%CI: 2.62–5.17), −LR = 0.17 (95%CI: 0.11–0.26), DOR = 21.56 (95%CI: 11.63–39.99), and area under the SROC curve = 0.89.

Conclusion

Anti-CCP and RF combined detection improves the diagnostic efficiency of RA, providing a potential strategy for early clinical screening in the Asian population. This trial was retrospectively registered in the INPLASY/Research Registry ( https: //inplasy.com/ ) with the registration number INPLASY202180106.
Twenty-Year Outcomes After Anterior Cruciate Ligament Reconstruction: A Systematic Review of Prospectively Collected Data
Authors: Everhart Joshua S. , Yalcin Sercan , Spindler Kurt P.
Published: September 2021

Background:

Several long-term (≥20 years) follow-up studies after anterior cruciate ligament (ACL) reconstruction have been published in recent years, allowing for a systematic evaluation of outcomes.

Purpose:

To summarize outcomes at ≥20 years after ACL reconstruction and identify patient and surgical factors that affect these results.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

Prospective studies of primary ACL reconstructions with hamstring or bone–patellar tendon—bone (BTB) autograft via an arthroscopic or a mini-open technique and with a mean follow-up of ≥20 years were identified. When possible, the mean scores for each outcome measure were calculated. Factors identified in individual studies as predictive of outcomes were described.

Results:

Five studies met the inclusion and exclusion criteria with a total of 2012 patients. The pooled mean follow-up for patient-reported outcome measures was 44.2% (range, 29.6%-92.7%) and in-person evaluation was 33.2% (range, 29.6%-48.9%). Four studies (n = 584) reported graft tears at a mean rate of 11.8% (range, 2%-18.5%) and 4 studies (n = 773) reported a contralateral ACL injury rate of 12.2% (range, 5.8%-30%). Repeat non-ACL arthroscopic surgery (4 studies; n = 177) to the ipsilateral knee occurred in 10.4% (range, 9.5%-18.3%) and knee arthroplasty (1 study; n = 217) in 5%. The pooled mean of the International Knee Documentation Committee subjective knee function (IKDC) score was 79.1 (SD, 21.8 [3 studies; n = 644]). In 2 studies (n?= 221), 57.5% of patients continued to participate in strenuous activities. The IKDC-objective score was normal or nearly normal in 82.3% (n = 496; 3 studies), with low rates of clinically significant residual laxity. Moderate-severe radiographic osteoarthritis (OA) (IKDC grade C or D) was present in 25.9% of patients (n = 605; 3 studies). Medial meniscectomy is associated with increased risk of radiographic OA. Radiographic OA severity is associated with worse patient-reported knee function, but the association with knee pain is unclear.

Conclusion:

Currently available prospective evidence for ACL reconstruction with hamstring or BTB autograft provides several insights into outcomes at 20 years. The rates of follow-up at 20 years range from 30% to 93%. IKDC-objective scores were normal or nearly normal in 82% and the mean IKDC-subjective score was 79 points.
Age-Related Changes in the Microvascular Density of the Human Meniscus
Authors: Michel Philipp A. , Domnick Christoph J. , Raschke Michael J. , Hoffmann Anna , Kittl Christoph , Herbst Elmar , Glasbrenner Johannes , Hardes Jendrik , Streitbürger Arne , Gosheger Georg , Herbort Mirco
Published: September 2021

Background:

The microvascular anatomy of the meniscus of the human knee is regarded as a crucial factor in the injury response. Previous studies have investigated the zone-dependent distribution pattern, but no quantitative data exist on vascular density and its age-related changes.

Hypothesis/Purpose:

The aim of the present study was to histologically analyze the vascular anatomy of the meniscus as a function of age. It was hypothesized that vascular density would decrease with increasing age.

Study Design:

Descriptive laboratory study.

Methods:

Human menisci were retrieved from patients who underwent tumor resection or who received total knee replacement because of osteoarthritis. A total of 51 menisci were collected from 28 patients over 9 years (mean age, 25.6 ± 20.4 years; range 3-79 years). Immunohistological staining (alpha–smooth muscle actin) in combination with serial sections and standardized software-based contrast detection were used for the quantitative analysis. Data were analyzed using multiple t tests and the analysis of variance for trends, with a statistical significance level of P < .05.

Results:

The overall vascular density in the meniscus was lower in the 61- to 80-year age group than in the age groups of 0 to 10, 11 to 20, and 21 to 30 years ( P < .01). A negative linear trend was detected with increasing age (slope, -0.007; P = .016). Within the red-white (RW) zone, a low vessel density was detected for the age groups of 0 to 10 and 11 to 20 years. Beyond these age groups, no vasculature was found in the RW zone. For the white-white (WW) zone, no vessel formations were noted in any age group. Almost 95% of the vessels in the meniscus were located in the capsule.

