bluuebunny/crossref_metadata_2025 huggingface dataset:
An Asset-Based Approach to Understanding College Students as Sources of Support
Authors: Kellogg B. Tait
Published: June 2021

This study uses an asset-based lens to explore the support college students give to others in their social network. Retention literature often categorizes students as passive receivers of social support. Qualitative data comes from a 3-year longitudinal study of college students who graduated from the same urban school district, drawing from a larger mixed-methods research project (MCAP). Data from this study demonstrates that many college students are actively supporting peers, siblings and parents in the form of tangible (monetary) help, informational assistance and emotional support. Recognizing students as important contributors in their communities is important for educators seeking to understand the experience of college students and the assets they bring with them when they enter campus.
Involvement of Jordanian Head Nurses’ in Health Policy Development: A Cross-Sectional Study
Authors: Al Faouri Ibrahim Ghaleb , Elfaqieh Khloud , AbuAlRub Raeda
Published: June 2021

Background

Despite the importance of involving nurses in health policy, nurse’s involvement faces many challenges. Literature showed that there is a low level of nurses’ and nurse leaders’ involvement in health policy development.

Aim

The aims of this study were to examine (a) the level of Jordanian head nurses’ involvement in health policy development and their perceived benefits and barriers; (b) the relationships between level of knowledge, competence, and interest in health policy and the level of involvement in health policy development; and (c) the relationship between the level of self-efficacy (efficacy expectation and outcome expectation) and the level of involvement in health policy development.

Methods

A cross-sectional descriptive correlational study design was adopted in this study. A convenience sampling of 250 participants from hospitals affiliated to three health sectors in Jordan (private, governmental, and university) were recruited to complete a self-administered questionnaire. Descriptive statistics and Pearson correlation coefficient were used to answer the study questions.

Results

The results revealed a moderate level of involvement of head nurses in the policy development. The most frequent cited political activity was “providing written reports, consultations, research.” “Lack of time” was the most perceived barrier, while “improving the health of the public” was the most perceived benefit. Workshops or sessions at conferences is the most indicated source of knowledge. Participants had an excellent level of skills with positive relationships between the competence and both of the levels of professional and personal involvement in health policy. Participants reported a low level of confidence in performing political activities as well as the impact of such activities on health outcomes. Positive relationship was indicated between self-efficacy and the levels of professional and personal involvement in political activities. Implications: Health policies affect nurses and their practice. Overcoming the barriers and enhancing the levels of head nurses’ knowledge and competence regarding health policies can help activating their roles in health policy development process. This will help in activating nurses’ role in health policy development, which in turn will have a positive impact on health outcomes.
I Am Not Represented Here: Cultural Frameworks and Indigenous Methodology Primer for Postsecondary Settings
Authors: Fraser Tina , O’Neill Linda
Published: June 2021

The purpose of this article is to share approaches for Indigenous students who are novice researchers at post-secondary settings in finding space and culturally relevant ways of representing their worldview in research through Indigenous methodologies and cultural frameworks. While there may be some similarities between Indigenous methodologies and Western qualitative research approaches, there are obvious cultural differences. This article presents an example of an Indigenous Māori centered approach and examples of Aboriginal approaches using Indigenous research methodology through cultural frameworks that may have relevance to both Indigenous students and non-Indigenous allies who support them on their research journey.
Dimensional accuracy in quick plastic forming of aluminum alloy using demolding mechanism
Authors: Liu Chin-Wei , Lee Shyong , Chou Dean , Hsu Shu-Han , Chu Chun Lin
Published: June 2021

This study focuses on quick plastic forming (QPF), product dimensional tolerances, and removal methods. The traditional curled metal shell mold in QFP, has limitations such as long process time and unstable quality. Therefore, this investigation designed a demolding mechanism, in order to improve the process efficiency and dimensional accuracy of QPF, in the manufacture of metal casings. The research results show that the proposed mechanism can significantly decrease the process time, because it replaces most of the operations of specimens movement after forming completely. The shorter process time reduce the die temperature loss during operation, thus also improving the efficiency by eliminating the need to wait for the die to return to its operation temperature. In terms of dimensional tolerance, the tolerance grade of QPF process was determined using the standard deviation, and found to be between IT10 and IT14. This range covers the scope of CNC cutting and stamping processing, indicating that the process has commercial value in the production of metal casings, because the current mainstream manufacturing process of metal casings comprises casting, stamping and CNC machining.
A comparison of endovascular versus open repair for ruptured abdominal aortic aneurysm – Meta-analysis of propensity score-matched data
Authors: Alsusa Hatim , Shahid Abbas , Antoniou George A
Published: June 2021

Background

Optimal management of ruptured abdominal aortic aneurysms (rAAA) has been heavily debated in the literature. The aim of this review is to assess comparative outcomes from propensity-matched studies of endovascular versus open for rAAA.

Methods

Electronic databases (MEDLINE and Embase) were searched in January 2021 using the Healthcare Databases Advanced Search interface. Eligible studies compared endovascular versus open repair for rAAA using propensity-matched cohorts. Pooled estimates of perioperative outcomes were calculated using odds ratio (OR) or mean difference (MD) and 95% confidence interval (CI) using the random-effects model. Time-to-event data meta-analysis was conducted using the inverse-variance method and reported as summary hazard ratio (HR) and associated 95% CI. The quality of evidence was graded using a system developed by the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) working group.

