bluuebunny/crossref_metadata_2025 huggingface dataset:
Seizing the Moment: Policy Advocacy to End Mass Incarceration in the Time of COVID-19
Authors: Minkler Meredith , Griffin Joseph , Wakimoto Patricia
Published: June 2020

The mass human and economic casualties wrought by the COVID-19 pandemic laid bare the deep inequities at the base of the disproportionate losses and suffering experienced by diverse U.S. populations. But the urgency and enormity of unmet needs requiring bold policy action also provided a unique opportunity to learn from and partner with community-based organizations that often are at the frontlines of such work. Following a review of Kingdon’s model of the policy-making process, we illustrate how a partnership in a large California county navigated the streams in the policy-making process and used the window of opportunity provided by the pandemic to address a major public health problem: the incarceration of over 2 million people, disproportionately African American and Latinx, in overcrowded, unsafe jails, prisons, and detention centers. We highlight tactics and strategies used, challenges faced, and implications for health educators as policy advocates during and beyond the pandemic.
Talking Circles: A Culturally Responsive Evaluation Practice
Authors: Brown Martha A. , Di Lallo Sherri
Published: June 2020

Talking Circles are safe spaces where relationships are built, nurtured, reinforced, and sometimes healed; where norms and values are established; and where people connect intellectually, spiritually, and emotionally with other members of the Circle. The Circle can also be an evaluation method that increases voice, decreases invisibility, and does not privilege one worldview or version of reality over another. The purpose of this article is to describe how the Circle can be a culturally responsive evaluation practice for those evaluators wishing to build relationships, share power, elicit stakeholder voice, solve problems, and increase participants’ capacity for program design, implementation, and evaluation. Circles can be used by both Indigenous and non-Indigenous evaluators. By offering the global evaluation community this concrete, practical, and culturally responsive approach, we open the door so that others can build on this work and offer additional insights as this practice is used, refined, and documented.
Solid particle erosive wear behaviour of Eulaliopsis binata fiber reinforced epoxy composite
Authors: Pradhan Subhrajit , Acharya Samir K
Published: June 2020

In the present work, Eulaliopsis binata, a natural fiber collected from the eastern part of India is taken as a reinforcement with epoxy resin to develop a new class of polymer composite material, which has been unexplored till date for tribological applications in the composite industry. Different characterization studies of the fiber such as SEM, EDS, XRD are carried out to astern its potential to be used as a fiber in composite. Short Eulaliopsis binata fiber of different weight percent (10, 20, 30, and 40) is incorporated in neat epoxy and polymer composites are fabricated using the hand lay-up method. Solid particle erosion behavior of the fabricated composites is studied with four different impact velocities (48, 72, 82, 116 m/s) and impinging angles (30°, 45°, 60°, 90°). Improved erosion wear resistance is exhibited by the composites after the addition of Eulaliopsis binata fiber to neat epoxy. In addition, the inclusion of fiber altered the erosion behavior of neat epoxy from brittle to semi ductile nature. The impact velocity of the erodent particles also shows significant effect on the erosion behavior of the developed composites. The eroded surfaces of the worn samples are analyzed with SEM to ascertain the failure mechanism of the developed composites.
Experimental and numerical investigations on rolling element bearing thermal behaviour
Authors: Brossier P , Niel D , Changenet C , Ville F , Belmonte J
Published: June 2020

In the present study, some measurements have been conducted on a dedicated test rig to investigate rolling element bearing thermal behaviour. This test rig makes possible the determination of the tested rolling element bearing power losses through the resistive torque measurement. Some thermocouples are located on fixed parts of the system (housing, rolling element bearing outer ring) and others on rotating parts (rolling element bearing inner ring and shaft) via a telemetry system. A deep groove ball bearing, whose pitch diameter is equal to 85 mm, has been tested under oil jet lubrication for different operating conditions. Measurements of the penetration ratio, defined as the proportion of oil actually entering the rolling element bearing versus the oil injected, have also been conducted. An extended thermal network of the test rig has been established to enable a closer understanding of the rolling element bearing inner thermal behaviour. Based upon the first principle of thermodynamics for transient conditions, the studied system is divided into lumped elements at uniform temperature connected by thermal resistances which account for conduction, radiation and convection. Convection within the rolling element bearing depends on the amount of oil in the oil–air mixture known as the volume fraction. At specific test conditions, the developed model found good agreements with experiences for a given oil volume fraction of 15%. This value of volume fraction leads to an adapted formula for volume fraction in the case of jet lubrication which includes the measured penetration ratio.
Telling lies together? Sharing news as a form of social authentication
Authors: Waruwu Barui K , Tandoc Edson C , Duffy Andrew , Kim Nuri , Ling Rich
Published: June 2020

The increasingly assertive position of social media as a news source means that news audiences can no longer depend on traditional journalists for information verification. Instead, they must determine the news credibility on their own. The majority of information credibility studies have considered news audiences’ information evaluation as a purely cognitive endeavor, implying that individuals can arrive at valid information without social validation. By drawing on self-categorization theory, this article re-conceptualizes audiences’ acts of news authentication by considering it not as a one-off activity under the uncontested control of the individual, but as a cycle of collective authentication strategies whereby individual authentication and social validation are entangled in the context-dependent processing of social news. To do this, we unpacked the social dimension of news authentication by looking at the social motivation, strategies, as well as the consequences that support it through a series of focus group discussions in Singapore.
Pediatricians as Child Health Advocates: The Role of Advocacy Education
Authors: Dodson Nancy A. , Talib Hina J. , Gao Qi , Choi Jaeun , Coupey Susan M.
Published: June 2020