Conclusion:

This study reports quantitative histological data for microvascular anatomy as a function of age in a broad cohort of human knee menisci. The overall vascular density decreased with increasing age. No vessel formations were detected in the RW and WW zones after adolescence. Additionally, the capsule is far more densely vascularized than any other part of the meniscus.

Clinical Relevance:

Vascular density might be an additional factor to consider, along with tear location and patient age, for future treatment options.
Prediction of Hamstring Injuries in Australian Football Using Biceps Femoris Architectural Risk Factors Derived From Soccer
Authors: Lee Dow Connor , Timmins Ryan G. , Ruddy Joshua D. , Williams Morgan D. , Maniar Nirav , Hickey Jack T. , Bourne Matthew N. , Opar David A.
Published: September 2021

Background:

Hamstring strain injuries are the most common injuries in team sports. Biceps femoris long head architecture is associated with the risk of hamstring injury in soccer. To assess the overall predictive ability of architectural variables, risk factors need to be applied to and validated across different cohorts.

Purpose:

To assess the generalizability of previously established risk factors for a hamstring strain injury (HSI), including demographics, injury history, and biceps femoris long head (BFlh) architecture to predict HSIs in a cohort of elite Australian football players.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Demographic, injury history, and BFlh architectural data were collected from elite soccer (n = 152) and Australian football (n = 169) players at the beginning of the preseason for their respective competitions. Any prospectively occurring HSIs were reported to the research team. Optimal cut points for continuous variables used to determine an association with the HSI risk were established from previously published data in soccer and subsequently applied to the Australian football cohort to derive the relative risk (RR) for these variables. Logistic regression models were built using data from the soccer cohort and utilized to estimate the probability of an injury in the Australian football cohort. The area under the curve (AUC) and Brier score were the primary outcome measures to assess the performance of the logistic regression models.

Results:

A total of 27 and 30 prospective HSIs occurred in the soccer and Australian football cohorts, respectively. When using cut points derived from the soccer cohort and applying these to the Australian football cohort, only older athletes (aged ≥25.4 years; RR, 2.7 [95% CI, 1.4-5.2]) and those with a prior HSI (RR, 2.5 [95% CI, 1.3-4.8]) were at an increased risk of HSIs. Using the same approach, height, weight, fascicle length, muscle thickness, pennation angle, and relative fascicle length were not significantly associated with an increased risk of HSIs in Australian football players. The logistic regression model constructed using age and prior HSIs performed the best (AUC = 0.67; Brier score = 0.14), with the worst performing model being the one that was constructed using pennation angle (AUC = 0.53; Brier score = 0.18).

Conclusion:

Applying cut points derived from previously published data in soccer to a dataset from Australian football identified older age and prior HSIs, but none of the modifiable HSI risk factors, to be associated with an injury. The transference of HSI risk factor data between soccer and Australian football appears limited and suggests that cohort-specific cut points must be established.
Effects of Category Labeling With Emojis on Likert-Type Scales on the Psychometric Properties of Measurements
Authors: İlhan Mustafa , Taşdelen Teker Gülşen , Güler Neşe , Ergenekon Ömer
Published: September 2021

Today, emoji have become a popular option for anchoring the categories of Likert-type scales applied to not only adults but also children. The aim of this study was to investigate the effects of category labeling with emoji by comparing the psychometric properties of the emoji- and verbal-anchored versions of the mathematics motivation scale applied to students aged 8–11 years (grades 3, 4, and 5). The participants of the study comprised 658 students. According to the research results, students used the upper categories of the scale more intensively in the emoji-anchored version than in the verbal-anchored one. Parallel to this, the means calculated for the emoji-anchored version were found to be significantly higher. Moreover, the results of the research revealed that the verbal-anchored scale form yielded more reliable and valid measures than the emoji-anchored version.
Pathways From Narcissism to Leadership Emergence in Social Groups
Authors: Härtel Tobias M. , Leckelt Marius , Grosz Michael P. , Küfner Albrecht C. P. , Geukes Katharina , Back Mitja D.
Published: September 2021

Narcissists successfully emerge as leaders. However, the processes by which this occurs are mostly unknown. Following a dual-pathway approach and differentiating between agentic (narcissistic admiration) and antagonistic (narcissistic rivalry) narcissism, we investigated the behavioral processes underlying narcissists’ leadership emergence in social groups. We applied data from a multimethodological laboratory study ( N = 311) comprising three groups of variables: personality traits, expressed interaction behaviors, and interpersonal perceptions. Prior to the laboratory sessions, participants provided self-reported answers to various narcissism measures. Interpersonal perceptions were obtained from round-robin ratings after participants completed the Lost on the Moon task in small groups. Participants’ behaviors during the group discussion were videotaped and coded by trained raters. Results supported the notion of a pathway from agentic narcissism to leadership (measured as target effects of being seen as a leader) determined by narcissistic admiration, dominant-expressive behavior, and being seen as assertive. To clarify narcissism’s relationship to leadership emergence, the effects were (a) contrasted with narcissism’s effects on popularity and (b) set in relation to process pathways leading from intelligence and physical attractiveness to leadership. The findings underscore the benefits of a behavioral pathway approach for unravelling the impact of narcissism on leadership emergence.
A Patchwork of Femininities: Working-Class Women’s Fluctuating Gender Performances in a Pakistani Market
Authors: Kamran Sidra
Published: September 2021