Results

Six studies published between 2010 and 2020 were selected for qualitative and quantitative synthesis, reporting a total of 6731 patients. The odds of perioperative mortality after endovascular aneurysm repair (EVAR) were significantly lower than after open surgical repair (OSR) (OR 0.52, 95% CI 0.41–0.65). The hazard of overall mortality during follow-up was lower, although not significantly, after EVAR than after OSR (HR 0.79, 95% CI 0.62–1.01). The odds of acute kidney injury and early aneurysm-related reintervention were both significantly lower after EVAR than after OSR (OR 0.34, 95% CI 0.14–0.78 and OR 0.57, 95% CI 0.33–0.98, respectively). Patients treated with EVAR stayed in hospital for significantly less time than those treated with OSR (MD −5.13, 95% CI −7.94 to −2.32). The certainty of the body of evidence for perioperative mortality was low and for overall mortality was very low.

Conclusion

The evidence suggests that EVAR confers a significant benefit on perioperative mortality.
Pharmacist-led sedative-hypnotic deprescribing in team-based primary care practice
Authors: Lui Eric , Wintemute Kimberly , Muraca Maria , Truong Christine , Ha Rita , Choe Albert Kee Buhm , Michell Laura , Laine-Gossin Joanne , Blankenstein Harvey , Klein Stephanie , Mayer Dana , Feder Victor , Greiver Michelle
Published: June 2021

Background:

Sedative-hypnotic (SH) medications are often used to treat chronic insomnia, with potentially serious long-term side effects. The objective of this study is to evaluate an interprofessional SH deprescribing program within a community team-based, primary care practice, with or without cognitive behavioural therapy for insomnia (CBT-I).

Methods:

Retrospective chart review for patients referred to the team pharmacist for SH deprescribing from February 2016 to June 2019.

Results:

A total of 121 patients were referred for SH deprescribing, with 111 (92%) patients who attempted deprescribing (average age 69, range 29-97 years) and 22 patients who also received CBT-I. Overall, 36 patients (32%) achieved complete abstinence, and another 36 patients (32%) reduced their dosage by ≥50%. For the 36 patients who achieved complete abstinence, 26 (72%) patients remained abstinent at 6 months (9 patients resumed using SH and 1 patient was lost to follow-up). The proportion of patients achieving complete abstinence or reduced dosage of ≥50% (successful tapering) was higher with CBT-I than without CBT-I but did not reach statistical significance (77% vs 62%, p = 0.22). There were also no statistically significant differences detected in the success between those who took a benzodiazepine and those who took a Z-drug (67% vs 61%, p = 0.55) or for those who took SH daily and those who took them intermittently (67% vs 44%, p = 0.09).

Conclusion:

Almost two-thirds of patients participating in our pharmacist-led program were able to stop or taper their SH medications by ≥50%. The role of CBT-I in SH deprescribing remains to be further elucidated. Can Pharm J (Ott) 2021;154:xx-xx.
The role of language production in making predictions during comprehension
Authors: Lelonkiewicz Jarosław R , Rabagliati Hugh , Pickering Martin J
Published: June 2021

Language comprehension depends heavily upon prediction, but how predictions are generated remains poorly understood. Several recent theories propose that these predictions are in fact generated by the language production system. Here, we directly test this claim. Participants read sentence contexts that either were or were not highly predictive of a final word, and we measured how quickly participants recognised that final word (Experiment 1), named that final word (Experiment 2), or used that word to name a picture (Experiment 3). We manipulated engagement of the production system by asking participants to read the sentence contexts either aloud or silently. Across the experiments, participants responded more quickly following highly predictive contexts. Importantly, the effect of contextual predictability was greater when participants had read the sentence contexts aloud rather than silently, a finding that was significant in Experiment 3, marginally significant in Experiment 2, and again significant in combined analyses of Experiments 1–3. These results indicate that language production (as used in reading aloud) can be used to facilitate prediction. We consider whether prediction benefits from production only in particular contexts and discuss the theoretical implications of our evidence.
Beyond the Crew: Hip-Hop and Professionalization in Mexico City
Authors: Green Andrew
Published: June 2021

In recent years profesionalización – professionalization – has become an increasingly influential concept in the hip-hop scene in Mexico City. This term can refer to a variety of changing practices relating to artistic presentation, the organization of hip-hop events, and the hip-hop scene’s model of creative production. The influence of professionalization relates to the rising specialization of hip-hop production and the increasing importance of the digital circulation of music and images; increasingly, success is made on YouTube and Spotify. It also relates to new sources of income, such as freestyle rap battles with corporate sponsorship, and to nascent spaces for hip-hop within adult education. Above all, professionalization relates to a series of structural changes connected to the declining influence of crews, oriented around something akin to Spillman’s ‘non-strategic solidarity’: fraternity, informality, and shared identity. In some cases, crews are giving way to more formal ‘teams’, oriented around the solo artists that now dominate the hip-hop scene.