In this article, we discuss the role of formal advocacy education with high-effort advocacy activities among pediatricians. We discuss the historical role of advocacy in the field of pediatrics and the changing role of advocacy education in pediatric training programs. We describe our survey of pediatricians in New York, in which we asked about a history of formal child health advocacy education, current high- and low-effort advocacy activities, perceived barriers to advocacy work, and child health advocacy issues of interest. Our findings demonstrate an association between a history of formal child health advocacy education and recent participation in high-effort advocacy activities on behalf of children’s health. We also found that practicing pediatricians were more likely to participate in high-effort advocacy work than individuals still in pediatric residency training. Our findings imply that education in child health advocacy should be considered an important part of pediatric training. Advocacy education should not only be included in residency and fellowship training programs but also made available as part of continuing medical education for pediatricians. Time for professional advocacy work should be allotted and encouraged.
Long-term Outcomes Following Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysms
Authors: Guéroult Aurélien M. , Khan Farhaan A. , Stather Philip W. , Harrison Seamus C. , Boyle Jonathan R.
Published: June 2020

Purpose: To investigate the long-term outcomes of endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (rAAA) from a single center over an 11-year period. Materials and Methods: A retrospective analysis was conducted of 121 patients (median age 78 years; 100 men) with rAAA who underwent emergency EVAR at a single tertiary vascular center from January 2006 to December 2016. The study included only ruptures confirmed by evidence of hematoma on preoperative computed tomography; both iliac and aortic aneurysm ruptures were eligible. The primary outcome measures included mortality and reintervention rates. Kaplan-Meier estimates of survival and freedom from reintervention are reported with the 95% confidence interval (CI). Results: In-hospital and 30-day mortality rates for emergency EVAR were 16.5%; 90-day mortality was 24.0%. The mortality estimates were 27.3% (95% CI 20% to 36%) at 1 year and 61.7% (95% CI 51% to 72%) at 5 years. In the observation period to 2017, 63 reinterventions were performed on 37 patients (30.6%). Median time to the first reintervention was 3.2 years. Freedom from reintervention in surviving patients at 1 year was 86% (95% CI 72% to 94%) and 51% (95% CI 26% to 71%) at 5 years. Four patients (3.3%) had a secondary sac rupture over the study period. Conclusion: Emergency EVAR for ruptured AAA can be performed with acceptable short-term outcomes; however, long-term surveillance is necessary, and reintervention is common.
A novel pigeon-inspired optimization with QUasi-Affine TRansformation evolutionary algorithm for DV-Hop in wireless sensor networks
Authors: Sun Xiao-Xue , Pan Jeng-Shyang , Chu Shu-Chuan , Hu Pei , Tian Ai-Qing
Published: June 2020

In modern times, swarm intelligence has played an increasingly important role in finding an optimal solution within a search range. This study comes up with a novel solution algorithm named QUasi-Affine TRansformation-Pigeon-Inspired Optimization Algorithm, which uses an evolutionary matrix in QUasi-Affine TRansformation Evolutionary Algorithm for the Pigeon-Inspired Optimization Algorithm that was designed using the homing behavior of pigeon. We abstract the pigeons into particles of no quality and improve the learning strategy of the particles. Having different update strategies, the particles get more scientific movement and space exploration on account of adopting the matrix of the QUasi-Affine TRansformation Evolutionary algorithm. It increases the versatility of the Pigeon-Inspired Optimization algorithm and makes the Pigeon-Inspired Optimization less simple. This new algorithm effectively improves the shortcoming that is liable to fall into local optimum. Under a number of benchmark functions, our algorithm exhibits good optimization performance. In wireless sensor networks, there are still some problems that need to be optimized, for example, the error of node positioning can be further reduced. Hence, we attempt to apply the proposed optimization algorithm in terms of positioning, that is, integrating the QUasi-Affine TRansformation-Pigeon-Inspired Optimization algorithm into the Distance Vector–Hop algorithm. Simultaneously, the algorithm verifies its optimization ability by node location. According to the experimental results, they demonstrate that it is more outstanding than the Pigeon-Inspired Optimization algorithm, the QUasi-Affine TRansformation Evolutionary algorithm, and particle swarm optimization algorithm. Furthermore, this algorithm shows up minor errors and embodies a much more accurate location.
Occupational Outcomes and Return to Running After Operative Management of Lisfranc Injuries in a High-Demand Population
Authors: Koehler Logan , Waterman Brian R. , Kusnezov Nicholas A. , Blair James A. , Belmont Philip J. , Orr Justin D.
Published: June 2020