Scholars have studied multiple femininities across different spaces by attributing variation to cultural/spatial contexts. They have studied multiple femininities in the same space by attributing variation to class/race positions. However, we do not yet know how women from the same cultural, class, and race locations may enact multiple femininities in the same context. Drawing on observations and interviews in a women-only bazaar in Pakistan, I show that multiple femininities can exist within the same space and be enacted by the same individual. Working-class women workers in Meena Bazaar switched between performances of “pariah femininity” and “hegemonic femininity,” patching together contradictory femininities to secure different types of capital at the organizational and personal levels. Pariah femininities enabled access to economic capital but typically decreased women’s symbolic capital, whereas hegemonic femininities generated symbolic capital but could block or enable access to economic capital. The concept of a patchwork performance of femininity explains how and why working-class women simultaneously embody idealized and stigmatized forms of femininity. Furthermore, it captures how managerial regimes and personal struggles for class distinction interact to produce contradictory gender performances. By examining gender performances in the context of social stratification, I explain the structural underpinnings of working-class women’s gendered struggles for respectability and work.
Theta-Rhythmic Oscillation of Working Memory Performance
Authors: Pomper Ulrich , Ansorge Ulrich
Published: September 2021

Representations held in working memory are crucial in guiding human attention in a goal-directed fashion. Currently, it is debated whether only a single representation or several of these representations can be active and bias behavior at any given moment. In the present study, 25 university students performed a behavioral dense-sampling experiment to produce an estimate of the temporal-activation patterns of two simultaneously held visual templates. We report two key novel results. First, performance related to both representations was not continuous but fluctuated rhythmically at 6 Hz. This corresponds to neural oscillations in the theta band, the functional importance of which in working memory is well established. Second, our findings suggest that two concurrently held representations may be prioritized in alternation, not simultaneously. Our data extend recent research on rhythmic sampling of external information by demonstrating an analogous mechanism in the cyclic activation of internal working memory representations.
Are the Poor Catching Up with the Rich in Utilising Maternal Health Care Services? Evidence from India
Authors: Paul Sohini
Published: September 2021

India launched the National Rural Health Mission (NRHM) in 2005 to improve maternal and child health by providing good quality health services to all, especially deprived sections of society, to reduce inequality in access to health services. With the backdrop of NRHM, we analysed the extent to which the utilisation of maternal health care services (MHCSs) in the three stages of the continuum of care—antenatal care (ANC), care during child delivery and postnatal care (PNC)—–has improved among the poor vis-à-vis the rich in India, and the corresponding narrowing down in inequality in the period 2006–2016. Data from the 3rd round of the National Family Health Survey (NFHS) in 2005–2006, capturing the pre-NRHM period and the 4th round of NFHS 2015–2016, capturing the post-NRHM era ten years after the implementation of the flagship programme, are used for the analysis. We estimated absolute as well as relative measures of inequality, absolute gap and coverage ratio between the poor and rich, slope index of inequality and concentration index. Our findings show that maternal health care coverage increased significantly among the poor for all components of MHCSs. Even so, the extent of utilisation of services remains significantly lower among the poor in 2015–2016 compared to the coverage among the rich in 2005–2006. Although inequality declined at the national level over the decade, it still persists. High equity has been achieved in using skilled birth attendance during child delivery and institutional delivery during 2015–2016, however, inequality continues to be higher for ANC indicators including consumption of iron and folic acid supplements for at least 100 days, receipt of four or more antenatal check-ups and comprehensive health check-ups at least once during antenatal visits and receipt of first check-up in the first trimester.
Impact of Supply Chain Performance on Firms’ Export Capability: Development of a Statistical Model
Authors: Talukder Bijoy , Tripathi Saswati
Published: September 2021