This article builds on ongoing ethnographic research since 2012 and a series of interviews with over 40 local hip-hop artists, to explore professionalism and professionalization as emergent, negotiated values within Mexico City’s hip-hop scene. It offers a frame through which different ideas of the ‘professional’ may be considered: object-forming (relating to the creation of a ‘professional’ music object) and subject-forming (relating to the formation of a ‘professional’ subject). Profesionalización cannot be understood in a functionalist sense, nor may the hip-hop ‘professional’ be conceptualized as a straightforward antonym of ‘amateur’. This article instead shows different ways that ‘object-forming’ and ‘subject-forming’ professionalization both incorporate and texture the ‘non-strategic’ and distinguish hip-hop ‘professionalism’ from the same texture the ‘non-strategic’, and distinguish hip-hop professionalism from it.
Determination and clinical significance of bone pseudoprogression in hormone receptor-positive metastatic breast cancer
Authors: Lin Mingxi , Jin Yizi , Yang Ziyi , Hu Xichun , Zhang Jian
Published: June 2021

Background:

99mTechnetium labeled methylene diphosphonate bone scans (BSs) are commonly used to monitor disease progression in bone for patients with metastatic breast cancer (MBC). However, new BS lesions may represent osteoblastic bone healing, which we now define as bone pseudoprogression. In this study, we aimed to assess the clinical significance and determination methods of bone pseudoprogression.

Methods:

This retrospective analysis was conducted among 48 patients with hormone receptor-positive MBC treated with first-line endocrine therapy. Four months after initiating therapy, all the participants did not show extraosseous disease progression. Participants were divided into two groups according to the presence of new BS lesions. All the patients continued on treatment until explicit disease progression (extraosseous disease progression or progressive lysis on bone lesions). Explicit progression-free survival (PFS) and extraosseous objective response rate were analyzed between the two groups.

Results:

New BS lesions were observed in 11 of 48 (22.9%) patients. All the new BS lesions appeared as osteoblastic bone lesions on computed tomography. For patients with new BS lesions, the median PFS was 26.57 months [95% confidence interval (CI) 15.46–37.68], which was similar to that (29.57 months; 95% CI 19.24–39.90) in patients without new BS lesions [hazard ratio: 1.098 (95% CI 0.482–2.503), p = 0.818]. Notably, 82.9% of patients without new BS lesions showed an extraosseous objective response, whereas 85.7% of patients with new BS lesions demonstrated an extraosseous objective response [odds ratio: 0.806 (95% CI 0.061–5.682), p = 0.999]. The median interval between bone pseudoprogression and true disease progression was 21.26 months (95% CI 10.11–32.42).

Conclusions:

Osteoblastic new BS lesions detected on follow-up BSs may represent bone pseudoprogression. Clinicians should raise awareness of bone pseudoprogression, thereby avoiding premature discontinuation of therapy and maximizing the opportunity to benefit from endocrine therapy. Due to the small sample size and retrospective nature of the study, large prospective clinical trials are needed to confirm our findings.
Intramuscular neridronate for the treatment of complex regional pain syndrome type 1: a randomized, double-blind, placebo-controlled study
Authors: Varenna Massimo , Braga Vania , Gatti Davide , Iolascon Giovanni , Frediani Bruno , Zucchi Francesca , Crotti Chiara , Nannipieri Fabrizio , Rossini Maurizio
Published: June 2021

Background:

Complex regional pain syndrome type-1 (CRPS-1) is a severely disabling painful disease challenging to treat. This multicenter, randomized, double-blind placebo-controlled trial examined the efficacy of intramuscular (i.m.) neridronate in CRPS-1 patients.

Methods:

A total of 78 patients diagnosed with CRPS-1 (aged 59.5 ± 10.3, 66.7% female) were randomly assigned to 25 mg (i.m.) neridronate ( N = 41) given once daily for 16 consecutive days or placebo control ( N = 37). Efficacy was assessed after 30 days using a visual analogue scale (VAS) pain score and the number of patients achieving ⩾50% reduction in VAS score. Change in clinical signs and symptoms, quality of life (QoL) using Short Form Health Survey (SF-36) and the McGill Pain Questionnaire were also assessed.

Results:

After 30 days, VAS score decreased significantly to a greater extent in neridronate-treated patients versus placebo (31.9 ± 23.3 mm versus 52.3 ± 27.8 mm, p = 0.0003). Furthermore, the proportion of patients achieving a VAS reduction of ⩾50% was greater in the neridronate group (65.9% versus 29.7%, p = 0.0017). Clinical signs and symptoms were improved significantly in the neridronate group versus placebo for edema (72.5% versus 79.9%, p = 0.03), pain during motion (70% versus 83.3%, p = 0.0009), allodynia (20% versus 63.3%, p = 0.0004), and hyperalgesia (20% versus 56.7%, p = 0.0023). Whereas no difference was observed for QoL measures using the SF-36 questionnaire, three of the four pain variables using the McGill Pain Questionnaire improved significantly in the neridronate group. No serious drug-related adverse events were reported during the study.

Conclusion:

In patients with acute CRPS-1, i.m. injections of 25 mg neridronate were associated with clinically relevant benefit compared with placebo controls.