Background: Literature evaluating outcomes following operative fixation of Lisfranc injuries has demonstrated high rates of chronic disability, particularly in those returning to prior levels of physical function. The purpose of this study is to evaluate the occupational outcomes and return to running after open reduction and internal fixation (ORIF) or arthrodesis for Lisfranc fracture-dislocations in a moderate- to high-demand military cohort. Methods: All active-duty servicemembers undergoing ORIF or primary arthrodesis (Current Procedural Terminology 28615 and 28730, respectively) for confirmed Lisfranc fracture-dislocations (International Classification of Diseases, Ninth Revision codes 838.03 or 838.13) with minimum 2-year follow-up were isolated from the Military Health System. Demographic and surgical variables were recorded. Return to military function, return to running, perioperative morbidity, and rates of reoperation for complication were the outcomes of interest. Univariate analysis followed by multivariate logistic regression determined the association between patient demographics, type of fracture fixation (ie, ORIF vs arthrodesis) and functional outcomes, including medical separation. Results: Among Lisfranc injuries, 64 patients underwent ORIF while 6 underwent primary arthrodeses with a mean age of 28.1 years. At mean follow-up of 3.5 years (range, 2.0-6.3 years), 20% of servicemembers underwent medical separation due to limitations related to their injuries. body mass index (BMI) ≥30 kg/m2 (OR 17.67; 95% CI, 3.69-84.53) and Army or Marines service branch (OR 3.86; 95% CI, 1.08-13.86) were significant independent predictors for medical separation. Among servicemembers undergoing ORIF or primary arthrodeses, 69% returned to occupationally required daily running during the follow-up period. Servicemembers with a BMI <30 kg/m2 were more likely to return to running (OR 13.14, 95% CI, 2.50-69.19). Radiographic evidence of posttraumatic Lisfranc osteoarthritis occurred in 10 (16%) servicemembers who underwent internal fixation, and 82% of ORIF patients underwent implant removal. Conclusions: At mean 3.5-year follow-up, 80% of servicemembers undergoing ORIF or primary arthrodeses for Lisfranc injuries remained on active duty or successfully completed their military service, and 69% were able to resume occupationally required daily running. Surgeons should preoperatively counsel patients with these injuries on the possibility of persistent long-term disability.

Levels of Evidence: Level IV: Retrospective series
Cross-Temporal Exploration of the Relationship Between Wisdom-Related Cognitive Broadening and Subjective Well-Being: Evidence From a Cross-Validated National Longitudinal Study
Authors: Santos Henri C. , Grossmann Igor
Published: June 2020

How do intraindividual changes in wisdom-related characteristics of cognitive broadening—open-minded reflection on challenging situations, consideration of change, and epistemic humility—relate to subjective well-being over time? To test this relationship, we performed cross-lagged panel analyses from three waves of the national U.S. sample taken across 20 years, utilizing a cross-validation approach: (i) conduct exploratory analyses on a random subset of data, (ii) preregister hypotheses and methods, and (iii) cross-validate preregistered hypotheses on the other random subset of the data. We found that broadening attitudes predicted greater affect balance and life satisfaction in later years, but not vice-versa. The effect was robust when controlling for trait-level broadening well-being associations, as well as sociodemographic characteristics, openness, and general cognitive abilities. The direction of the positive longitudinal relationship between broadening attitudes and subjective well-being has implications for major existing theories of adult development and subjective well-being.
Incidence and risk factors of type 2 diabetes mellitus in individuals with different fasting plasma glucose levels
Authors: Han Yumei , Zhang Shan , Chen Shuo , Zhang Jingbo , Guo Xiuhua , Yang Xinghua
Published: June 2020

Objective:

Our aim was to examine the incidence and risk factors of type 2 diabetes mellitus (T2DM) among individuals with different fasting plasma glucose (FPG) levels.

Methods:

According to the first FPG value recorded between January 2006 and December 2017, individuals without T2DM (FPG <7 mmol/L) were divided into three groups: normal fasting glucose (NFG, FPG < 5.6 mmol/L), slightly impaired fasting glucose (IFGlow, 5.6 mmol/L ⩽ FPG < 6.1 mmol/L), and severely impaired fasting glucose (IFGhigh, 6.1 mmol/L ⩽ FPG < 7.0 mmol/L). Physical examination results, blood biochemical indicators, and questionnaire survey data were collected and the T2DM incidence was examined during the follow-up period. A Cox regression model was used to analyze the T2DM risk factors in the three groups.

Results:

A total of 44,852 individuals (55.33% men) were included in our study. During the follow-up period (mean follow-up time: 3.73 ± 0.01 years), 2912 T2DM cases occurred. The T2DM incidence rate of the NFG, IFGlow, and IFGhigh groups were 1.5%, 22.2%, and 43.8%, respectively ( p < 0.05). In the NFG group, the risk factors for T2DM were older age, overweight, obesity, hypertension, hyperuricemia, and increased estimated glomerular filtration rate (eGFR); the protective factors were female sex and high high-density lipoprotein cholesterol (HDL-C). In the IFGlow group, the risk factors for T2DM were older age, overweight, obesity, hypertension, and high total cholesterol (TC); the protective factors were increased triglyceride, low-density lipoprotein cholesterol (LDL-C), and HDL-C. In the IFGhigh group, the risk factors for T2DM were older age, obesity, high eGFR, and high TC; the protective factors were female sex, hyperuricemia, high LDL-C, and high HDL-C (all, p < 0.05).