The purposes of this article are to establish the crucial indicators of supply chain performance (SCPI) impacting firms’ export performance, revealing its unique characteristics, and assess the effects of these SCPIs on the export capability of the firms. This article develops a statistical model, involving how critical SCPIs can influence firms’ export performance. The developed model is then empirically validated using top 53 firm-level data, based on market share, from the Indian pharmaceutical industry, taken for 10 years. The randomized complete block design approach is employed to confirm the variation of export intensity across firms and time. A panel data fixed-effects model is developed, associating critical SCPIs with export intensity to understand their impact on export performance. Finally, bootstrap is applied as a cross-validation procedure to carry out model authentication. This article contributes to obtaining crucial SCPIs and their impact on firms’ export competitiveness. It has revealed that firms’ raw material import efficiency, working capital efficiency, asset management efficiency, research and development (R&D) capability, and the total cost to serve have a significant impact on the firms’ export capability. The proposed model can help firms make appropriate decisions about different influencing parameters of supply chain performance to improve their export competitiveness.
Women's consumption of men's professional sport in Canada: Evidence of the ‘feminization’ of sports fandom and women as omnivorous sports consumers?
Authors: Gemar Adam , Pope Stacey
Published: September 2021

Women sports fans have been substantially understudied compared to their male counterparts. While a growing number of studies seek to redress this, there remains a stark absence of quantitative approaches that would allow investigations regarding patterns of women’s sporting consumption and historical trends in the potential growth of this fandom. Using large-scale survey data from Canada from 1990 through to 2015, and employing quantitative methods of latent class and regression analysis, this study seeks to redress these issues by testing the ‘feminization’ thesis of increased women’s sporting fandom over the past three decades. In addition, we consider whether women’s fandom has become increasingly ‘omnivorous’ over this time period and the nature of this consumption today. Results show support for the feminization thesis. These findings are significant as through the use of quantitative methodologies we evidence the narrowing gender gaps in professional sports following between men and women, and women’s increasingly omnivorous consumption of sports. However, we find substantial gender gaps and inequalities in omnivorism by which the evidence suggests increased socio-economic and cultural barriers to omnivorous consumption of sport for women. We suggest that these women omnivores may be able to utilize their sporting knowledge in an instrumental way for benefits in various social settings, especially workplaces. It is hoped that this article will pave the way for further quantitative studies on women sports fans across different contexts.
Public service media, sports and cultural citizenship in the age of social media: An analysis of BBC Sport agenda diversity on Twitter
Authors: Ramon Xavier , Rojas-Torrijos José Luis
Published: September 2021

As a crucial part of their mandate, public service media have historically used sports to construct and nurture cultural citizenship. In a landscape characterised by dwindling resources and growing competition from pay-TV channels and on-demand streaming services, concerns about how public service media will enhance cultural citizenship through new platforms, including social media, are all the greater. In the digital age, delivering diverse content should remain a foundation of public service media in their countless platforms: public media should not only concentrate on major sports but also provide exposure to traditionally underrepresented disciplines and individuals, including sportswomen and athletes with disabilities. Through content analysis, this research examines the agenda diversity offered by the British Broadcasting Corporation through its sports-centred Twitter account ( @BBCSport). The analysis of 10,821 tweets indicates how the British Broadcasting Corporation's content reinforces, rather than counteracts, the long-standing diversity imbalances in the analogue age. This case study facilitates an understanding of the nuanced relationship among public service media, social media and sports, demonstrating that more content does not necessarily ensure diversity. The football-driven, male-centred and able-bodied agenda displayed by @BBCSport signals that public service media should reframe their social media strategies to adequately contribute to fostering cultural citizenship.
The Effect of Triggered Palliative Medicine Consults on Nurse Moral Distress in the Medical Intensive Care Unit
Authors: Piscitello Gina M. , Lamadrid Vivien Joy , Post Zoë , Kaur Ramandeep , Gulczynski Barbara , Baldeo Ryan , Hudoba Christine , O’Mahony Sean , Chen Elaine , Greenberg Jared
Published: September 2021

Purpose:

Moral distress in the intensive care unit contributes to negative emotional experiences in nurses and adversely affects patient care. This prospective cohort study evaluates an intervention designed to improve nurse moral distress in the medical intensive care unit and assesses patient outcomes which may improve moral distress.

Methods:

Nurse moral distress was measured before and after an intervention of triggered palliative consults and scheduled family meetings in the intensive care unit during the COVID-19 pandemic. Patient outcomes in the intervention medical intensive care unit were compared to a control group.

Results:

Forty-eight nurses (n = 48/78, 62%) completed the pre-intervention survey and 33 (n = 33/78, 42%) completed the post-intervention survey. Nurse moral distress using the MMD-HP scale pre- and post-intervention (122.5 vs. 134.0, P = 0.1210) was not statistically different. Intervention group patients (n = 57/64, 89%) had earlier transition to do not resuscitate status (hazard ratio 2.1, 95% CI 1.1-4.0, P = 0.0294), higher rate of documented alternate decision makers (100% vs. 61%, P < 0.0001), and higher rate discharged to a facility (28% vs. 14%) or hospice (19% vs. 7%) (P = 0.0090). Intervention group patients with a do not resuscitate (DNR) order had lower median length of stay in the intensive care unit (4 days vs. 13 days, P = 0.0004) and hospital (10 days vs. 21 days, P = 0.0005), and lower median total hospital costs per patient ($39,067 vs. $116,476, P = 0.0029) when compared control group patients with a DNR order.