Trial registration:

EU Clinical Trials Register: https://www.clinicaltrialsregister.eu/ctr-search/search?query=2014-001156-28
Making Good Trouble: Becoming-With Critical Inquiry
Authors: Flint Maureen A. , Toledo Whitney
Published: June 2021

In this article, we conceptualize a methodology of “good trouble.” Making good trouble, as described by Civil Rights Leader and Congressman John Lewis is doing “something out of the ordinary,” making “a way out of no way.” Troubling is about how we relate as we live and become together in the world. We use the concept of troubling as a theoretical framing that simultaneously draws attention to in(un)justice and seeks new modes of relating. Making good trouble became a practice of critical inquiry that stirred us to question cultural and societal norms that are often assumed to be natural and immutable, as well as our co-implication within them.
Radical Uncertainty Is Not Enough: (In)Justice Matters of Post-Qualitative Research
Authors: Wolgemuth Jennifer R. , Marn Travis M. , Barko Tim , Weaver-Hightower Marcus B.
Published: June 2021

How can (post-)qualitative inquiry do justice in uncertain times? Post-qualitative inquiry, in its embrace of radical uncertainty, held promise for ethical and political responsibility in an entangled, hardly knowable world. Lately, we (authors) are doubtful of that promise. For over a year, through in-person and Zoom conversations, before and during the global pandemic, punctuated by weekly protests of a resurging Black Lives Matter movement, we reckoned with our hopes, doubts, dreams, and disappointments of justice in qualitative and post-qualitative inquiry. We reconstituted our dialogue in this paper around the topics most pressing to us: coming to justice, being wary of idols and ideology, and deciding what matters in post-qualitative inquiry. We came to the uneasy conclusion that, with no one to blame yet everyone responsible, the veneer of justice is peeling away from post-qualitative inquiry; that post-qualitative inquiry has, largely against its will, become a stable, divisive, and totalizing methodology; and that post-qualitative inquiry’s radical uncertainty has created the enabling conditions of indifference, apathy, and triviality. We urge (post-)qualitative inquirers to keep talking about justice and to balance a desire for post-theory with the responsibility for praxis, action, and decision-making.
Artery of Davidoff and Schechter: A Large Angiographic Case Series of Dural AV Fistulas
Authors: Roman Neda Isabel Sedora , Rodriguez Pavel , Nasser Hussein , Cox Mougnyan , Ramchand Preethi , Choudhri Omar , Satti Sudhakar R. , Kung David , Pukenas Bryan , Hurst Robert W.
Published: June 2021

The artery of Davidoff and Schechter (ADS) is the only meningeal branch of the posterior cerebral artery (PCA), supplying the medial tentorial margin and posterior portions of the falx. Given its small size, it is rarely identified on angiographic studies, unless enlarged in pathologies such as dural arteriovenous fistulas (DAVFs) or vascularized masses. This artery was first described by Wollschlaeger and Wollschlaeger in 1965, and to date, only a few reports have described its significance. The objective of this study is to report our experience with the ADS in dural fistulas from 2 tertiary medical centers and to emphasize the importance of recognizing this artery during angiographic examination of vascular tentorial and posterior fossa lesions. To our knowledge, this report demonstrates the largest angiographic case series published to date, recognizing a total of 7 patients with ADS arising secondary to a posterior fossa or tentorial DAVF and one of the largest reported series of DAVFs supplied by the ADS treated by endovascular and surgical techniques. Our cases validate the importance of prompt identification of the ADS for the diagnosis as well as endovascular treatment of vascular malformations in the posterior fossa and tentorial region.
Ophthalmoplegia and cranial nerve deficits in an adolescent with headache
Authors: Corredor Margarita M , Holmberg Peter J
Published: June 2021

Tolosa–Hunt syndrome is an idiopathic, inflammatory condition involving the cavernous sinus and is characterized by unilateral, painful ophthalmoparesis. The condition often begins with retro-orbital pain followed by select cranial nerve involvement. We report the case of a 17-year-old female whose presentation with progressive left-sided headache and ophthalmoparesis culminated in the diagnosis of Tolosa–Hunt syndrome. While many of her signs and symptoms have been previously reported in the rare pediatric cases of Tolosa–Hunt syndrome described in the literature, this case illustrates a unique presentation involving cranial nerves V and VII in addition to the more commonly reported cranial nerve III, IV, and VI palsies.
Complete reversibility of pembrolizumab-induced eosinophilic fasciitis without corticosteroids: A case report
Authors: Bourcier Liane , St-Hilaire Ève , LeBlanc Martin , Picard Léo
Published: June 2021

Checkpoint inhibitor immunotherapy has recently started to play a fundamental role in the management of metastatic melanoma. It is however accountable for many undesirable adverse effects involving many organ systems. Eosinophilic fasciitis is a rare immune-related adverse effect associated to checkpoint inhibitors such as pembrolizumab and nivolumab. We report the case of a 25-year-old male who received pembrolizumab as a second-line therapy for metastatic melanoma. Approximately 8 months after starting the treatment, the patient developed signs and symptoms of eosinophilic fasciitis, including edema of his hands and lower legs, as well as joint limitation. Pembrolizumab was discontinued after 15 cycles because of symptom progression. The patient experienced complete resolution of symptoms 4 months after cessation of pembrolizumab and without corticosteroids. This case illustrates the reversibility of this immune adverse effect by discontinuation of the treatment, speculating that corticotherapy may not be needed in all cases.
A Framework for Enhancing the Spatial Urban Form of Informal Economies in India: The Case of Krishna Rajendra Market, Bangalore
Authors: Patel Shikha , Furlan Raffaello , Grosvald Michael
Published: June 2021