Conclusions:

The increased T2DM rates were associated with increased FPG. Risk factors for T2DM vary in the NFG, IFGlow, and IFGhigh groups.
Smart cities and a data-driven response to COVID-19
Authors: James Philip , Das Ronnie , Jalosinska Agata , Smith Luke
Published: June 2020

This commentary describes the rapid development of a COVID-19 data dashboard utilising existing Urban Observatory Internet of Things (IoT) data and analytics infrastructure. Existing data capture systems were rapidly repurposed to provide real-time insights into the impacts of lockdown policy on urban governance.
From crisis to catastrophe: The death and viral legacies of austere neoliberalism in Europe?
Authors: Standring Adam , Davies Jonathan
Published: June 2020

The COVID-19 pandemic is a global event, but what became apparent almost immediately was that while the virus seems indiscriminate, vulnerability and the capacity to mitigate its impact are not spread equally, either between or within countries. Years of austere neoliberalism in Europe have exacerbated inequality and precarity, acting as a ‘pre-existing condition’ onto which the virus has now landed. The question we ask is: when the pandemic subsides, can the underlying conditions of contemporary neoliberalism remain? And what may replace it?
Intervertebral Disk Degeneration in Rabbits: Histomorphometric and Histomorphological Effects of Aloe Vera Gel
Authors: Akinola Busuyi Kolade , Abiodun Adeleke Adegboyega
Published: June 2020

Study Design:

This is an experimental study using an animal model.

Objectives:

Disk degeneration is a common cause of low back pain. However, few attempts have been made to proffer a medical solution. The aim of this study was to investigate the effect of aloe vera gel (AVG) on the histomorphometric changes in the intervertebral disk of annular-punctured rabbits.

Methods:

A total of 25 rabbits weighing 1.0 to 3.5 kg were used for this study; 20 rabbits were subjected to annular puncture of the L3/L4, L4/L5, and L5/L6 disks using an 18G needle. Five rabbits were randomly assigned to 5 groups (A, B, C, D, and E) of 5 animals per group. Group A was not punctured. Group B was punctured. Groups C, D, and E were punctured and given 600 400, and 200 (mg/kg) of AVG orally, respectively. The disk histology and nucleus pulposus cell count were done 6 weeks after the puncture procedure.

Results:

The results revealed a gradual reversal of degenerative changes in the treated groups compared with the nontreated groups ( P < .05). The observed changes in the organization of the elastic and collagen content, increase in fibrochondrocyte-like cells of the nucleus pulposus and annulus fibrosus ( P = .0027), and the degree of degeneration of the disk ( P = .0001) in the treated groups compared with the nontreated groups were statistically significant.

Conclusion:

Administration of AVG halted and reversed disk degeneration in an annular puncture–induced disk degeneration rabbit model.
Incoming Interns Recognize Inadequate Physical Examination as a Cause of Patient Harm
Authors: Russo Stefani , Berg Katherine , Davis Joshua , Davis Robyn , Riesenberg Lee Ann , Morgan Charity , Chambers Lucas , Berg Dale
Published: June 2020

Introduction:

As providers of a large portion of the care delivered at academic health centers, medical trainees have a unique perspective on medical error. Despite data suggesting that errors in physical examination (PE) can lead to adverse patient events, we are not aware of previous studies exploring medical trainee perceptions of the relationship between patient harm and inadequate PE. We investigated whether first-year residents at a large tertiary care academic medical center perceive inadequate PE as a cause of adverse patient events.

Methods:

As part of a larger survey given to incoming interns at Thomas Jefferson University Hospital orientation (2014-2018), the authors examined the perceptions of inadequate PE and adverse patient events. We also examined other details related to PE educational experiences and self-reported PE proficiency. The survey was developed a priori by the authors and assessed for face validity by expert faculty.

Results:

Ninety-eight percent of respondents (695/706) reported that inadequate PE leads to adverse patient events. Seventy percent (492/706) believe that inadequate PE causes adverse events in up to 10% of all patient encounters, and 30% (214/706) reported that inadequate PE causes adverse events in greater than 10% of patient encounters. Forty-five percent of surveyed interns (319/715) had witnessed a patient safety issue as a result of an inadequate PE. Only 2% of surveyed interns (11/706) did not think patients experience adverse events because of inadequate PEs. Ninety percent of surveyed interns (643/712) reported feeling proficient in performing PE. From 2015 to 2018, 80% (486/604) indicated that they received “just enough” PE education.

Conclusion:

Nearly all incoming interns surveyed at our institution believe that inadequate PE leads to adverse patient events, and 45% have witnessed an adverse patient event due to inadequate PE. We urge clinicians, educators, and health care administrators to consider enhanced PE skills training as an important and viable approach to medical error reduction, and as such, we propose a 5-pronged intervention for improvement, including a redesign of PE curricula, development of checklist-based assessment methods, ongoing skills training and assessment of physicians-in-practice, rigorous study of PE maneuvers, and research into whether enhanced PE skills improve patient outcomes.
Talin-1 is the principal platelet Rap1 effector of integrin activation
Authors: Lagarrigue Frederic , Paul David S. , Gingras Alexandre R. , Valadez Andrew J. , Sun Hao , Lin Jenny , Cuevas Monica N. , Ablack Jailal N. , Lopez-Ramirez Miguel Alejandro , Bergmeier Wolfgang , Ginsberg Mark H.
Published: June 2020