Conclusion:

Triggered palliative consults with scheduled family meetings were not associated with change in nurse moral distress. More research is needed to uncover methods to improve nurse moral distress in the intensive care unit.
Curricular Efforts in Technical Communication After the Social Justice Turn
Authors: Agboka Godwin Y. , Dorpenyo Isidore K.
Published: September 2021

The social justice turn in technical and professional communication (TPC) has inspired a substantial body of progressive scholarship and discussion. But it is not clear how these scholarly efforts have shaped (or are shaping) programmatic and curricular efforts. This article reports the findings of a survey of TPC instructors and an analysis of 231 TPC programs to examine their curricular efforts toward social justice. Drawing from the mixed findings, the authors argue that vigorous curricular efforts in social justice enable TPC to fully and practically demonstrate the core mandate of our discipline.
Targeted Education for School Staff on Electronic Nicotine Delivery Systems: A Nurse Led Intervention
Authors: Smith Lorraine M. , Boehm Lindsey , Strang Lyndsey V. , DeMarre Chelsea , Marcyjanik Diane
Published: September 2021

There is a public health epidemic in adolescents’ use of Electronic Nicotine Delivery Systems (ENDSs), also known as electronic cigarettes, vaping products, or JUULs. However, little is known about the level of knowledge school staff have about ENDS. The purpose of this study is to examine outcomes of a nurse-led educational intervention designed to increase school staff knowledge about ENDS. A descriptive, nonrandomly selected pre-test/post-test design was used with 125 Wisconsin school staff. Results revealed further educational needs of school staff in content areas including advertising to youth and flavoring of ENDS. Following the educational intervention, post-test results showed a significant overall improvement in participant knowledge scores. Recommendations include implementing nurse-led education about ENDS to a more diverse population of school staff. Providing nurse-led ENDS education to school staff offers an upstream, proactive approach for school nurses to help address this public health epidemic.
Inflammation Suppresses Patients’ Ability to Metabolize Cytochrome P450 Substrate Drugs
Authors: White C. Michael
Published: September 2021

Objective:

To assess the impact of inflammation on cytochrome P450 (CYP) drug metabolism in human subjects.

Data Sources:

A PubMed search was done from 1980 to July 2021 limited to human subjects and English language using a search strategy of (((phase I metabolism) OR (CYP) OR (cytochrome P450)) AND (inflammatory OR inflammation)).

Study Selection and Data Extraction:

Narrative review of human studies assessing the impact of inflammation or inflammatory suppression with biologic drugs on CYP drug metabolism were used.

Data Synthesis:

Patients with inflammatory conditions ranging from fungal, viral, or bacterial infections to noninfectious causes (critical illness, surgical procedure, cancer, or transplantation of stem cells or organs) have suppressed drug metabolism. Markers of inflammation such as C-reactive protein or α-1-acid glycoprotein are correlated with reduced clearance through CYP3A4, CYP1A2, and CYP2C19. Elevated interleukin-6 concentrations are also associated or correlated with reduced clearance for CYP3A4 and CYP2C-19 isoenzymes. There was insufficient information to properly assess CYP2D6.

Relevance to Patient Care and Clinical Practice:

Health professionals should appreciate that patients with acute or chronic inflammation from infectious or noninfectious causes could have suppressed drug metabolism through CYP3A4, CYP1A2, and CYP2C19. For narrow therapeutic index drugs, such as many of the drugs assessed in this review, that means more judicious drug monitoring to prevent adverse events.

Conclusions:

Like other types of drug-drug or drug-disease interactions, inflammation can alter the steady-state concentration of CYP metabolized drugs.
Ultimate Load Measuring System for Fixation of Soft Tissue to Bone
Authors: Fujii Tatsuya , Tateura Makoto , Ogawa Masato , Ozeki Satoru
Published: September 2021

Background:

The initial ultimate load for graft fixation is one of the essential factors in the reconstruction of lateral ankle ligaments. Several anchoring devices have been developed to fix the substitute ligament into the bone. A fair comparison of these fixation methods warrant a reproducible examination system. The purpose of this study was to make an experimental animal model and to compare the initial ultimate loads of 3 graft fixation methods, including the use of EndoButton (EB), interference screw (IFS), and a novel socket anchoring (SA) technique.

Methods:

Porcine calcaneus bones and 5-mm-wide split bovine Achilles tendons were used as fixation bases and graft materials, respectively. Both ends were ﬁrmly sutured side-by-side, using the circumferential ligation technique as a double-strand substitute that was 45 mm in length. Porcine calcanei with similar characteristics to adult human calcanei were mounted on a tensile testing machine, and substitutes were fixed into bones using the 3 fixation methods. A polyester tape was passed through the tendon loop and connected to a crosshead jig of the testing machine. The initial ultimate loads were measured in 15 specimens for each fixation method to simulate a lateral ankle ligament (LAL) injury.