The International Monetary Fund estimates that the Indian economy contributes over 8% to the global gross domestic product (GDP), making India the fifth largest economy in the world. However, the formal and informal sectors do not contribute equally to the national GDP, with over 80% of this total originating from the informal sector. Street vending, among other informal activities in India, is a vital contributor to the informal economy. Many scholars argue that despite the critical influence of physical urban patterns on the practicability and viability of informal activities, urban planners are not providing adequate urban planning policies. Bangalore, the third largest Indian city by population, is the subject of the present case study. Although this city hosts a wide variety of cultures, economies, and lifestyles, 74% of its population can be categorized as working in the informal sector. The goals of this research study are (a) to explore spatial planning in relation to the urban informal sector in Central Bangalore, (b) to identify the physical urban challenges experienced by the city’s street vendors, and (c) to examine the implications of these challenges for the city’s master plan. Through interviews, surveys, and site analysis (mapping), This study elucidates (a) the challenges experienced by the area’s stakeholders (i.e., vendors and buyers), (b) the limited planning of the spatial urban form by urban planners with regard to the accommodation of informal economic activities, and accordingly, (c) the need to implement spatial planning policies and design regulations appropriate to Bangalore’s high-density marketplace.
On being insecure: Heidegger’s fears
Authors: Burgess J Peter
Published: June 2021

Security happens in the future. Threats to our security concern the potential of a future event, of possibility and uncertainty. Fear, omnipresent in popular culture is thereby non-uniform. Like time itself, it intensifies and softens, accelerates and slows, and disrupts and destabilises as a function of many variables. This article re-interprets the phenomenon of insecurity by reading it together with Heidegger’s analytic of time as a function of our proximity to being as fundamental ontological question, one which unfolds in the form of a threatening future.
Cross-echelon managerial design competencies: Relational coordination in organizational learning and growth performance
Authors: Hernaus Tomislav , Juras Ana , Matic Ivan
Published: June 2021

We followed the continuity perspective of leadership skill requirements to examine the interplay between the design competencies of different management cohorts, relational coordination, and organizational learning and growth performance outcomes. Using a two-source sample of 103 organizations, we found evidence for compensatory effects. Specifically, a conditional process analysis (moderated mediation) revealed that: (a) design competencies are a highly relevant type of managerial knowledge or skill, (b) competent middle-level managers compensate for a lack of design skills and design-related knowledge at the top management level, and (c) top- and middle-level managerial design competencies simultaneously create a cross-echelon complementarity effect on organizational learning and growth performance.

JEL classification
β-elemene alleviates airway stenosis via the ILK/Akt pathway modulated by MIR143HG sponging miR-1275
Authors: Zhang Guoying , Xue Cheng , Zeng Yiming
Published: June 2021

Background

We have previously found that β-elemene could inhibit the viability of airway granulation fibroblasts and prevent airway hyperplastic stenosis. This study aimed to elucidate the underlying mechanism and protective efficacy of β-elemene in vitro and in vivo.

Methods

Microarray and bioinformatic analysis were used to identify altered pathways related to cell viability in a β-elemene-treated primary cell model and to construct a β-elemene-altered ceRNA network modulating the target pathway. Loss of function and gain of function approaches were performed to examine the role of the ceRNA axis in β-elemene's regulation of the target pathway and cell viability. Additionally, in a β-elemene-treated rabbit model of airway stenosis, endoscopic and histological examinations were used to evaluate its therapeutic efficacy and further verify its mechanism of action.

Results

The hyperactive ILK/Akt pathway and dysregulated LncRNA-MIR143HG, which acted as a miR-1275 ceRNA to modulate ILK expression, were suppressed in β-elemene-treated airway granulation fibroblasts; β-elemene suppressed the ILK/Akt pathway via the MIR143HG/miR-1275/ILK axis. Additionally, the cell cycle and apoptotic phenotypes of granulation fibroblasts were altered, consistent with ILK/Akt pathway activity. In vivo application of β-elemene attenuated airway granulation hyperplasia and alleviated scar stricture, and histological detections suggested that β-elemene's effects on the MIR143HG/miR-1275/ILK axis and ILK/Akt pathway were in line with in vitro findings.

Conclusions

MIR143HG and ILK may act as ceRNA to sponge miR-1275. The MIR143HG/miR-1275/ILK axis mediates β-elemene-induced cell cycle arrest and apoptosis of airway granulation fibroblasts by modulating the ILK/Akt pathway, thereby inhibiting airway granulation proliferation and ultimately alleviating airway stenosis.
Feasibility and safety of cangrelor in patients with suboptimal P2Y12 inhibition undergoing percutaneous coronary intervention: rationale of the Dutch Cangrelor Registry
Authors: Selvarajah A. , Tavenier A. H. , Bor W. L. , Houben V. , Rasoul S. , Kaplan E. , Teeuwen K. , Hofma S. H. , Lipsic E. , Amoroso G. , van Leeuwen M. A. H. , Berg J. M. ten , van ‘t Hof A. W. J. , Hermanides R. S.
Published: June 2021

Background

Despite the advances of potent oral P2Y12inhibitors, their onset of action is delayed, which might have a negative impact on clinical outcome in patients undergoing percutaneous coronary intervention (PCI). Trials conducted in the United States of America have identified cangrelor as a potent and rapid-acting intravenous P2Y12inhibitor, which has the potential of reducing ischemic events in these patients without an increase in the bleeding. As cangrelor is rarely used in The Netherlands, we conducted a nationwide registry to provide an insight into the use of cangrelor in the management of patients with suboptimal platelet inhibition undergoing (primary) PCI (the Dutch Cangrelor Registry).