Ras-related protein 1 (Rap1) is a major convergence point of the platelet-signaling pathways that result in talin-1 binding to the integrin β cytoplasmic domain and consequent integrin activation, platelet aggregation, and effective hemostasis. The nature of the connection between Rap1 and talin-1 in integrin activation is an important remaining gap in our understanding of this process. Previous work identified a low-affinity Rap1-binding site in the talin-1 F0 domain that makes a small contribution to integrin activation in platelets. We recently identified an additional Rap1-binding site in the talin-1 F1 domain that makes a greater contribution than F0 in model systems. Here we generated mice bearing point mutations, which block Rap1 binding without affecting talin-1 expression, in either the talin-1 F1 domain (R118E) alone, which were viable, or in both the F0 and F1 domains (R35E,R118E), which were embryonic lethal. Loss of the Rap1–talin-1 F1 interaction in platelets markedly decreases talin-1–mediated activation of platelet β1- and β3-integrins. Integrin activation and platelet aggregation in mice whose platelets express only talin-1(R35E, R118E) are even more impaired, resembling the defect seen in platelets lacking both Rap1a and Rap1b. Although Rap1 is important in thrombopoiesis, platelet secretion, and surface exposure of phosphatidylserine, loss of the Rap1–talin-1 interaction in talin-1(R35E, R118E) platelets had little effect on these processes. These findings show that talin-1 is the principal direct effector of Rap1 GTPases that regulates platelet integrin activation in hemostasis.
Developing new ceramide analogs and identifying novel sphingolipid-controlled genes against a virus-associated lymphoma
Authors: Chen Jungang , Goyal Navneet , Dai Lu , Lin Zhen , Del Valle Luis , Zabaleta Jovanny , Liu Jiawang , Post Steven R. , Foroozesh Maryam , Qin Zhiqiang
Published: June 2020

Primary effusion lymphoma (PEL) is an aggressive malignancy with poor prognosis even under chemotherapy. Kaposi sarcoma–associated herpesvirus (KSHV), one of the human oncogenic viruses, is the principal causative agent. Currently, there is no specific treatment for PEL; therefore, developing new therapies is of great importance. Sphingolipid metabolism plays an important role in determining the fate of tumor cells. Our previous studies have demonstrated that there is a correlation between sphingolipid metabolism and KSHV+ tumor cell survival. To further develop sphingolipid metabolism-targeted therapy, after screening a series of newly synthesized ceramide analogs, here, we have identified compounds with effective anti-PEL activity. These compounds induce significant PEL apoptosis, cell-cycle arrest, and intracellular ceramide production through regulation of ceramide synthesizing or ceramide metabolizing enzymes and dramatically suppress tumor progression without visible toxicity in vivo. These new compounds also increase viral lytic gene expression in PEL cells. Our comparative transcriptomic analysis revealed their mechanisms of action for inducing PEL cell death and identified a subset of novel cellular genes, including AURKA and CDCA3, controlled by sphingolipid metabolism, and required for PEL survival with functional validation. These data provide the framework for the development of promising sphingolipid-based therapies against this virus-associated malignancy.
Low-value care practice in headache: a Spanish mixed methods research study
Authors: Pozo-Rosich Patricia , Layos-Romero Almudena , Martin-Delgado Jimmy , Pascual Julio , Bailón Cristina , Tentor Ana , Santiago Alejandro , Ignacio Emilio , Torrés Antonio , Mira José Joaquín
Published: June 2020

Background

Headache is one of the most prevalent diseases. The Global Burden of Disease Study ranks it as the seventh most common disease overall and the second largest neurological cause of disability in the world. The “Do Not Do” recommendations are a strategy for increasing the quality of care and reducing the cost of care for headache. This study aimed to identify specific low-value practices in headache care, determine their frequency, and estimate the cost overrun that they represent, in order to establish “Do not Do” recommendations specifically for headache by consensus and according to scientific evidence.

Methods

This was a mixed methods research study that combined qualitative consensus-building techniques, involving a multidisciplinary panel of experts to define the “Do Not Do” recommendations in headache care, and a retrospective observational study with review of a randomized set of patient records from the past 6 months in four hospitals, to quantify the frequency of these “Do Not Do” practices. We calculated the sum of direct costs of medical consultations, medicines, and unnecessary diagnostic tests.

Results

Seven “Do Not Do” recommendations were established for headache. In total, 3507 medical records were randomly reviewed. Low-value practices had a highly variable occurrence, depending on the hospital and type of headache. Overall, 34.1% of low-value practices were related to treatment, 21% were related to overuse of imaging in consultation, and 19% were related to emergency care. The estimated cost of low-value practices in the four hospitals was 203,520.47 euros per 1000 patients.