Results:

The ultimate loads (ULs) were 223.6 ± 52.7 N for EB, 229.7 ± 39.7 N for SA, and 208.8 ± 65.3 N for IFS. No statistically significant difference was observed among the 3 groups ( P = .571). All failures occurred at the bone–ligament substitute interface.

Conclusion:

The initial ULs in all 3 fixation methods were sufficient for clinical usage. These values were larger than the UL of the anterior talofibular ligament; however, these were smaller than the UL of the calcaneofibular ligament.

Clinical Relevance:

In an experimental animal model, ULs for SA, EB, and IFS techniques showed no significant difference. All failures were observed in the fixation site of the calcaneus and were overwhelmingly related to suture fixation failure.
Striving for the Im/Possible “Home”: A Tale of a Foreign-Born Scholar in U.S. Academia
Authors: Chuang Andy Kai-chun
Published: September 2021

In this essay, I utilize autoethnographic storytelling to interrogate the notion of searching for an im/possible “home” as a foreign-born, yet U.S. post-graduate educated scholar in the U.S. academy and extend the discussion of theorizing academic home to demonstrate how I am labeled as an Other within the academic arena, and to examine the constant silencing and scrutiny of my teaching, service, and research in my professional life. This essay responds to the call of using autoethnography as a legitimizing space to re-center transnational scholars’ voices and to resist master narratives of being a professional in academia.
Influence of the implementation of a multidisciplinary consultation program on adherence to the first ever course of oral antineoplastic treatment in patients with cancer
Authors: Feral Aurelie , Boone Mathieu , Lucas Virginie , Bihan Céline , Belhout Mohamed , Chauffert Bruno , Lenglet Aurelie
Published: September 2021

Purpose

To evaluate adherence (as measured by the medication possession ratio) to the first ever course of oral antineoplasic treatment in cancer patients before and after the implementation of a multidisciplinary consultation program (involving an oncologist, a pharmacist, and a nurse) and to investigate the program's impact on adverse events and drug-related problems.

Patients and Methods

In a retrospective single-center study, we compared the medication possession ratio 2 months after treatment initiation in a control group (before multidisciplinary consultation program implementation) versus an interventional group (after multidisciplinary consultation program implementation).

Results

Two months after oral antineoplasic treatment initiation, the mean ± standard deviation medication possession ratio did not differ significantly when comparing the interventional (multidisciplinary consultation program) group ( n = 33; 0.99 ± 0.06) with the control group ( n = 64; 0.94 ± 0.16) ( p = 0.062). Patients in the multidisciplinary consultation program group had fewer adverse events in general (41, vs 109 in the control group; p = 0.048) and digestive adverse events in particular (6 vs 29, respectively; p = 0.007). A total of 53 and 40 drug-related problems were identified in the control and multidisciplinary consultation program groups, respectively ( p = 0.074).

Conclusions

Implementation of an multidisciplinary consultation program was not associated with a significant difference in drug adherence (as assessed by the medication possession ratio), which was good before and after implementation. The multidisciplinary consultation program was associated with a lower incidence of adverse events.
A successful initiation of treatment of Hodgkin's lymphoma with adriamycin-bleomycin-vinblastine-dacarbazine dose reduction in a patient with fulminant hepatic failure and co-infection with human immunodeficiency virus and hepatitis B
Authors: Veeraballi Sindhusha , Chan Kok H , Slim Jihad , Shaaban Hamid S , Guron Gunwant
Published: September 2021

Introduction

Hodgkin lymphoma is a highly curable lymphoproliferative malignancy with an overall relative survival rate of 87.4%. It is characterized by multinucleated Reed–Sternberg cells which are mostly derived from B cells in the germinal center.

Case report

We present a case of a 40-year-old gentleman with acquired immunodeficiency syndrome who presented with Stage 4b Hodgkin lymphoma complicated with fulminant hepatic failure and direct hyperbilirubinemia. The initial presentation of Hodgkin lymphoma as cholestatic jaundice is extremely rare.

Management and outcome

Though the survival rate with chemotherapy is high, the fulminant hepatic failure made the situation challenging with the use of chemotherapeutic regimens that require hepatic excretion. He received dose reduced adriamycin-bleomycin-vinblastine-dacarbazine regimen [doxorubicin 12.5 mg (6.75 mg/m2), bleomycin 18 units (10 units/m2), vinblastine 3 mg (1.5 mg/m2), dacarbazine 380 mg (190 mg/m2)] as well as bictegravir/emtricitabine/tenofovir alafenamide since admission for treatment of human immunodeficiency virus and hepatitis B. He started responding with the first cycle of dose reduced adriamycin-bleomycin-vinblastine-dacarbazine regimen with bilirubin levels trended down and normalized as well as his clinical condition improved. He received the full dose of adriamycin-bleomycin-vinblastine-dacarbazine on day 15.