Study design

The Cangrelor Registry is a prospective, observational, multicenter, single-arm registry with cangrelor administered pre-PCI in: (1) P2Y12naive patients with ad-hoc PCI, (2) patients with STEMI/NSTEMI with suboptimal P2Y12inhibition including (3) stable resuscitated/defibrillated patients with out-of-hospital cardiac arrest (OHCA) due to acute ischemia and (4) STEMI/NSTEMI patients with a high thrombotic burden. Primary endpoint is 48 h Net Adverse Clinical Events (NACE), which is a composite endpoint of all-cause death, recurrent myocardial infarction (MI), target vessel revascularization (TVR), stroke, stent thrombosis (ST) and BARC 2-3-5 bleeding.

The Dutch Cangrelor Registry will assess the feasibility and safety of cangrelor in patients with suboptimal P2Y12inhibition undergoing (primary) PCI in the setting of acute coronary syndrome (ACS) and stable coronary artery disease (CAD) in the Netherlands.
Is achieving 7,000 steps/day cross-sectionally and prospectively associated with older adults’ lower-extremity performance?
Authors: Hsueh Ming-Chun , Lin Chien-Yu , Lai Ting-Fu , Yu Yi-Chien , Chang Shao-Hsi , Bae Ju Yong , Liao Yung
Published: June 2021

Background

Evidence regarding the association between daily steps recommendation and older adults’ lower limb strength is lacking; thus, this study investigated whether taking at least 7,000 steps/day is cross-sectionally and prospectively related to lower-extremity performance in older Taiwanese adults.

Methods

There were 89 community-dwelling adults aged over 60 years (mean age: 69.5 years) attending both baseline and follow-up surveys. This study used adjusted logistic regression analysis to explore cross-sectional and prospective relationships between their accelerometer-assessed daily steps and lower-extremity performance (five-times-sit-to-stand test).

Results

This study found the older adults who took 7,000 steps/day were more likely to have better lower-extremity performance cross-sectionally (odds ratio [OR] = 3.82; 95 % confidence interval [CI]: 1.04, 13.95;p = 0.04), as well as to maintain or increase their lower-extremity performance prospectively (OR = 3.53; 95 % CI: 1.05, 11.84;p = 0.04).

Conclusions

Our findings support a minimum recommended level of step-based physical activity for older adults, namely, 7,000 steps/day, as beneficial for maintaining or increasing older adults’ lower-extremity performance.
Quantitative analysis of retinal vessel density and thickness changes in diabetes mellitus evaluated using optical coherence tomography angiography: a cross-sectional study
Authors: Li Xinyue , Yu Yu , Liu Xueting , Shi Yan , Jin Xin , Zhang Yanyan , Xu Shuo , Zhang Nan , Dong Li , Zhou Sujun , Wang Yingbin , Ding Yiheng , Song Zhen , Zhang Hong
Published: June 2021

Background

Diabetic retinopathy is the most common microvascular complication of diabetes; however, early changes in retinal microvessels are difficult to detect clinically, and a patient’s vision may have begun to deteriorate by the time a problem is identified. Optical coherence tomography angiography (OCTA) is an innovative tool for observing capillaries in vivo. The aim of this study was to analyze retinal vessel density and thickness changes in patients with diabetes.

Methods

This was a retrospective, observational cross-sectional study. Between August 2018 and February 2019, we collected OCTA data from healthy participants and diabetics from the First Affiliated Hospital of Harbin Medical University. Analyzed their retinal vessel density and thickness changes.

Results

A total of 97 diabetic patients with diabetes at different severity stages of diabetic retinopathy and 85 controls were involved in the experiment. Diabetic patients exhibited significantly lower retinal VD (particularly in the deep vascular complexes), thickening of the neurosensory retina, and thinning of the retinal pigment epithelium compared with controls. In the control group, nondiabetic retinopathy group and mild diabetic retinopathy group, superficial VD was significantly correlated with retinal thickness (r = 0.3886, P < 0.0001; r = 0.3276, P = 0.0019; r = 0.4614, P = 0.0024, respectively).

Conclusions

Patients with diabetes exhibit ischemia of the retinal capillaries and morphologic changes in vivo prior to vision loss. Therefore, OCTA may be useful as a quantitative method for the early detection of diabetic retinopathy.
Resilience as a predictor of quality of life in participants with borderline personality disorder before and after treatment
Authors: Guillén Verónica , Tormo Mireia Esplugues , Fonseca-Baeza Sara , Botella Cristina , Baños Rosa , García-Palacios Azucena , Marco José Heliodoro
Published: June 2021

Background

Studies have suggested that psychotherapy improves the Quality of Life (QoL) of participants with Borderline Personality Disorder (BPD). However, there are no studies on the differential efficacy of treatments on the QoL of participants with BPD. Moreover, the relationship between QoL and resilience has rarely been studied in participants with BPD. Objectives: a) to examine whether people with BPD have worse QoL than the non-clinical population; b) to examine whether there are statistically significant differences between Dialectical Behavioural Therapy (DBT), Systems Training for Emotional Predictability and Problem Solving (STEPPS), or Cognitive Behavioural Therapy-Treatment at Usual (CBT-TAU) in the improvement of QoL; c) to examine whether participants show clinically significant improvements in QoL after treatment; d) to analyse whether resilience is associated with QoL before and after the BPD treatment; e) to analyse whether resilience is a predictor of QoL at pre-treatment and posttreatment.