Conclusions

This study identified low-value headache practices that need to be eradicated and provided data on their frequency and cost overruns.
Osa-miR162a fine-tunes rice resistance to Magnaporthe oryzae and Yield
Authors: Li Xu-Pu , Ma Xiao-Chun , Wang He , Zhu Yong , Liu Xin-Xian , Li Ting-Ting , Zheng Ya-Ping , Zhao Ji-Qun , Zhang Ji-Wei , Huang Yan-Yan , Pu Mei , Feng Hui , Fan Jing , Li Yan , Wang Wen-Ming
Published: June 2020

MicroRNAs (miRNAs) play essential roles in rice immunity against Magnaporthe oryzae, the causative agent of rice blast disease. Here we demonstrate that Osa-miR162a fine-tunes rice immunity against M. oryzae and yield traits. Overexpression of Osa-miR162a enhances rice resistance to M. oryzae accompanying enhanced induction of defense-related genes and accumulation of hydrogen peroxide (H2O2). In contrast, blocking Osa-miR162 by overexpressing a target mimic of Osa-miR162a enhances susceptibility to blast fungus associating with compromised induction of defense-related gene expression and H2O2 accumulation. Moreover, the transgenic lines overexpressing Osa-miR162a display decreased seed setting rate resulting in slight reduced yield per plant, whereas the transgenic lines blocking Osa-miR162 show an increased number of grains per panicle, resulting in increased yield per plant. Altered accumulation of Osa-miR162 had a limited impact on the expression of rice Dicer-like 1 (OsDCL1) in these transgenic lines showing normal gross morphology, and silencing of OsDCL1 led to enhanced resistance to blast fungus similar to that caused by overexpression of Osa-miR162a, suggesting the involvement of OsDCL1 in Osa-miR162a-regulated resistance. Together, our results indicate that Osa-miR162a is involved in rice immunity against M. oryzae and fine-tunes resistance and yield.
Efficacy of electrical stimulation on epidural anesthesia for cesarean section: a randomized controlled trial
Authors: Kim Young Sung , Kim Hyo Sung , Jeong Hyerim , Lee Chung Hun , Lee Mi Kyoung , Choi Sang Sik
Published: June 2020

Background

Loss of resistance (LOR) technique is a widely used method to identify the epidural space. However, cases of inadequate epidural anesthesia in cesarean section were frequently reported. Also, the success rate of epidural anesthesia with LOR technique varied depending on the proficiency of the practitioner. The purpose of this study was to assess the efficacy and safety of electrical stimulation to identify epidural spaces in cesarean section for novices or clinicians with recent gap in experience.

Methods

Pregnant women scheduled for elective cesarean section were randomly allocated to two groups. Groups were classified based on the methods used for identifying the epidural space: the LOR group (group L) and the LOR with epidural electrical stimulation group (group E). Clinicians with less than 10 epidural cesarean section experiences in the recent year performed epidural anesthesia for cesarean section. In the group E, a RegionalStim® conductive catheter was inserted through the Tuohy needle, and the guidewire passing through the catheter was connected to a peripheral nerve stimulator. The intensity of the stimulation was gradually increased from 0.25 mA to 1.5 mA until paresthesia was elicited and radiated. We assessed the success of epidural anesthesia (complete success, partial success or failure). Other clinical parameters including maternal satisfaction, time required for epidural anesthesia, neonatal Apgar scores, pain scores and adverse events were compared between the two groups.

Results

Except for 6 patients who withdrew consent, 54 patients were enrolled in this study (28 for the group L and 26 for the group E). The demographic data showed no difference between the two groups. There was no adverse event resulted from electrical stimulation. The group E showed higher rate of complete success, sensitivity in finding epidural space and maternal satisfaction compared to the group L (21/26 vs. 15/28, p = 0.034, 0.96 vs. 0.68, p = 0.012 and 4.04 vs. 3.39, p = 0.02, respectively). The other clinical parameters showed no differences between the two groups.

Conclusion

In addition to the conventional LOR technique, identifying epidural spaces using electrical stimulation led to better outcomes without additional risks for novices as well as clinicians with recent gap in experience.

Trial registration

This study was retrospectively registered in the ClinicalTrials.gov Registry (NCT03443466) on February 23, 2018.
Predicting GP visits: A multinomial logistic regression investigating GP visits amongst a cohort of UK patients living with Myalgic encephalomyelitis
Authors: Walsh R. Stephen , Denovan Andrew , Drinkwater Kenneth , Reddington Sean , Dagnall Neil
Published: June 2020

Background

Myalgic Encephalomyelitis (ME) is a chronic condition whose status within medicine is the subject of on-going debate. Some medical professionals regard it as a contentious illness. Others report a lack of confidence with diagnosis and management of the condition. The genesis of this paper was a complaint, made by an ME patient, about their treatment by a general practitioner. In response to the complaint, Healthwatch Trafford ran a patient experience-gathering project.

Method

Data was collected from 476 participants (411 women and 65 men), living with ME from across the UK. Multinomial logistic regression investigated the predictive utility of length of time with ME; geographic location (i.e. Manchester vs. rest of UK); trust in GP; whether the patient had received a formal diagnosis; time taken to diagnosis; and gender. The outcome variable was number of GP visits per year.

Results

All variables, with the exception of whether the patient had received a formal diagnosis, were significant predictors.