Discussion

Our case report emphasizes that the early usage of dose reduced adriamycin-bleomycin-vinblastine-dacarbazine regimen can restore hepatic function and can achieve improvement in hepatic function allowing the delivery of full-dose chemotherapy.
Nurses’ knowledge and experience related to short peripheral venous catheter extravasation
Authors: Atay Selma , Üzen Cura Şengül , Efil Sevda
Published: September 2021

Background:

The majority of hospitalized patients receive a Peripheral Venous Catheter (PVC) in the course of their treatment. Extravasation injury is a serious complication of intravenous treatment.

Objective:

This cross-sectional survey designed study aims to investigate nurses’ knowledge and experience related to short peripheral venous catheter extravasation.

Method:

The study sample included 145 nurses working in a university hospital in the west of Turkey. A questionnaire developed in accordance with the literature was used for data collection. The data were assessed by frequency and proportions.

Results:

Of the nurses included in this study, 26.2% reported they had experienced extravasation injury in a patient; 74.5% said they had received no instruction in the management of extravasation during their in-service training program; and 85.5% stated they did not keep a record of extravasation. 89.7% of the nurses reported infused medications as a cause of extravasation, and 81.4% reported catheter sites as a cause. Among the medications reported by the nurses as causing extravasation: 89.7% reported contrast agents; 84.8% TPN solutions; 71.0% cytotoxic agents; and 65.1% mannitol. The symptoms of extravasation reported by nurses included: swelling (97.9%), redness (97.2%), pain (92.4%), rise in temperature (65.5%), and ulceration (60.0%). In responding to the occurrence of extravasation, interventions reported by the nurses included: stopping the flow of fluid (98.6%), elevation (89.7%), cold application (76.6%), and aspiration of drug (40.7%).

Conclusion:

Based on these results, it is recommended that guidelines are developed for the management of extravasation, that periodic in-service training programs are provided and that observational studies are carried out into the administration of vesicant drugs.
A cluster of grapes: Right atrial masses of uncertain origin
Authors: Dayco John S , DeSouza Niketh , Cardozo Shaun
Published: September 2021

Implanted ports have provided clinicians with long term venous accessibility, while maintaining comfort and convenience for their patients. One of the most commonly used implanted ports for oncological access is a Mediport (Norfork Medical, Skokie, IL). Guidelines (INS2021) strongly recommend placing central catheter tips at the cavo-atrial junction. In fact, too deep atrium position may be associated with micro-traumatism, possibly leading to a catheter associated right atrial thrombosis (CRAT). No significant literature discusses the possibility of such port masses being seeded by a bacteria, as in the case for endocarditis, which was seen in our patient. In the following case report, we will explore the case of a 41-year-old female with metastatic urothelial carcinoma who developed multiple right atrial masses possibly associated with a deeply seated totally implanted vascular access device (TIVAD) tip within the right atrial wall. These right atrial masses were of unknown origin, and in the setting of MRSA bacteremia, multiple possible etiologies would be discussed. We will also explore ways in which similar complications can be easily prevented in the future.
Ultrasound guided cannulation of dialysis access
Authors: Iglesias Ruben , Lodi Massimo , Rubiella Carolina , Teresa Parisotto Maria , Ibeas Jose
Published: September 2021

Vascular access is the key part of haemodialysis (HD) treatment, as this is not possible without a functioning access. The use of the arteriovenous fistula (AVF) has fewer complications, lower mortality and fewer hospital admissions compared to central venous catheter (CVC). However, although guidelines recommend AVF as the access of choice, access-related cannulation complications may lead to greater morbidity. Most guidelines recommend using Doppler ultrasound (DU) to surveil the AVF for HD, but its use must not only be limited to surveillance as it can also be used for needling. Therefore, among those techniques at our disposal today, one of the best tools for AVF needling is Doppler ultrasound (DU). Despite the lack of evidence regarding ultrasound-guided needling of AVF, it is becoming part of our usual practice arsenal in many HD centres. Its use has allowed needling results to improve and the number of complications to be reduced versus traditional ‘blind’ needling. It should be remembered that even though it is very useful for the daily work of dialysis nurses, as in the case of other techniques, it requires adequate, specialised and long-term training to acquire competence in using it. For example, it is important to learn some concepts and terminology that should be known and, at the same time, be highly familiar with different techniques available. Two types of needling techniques are described using US assistance: US-guided needling, where DU is used to make a map of the vessels which can be utilised and to mark the best site to insert the needles once the mapping is done; and real-time US-guided needling, the simultaneous manipulation of the probe and the insertion of the puncture needle through the slice plane of the ultrasound device. Regarding the real-time technique, there are two approaches: out of plane (the probe takes a transversal image of the needle) and in plane (vessel axis aligned with the probe and the needle in the same plane) To ensure successful needling and to maximise reproducibility, especially with tight deadlines and staff resources, nursing staff need to follow some important recommendations that include safety and the use of the method, both for them and the patient. In this way, ultrasound-guided needling becomes a tool with enormous potential utility, but practical training is as important as knowing the technique.
Recognising British Bodies: The Significance of Race and Whiteness in ‘Post-Racial’ Britain
Authors: Clarke Amy
Published: September 2021