Method

The sample comprised 403 participants (n = 202 participants diagnosed with BPD and n = 201 non-clinical). Participants filled out the Quality of Life Index, Resilience Scale, and Beck Depression Inventory. The clinical participants received one of these possible treatments, DBT, STEPPS, or CBT-TAU. MANOVA and regression analyses were performed.

Results

a) participants diagnosed with BPD had statistically significant lower resilience than the non-clinical population; b) all three forms of psychotherapy statistically improved QoL, but there were no statistically significant differences between DBT, STEPPS, and CBT-TAU in the improvement of QoL; c) participants did not show clinically significant improvements in QoL after treatment; d) resilience was associated with QoL before and after treatment; and e) resilience was a predictor of QoL before and after treatment.

Conclusion

It is necessary to assess QoL and Resilience in studies on psychotherapy with BPD patients.
Medicine storage, wastage, and associated determinants among urban households: a systematic review and meta-analysis of household surveys
Authors: Jafarzadeh Adineh , Mahboub-Ahari Alireza , Najafi Moslem , Yousefi Mahmood , Dalal Koustuv
Published: June 2021

Background

Irrational household storage of medicines is a world-wide problem, which triggers medicine wastage as well as its associated harms. This study aimed to include all available evidences from literature to perform a focused examination of the prevalence and factors associated with medicine storage and wastage among urban households. This systematic review and meta-analysis mapped the existing literature on the burden, outcomes, and affective socio-economic factors of medicine storage among urban households. In addition, this study estimated pooled effect sizes for storage and wastage rates.

Methods

Household surveys evaluating modality, size, costs, and affective factors of medicines storage at home were searched in PubMed, EMBASE, OVID, SCOPUS, ProQuest, and Google scholar databases in 2019. Random effect meta-analysis and subgroup analysis were used to pool effect sizes for medicine storage and wastage prevalence among different geographical regions.

Results

From the 2604 initial records, 20 studies were selected for systematic review and 16 articles were selected for meta-analysis. An overall pooled-prevalence of medicine storage and real wastage rate was 77 and 15%, respectively. In this regard, some significant differences were observed between geographical regions. Southwest Asia region had the highest storage and wastage rates. The most common classes of medicines found in households belonged to the Infective agents for systemic (17.4%) and the Nervous system (16.4%). Moreover, income, education, age, the presence of chronic illness, female gender, and insurance coverage were found to be associated with higher home storage. The most commonly used method of disposal was throwing them in the garbage.

Conclusions

Factors beyond medical needs were also found to be associated with medicine storage, which urges effective strategies in the supply and demand side of the medicine consumption chain. The first necessary step to mitigate home storage is establishing an adequate legislation and strict enforcement of regulations on dispensing, prescription, and marketing of medicines. Patient’s pressure on excessive prescription, irrational storage, and use of medicines deserve efficient community-centered programs, in order to increase awareness on these issues. So, hazardous consequences of inappropriate disposal should be mitigated by different take back programs, particularly in low and middle income countries.
Interpersonal violence in a deprived Scottish urban area with aggregations of physical health risks and psychiatric morbidity: an ecological study
Authors: Coid Jeremy , Zhang Yingzhe , Ullrich Simone , Wood Jane , Bhavsar Vishal , Bebbington Paul , Bhui Kamaldeep
Published: June 2021

Background

Glasgow, Scotland, has previously shown exceptional levels of violence among young men, shows aggregations of health conditions, with shortened life expectancy. Health conditions can be both causes and consequences of violence, of shared community-level socio-economic risk factors, and can result from large-scale social forces beyond the control of populations with high levels of violence. The aim of the study was to provide an in depth understanding of the Public Health problem of violence among young adult men in Glasgow East.

Method

Ecological investigation of violence and its associations with health conditions in areas of contrasting socioeconomic deprivation. National survey of 1916 British men aged 18–34 years, augmented by a sub-sample of 765 men in Glasgow East (GE). Participants completed questionnaires covering current physical and sexual health, psychiatric symptoms, substance misuse, lifestyle, and crime and violence.

Results

The 5-year prevalence of violence was similar in both surveys but fights involving weapons (AOR 3.32, 95% CI 2.29–4.79), gang fights (AOR 2.30, 95% CI 1.77–2.98), and instrumental violence supporting criminal lifestyles were more common in GE, where 1 in 9 men had been in prison. Violent men in both samples reported poorer physical and sexual health and all types of psychiatric morbidity except depression, with multiple high-risk behaviours for both future poor health and violence. Associations between drug and alcohol dependence and violence in GE could not be entirely explained by deprivation.