Conclusions

Relationships between ME patients and their GPs are discussed and argued to be key to the effective delivery of care to this patient cohort. Identifying potential barriers to doctor patient interactions in the context of ME is crucial.
Immunosuppression-induced clonal T-cell lymphoproliferative disease causing severe diarrhoea mimicking coeliac disease following renal transplantation: a case report
Authors: Glover Emily K. , Speight R. Alexander , Televantou Despina , Needham Stephanie , Sheerin Neil S.
Published: June 2020

Background

Post-transplant lymphoproliferative disease is a recognized complication following solid organ transplantation. This is usually a B cell disease and frequently associated with Epstein Barr virus infection, although T cell PTLD can occur. T cell PTLD is usually a monomorphic, lymphomatous disease associated with an adverse prognosis.

Case report

We report a 52 year old male pre-emptive renal transplant recipient who developed severe diarrhea with weight loss following intensification of his immunosuppression due to antibody mediated rejection 3 years after transplantation. Duodenal biopsy demonstrated monoclonal CD8+ T cell duodenitis leading to increased intraepithlieal lymphocytes and sub-total villous atrophy mimicking coeliac disease. Coeliac disease was excluded by negative anti-tissue transglutaminase antibody, HLA-DQ2 and HLA-DQ8 testing. There was no evidence of lymphoma either on biopsy or CT enterography and no FDG avid disease on PET. Symptoms did not improve with reduction of immunosuppression, but resolved fully on complete withdrawal of treatment. The transplant failed and he was established on dialysis. The diagnosis was early PTLD.

Conclusions

Oesophagogastroduodenoscopy with small bowel biopsies is a useful investigation for determining the cause of diarrhoea in renal transplant patients when more common causes have been excluded. This is the first report that we are aware of clonal T cell PTLD mimicking coeliac disease which only resolved after complete withdrawal of immunosuppression. As treatments for lymphoma are aggressive they are only initiated in the malignant phase and management of early stage PTLD is to minimise risk of progression by reducing immunosuppression. Any plans to retransplant will have to take into consideration the possibility that PTLD will recur.
Two case reports of distal upper limb weakness following influenza-like illness: an emerging pattern of para-infectious myositis in adults
Authors: Scaber Jakub , Molyneux Adam J , Buckley Camilla , Webb Alastair J S
Published: June 2020

Background

Myositis is a recognised complication of numerous systemic viral infections including influenza. In adults the typical pattern is characterised by myalgia and marked proximal muscle weakness in upper and lower limbs and resolves slowly over weeks rather than days.

Case presentation

Here, we describe two male patients with myositis with an unusual distribution of weakness in the distal upper limbs, which both followed a flu-like illness and resolved spontaneously. Both patients had moderate elevations in creatine kinase, extensive negative serological investigations, normal nerve conduction studies and myopathic changes on electromyography.

Conclusions

In the para-infectious context, myositis is an important differential of acute distal upper limb weakness. This unusual pattern of acute muscle weakness should be recognised to avoid unnecessary in treatments. Similar cases in the recent literature in male patients between the ages of 25 to 55 are reviewed and suggest an emerging pattern of para-infectious myositis.
Prognostic value of lymph node to primary tumor standardized uptake value ratio in unresectable esophageal cancer
Authors: Chen Po-Jui , Yap Wing-Keen , Chang Yu-Chuan , Tseng Chen-Kan , Chao Yin-Kai , Hsieh Jason Chia-Hsun , Pai Ping-Ching , Lee Ching-Hsin , Yang Chan-Keng , Ho Albert Tsung-Ying , Hung Tsung-Min
Published: June 2020

Background

Unresectable esophageal cancer harbors high mortality despite chemoradiotherapy. Better patient selection for more personalized management may result in better treatment outcomes. We presume the ratio of maximum standardized uptake value (SUV) of metastatic lymph nodes to primary tumor (NTR) in 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography (FDG PET/CT) may provide prognostic information and further stratification of these patients.

Methods

The patients with non-metastatic and unresectable esophageal squamous cell carcinoma (SCC) receiving FDG PET/CT staging and treated by chemoradiotherapy were retrospectively reviewed. Receiver operating characteristic (ROC) analysis was performed to determine the optimal cut-off value for NTR. Kaplan-Meier method and Cox regression model were used for survival analyses and multivariable analyses, respectively.

Results

From 2010 to 2016, 96 eligible patients were analyzed. The median follow-up time was 10.2 months (range 1.6 to 83.6 months). Using ROC analysis, the best NTR cut-off value was 0.46 for prediction of distant metastasis. The median distant metastasis-free survival (DMFS) was significantly lower in the high-NTR group (9.5 vs. 22.2 months, p = 0.002) and median overall survival (OS) (9.5 vs. 11.6 months, p = 0.013) was also significantly worse. Multivariable analysis revealed that NTR was an independent prognostic factor for DMFS (hazard ratio [HR] 1.81, p = 0.023) and OS (HR 1.77, p = 0.014).