This article examines the significance of race in how nation is articulated by the white middle-classes in ‘post-racial’ Britain. In doing so, it highlights the centrality of bodies and informal markers of difference within processes of national recognition and reveals a normative expectation for British bodies racialised as non-white to perform or inhabit (particular kinds of) whiteness. Bringing insights from post-race theory and advocating a broad conceptualisation of whiteness as a set of relational ideas and codes, the article demonstrates that whiteness continues to shape and underpin dominant conceptions of Britishness – articulated by middle-class white Britons – even as they recognise people of colour individually, and to some extent collectively, as British. Since the role and symbolic power of the white middle-classes is often overlooked in discussions of Britishness, the article makes an important contribution to debates on race and nation, illustrating how whiteness continues to function in alledgedly ‘post-race’ societies. It concludes that narrow definitions of race and whiteness allow their continued significance to be under-estimated and ultimately enable the perpetuation of racialised hierarchies of belonging.
Research on the hysteretic performance of flower-gusset composite joints for single-layer aluminium alloy lattice shell structures
Authors: Zhao Caiqi , Wang Gang , Zheng Tengteng
Published: September 2021

Joints are the most critical component of reticulated shell structures, and their hysteretic performance is crucial to the mechanical properties of the whole reticulated shell structure under seismic action. Therefore, the hysteretic behaviour of aluminium alloy flower-gusset composite joint for an out-of-plane bending moment was studied by experiments and numerical analysis. The results show that the hysteretic curves of flower-gusset composite joints and gusset joints contain four stages: an elastic stage, a bolt slip stage, a hole wall pressure-stiffness degradation stage and a failure stage. The hysteretic performance of the new flower-gusset composite joint is obviously better than that of the traditional plate joint. With the increase in the thickness of the cover plate, the bending stiffness of the flower-gusset composite joint increases significantly, while the rotational deformation decreases. Then, a restoring force model of the flower-gusset composite joint is proposed through theoretical analysis based on experiments and numerical analysis.
The relationship between substance use disorder and gambling disorder: A nationwide longitudinal health registry study
Authors: Leino Tony , Torsheim Torbjørn , Griffiths Mark D. , Pallesen Ståle
Published: September 2021

Aim: This study aimed to examine the co-morbidity and temporal relationship between substance abuse disorders (SUDs) and gambling disorder (GD). Method: Cross-tabulated census data were retrieved from the Norwegian Patient Registry. The data included the number of patients by year of first-time incidence of GD and/or SUD diagnoses, age and sex from 2008 to 2017. Results: Approximately 22.5% of GD patients were also diagnosed with SUD, whereas 0.7% of SUD patients were also diagnosed with GD. Among GD patients, males had a greater risk of SUD in the same year compared to females, whereas the risk of SUD a year or more after the onset of GD was greater among females compared to males. Among SUD patients, males had a greater risk of GD in all age categories and across all time periods except among those aged 40–66 years. The risk of GD three to four years after the onset of SUD among those aged 40–66 years was similar between SUD males and females. Discussion: The overall co-morbidity of SUD and GD was low. However, the risk of the other addictive disorder was contingent upon the nature of the first disorder. The risk of SUD among GDs over time was greater among females compared to males. Conclusions: The risk of the other addictive disorder appears to be contingent upon the first addictive disorder. There are sex differences in the risk trajectories of the other addictive disorder over time between GD patients and SUD patients.
The impact of using a mobile application to improve asthma patients’ adherence to medication in Jordan
Authors: Al-Nawayseh Mohammad K , AL-Iede Montaha , Elayeh Eman , Hijazeen Rima , Oweidat Khaled Al , Aleidi Shereen M
Published: September 2021

The main aim of this study is to assess the effectiveness of using a developed asthma mobile application to enhance medication adherence in Jordan. Asthma patients visiting outpatient respiratory clinics and using inhalers were recruited. Patients were assigned into two groups: intervention and control. The intervention group was instructed to download and use the application. Asthma control was assessed using Asthma Control Test (ACT) at baseline and at follow-up of 3 months for both groups. A total of 171 patients (control, n = 83, and intervention, n = 88) participated in the study. After 3 months of usage, patients in the intervention group achieved a significant improvement in ACT score compared to control ( p-value <0.05), and reported a significant satisfaction of the application use. Therefore, the asthma mobile application is found as an effective tool to enhance medication adherence in asthma patients.