Conclusion

Violence in deprived urban areas is one among many high-risk behaviours and lifestyle factors leading to, as well as resulting from, aggregations of both psychiatric and physical health conditions. Poverty partly explained raised levels of violence in GE. Other factors such as drug and alcohol misuse and macho attitudes to violence, highly prevalent among men in this socially excluded community, also contributed. Multi-component preventive interventions may be needed in deprived areas and require future investigations into how multiple co-existing risk factors produce multimorbidity, including psychiatric disorders, substance misuse, poor physical health and violence.
HIV and cardiovascular disease in sub-Saharan Africa: Demographic and Health Survey data for 4 countries
Authors: Egede Leonard E. , Walker Rebekah J. , Monroe Patricia , Williams Joni S. , Campbell Jennifer A. , Dawson Aprill Z.
Published: June 2021

Background

Investigate the relationship between two common cardiovascular diseases and HIV in adults living in sub-Saharan Africa using population data provided through the Demographic and Health Survey.

Methods

Data for four sub-Saharan countries were used. All adults asked questions regarding diagnosis of HIV, diabetes, and hypertension were included in the sample totaling 5356 in Lesotho, 3294 in Namibia, 9917 in Senegal, and 1051 in South Africa. Logistic models were run for each country separately, with self-reported diabetes as the first outcome and self-reported hypertension as the second outcome and HIV status as the primary independent variable. Models were adjusted for age, gender, rural/urban residence and BMI. Complex survey design allowed weighting to the population.

Results

Prevalence of self-reported diabetes ranged from 3.8% in Namibia to 0.5% in Senegal. Prevalence of self-reported hypertension ranged from 22.9% in Namibia to 0.6% in Senegal. In unadjusted models, individuals with HIV in Lesotho were 2 times more likely to have self-reported diabetes (OR = 2.01, 95% CI 1.08–3.73), however the relationship lost significance after adjustment. Individuals with HIV were less likely to have self-reported diabetes after adjustment in Namibia (OR = 0.29, 95% CI 0.12–0.72) and less likely to have self-reported hypertension after adjustment in Lesotho (OR = 0.63, 95% CI 0.47–0.83). Relationships were not significant for Senegal or South Africa.

Discussion

HIV did not serve as a risk factor for self-reported cardiovascular disease in sub-Saharan Africa during the years included in this study. However, given the growing prevalence of diabetes and hypertension in the region, and the high prevalence of undiagnosed cardiovascular disease, it will be important to continue to track and monitor cardiovascular disease at the population level and in individuals with and without HIV.

Conclusions

The odds of self-reported diabetes in individuals with HIV was high in Lesotho and low in Namibia, while the odds of self-reported hypertension in individuals with HIV was low across all 4 countries included in this study. Programs are needed to target individuals that need to manage multiple diseases at once and should consider increasing access to cardiovascular disease management programs for older adults, individuals with high BMI, women, and those living in urban settings.
Measuring recovery after open lower limb fractures: combined objective functional tests and global perceived recovery outperform narrower metrics and a standard generic patient reported outcome measure
Authors: Pallister Ian , Handley Gregory Jack , Maggs Sharon , Davies Ann-Marie , Kyle Amanda , Bodger Owen , Dafydd Hywel
Published: June 2021

Background

Open lower limb fractures are serious injuries requiring combined ortho-plastic surgery and have significantly worse outcomes than similar closed fractures. There is little objective published data to determine which functional outcome measures best reflect progress or completeness of physical recovery.

Our hypothesis was that objective measures combining strength, mobility and balance would better reflect recovery than isolated parameters (e.g. range of motion ROM) and would compare well to patients’ perceived recovery.

Methods

Adult open lower limb fracture patients were reviewed 6 and 12 weeks, 6, 9 and 12 months post-injury. The mechanism, injury pattern, age, gender and treatment were recorded. Isolated parameter objective functional outcome measures (OFOMs) (ROM and MRC strength grade) were compared to combined OFOMs (timed up and go, comfortable gait speed and fast gait speed, Edgren Side Step Test (TUAG, CGS, FGS, ESST) and Single Leg balance. Patient reported outcomes were recorded (Global Perceived Effect (GPE) score and Disability Rating Index (DRI)). Statistical analysis used non-parametric tests (e.g. Spearman correlation) compared each with time since injury.

Results

Sixty-eight patients (54 male) with a median age of 45(20–75) years. Of the 19 isolated OFOMs, only knee flexion and ankle plantar flexion ROM and strength improved with time (Spearman correlation p = 0.042, 0.008, 0.032, 0.036 respectively). TUAG, ESST, CGS, FGS and GPE scores showed significant improvement (Spearman correlation p < 0.001). Patients’ estimation of recovery paralleled these measures (Spearman correlation p < 0.001) with all but 2 patients achieving the minimum clinical important difference in DRI by 12 months compared to baseline. However, the GPE score had a higher proportion of improving responses than DRI at each time-point.

Discussion

Functional recovery is a key determinant in patients returning to work, providing for themselves and their family or resuming independent living for older patients. This study has demonstrated time-related improvements in combined OFOMs measuring mobility, strength, agility and balance paralleling patients’ perception of recovery in the 12 months after open lower limb fractures. Over the same time-frame, the simple GPE score compared favourably with the DRI. Such parameters could become part of a defined core outcomes set. Focussing rehabilitation towards these combined OFOMs may help hasten recovery.

Trial registration

South West Wales REC 06/WMW02/10).