Conclusions

High pretreatment NTR predicts worse treatment outcomes and could be an easy-to-use and helpful prognostic factor to provide more personalized treatment for patients with non-metastatic and unresectable esophageal SCC.
Safe diagnostic management of malignant mediastinal tumors in the presence of respiratory distress: a 10-year experience
Authors: Tanaka Tomoko , Amano Hizuru , Tanaka Yujiro , Takahashi Yoshiyuki , Tajiri Tatsuro , Tainaka Takahisa , Shirota Chiyoe , Sumida Wataru , Yokota Kazuki , Makita Satoshi , Tani Yukiko , Hinoki Akinari , Uchida Hiroo
Published: June 2020

Background

The fundamental treatment for patients with pediatric malignant mediastinal tumors is chemotherapy. Therefore, accurate diagnosis is essential for selecting the appropriate chemotherapeutic regimen. However, malignant mediastinal tumors occasionally cause respiratory distress, and biopsies under general anesthesia are dangerous for such patients as invasive mechanical ventilation can aggravate airway obstruction caused by mass effect. In this study, we reviewed our 10-year diagnostic experience to evaluate the efficacy of our practices and confirm a safe diagnostic protocol for future patients.

Methods

We retrospectively reviewed medical records of children with malignant mediastinal tumors diagnosed at Nagoya University Hospital from 2007 to 2018 who demonstrated respiratory distress. Respiratory distress included dyspnea, massive pleural effusion, wheezing, and hypoxemia owing to tumors. Data on sex, age at onset, primary symptoms, location of tumor, management strategy (especially the method of diagnosis and definitive diagnosis), clinical course, prognosis during the acute phase (within 3 months from the onset of respiratory symptoms), and long-term outcome were collected.

Results

Twelve pediatric patients met the review criteria. There were seven anterior mediastinal tumors and five posterior mediastinal tumors. All anterior mediastinal tumors were diagnosed via bone marrow smear, thoracentesis, or core needle biopsy while maintaining spontaneous breathing. Regarding posterior tumors, two patients were diagnosed via a core needle biopsy and lymph node excisional biopsy under spontaneous breathing. Two cases were initially diagnosed solely using tumor markers. One patient with severe tracheal compression underwent tumor resection with extracorporeal membrane oxygenation stand-by. No patient died of diagnostic procedure-related complications.

Conclusions

In 11 of the 12 cases reviewed, safe and accurate tumor diagnosis was accomplished without general anesthesia. A diagnostic strategy without general anesthesia considering the tumor location proved to be useful.
Impaired early information processing in adult ADHD: a high-density ERP study
Authors: Papp Szilvia , Tombor László , Kakuszi Brigitta , Balogh Lívia , Réthelyi János M. , Bitter István , Czobor Pál
Published: June 2020

Background

Children with attention-deficit/hyperactivity disorder (ADHD) often demonstrate sensory processing difficulties in the form of altered sensory modulation, which may contribute to their symptomatology. Our objective was to investigate the neurophysiological correlates of sensory processing deficits and the electrophysiological characteristics of early information processing in adult ADHD, measured by the P1 event-related potential (ERP).

Methods

We obtained ERPs during a Go/NoGo task from 26 adult patients with ADHD and 25 matched controls using a high-density 128-channel BioSemi ActiveTwo recording system.

Results

ADHD patients had a significantly reduced P1 component at occipital and inferotemporal scalp areas compared to controls. The reduction was associated with inattention and hyperactivity symptom severity, as measured by the Conners’ Adult ADHD Rating Scale. ADHD patients with higher inattention scores had significantly smaller P1 amplitudes at posterior scalp sites, while higher hyperactivity scores were associated with higher P1 amplitudes.

Conclusions

Deficits in early sensory processing, as measured by the P1 ERP component, are present in adult ADHD patients and are associated with symptom severity. These findings are suggestive of bottom-up cognitive deficits in ADHD driven by impairments in early visual processing, and provide evidence that sensory processing problems are present at the neurophysiological level in this population.
Assessment of changes in place of death of older adults who died from dementia in the United States, 2000–2014: a time-series cross-sectional analysis
Authors: Xu Wei , Wu Changshan , Fletcher Jason
Published: June 2020

Background

As the mortality attributable to dementia-related diseases in the United States escalates, providing quality and equitable end-of-life care for dementia patients across care settings has become a major public health challenge. Previous research suggests that place of death may be an indicator of quality of end-of-life care. This study aims to examine the geographical variations and temporal trends in place of death of dementia decedents in the US and the relationships between place of death of dementia decedents and broad structural determinants.

Methods

Using nationwide death certificates between 2000 and 2014, we described the changes in place of death of dementia decedents across states and over time. Chi-square test for trend in proportions was used to test significant linear trend in the proportion of dementia decedents at difference places. State fixed effects models were estimated to assess the relationships between the proportion of dementia decedents at difference places and state-level factors, particularly availability of care facility resources and public health insurance expenditures.

Results

Dementia decedents were more likely to die at home and other places and less likely to die at institutional settings over the study period. There was wide inter-state and temporal variability in the proportions of deaths at different places. Among state-level factors, availability of nursing home beds was positively associated with rates of nursing home/long term care deaths and negatively associated with rates of home deaths. Medicaid expenditure on institutional long term supports and services was positively associated with rates of nursing home/long term care deaths and negatively associated with rates of home deaths. Medicaid expenditure on home and community based services, however, had a positive association with rates of home deaths.

Conclusions

There was a persistent shift in the place of death of dementia decedents from institutions to homes and communities. Increased investments in home and community based health services may help dementia patients to die at their homes. As home becomes an increasingly common place of death of dementia patients, it is critical to monitor the quality of end-of-life care at this setting.